Sir James Mackenzie is revered by general practitioners as the father of general practice-based research.' His name is associated with the University Department of General Practice at Edinburgh and with the Chair at Aberdeen, and he is commemorated in the James Mackenzie lecture given annually at the Royal College of General Practitioners. His fame rests largely on his achievements as a solitary researcher while he worked as a GP in Burnley, a mill town in Lancashire, between 1879 and 1907. It was here that he carried out the pioneering work which contributed to the development of the "new cardiology" at the beginning of the century.2 His work in Burnley took him away from general practice and he moved to London to take up private and hospital consulting work to further the impact of his research. He regarded himself, however, as first and foremost a GP, and believed general practice was the proper place for clinical research.3 Mackenzie was so committed to this belief that he left London in 1919, an ill man at the age of sixty-six, and the GPs of St Andrews working together in collaborative research under Mackenzie's leadership. This paper will reassess Mackenzie's significance for the development of general practice-based research and for general practice as a specialty by examining this project of his later years. The Institute was an innovative venture at this time. Clinical research was still very much an individualistic activity and, as fewer GPs were doing research in the form of MD degrees, individual GPs were generally less likely to be involved in research.4 The St Andrews Institute can be seen as an attempt by Mackenzie to set up the kind of research structure for GPs that was beginning to emerge in the London teaching hospitals: specialist clinicians associated with university scientists. Mackenzie's model did not continue and there was a long gap before university departments of general practice emerged (the first professor of general practice was Richard Scott appointed in 1963 in Edinburgh).' The first section of the paper will fill in some background of Mackenzie's life and work before he came to St Andrews in order to give some understanding of his motivation and experience, and of his early fame. The second section will describe the Institute, its members, what it set out to do, and, particularly, how it was funded; and the final section will discuss why Mackenzie did not succeed in establishing the Institute on a permanent basis and assess its significance in the history of GP research.
Macnaughton, R. (2002). The St Andrews Institute for Clinical Research: An early Experiment in Collaboration. Medical History, 46(4), 549-568