Prior to the Second World War, Newcastle City Council became increasingly concerned about the high infant mortality rate in the city (in 1939 the rate was 62 per 1000 live births) and asked Spence to undertake a review of all deaths of babies.
Spence concluded that the excess infant mortality was due to death from acute infection.
One of those was Fred Miller and in 1946 Spence is reported to have said to him at a weekly departmental meeting "Well Freddie, what are we going to do about all these infections?".
Several publications document the study:- A Thousand Families in Newcastle upon Tyne by James Spence, W S Walton, F J W Miller and S D M Court, OUP, 1954 [This covers the first year of life] Growing up in Newcastle upon Tyne by F J W Miller, S D M Court, W S Walton and E G Knox, OUP, 1960 [Pre-school years] The School Years in Newcastle upon Tyne, 1952 - 1962 by F J W Miller, S D M Cour, E G Knox and S Brandon, OUP, 1974.
A range of health outcomes including cardiovascular disease, osteoporosis, diabetes, Helicobacter pylori, depression, telomere length, lung function and teeth were assessed in relation to the data collected at that follow-up and also that collected in previous follow-ups.