The man that could not stop eating

A screenshot of the Journal front cover article showing the title, the full list of authors and part of the abstract.

The story

I recently answered a question on Bio.SE regarding the medical case of a French man called Tarrare who was alive in the revolution. The case has achieved near-legendary status due to the fantastic accounts of his showmanship, his seemingly insatiable hunger, his botched attempt at espionage, and his tragic descent into cannibalism.

I am not a medical doctor. I cannot at all approach this case from the angle of a diagnostician and hope to conclusively form a diagnosis that nobody else has managed to notice. I have however had a lot of fun reading this case and would like to share my views on this incredible story.

If you want to read more about the exploits and drama surrounding Tarrare, I don’t think I could do a better job than the source material (it is only a couple of pages), or a more dramatised blog post can be read here.

Here I will regurgitate my answer, embellished with a few opinions that wouldn’t suit the Stack Exchange format.

Tarrare’s life

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 purulent diarrhoea, 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 after eating large quantities of food.

Autopsy

A passage from the 1819 London Medical and Physical Journal:

His body, as soon as he was dead, became a prey to a horrible corruption. The entrails were putrefied, confounded together, and immersed in pus: the liver was excessively large. Void of consistency and in a putrescent state; the gall-bladder was of considerable magnitude; the stomach, in a lax state, and, having ulcerated patches dispersed about it, covered almost the whole of the abdominal region. The stench of the body was so insupportable, that M. Tessier, chief surgeon of the hospital, could not' carry hi* investigation to any further extent,

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

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:

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.

From discussions on the Bio.SE forums, we have concluded that cholera could have been the illness that finally struck him down although his death was a dozen years or so before the first European epidemic, and 50 years before Cholera was first cultures and described. It seems to me however that the laxness of his guts, skin, and jaw, could all be accounted for by excessive abuse due to his polyphagia. His insatiable appetite could have been derived from a bulimic-like effect of diarrhoea as a consequence of poor hygiene and diet in conjunction with some metabolic disorder. If there was a more systemic disease at play (such as Ehlers-Danlos syndrome), being the showman he was, I am sure Tarrare would have performed contortion acts and it would have been documented.

So in reality, it could have been any number of pathogens that finally got the best of him, and any number of underlying conditions that exacerbated his illness.

T. BRADLEY, M. D., A. F. M. WILLICH, M.D., J. P. PFAFF, M.D., R. RATTY, M.D., J. ADAMS, M.D., A. A. NOEHDEN, M.D., W. SHEARMAN, MSD., J. ARNEMAN, M.D., W. ROYSTON, Esq., SAMUEL FOTHERGILL, M.D. AND WILLIAM T. (1819). THE LONDON MEDICAL and PHYSICAL JOURNAL, Published by Oxford Univ. 1986;XXX:60. Retrieved from https://books.google.co.uk/books?id=4e0EAAAAQAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false