Sometimes a dreaded thing occurs in the body—a mutiny—resulting in a tumor or a runaway clogging of the system.

At the central railway station in Madras, India, lay one beggar woman more pitiful than the others I saw there. She had positioned herself alongside the stream of passengers hurrying to catch their trains. Businessmen with briefcases passed by her, as did wealthy tourists and government officials.

Like many Indian beggars, the woman was emaciated, with sunken cheeks and eyes and bony limbs. But, paradoxically, a huge mass of plump skin, round and sleek like a sausage, was growing from her side. It lay beside her like a formless baby, connected to her by a broad bridge of skin. The woman had exposed her flank with its grotesque deformity to give her an advantage in the rivalry for pity. Though I saw her only briefly, I felt sure that the growth was a lipoma, a tumor of fat cells. It was a part of her and yet not, as if some doctor had carved a hunk of fat out of a 300-pound person, wrapped it in live skin, and deftly sewed it on this woman. She was starving; she feebly held up a spidery hand for alms. But her tumor was thriving, nearly equaling the weight of the rest of her body. It gleamed in the sun, exuding health, sucking life from her.

Fat cells: the Madras beggar’s tumor was composed entirely of an orgiastic community of them. In our figure-conscious Western culture, the word “fat” connotes a lack of discipline, an unnecessary aggregation of cells that should be reduced.

From the surgeon’s vantage point, however, as he draws a knife across the skin exposing oleaginous layers of fat cells, the evil connotation is balanced by a sense of the value of fat. It insulates against cold, and for that reason billions of ...

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