The authors write regarding a previous Letter to the Editor (Hoehmann CL, Cuoco JA. Landmark article transforms traditional view of the autonomic nervous system. J Am Osteopath Assoc 2017;117(2):72. doi:10.7556/jaoa.2017.016) in which the authors proposed that the sacral spinal outflow to the pelvic organs should be reclassified as the caudal outflow of the peripheral sympathetic nervous system. The authors of the present Letter object, stating that reclassification would imply that the peripheral autonomic nervous system with preganglionic neurons in the spinal cord and brainstem is divided into a cranial (parasympathetic) system and a spinal (sympathetic) system.