Thus the cells so sensitive to altered vascular changes are directly and remotely affected, and disease characteristics dependent upon structure and function of tissue, and degree of irritant are evident. This can vary, in degree only, with the muscular lesion that involves collateral spinal cord circulation, the visceral lesion that irritates sympathetic life, or the composite lesion that deforms or perverts structure en masse. But is the physical noxa as potent an etiologic factor as the chemical or bacteriologic? Adami[21] informs us whether an irritant is physical, bacterial or chemical, no satisfactory distinction can be founded on the duration of the irritation; that a local irritation of the nervous system may lead apart from “direct reflex action, to changes of nervous origin, in the region of the injury and in the reflexes affecting associated regions, the higher centers; and through them the system at large, may become affected by paths that it is not always easy to trace.” Again he says that “centrifugal impulses alone, apart from any local injury, may originate a succession of phenomena of inflammation in a part.” And “in all probability a nervous and central origin must be ascribed to some, at least, of the sympathetic inflammations seen to occur in areas supplied by the other branches of a nerve supplying a part primarily inflamed; and again in areas supplied from the same region of the brain or cord as the inflamed organ.” Other inflammatory changes, of course, may occur independently of centrifugal nervous influences, and the vessels react independently of central influences. This, then, presents a situation postulated thus: 1. The body follows definite structural relations and is influenced by mechanical arrangements in its morphology. 2. The integrity of tissue depends upon structural freedom of nutritive courses. 3. The above predicates a structural etiology as exact and precise as structural relations are important to nutrition. What proof, then, of the foregoing have we to offer? First, the =clinical proof=. Clinical results have been obtained in tens of thousands of cases that include disease of various types and lesions, and of all sections and organs of the body. The art of osteopathy has been perfected in many of its details, based upon actual experience and splendid results. The cure of the patient is paramount to all other consideration, and whereas the osteopathic school has been shown a superior system it logically follows on _a priori_ grounds that relief and cure of suffering is of the first and final importance.[22] Were it not for clinical results no new system of therapeutics could withstand criticism and calumny and finally triumph and be publicly, legislatively, and scientifically recognized.