What was the biological mechanism that allowed Tarrare to eat so much?

Question

Are there any conjectured mechanisms that cause Tarrare's extremely oversized stomach and abdominal cavity? Along with his superhuman appetite of course. Whether from a medical perspective or a genetic one (I.e a potential diagnosis that is perhaps quite similar or the genes that would be at play).

Even correlated genes and their subsequent mechanisms that are being affected could be an interesting addendum.

*I would like to make sure that any answer is also trying to explain the enlarged esophagus and abdominal cavity(seen during autopsy) along with the appetite, sweating, and other observed manifestations of an underlying condition(see Death section of Wiki for info and associated source material in book "Two-headed Boy and other Medical Marvels").

Answer 1

Tarrare

Tarrare was a showman who was renowned for his insatiable appetite including eating cats, dogs, and snakes sometimes raw. He is also said to have eaten many inedible items. At the time, he was alleged to have committed cannibalism of a 14-month-old baby and was caught in the act of cannibalising cadavers by hospital staff.

He was given away as a child by his parents and served in the French Revolutionary Army.

Tarrare died at the age of around 26. From the book "Anomalies and Curiosities of Medicine" originally published in 1896 by Gould and Pyle:

He was of middle height and was always heated and sweating. He died of a purulent diarrhea, all his intestines and peritoneum being in a suppurating condition.

This record is 100 years after Tarreres death and is largely based on the 1819 London Medical and Physical Journal. The earlier record claims:

At seventeen years of age, Tarrare weighed only one hundred pounds, and was already able to eat, in twenty-four hours, a quarter of a bullock of that weight.

From these accounts, I form the opinion that Tarrare ate an incredibly poor diet of raw meat and offal and countless inedible objects. There are references to throwing up after consuming raw animals and chronic diarrhoea. There are references to sleeping for large periods of time after eating large quantities of food.

Autopsy

A passage from the 1819 London Medical and Physical Journal:

This is the closest article we have to a contemporary record. From this account we gather that his stomach was enlarged and ulcerated, his gall bladder was enlarged, and his liver was diseased and enlarged. Also, it might be a factor that his appetite was lost during these final days, common among patients with diarrhoea. The record at the time, as quoted above, attributes the cause of death to diarrhoea.

Although the picture is painted that the autopsy occurred soon after death, we have no idea if this was hours, days, weeks, and conditions were much less sterile than modern morgues. I am not sure if the "corruption" mentioned is significant. One source claims Tarrare died of TB, however, I cannot find any corroborating evidence. Another source recounts Tarrare blaming his demise on eating a golden fork.

These post mortem observations could have developed from 20 years of eating an exceptionally poor, unhygienic, and often inedible diet and may or may not have been the cause of his underlying condition.

Summary

So we have a few things to consider.

• Polyphagia including inedible object consumption
• Died young
• Gastrointestinal abnormalities identified post mortum
• Chronic fever and sweating
• Chronic diarrhoea and vomiting
• Periods of prolonged sleep

Polyphagia

The London Medical and Physical Journal describes Tarrare as having polyphagia which in his case could not be cured by acids, opium, or tobacco.

Colloquially, polyphagia means ingesting a wide variety of items. However, if they meant "polyphagia" medically, it could be a symptom.

Polyphagia is a medical symptom defined as excessive hunger. In modern times, this can indicate a disorder such as diabetes (improper production or reception of insulin) or Kleine–Levin syndrome (a disorder of the hypothalamus). It could also indicate a genetic condition Prader–Willi syndrome and Bardet–Biedl syndrome.

The full list of causes from Wikipedia is:

• Anxiety
• Stress
• Depression
• Orexigenic drugs
• Diabetes mellitus
• Hyperthyroidism
• Hypoglycemia
• Fatigue
• Premenstrual syndrome
• Prader–Willi syndrome
  • From the NHS: Prader-Willi syndrome is a rare genetic condition that causes a wide range of physical symptoms, learning difficulties and behavioural problems.
• Bulimia
• Graves' disease
  • Autoimmune thyroid disorder that can lead to an intolerance of heat
• Kleine–Levin syndrome
  • A sleep disorder

We cannot know if Tarrare's polyphagia was brought on by his stressful exhausting life, his poor diet, or some genetic condition. We cannot even be sure if his condition was responsible directly or indirectly for his death. We cannot know if his sweating was related to; his underlying condition, or a chronic state of infection. The only cause for his eating we can rule out from the above list of underlying causes is premenstrual syndrome (PMS) and orexigenic drugs (which are not documented). There could be a case made for most of the other causes.

Concluding remarks

Given the scarceness of good quality medical records, the anecdotal nature of what was recorded, and the relatively poor diagnostic power of medical practitioners of the time, it would be, in my non-medical opinion, impossible to conclusively form a diagnosis.

Answer 2

Tarrare had these symptoms:

• Grossly increased appetite, eating raw meat and other inedible things
• Excessive sweating with bad body odor
• Chronic diarrhea, which was "fetid beyond all conception"
• Wide jaw, abnormally large esophagus and stomach
• Loose skin around his cheeks and stomach
• Heavily stained teeth
• Unusually soft fair hair
• Apathetic temperament

He didn't vomit excessively and he was not overweight.

Description of his skin and internal organs:

When he had not eaten, his skin would hang so loosely that he could wrap the fold of skin from his abdomen around his waist. When full, his abdomen would distend "like a huge balloon". The skin of his cheeks was wrinkled and hung loosely, and when stretched out, he could hold twelve eggs or apples in his mouth.

At the autopsy, Tarrare's gullet was found to be abnormally wide and when his jaws were opened, surgeons could see down a broad canal into the stomach. His body was found to be filled with pus, his liver and gallbladder were abnormally large, and his stomach was enormous, covered in ulcers and filling most of his abdominal cavity. (Wikipedia)

Possible causes:

• Constant hunger and excessive eating was obviously due to chronic diarrhea that resulted in loss of most nutrients he consumed, which also explains why he was keeping relatively low body weight.
• Saggy skin, large esophagus and stomach can be explained by a combination of eating large amounts of food at once and lax connective tissue - the later could be genetically predisposed. It is known that eating huge amount of food at once can result in acute gastric dilatation.
• Enlarged liver (hepatomegaly) and gallbladder were likely due to abscesses as part of purulent infection in his abdomen discovered at autopsy.
• Chronic diarrhea could be caused by a gastrointestinal infection or intestinal parasites, which may also explain his other symptoms: eating inedible things ("pica"), excessive sweating, bad smell of the skin and stools, apathy (due to anemia) and ulcers and pus found in the gastrointestinal tract at autopsy.
• Excessive sweating could be a combination of:
  • Chronic infection
  • Diet induced thermogenesis due to eating a lot of meat, which is high in protein, which releases a lot of heat when metabolized (see also "meat sweats"). This same effect can explain why the other man, Charles Domery, who was eating huge amounts of meat, was sweating profusely at night (after eating), despite having no diagnosis of infection, diarrhea or other health condition.