Naturally there being such a wide difference in theory of the cause of disease it would be also shown in diagnosis as well as treatment. The most striking points to the layman in medical procedure are: first, wide difference in the system of diagnosis and in its findings by physicians of the same school; second, the great variance in remedies employed by different physicians of the same school for the same disease. Osteopathic diagnosis is so physical in its character, depending upon actual conditions found and not upon the subjective symptoms alone, that the same patient examined by a number of experienced osteopaths will be given the same diagnosis, and he will also be able to detect in each the same effort to correct in all their technique. All the methods of physical diagnosis are used plus the distinctive osteopathic procedure. Results wherever used bear out the effectiveness of the system. The osteopath must and does consider the necessity of surgery, but his effort is always to prevent the operation if possible. There can be no doubt that surgery is carried to extremes and there is a strong sentiment growing that much of it is unnecessary. Says Homer Wakefield, M. D.[13]: “It is to the everlasting disgrace and mortification of the medical man that the wealthy classes who are continually under the observation and direction of eminent men, in dietary, and all life habits, in health as well as in sickness, are not only the very ones who develop appendicitis and most largely go to operation, but are almost exclusively those who attain to this distinction.” The operations of today are wonderful and the surgeon shows great skill and genius in their performance, but great as he is in these matters how infinitely greater is the man who can prevent them. The need of the osteopath today is to be trained to recognize surgical conditions and neither allow surgery unnecessarily nor make the more terrible error of not acting soon enough. Where surgery is a necessity there is always an etiological factor to be considered. The cause of the manifestation not always being removed what is to prevent a recurrence or serious sequela in spite of the operation? “The specialist ... if he has wit enough to read the lesson presented to him, that it is not sufficient to remove an ovarian tumor, e. g., and that if nothing is said at the same time or subsequently as to the causes which induced it, a positive damage may be done to the woman, who may, therefore, while considering herself cured, proceed to manufacture one on the other side, or may find herself in a few years suffering from cancer in the stump of the previous one[14].” And so the combination of osteopathy with surgery may be necessary that the cause shall be removed. Osteopathic treatment before operations in reducing congestions and inflammations, also in toning the nervous system, is particularly efficacious while the after treatment gives gratifying results. In fact, the two go hand in hand