THE IMPORTANCE OF ENBOCKINOLOGY 941 



5. Special Opportunities lor Observation by 



General Practitioners 



The general practitioner is particularly favorably situated to make 

 contributions, at least of a certain sort, to the progress of knowledge of the 

 internal secretions. He, more than any other practitioner, has the oppor- 

 tunity to study the influences of heredity on the one hand and of en- 

 vironment on the other in normal and diseased states. 



Every general practitioner must already have been impressed with the 

 frequency of the tendency of thyroid disease and of hypophyseal disease, 

 to take two striking instances, to run in families. The careful keeping 

 of family records by general practitioners could doubtless contribute in 

 an important way to our knowledge of hereditary factors in endocrin 

 disease. 



The influence of geographic and climatic factors could also be ad- 

 vantageously studied by general practitioners who live in regions in 

 which certain endocrin diseases are particularly prevalent or in regions 

 in which certain others are particularly uncommon. Much has already 

 been done in this connection to throw light upon the origin of goiter and 

 of endemic cretinism. In how far such environmental factors play a 

 part in the origin of other endocrin diseases the future will doubtless dis- 

 close. 



Another way in which the general practitioner can be helpful is in 

 the studies that he can make of the gradual development of the various 

 endocrin diseases. The general practitioner sees patients before they are 

 ill and has an unusual opportunity for studying the very earliest stages 

 of particular diseases and the slow or rapid evolution of the maladies to 

 their full-blown states. 



The general practitioner should, too, be ever on the lookout for new 

 clinical syndromes, They lie undetected all about us. The practitioner 

 who, like Addison or Graves, is able to detect the recurring co-existence 

 of clinical phenomena and to create for us new clinical types is needed 

 iust as much to-day as in the past. 



6. The Value and Place of Hypothesis in 



Endocrinology 



Though it is important carefully to distinguish objective facts from 

 hypothetical interpretation of facts, I have no sympathy with those who 

 decry all theory and who see no value in the formulation of hypotheses. 

 Even experimenters who decry theory and rail at hypotheses often theorize 

 themselves, though they may not be conscious of it, and frequently on 



