Paget's Disease of Bone

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Abstract
When I was invited by Professor Trueta to give a lecture I chose this subject because it is a condition which is recognisable by radiography long before the clinical evidence is distinctive and because I am able to demonstrate these earlier radiographic signs; though if you ask me what value I confer on the community by this early recognition I am less confident and satisfied. The subject does give me the opportunity of discussing certain important features of investigation, diagnosis, differential diagnosis and treatment. It is just 100 years ago since a man, aged 46 years, began to complain of aching pains in his thighs and legs without any apparent cause. Two years later he consulted James Paget, who found that, except for a swelling on the left tibia, the man appeared other-wise quite healthy. Paget examined the man periodically during the next 20 years and watched the steady progressive development of the malady. The left tibia became thickened and bent; then the left femur showed a similar change and gradually the patient lost the ability to touch one knee with the other. Similar progression later developed in the opposite limb; the curvature of his back became exaggerated; his stature gradually diminished; the arms showed some bowing; and, owing to a progressive thickening of the skull, he had to wear larger and larger hats.

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