James Paget left Great Yarmouth in 1834 after securing a training place at St. Batholemews Hospital in London. His elder brother George was also at St. Batholemews and he went on to pursue a successful career as a Physician which is another story which will be pursued at another time.
James' intention was to pursue a career as a Surgeon but his training course at St. Batholemews did not include surgery. Surgical places were few and very expensive to procure. Medical students in the early nineteenth century were not closely supervised which allowed James to pursue his interest in surgery. As a first year student James made a remarkable discovery. He noted some white specks in the muscle of a cadaver he was dissecting. Upon microscope examination he found them to be small, encapsulated worms, later named Trichina spiralis by the British anatomist and palaeontologist Richard Owen who at the time was erroneously credited with this discovery. This was the first demonstration of Trichinosis in man. This worm can be transferred from pigs to humans and if this condition is untreated it can lead to death in about ten days. Ensuring that the meat of the pig is properly cooked kills the worm and ensures it deadly effects were/are nullified. This was an important discovery which had obvious public health implications.
His first two years at St. Batholemews saw him win many accolades for his academic achievements which culminated in May 1836 with his graduation from the College of Surgeons, becoming a member of the Royal College of Surgeons the same year. However lack of money was a constant concern. His medical practice never generated an income sufficient to keep him so he had to take on other jobs to augment his income. He managed to keep himself by writing for medical journals, and preparing the catalogues of the Hospital Museum and of the Pathological Museum of the Royal College of Surgeons a post in which he was responsible for procuring bodies and performing dissections.
James became the first Warden of St. Bartholemews College when it was founded. He was now living within the walls of the hospital and was supervising the thirty students resident at the College. James was also managing the finances and the general affairs of the College. During this period his physiological lectures at St Bartholomew's College were the chief cause of the rise in the fortunes of the college which by 1843 had descended to a low point.