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.
