Rebecca Begins Eating the Earth Again
J R Soc Med. 2002 Mar; 95(three): 143–146.
Geophagia: the history of globe-eating
Geophagia is divers as deliberate consumption of earth, soil, or dirt1. From unlike viewpoints it has been regarded as a psychiatric disease, a culturally sanctioned practice or a sequel to poverty and dearth. Prompted past a remarkable case in our own practice2 we became increasingly enlightened of geophagia in gimmicky urban South Africa. In view of the high prevalence of geophagia there and in many other regions of the earth1, we hypothesized that ancient medical texts would also comprise reports of the disorder. To our surprise, geophagia was indeed reported by many authors ranging from Roman physicians to 18th century explorers. Here we present, together with a brief clarification of the disorder, some of the well-nigh remarkable examples.
GEOPHAGIA
From a psychiatric bespeak of view, geophagia has been classed as a form of picaiii—a term that comes from the Latin for magpie, a bird with indiscriminate eating habits. In its Diagnostic and Statistical Manual, the American Psychiatric Association defines pica as persistent eating of non-nutritive substances that is inappropriate to developmental level, occurs exterior culturally sanctioned practice and, if observed during the course of another mental disorder, is sufficiently severe to warrant contained attentioniv. Geophagia denotes the habit of eating earth, soil or clay and is not uncommon in southern parts of the United States5 as well as urban Africa. Fine red dirt is often preferred (Figure 1). In item, geophagia is observed during pregnancyvi or as a characteristic of iron-deficiency anaemia7. Where poverty and famine are implicatedi, earth may serve as an appetite suppressant and filler; similarly, geophagia has been observed in anorexia nervosa. However, geophagia is frequently observed in the absence of hunger, and environmental and cultural contexts of the habit have been emphasized8. Finally, geophagia is encountered in people with learning disability, peculiarly in the context of long-term institutionalization; in this regard, geophagia and other forms of pica are associated with a high charge per unit of complications9 and substantial morbidity10 and bloodshed11. Geophagia has also been reported to serve specific purposes. For example, young women in urban South Africa believe that earth-eating will give them a lighter colour (making them supposedly more attractive) and soften their skin. There is reason to believe that geophagia often goes unrecognized by doctors because patients are reluctant to volunteer the history. Indeed, stigma plays a role, and concealment of the aberrant eating behaviour is an important issue. The diagnosis normally emerges when a patient is accidentally discovered during a 'binge' of geophagia12. Intestinal radiography2 can be of not bad help in the occasional patient who fervently denies the habit. Complications of geophagia are rare but closely linked to the amount of ingested material. They include parasitic infestation, electrolyte disturbances and intestinal obstruction. Perforation and peritonitis are rare but the associated bloodshed is very highii.
A sample of clay obtained from vendor in urban Johannesburg, South Africa
ANTIQUITY
Despite limited insight into anatomy and physiology, Greek and Roman medical textbooks reveal astute descriptions of medical disorders and striking diagnostic acumen. The textbook compiled by Hippocrates of Kos (460-377 BC) provides a masterly example. Hippocrates, who marks the transition from a magical view of wellness and disease to one of belief in causation, must exist credited with the first description of geophagia:
'If a meaning woman feels the desire to eat earth or charcoal and then eats them, the kid will bear witness signs of these things'thirteen.
For centuries, Hippocrates' textbook was a cornerstone of medical practice, and then we can presume that Greek and Roman physicians were familiar with geophagia. Only fifty-fifty today the reason for geophagia in pregnancy remains elusive6. A famous Roman medical textbook, De Medicina, was compiled past A Cornelius Celsus during the reign of Emperor Tiberius (14-37 Advertizing). His second book contains a passage that deals with the utilise of skin colour as a diagnostic sign:
'People whose colour is bad when they are non jaundiced are either sufferers from pains in the head or earth eaters'fourteen.
Even this early report points to a link betwixt geophagia and anaemia. It is still unclear, however, whether anaemia prompts geophagia (to compensate for atomic number 26 deficiency) or whether geophagia is the crusade of anaemia7. Taken together, the reports provided by Hippocrates and Celsus suggest that earth-eating was not uncommon in ancient times. Pliny (Gaius Plinius Secundus, 23-79 Advertizing), a universal scientific writer, supports this supposition. He describes the popularity of alica, a porridge-like cereal that contained reddish clay:
'Used as a drug it has a soothing event... every bit a remedy for ulcers in the humid function of the trunk such every bit the oral cavity or anus. Used in an enema it arrests diarrhoea, and taken through the rima oris... it checks catamenia'15.
Aetius of Amida, now the Turkish city of Djabakir, compiled an obstetric textbook during the 6th century that provides evidence from the Byzantine era. A physician to Emperor Justinian in Constantinople, Aetius states:
'Approximately during the 2nd month of pregnancy, a disorder appears that has been called Pica, a name derived from a living bird, the magpie... Women so want different objects... some prefer spicy things, others salty dishes and once again others earth, egg shells or ashes'16.
THE MIDDLE AGES
Fewer reports of geophagia are bachelor from this period, partly because of the scarcity of new medical works in general. Instead, Roman, Greek and Arab textbooks were used at the time. The Persian Ibn Sina (980-1037 Advertising), too known as Avicenna, compiled one of the most widely used medical textbooks and fabricated detailed mention of geophagia. To cure geophagia in immature boys Avicenna recommended imprisonment12, but more than gentle treatment was advocated during pregnancy17. In medieval Europe both gynaecology and obstetrics were largely performed by midwives, and few documents survive. An exception is the remarkable textbook written by Trotula of Salerno. A midwife in the 11th century, she dealt with geophagia as a common merely treatable problem in pre-delivery care:
'Merely if she should seek to take potter'due south earth or chalk or coals, allow beans cooked with sugar be given to her'eighteen.
GEOPHAGIA IN THE 16TH AND 17TH CENTURIES
Many reports of geophagia are available from this period, and the term pica was first mentioned in the context of a surgical piece of work19. Geophagia was often observed as a symptom of another illness, chlorosis. The 'dark-green disease', also known as febris alba, mainly affected pubescent girls and spread widely through Europe during the 16th centuryxx. In France, Libault described geophagia in maidens suffering from chlorosis in 158221. The exact nature of chlorosis remains controversial but anaemia must have been a salient feature. In view of the well-described association of anaemia and geophagia7, Libault'southward observations are not surprising.
More information can exist gathered from medical dissertations about pica. In this regard, some twenty thesis papers from the 16th and 17th centuries can be found in the British Library alone. Among reports of other forms of pica, they describe a remarkable spectrum of geophagia. Nosotros must be cautious, however, in taking them at face value. Indeed, information technology has been speculated that some of these reports originally stalk from mocking descriptions in songs and jokes of wandering minstrels22. Among the authors of these theses, Boetius was the showtime to advocate atomic number 26 treatment23. Ledelius, in turn, fabricated attempts to explain the pathogenesis of the disorder: he believed that pieces of leftover food rotted in the breadbasket and later on spoiled the sense of taste and caused craving for all sorts of substances24. Veryser in Utrecht was the showtime to regard pica as a mental disorder: 'In this disorder, 2 sites are afflicted, namely breadbasket and listen'25. Many of these authors, over again, observed geophagia during pregnancy. Christian provided a remarkable description of various forms of geophagia and vividly described the disorder: 'A girl ate earth and similar things just as they were breadstuff' (Figure 2)26.
Title folio of doctoral thesis on pica
But geophagia was non only observed in young women suffering from chlorosis. An astonishing report of geophagia equally a sequel to famine during the 17th century, by the superintendent of Coswig in Saxony, dates from 1617:
'So people finally started baking this earth and [...] the hill containing this white earth was undermined and collapsed killing v'27.
Finally, geophagia was also mentioned past scientists travelling abroad during the 17th century. Dr John Covel, travelling the Levant, reported in great item on the use of terra sigillata, the sacred earth, to facilitate childbirth and alleviate disorders of menses28.
ANTHROPOLOGISTS, COLONIAL PHYSICIANS AND EXPLORERS
Geophagia remained mutual in Europe during the 18th and 19th centuries; in particular, it was still observed in immature girls with chlorosisxx. Fifty-fifty more reports, nevertheless, were compiled by anthropologists, colonial physicians and explorers. 1 of these authors who came to broad attending was von Humboldt, who noted geophagical customs in natives of South America:
'This area is populated by the Otomacs, a forgotten tribe which shows the most peculiar behaviour. The Otomacs swallow earth, that is they wolf it down in quite considerable amounts'29.
Humboldt described geophagia in great detail and asserted that hunger could in part explicate this behaviour. In item, he observed that dried world was piled upwardly in heaps to serve equally a store during periods of famine. It is noteworthy that members of the Otomac tribe were selective, preferring a brand of fine red clay that seems similar to that consumed in South Africa (meet Effigy 1). In Africa, Livingstone subsequently described safura, a disease of earth-eating among slaves in Zanzibar. Livingstone refuted poverty every bit a possible explanation after observing that wealthy people were also afflicted. The course of the disorder was described every bit invariably fatal30. Similar reports from colonial physicians are discussed in bang-up detail elsewhere22. Here, the disorder was often viewed as a matter of bully business concern among plantation owners, in that slaves who were addicted to geophagia became progressively more than lethargic and debilitated until they somewhen died. Plantation owners went so far as to have face masks fitted to prevent the slaves from eating earth31 , 32 (see Figure 3). Like habits developed among slaves in southern parts of North America, where geophagia was known as cachexia Africana 33; the disorder is yet seen in Georgia and Louisiana. Finally, reports are available from Republic of india34 and the balance of Asia20.
Mouth-locks worn by slaves in Brazil to preclude geophagia
CONCLUSION
All the concepts of geophagia—equally psychiatric disorder, culturally sanctioned practice or sequel to dearth—fall short of a satisfying explanation. The causation is certainly multifactorial; and conspicuously the practice of globe-eating has existed since the showtime medical texts were written. The descriptions do non let simple categorization every bit a psychiatric disease. Finally, geophagia is not confined to a particular cultural surround and is observed in the absenteeism of hunger. Might it be an atavistic mode of behaviour, formerly invaluable when minerals and trace elements were scarce? Its re-emergence might then exist triggered by events such every bit dearth, cultural change or psychiatric disease. A cute description of the latter can be constitute in Gabriel García Màrquez' novel, One Hundred Years of Solitude, where he describes geophagia in a adult female who is madly in love:
'Rebecca got up in the eye of the night and ate handfuls of earth in the garden with a suicidal drive, weeping with hurting and fury, chewing tender earthworms and chipping her teeth on snail shells'35.
Acknowledgments
Nosotros are indebted to staff at the British Library, London, for fantabulous service, and to Dr Wolfgang Woywodt for help with German sources.
References
ane. Hawass NED, Alnozha MM, Kolawole T. Adult geophagia—report of iii cases with review of the literature. Trop Geogr Med 1987;39: 191-v [PubMed] [Google Scholar]
two. Woywodt A, Kiss A. Perforation of the sigmoid colon due to geophagia. Arch Surg 1999;134: 88-9 [PubMed] [Google Scholar]
3. McLoughlin IJ. The picas. Br J Hosp Med 1987;37: 286-90 [PubMed] [Google Scholar]
4. American Psychiatric Clan. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC: American Psychiatric Association, 1994
5. Edwards CH, Johnson AA, Knight EM, et al. Pica in an urban environment. J Nutr 1994;124: 954S-962S [PubMed] [Google Scholar]
6. O'Rourke DE, Quinn JG, Nicholson JO, Gibson HH. Geophagia during pregnancy. Obstet Gynecol 1967;29: 581-4 [PubMed] [Google Scholar]
7. Sayers G, Lipschitz DA, Sayers M, Seftel HC, Bothwell Th, Charlton RW. Relationship between pica and iron diet in Johannesburg black adults. Southward Afr Med J 1974;68: 1655-60 [PubMed] [Google Scholar]
8. Vermeer DE, Frate DA. Geophagia in rural Mississippi: ecology and cultural contexts and nutritional implications. Am J Clin Nutr 1979;32: 2129-35 [PubMed] [Google Scholar]
9. Decker CJ. Pica in the mentally handicapped: a 15-yr surgical perspective. Can J Surg 1993;36: 551-iv [PubMed] [Google Scholar]
x. Ilhan Y, Cifter C, Dogru O, Akkus MA. Sigmoid colon perforation due to geophagia. Acta Chir Belg 1999;99: 130-1 [PubMed] [Google Scholar]
eleven. McLoughlin IJ. Pica as a crusade of death in three mentally handicapped men. Br J Psychiatry 1988;152 ; 842-5 [PubMed] [Google Scholar]
12. Rosselle HA. Association of laundry starch and clay ingestion with anemia in New York City. Arch Intern Med 1970;125: 57-61 [PubMed] [Google Scholar]
13. Hippocrates. Oevres Complètes d'Hippocrate, Vol. eight, Piffling E, transl. Paris: Baillière, 1839: 487 [Google Scholar]
14. Celsus. De Medicina. Spencer WG, transl. Cambridge/Mass.: Harvard University Press, 1971: 116-17.
xv. Pliny. Natural History, Vol. 9, Rackham H, transl. London: Heinemann, 1972: 285 [Google Scholar]
16. Wegscheider M. Geburtshülfe und Gynäkologie bei Aëtius von Amida. Berlin: Julius Springer Verlag, 1901: 11-12
17. Kipel KF. Picca. In: The Cambridge World History of Homo Disease. Cambridge: Cambridge Academy Printing, 1993: 927
18. Mason-Hohl E. The Diseases of Women by Trotula of Salerno. Hollywood/Los Angeles: Ward Ritchie Press, 1940: 21
nineteen. Gale T. An Excellent Treatise of Wounds made with Gonneshot. London: R Hall, 1563
20. Parry-Jones B, Parry-Jones WL. Pica: symptom or eating disorder? A historical assessment. Br J Psychiatry 1992;160: 341-4 [PubMed] [Google Scholar]
21. Líebault J. Trois Libres Appartenant aux Infirmitez et Maladies des Femmes. Paris, 1609
22. Cooper M. Pica. Springfield, Illinois: CL Thomas, 1957
23. Boetius MH. De Pica. Leipzig, 1638
24. Ledelius J. Dissertatio inauguralis de Pica. Jena: Christoph Krebs, 1668
25. Veryser P. Disputatio medica inauguralis de malacia seu pica. Utrecht: Franziskus Halma, 1694
26. Christian D. Dissertatio medica de pica. Frankfurt/Oder: Christoph Zeitler, 1691: 11
27. Ströse K. Mitteilung über das Diatomeenlager bei Klieken in Anhalt. In: Suhle H, ed. Ix Jahresbericht des Friedrichs-Realgymnasiums und der Vorschule des Fridericianum für das Schuljahr 1890-1891. Dessau: 50. Reiter Herzogl. Hofbuchdrucker, 1891
28. Bent JF. Early Voyages and Travels in the Levant. London: Hakluyt Society, 1903, 282
29. Von Humboldt A. Vom Orinokko zum Amazonas. Wiesbaden: FA Brockhaus, 1985, 341
xxx. Livingstone D. Concluding Journals. London: John Murray, 1874: 83
31. Anell B, Lagercrantz S. Geophagical Customs. Uppsala: Almquist and Wiksell, 1958: 63
32. Debret JB. Voyage pittoresque et historique au Brésil, ou, Séjour d'united nations artiste français au Brésil, depuis 1816 jusqu'en 1831 inclusivement. Paris: Firmin-Didot Fréres, 1834
33. Mustacchi P. Cesare Bressa (1785-1836) on clay eating in Louisiana. A critical assay of his unpublished manuscript De la Dissolution Scorbutique. JAMA 1971;218: 229-32 [PubMed] [Google Scholar]
34. Thurston E. Ethnographic Notes in Southern India. Madras: Government Printing, 1906: 552
35. García Màrquez Thousand. Cien Años de Soledad. Madrid: Espasa-Calpe, 1982, 120
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279487/
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