The process is this. In consequence of the inflammation which then takes place, a yellow jelly-like substance is effused, covering the surfaces of the wound, called fibrin; veins and arteries from the sound flesh shoot into this, it becomes organized, another layer is thrown out, which in its turn passes through the same process; but now begins another step in the progress. From this organized fibrin spring innumerable little pointed cones, similar to the kernels of rice corn, at first of a pale red, becoming more florid as they increase in age, into which arteries and veins thrust themselves. These are the granulations. They have nerves and blood-vessels, are therefore alive, and when healthy, sensitive; and they likewise possess a disposition to unite, and when the two surfaces of a wound covered with granulations come in contact, the blood-vessels of one penetrate the other, they amalgamate and form flesh.
As they increase they contract, thus both filling the cavity and drawing the lips of the wound together, till, when it heals, the scar occupies much less space than the original cut. This process takes place when the granulations are healthy, and almost, but not completely, fill the wound, being a grain lower than the surface of the skin, and manifesting a disposition to glaze over.
At other times they are coarse, of large size, the points blunt, are spongy, pale, or blue, show no tendency to skin over, and puff up above the surface of the sound flesh, which swells and is inflamed. Physicians denominate these granulations fungus, it being found from experience that whenever granulations rise higher than the level of the surrounding surface they are not likely to form skin. This, among people in general, from the appearance, probably, goes by the name of proud flesh.
The old matrons cherished a mortal dread of proud flesh. They would put on their spectacles, look carefully at the wound, hold up both hands, and exclaim with alarm, "Proud flesh!" often times when only the proper amount of granulations was present, and they had numerous specifics for its removal—spruce gum, burnt alum, the ashes of oak bark, nutgalls, and red precipitate. But in their zeal to extirpate proud flesh, and, as they termed it, do something, they sometimes used little discrimination, and made war upon healthy material.
The particular thing that seemed to lie with the greatest weight upon the minds of the ancient dames and Miss Buckminster was, that, according to them, Rich was doing nothing for the poor lad. He was neither bleeding him, physicking him, putting on salves and heavy bandages, nor anything to kill the proud flesh. They made such a fuss that at last the boy, who had hitherto reposed the greatest confidence in his young physician, became a little nervous, and told Rich what the matrons said.
"My dear boy," said he, "there is very little to be done. What these good women call proud flesh is a healthy growth, the rudiments of new flesh, and without it your wound would never heal. It is no more in my power, or that of any other person, to heal your flesh than to make one hair white or black. Nature and time will do that. The inflammation has passed off, and the wound is healing. All that can be done is to keep the parts cool, defend them from the air, sustain your strength by a proper diet, and keep you quiet. The less you move, the faster your leg will heal; and as for bleeding, you have lost too much blood already from the cut."
The lad, after this, dismissing his anxieties, concerned himself no more about the proud flesh or the fears and prognostications of the matrons.
The patient in due time recovered, greatly to the satisfaction of Dr. Ryan. It also increased the reputation of Rich, though Miss Buckminster declared that "the boy should ought to have died of mortification or lockjaw, but the Lord overruled it and spared him for some good end, spite of the new-fangled doctor."