Jean Smellie who died at the age of 93 was a paediatrician who specialised in the investigation and management of children with urinary infection. Her meticulous research was important in developing understanding of the condition and significantly reducing the number of investigations and operations to which children were subjected.
She was born in Liverpool, the youngest of three children all of whom became doctors. Her father was a GP in Sefton Park and mother a teacher. Both families had originated from Lanarkshire. One of her classmates in primary school was George Melly. She went on to Huyton College. The war had a great effect on her and their house was hit by a bomb whilst she was at school, her family turning up with her young brother in his pyjamas to give her the news. She was later evacuated to the Lake District. She went up to St Hugh’s College Oxford then to University College in London for her clinical studies. In her first post after qualification she was asked by the senior paediatrician to compile a paediatric pharmacopeia for a group of young RAMC doctors heading for posts overseas. One of these was Alan Reay who became Lieutenant General and Director General of Army Medical Services and another was Colin Normand whom she subsequently married when he returned 5 years later from the Far East. They had three children. Their early married life was spent in London where Colin developed his academic career. Jean had a part-time post which she devoted largely to the urine infection clinic. When Colin was appointed to the Foundation Chair of Paediatrics in Southampton the family moved to Winchester where they lived close to the station so she could commute to London to continue her important work. She was highly organised, taking the children to school, doing her clinic in London and being back in time to put them to bed. Asked how long it took to walk to the station she would invariably reply ‘five minutes if you run’! Whilst continuing with her work in London she became increasingly involved in local paediatrics in Wessex. She also took a real interest in civic matters and conservation once going up on a cherry picker to demonstrate how high a proposed new building would be. She was described by friends and colleagues as a delightful person, charming, diligent and persistent. Her patients loved her and one mother described outpatient clinics as being like going to see the Queen. She was a multitasker par excellence and a skilled illustrator, a keen photographer, an excellent pianist and a successful and loving mother.
Having completed her training as a paediatrician in Liverpool and London in 1960 she was appointed to a part-time consultant post at University College Hospital in London with a remit to look after children who had urinary infections. These are a common problem in children, they are usually relatively mild in their effects and are mainly easily and effectively treated with antibiotics although some develop pyelonephritis. There was considerable interest in how best to investigate and manage such children as a small number are associated with scarring of the kidney leading to high blood pressure and occasional renal failure in later life. Clinical and radiological investigations had shown that some children had ureteric reflux and it was thought that this, with or without pyelonephritis might be the reason for the serious damage occasionally seen. There had been a perceived need to identify which children were at risk of scarring of the kidney and infection with reflux was the obvious candidate. She worked closely with radiologists and surgeons to develop and evaluate appropriate investigations which were often very intrusive, such as micturating cystography When reflux was identified surgery was advised and there was no shortage of surgeons willing to operate. Children were referred to her specialist clinic from all over London and she worked closely with colleagues, not least her paediatrician husband Colin Normand (Munks Roll), to understand how better these children could be managed. Between 1955 and 1975 almost 750 children attended the clinic and were systematically evaluated. She and her colleagues showed that a daily low dose of prophylactic antibiotics could reduce the number of urinary infections in these children. In a landmark paper in the Lancet in 2001 they reported the results of a randomised controlled trial showing that there was no difference in outcome between those who had surgery for reflux and those treated with prophylactic antibiotics. This immediately reduced the numbers of children referred for surgery. She also worked with colleagues from Germany on a major study funded by the Volkswagen Foundation which helped elucidate the natural history of urinary infections. She was highly respected by her international partners.
Since then it has become apparent that in many children the kidneys are already damaged at birth from congenital dysplasia, often associated with reflux, and that prophylactic antibiotics can lead to the emergence of antibiotic resistance. The emphasis now is on early diagnosis and rapid treatment of urinary infection in babies. The realisation of how important this is and the careful surveillance of children with damaged kidneys is in part the result of her research. Likewise, children are now rarely submitted to cystography or to surgery to prevent reflux. Today relatively non-invasive investigations such as ultrasonography and nuclear medicine scans are preferred. The clear guidance produced by NICE in 2010 on urinary tract infections in children was undoubtedly influenced by the meticulous studies led by Smellie.
Her husband died in 2011 and she is survived by her three children Alison, Cristopher and Caroline, none of whom are medical. For her last three years, she lived in a care home and died of old age and dementia at the age of 93. She died during the Covid pandemic so her wonderful funeral in Winchester Cathedral had limited attendees in person but by almost 70 on YouTube. Her daughter Alison gave a eulogy which expressed her achievements and the wide respect in which she had been held.
One of her close surgical collaborators commented that she epitomised a genre of post-war Oxford women who having broken the glass ceiling shone a light on those below
Her husband died in 2011 and she is survived by her three children none of whom are medical.
