PRESIDENTIAL ADDRESS. 83 
Enecapsuled fatty tumours or lipomata are typical instances 
of innocent tumours. Their relative independence of control 
by the rest of the body may be well seen in starvation or 
in emaciation from cachexia,’ when the normal fatty tissues 
may be absorbed to supply the needs of the moment, but 
those of the growth are unaffected. Here an interesting 
speculation may be hazarded. The fat manufactured in a 
fat cell is set free for use elsewhere by means of fat-split- 
ting ferments, lipases. This action is reversible, the same 
ferment having originally synthesised the fat from the 
materials furnished by the surrounding nutritive fluids. 
A condition of equilibrium is considered to exist between 
the pro-fat constituents on the outside of the cell-wall of 
the fat cell and the neutral fat stored within it, the lipase 
being the agent by which this equilibrium is maintained. An 
increase in the former constituents leads to storage of fat 
till equilibrium is again restored, whilst a diminution leads 
to splitting up of the stored fat with the same object in 
view. The accounts are transferred from side to side of 
the ledger according to requirements, so that, like an ideally- 
conducted business, with a perpetual audit, income and ex- 
penditure always balance. Now from this it will appear 
that in the absence of lipase or of means to set it working, 
the fat must remain where it is. The loaded fat cell will 
remain loaded if there is no percussion cap or ferment to 
initiate its discharge, or no finger to pull the trigger and so 
explode the percussion cap. It seems to me possible that 
lipomata may arise either through the disappearance of the 
lipase required to discharge the fat, or owing to failure of 
the required stimulus to make it split up the fat. The 
lipase may fail because the cells lose the capacity to make 
it, or an antilipase neutralises it as made—the stimulus (a 
+WVide Paget, Lects. on Surg: Path., Turner, 3rd Edit., 1870, p. 378. 
—case of intense emaciation from tuberculosis with fatty tumours . 
in the mesentery. 
