James Calvert Spence - Medical Career

Medical Career

After World War I, Spence worked as a house physician at the Royal Victoria Infirmary (RVI) in Newcastle upon Tyne and then moved on to work as a casualty officer at Great Ormond Street in London. He returned to Newcastle in 1922, where he took up the post of medical registrar and chemical pathologist at the RVI. He also joined the medical staff of a day nursery, in West Parade, Newcastle, which had been set up by a local wealthy lady to look after the children of munitions workers. The day nursery eventually became the Newcastle Babies' Hospital and provided the foundation for much of Spence's future work.

In this institution, Spence and his staff developed the practice of Social Paediatrics, which will always be associated with his name. In 1926–27 he spent a year at the Johns Hopkins Hospital in Baltimore as a Rockefeller Fellow, returning to the RVI in 1928. The period 1928–34 saw the publication of many of his most important works on scientific medicine. During the depression years, Spence was invited by the Newcastle city health committee to carry out a comparative study of The Health and Nutrition of Certain of the Children of Newcastle upon Tyne between the Ages of One and Five Years. Spence showed that 36 per cent of the children from 'poor districts of the city were unhealthy or physically unfit.' The correlation with malnutrition was not found in the control group of better class families, showing that the problem was preventable.

Spence was a strong advocate of breastfeeding, which he believed had superior health advantages. He was also acutely concerned that children have adequate nutrition during the time of wartime scarcity of food.

Spence began the practice, then unique in Britain, of admitting mothers to hospital with their sick children, so that they might nurse them and feel responsible for the child's recovery. Spence had begun receiving offers of professorial chairs, but declined them all as it would mean leaving Newcastle and the work to which he felt dedicated. He was by now paediatric physician at the Newcastle General Hospital and honorary physician to the Royal Victoria Infirmary. He also became Nuffield Professor of Child Health at Newcastle in 1942, and in 1948 when the National Health Service was established, Spence was a government adviser.

A subsequent study into infant mortality, again commissioned by the City Council, found the highest levels of infant mortality to be in the poorest areas of the city. The main cause of the excess mortality in these areas appeared to be infection. These two studies led on to one of the first ever longitudinal birth cohort studies, the Newcastle Thousand Families Study, although with the outbreak of the second world war, it was not until 1947 that the members of this cohort could be recruited. The Thousand Families Study was the basis of much of community paediatrics for the next 50 years.

Spence became a mentor in 1945 to Douglas Gairdner, M.D., who served for a time as Spence's first assistant. The two paediatricians remained close friends after Gairdner moved on.

Spence is also remembered for his pithy and witty comment on child circumcision, which he opposed.