ADIPOSE TISSUE. 



63 



According to the observations of William 

 Hunter, anasarcous dropsy is the only disease 

 in which the fat of the adipose membrane is 

 entirely consumed. " This disorder, when in- 

 veterate, has that effect in such a degree, that 

 we find the heart or mesentery in such subjects 

 as free from fat as in the youngest children." 

 This, however, is in some degree denied by 

 Bichat, who contends that it is not uncommon 

 to find much subcutaneous fat in subjects 

 greatly infiltrated.* It is obvious that much 

 will depend on the stage of the disease. It 

 cannot be expected that the moment serous 

 infiltration appears in the filamentous tissue, 

 all the fat should be at once removed from 

 the adipose. The process of absorption is 

 gradual as is that of deposition ; and the infe- 

 rence of Hunter may be regarded as nearly 

 exact in reference to long-continued, or what 

 he terms inveterate dropsy. It is certain, that 

 while it is very difficult to deprive the bones of 

 ordinary subjects of oil, those of dropsical sub- 

 jects are the only ones which it is possible to 

 obtain free from this substance. 



In certain diseases, especially those the ter- 

 mination of which is attended with serous 

 effusion into the cavities of the serous mem- 

 brane, the fat is partly absorbed or may be 

 converted into a sort of sero-gelatinous fluid. 

 In chronic dysentery, for example, the subcu- 

 taneous fat and that of the heart and omentum, 

 in a great measure disappear, while in their 

 place we find effused an orange-yellow coloured 

 sero-albuminous fluid, of a jelly-like aspect, 

 which coagulates on the application of heat or the 

 addition of re-agents. In the bodies of those, 

 also, cut off by scirrhous disorganization or 

 cancerous ulceration, the greater part of the 

 fat is in like manner absorbed, and in its place 

 appears a dirty orange-yellow coloured sero- 

 albuminous fluid. 



The removal of the fat from its containing 

 membrane is effected by the process of absorp- 

 tion, the agents of which are supposed by 

 William Hunter, Portal, Bichat, and Mascagni, 

 to be the lympathics. According to the results 

 of the experiments of Magendie, Mayer, Tiede- 

 mann and Gmelin, Segalas and others, it must, 

 in some measure at least, be ascribed to the in- 

 fluence of minute veins. It is a point of some 

 interest to know in what form it is absorbed, 

 whether as oily matter, or after undergoing a 

 process of decomposition The observation of 

 Dr. Traill, above quoted, would lead to the 

 former view ; but it is not easy to conceive that 

 this should be uniform. We want, in short, 

 correct facts on the point at issue. 



5. Adipose sarcoma. This consists in an un- 

 usual deposition of firm fatty matter in cells, 

 the component fibres of which are sufficiently 

 firm to give it consistence. The tumour, which 

 is generally globular, is always surrounded by 

 a thin capsule, formed by the condensation of 

 the contiguous filamentous tissue. The tumour 

 is supplied by a few bloodvessels, which pro- 

 ceed from the capsule, but which form so 

 slender an attachment that they are readily 



* Anut. Gun. vol. i. p. 57. 



broken, and the tumour is easily scooped from 

 its seat. This sort of tumour occurs almost 

 invariably in the adipose membrane, and seems 

 to consist in a local hypertrophy of the part in 

 which it is found. It may have a broad basis, 

 but is often pendulous, or attached by a narrow 

 neck or stalk. It is the most common form 

 of sarcomatous tumour, and may occur in any 

 part of the body in which there is adipose mem- 

 brane, but is chiefly found on the front and 

 back of the trunk, and not unfrequently on two 

 places at the same time. 



6. Steatoma. In adipose sarcoma the adi- 

 pose matter is deposited in cells, and the 

 tumour derives a degree of firmness from the 

 fibres with which it is thus traversed in every 

 direction. In other instances, however, the 

 adipose matter is deposited in a mass in the 

 cavity of a spherical or spheroidal cyst, formed 

 in the filamentous or adipose tissue ; and the 

 tumour is soft and compressible, and seems to 

 contain fluid or semifluid matter. When cut 

 open it is found to contain a soft semifluid 

 matter of the consistence of honey, but of oily 

 or adipose properties. In such circumstances 

 the inner surface of the cyst, or at least the 

 vessels of this surface, are the agents which 

 secrete the fatty matter. This tumour may 

 occur either in the filamentous or the adipose 

 tissue, but is to be regarded as an example of 

 local deposition of adipose matter. It may 

 appear in any region of the filamentous tissue, 

 but is most frequent about that of the head and 

 face. Small steatoms are not unfrequent in the 

 eyelids and in the scalp. Larger ones are more 

 frequent about the neck. 



7. Lipoma. This name was first applied 

 by Littre to a wen or cyst, filled with soft 

 matter, possessing the usual properties of ani- 

 mal fat. The matter of steatom, according to 

 this surgeon, is either not or imperfectly in- 

 flammable, by reason of its degeneration or 

 commixture with some other animal secretion. 

 The propriety of this distinction has been de- 

 nied by Louis and others, who maintain that 

 these tumours differ in nothing, unless per- 

 haps in degree. It has been favoured, never- 

 theless, by Morgagni, and adopted by Plenck, 

 Desault, Bichat, and various foreign surgeons, 

 and is defended by Boyer, who represents the 

 steatom as differing from lipoma in the matter 

 being white, firm, and changed from its origi- 

 nal character, and in possessing the tendency 

 to degenerate into cancer. Plenck had previ- 

 ously distinguished the lipoma by its being 

 destitute of a cyst, a circumstance not required 

 by Littre' . 



Though thus admitted to differ, the anato- 

 mical character, as given by Morgagni, and 

 confirmed by Boyer, is in both nearly the 

 same : a cyst, containing unchanged fat, or 

 granular adipose matter, in cells formed by the 

 original fibres of the adipose membrane, ac- 

 cording to Morgagni, or those of the filamen- 

 tous tissue, according to Boyer. At the base 

 or stalk, in the case of pendulous steatom, the 

 cells are compressed, but loose in the body of 

 the tumour. 



This description, with the alleged cancerous 





