Lives of the fellows

Gwladys Victoria Smallpeice

b.27 May 1901 d.21 September 1991
MB BS Lond(1928) MA Oxon(1928) MD Lond(1930) MRCP(1931) DCH(1937) FRCP(1952)

Victoria Smallpeice was born in London, the youngest of three children of William Donald and Cicely Smallpeice, née Philipps. She began her education at a school in Rome, went on to an Anglican convent in Warminster and subsequently received private tuition. Her father, a general practitioner, moved from London to a rural practice in East Anglia at the age of 58. During the first world war, the 15-year old Victoria took over the practice bookkeeping from her mother and ‘. . . learned to dread the agonizing climax each quarter-day . . .’ as bills had to be presented to those who could not pay. At 17 years she worked with the VAD, nursing Army amputees awaiting artificial limb fitting at Roehampton Hospital. When she began her medical studies at the Royal Free Hospital School of Medicine for Women in 1923 she was a little older than her contemporaries who were mostly school leavers. One of them, Mary Fraser, who was to join her in practice later, remembers how Victoria stood out among them for her ‘. . . experience of the outside world . . .’ and for her obvious ‘. . . integrity and reliability.’ She was a Langton Scholar and acted as student demonstrator in the Royal Free’s departments of pharmacology and anatomy. On her infrequent weekends at home, her father would make Sunday appointments for patients requiring minor surgery so that Victoria could help him and she wrote that it was ‘. . . a very happy partnership.’ Her father died before she qualified. She occasionally spoke in later years of extreme poverty as a student in London.

Her first post after qualifying was as house physician to the Royal Free’s children’s department. This was followed by a year as resident medical officer at the St Albans and Mid-Hertfordshire Hospital, and in 1930 she began general practice in Oxford. Her surgery was in Broad Street, now part of Blackwell’s bookshop, and several well known artists were on her list. Every Saturday morning she travelled to London, doing unpaid paediatric clinical assistantships successively at the Royal Free, 1930-32, the Hospital for Sick Children, Great Ormond Street, 1933-37, and the Infants Hospital, Vincent Square, 1937-39. Her paper on ‘Dysnopea, with special reference to the acute and paroxysmal forms’ was adjudged proxime accessit for the Hunterian gold medal in 1932. In 1938 she volunteered for full-time duty with the EMS and at the start of the second world war she was detailed to serve as medical officer in charge of the Children’s Hospital at Rycote Park, Oxon, and the children’s wards at the Radcliffe Infirmary. The war years brought a heavy load as the practice was also dealing with evacuee families and the patients of colleagues absent on active service, and as Victoria’s reputation as physician and paediatrician grew she travelled long distances beyond Oxford to see patients.

In 1947 she was appointed as the first physician in charge and clinical director to the children’s department, United Oxford Hospitals, and as consultant paediatrician to the Oxford regional hospital board; positions she held until her retirement in 1966. She ran the department single handed until 1949, when a second consultant paediatrician was appointed, and to begin with she visited hospitals as far afield as Abingdon, Banbury, Cirencester and Swindon. Further consultant appointments in the region followed only slowly so she elected to buy, as one of her very few extravagances, one of the fastest cars then on the market to help cover the prodigious mileage.

Victoria led her department by example: she was an astute clinician and her priority was always a high standard of care for her patients. She achieved an easy rapport with the wide variety of families she met, whether from the poorest parts of the city, from academe, or from the surrounding countryside. On the other hand, junior staff members were sometimes in awe of her. She was intolerant of fools and any clinical lapses on their part were often publicized by her throughout the department so that the lessons could be learnt by all. Although this exposure was often to the considerable chagrin of the unfortunate perpetrators they usually came to hold her in affectionate respect and appreciated the worth of her bedside teaching, as well as her disinterested advice on their careers and her generosity to them in times of trouble.

She was renowned for her punctuality, however busy, and for the brevity of her telephone conversations. The latter, when concerned with patients or departmental matters, were always short and to the point and she had a tendency to replace the receiver when she had heard or said enough. Consultant colleagues in other departments respected her for her integrity and for her knowledge of paediatrics, and entrusted her with the care of their own children. She was indefatigable in her teaching of nurses, undergraduates and postgraduates. Medical students were given a subject to explore in depth during their time on her wards. They later presented the fruits of their labours to her, after an excellent meal in her house on the Woodstock Road, and the ensuing discussions often reached a high standard. She tried to initiate them into critical appraisal of the relevant literature, to get them to understand the role of community and social services for children, and the importance of the family and its environment on child health - in its widest sense.

She was an original thinker and her many years in general practice had taught her the value of preventive medicine. Her contributions to medical literature were few but never slight and often showed her to be in advance of her contemporaries in her thinking. In the late 1940s, beds and a sitting room for mothers of young inpatients were set aside in one of her wards and she initiated day patient care in the late 1950s in order to avoid separating infants and young children from their homes. Necessary observation, investigations and treatment were undertaken in a special area of one of the children’s wards. She was aware that neonatal care should be greatly expanded and insisted that very careful figures for perinatal and neonatal mortality rates should be kept. She started regular meetings with a pathologist to discuss possible preventable factors in all such deaths long before this became standard practice. She also challenged the accepted dogma of the day which recommended initial starvation for newly born pre-term infants. She showed that by feeding them soon after birth serious hypoglycaemia, an acknowledged cause of brain damage in young infants, could be largely avoided. Her horror of iatrogenic disease reinforced her belief that documentation should always be made - with dates - of any changes in care made in neonatal units. Her joint exposure of the deteriorating social fabric of an Oxfordshire village, and its harmful effect on its child population, led to important changes there. But her particular fascination was with childhood urinary tract infection and by meticulous documentation of her cases over many years she showed that there could be serious long term implications of infections occurring in infancy and early childhood. Her monograph on the subject Urinary tract infection in childhood and its relevance to disease in adult life, London, Heinemann, 1968, published after she retired, was impressive yet is rarely quoted or acknowledged.

Victoria was very tall and dressed with quiet elegance. Her commanding presence belied her essential shyness and her shrewd intelligence was often underestimated for she was extremely modest about her own achievements. She was generous with her ideas and encouraged research and links with other hospital and academic departments. She knew instinctively when her young colleagues’ progress on MD theses, or the arduous collection of clinical data, was flagging and would boost them along with her enthusiasm. While she never shirked her share of administrative work, she disliked medical politics intensely. She occasionally admitted that this was sometimes detrimental to the department she ran so well for extra monies and adequate space were rarely allocated. She had no office to call her own until a year before her retirement. She was also wary of seeking financial support from pharmaceutical companies to fund meetings and avoided accepting hospitality or gifts from them, saying that it was morally wrong of doctors to do so. She was a member of council of the British Paediatric Association, 1959-62, and was elected an honorary members in 1970. From 1965-66 she was president of the paediatric section of the Royal Society of Medicine.

After retirement Victoria retained a keen and critical interest in medicine though taking no further part in it. An architect nephew designed a small house for her next to the larger one she had lived in for many years. She created a delightful garden there and was generous in sharing its produce with jaded city workers who visited her. She never married, but was devoted to her family circle of all ages, entertaining them, friends, and ex-colleagues, with the help of her secretary-cum-housekeeper and friend, Daphne Jones, who - like Victoria - was an excellent cook. She enjoyed having more time for the visual arts, for reading and for travel, particularly to favourite haunts in France and Italy. She grew old with grace and enjoyed conversation to the end. On her 90th birthday she was still recovering from broken bones following a fall but delighted in the many cards received from ex-staff. Many of those who worked with her have acknowledged her considerable influence over their medical practice. Victoria Smallpeice was indeed a remarkable woman.

P A Davies

(Volume IX, page 479)

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