Another point, which has in some cases impeded the adoption of the practice, is the increased responsibility it seems to involve. If a surgeon is to be mistrusted and charged with either, the "laisser mourir" is much less injurious to him than the "tuer." What we mean is this: Everything sometimes is going on well, until the opening of the deposited fluid. If it be left to open by the ordinary processes of nature, the subsequent symptoms are properly enough ascribed to the usual course of the disease; but if the surgeon has interfered, and, from any circumstances whatever, the opening does not heal, or bursts soon after from some slight accident (which has now and then happened), the surgeon is blamed. The only remedy for this, is to impress the necessary caution: repose of the part, and so forth.
There is, however, a third point, of great practical consequence, on which Mr. Abernethy has been misunderstood. I allude to the local condition under which the puncture should be made. When, notwithstanding our persevering observance of all measures calculated to repress the diseased actions, or to procure the absorption of the deposited fluid, we perceive it to be increasing or approaching the surface, _then, before any inflammation_ of the skin has taken place, it should be discharged.
In many cases, _this_ opening has been delayed until the skin _has become inflamed_, or much attenuated. Now this risks the accomplishment of an object which it is a material point with Mr. Abernethy to secure—namely, the _immediate healing_ of the puncture.
On this point, even so good an authority as Sir Astley Cooper has given a misdirection. "Let the abscess proceed," says Sir Astley, "until you observe a blush or redness on the skin, and then adopt Mr. Abernethy's plan." Now this direction does not absolutely prohibit the opening of the cyst with the object which Mr. Abernethy had in view; but, as before stated, it deprives us of _one most desirable condition_. To settle this point, we quote Mr. Abernethy's own words. In discussing the point of time at which the opening should be made, he asks: "Are we to wait until evident _signs of inflammation_ appear? I think not." Accordingly, in a case where the surface had become red, we find he took care to _avoid_ opening it _at that part_; because it risked the security of at once healing the puncture.