Differential diagnosis is of the first importance, and will first engage the attention of the surgeon. This paper is concerned with the management of acute stages after the diagnosis is made, especially with the question of immediate operation, and only acute conditions will be considered. It may be necessary, clinically, to distinguish the following: Suppurative cholangitis; suppurative cholecystitis associated or not with gallstones; acute suppurative pylephlebitis; various kidney inflammations; peritonitis following the perforation of viscera or of cystic tumors; acute hemorrhagic pancreatitis; ureteral calculus. Among intestinal conditions may be found strangulated hernia: obstruction due to bands; intussusception; volvulus of mesentery or of intestine; acute appendicitis; thrombosis or embolism of mesenteric vessels or those of the spleen. Salpingitis, ovaritis, metritis; postpuerperal, traumatic or due to such infecting agents as the tubercle bacilus or the gonococcus.
Of these conditions certain ones do not call for operation, and are, therefore