J R Soc Med 2002;95:143-146
doi:10.1258/jrsm.95.3.143
© 2002 Royal Society of Medicine
Geophagia: the history of earth-eating
Alexander Woywodt MD
Akos Kiss FCS (SA)
Department of Surgery, Chris Hani Baragwanath Hospital, University of the
Witwatersrand, Gauteng Province, Republic of South Africa
Correspondence to: Alexander Woywodt MD, Division of Nephrology, Department of
Medicine, University of Hannover School of Medicine, Carl-Neuberg-Strasse 1,
30625 Hannover, Germany E-mail:
Woywodt.Alexander{at}MH-Hannover.de
 |
INTRODUCTION
|
|---|
Geophagia is defined as deliberate consumption of earth, soil,
or
clay
1. From
different viewpoints it has been regarded as
a psychiatric disease, a
culturally sanctioned practice or a
sequel to poverty and famine. Prompted by
a remarkable case
in our own
practice
2 we became
increasingly aware of geophagia
in contemporary urban South Africa. In view of
the high prevalence
of geophagia there and in many other regions of the
world
1,
we
hypothesized that ancient medical texts would also contain
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 description
of the disorder, some of the most remarkable
examples.
|
GEOPHAGIA
|
|---|
From a psychiatric point of view, geophagia has been classed
as a form of
pica
3—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 outside
culturally
sanctioned practice and, if observed during the course of another
mental
disorder, is sufficiently severe to warrant independent
attention
4.
Geophagia
denotes the habit of eating earth, soil or clay and is not uncommon
in
southern parts of the United
States
5 as well as
urban Africa.
Fine red clay is often preferred
(
Figure 1). In particular,
geophagia
is observed during
pregnancy
6 or as a
feature of iron-deficiency
anaemia
7.
Where
poverty and famine are
implicated
1, earth
may serve as
an appetite suppressant and filler; similarly, geophagia has
been
observed in anorexia nervosa. However, geophagia is often
observed in the
absence of hunger, and environmental and cultural
contexts of the habit have
been emphasized
8.
Finally, geophagia
is encountered in people with learning disability,
particularly
in the context of long-term institutionalization; in this regard,
geophagia
and other forms of pica are associated with a high rate of
complications
9 and
substantial
morbidity
10 and
mortality
11.
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 commonly emerges when a patient is accidentally
discovered
during a ‘binge’ of
geophagia
12.
Abdominal
radiography
2 can be
of great 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 mortality
is very
high
2.
|
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
health and disease to one of belief in causation, must be
credited
with the first description of geophagia:
‘If a pregnant woman feels the desire to eat earth or charcoal and
then eats them, the child will show signs of these
things’13.
For centuries, Hippocrates' textbook was a cornerstone of medical practice,
so we can assume that Greek and Roman physicians were familiar with geophagia.
But even today the reason for geophagia in pregnancy remains
elusive6. A famous
Roman medical textbook, De Medicina, was compiled by A Cornelius
Celsus during the reign of Emperor Tiberius (14-37 AD). His second book
contains a passage that deals with the use of skin colour as a diagnostic
sign:
‘People whose colour is bad when they are not jaundiced are either
sufferers from pains in the head or earth
eaters’14.
Even this early report points to a link between geophagia and anaemia. It
is still unclear, however, whether anaemia prompts geophagia (to compensate
for iron deficiency) or whether geophagia is the cause 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 AD), a universal scientific writer, supports this assumption. He
describes the popularity of alica, a porridge-like cereal that
contained red clay:
‘Used as a drug it has a soothing effect... as a remedy for ulcers in
the humid part of the body such as the mouth or anus. Used in an enema it
arrests diarrhoea, and taken through the mouth... it checks
menstruation’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 second month of pregnancy, a disorder
appears that has been called Pica, a name derived from a living bird, the
magpie... Women then desire different objects... some prefer spicy things,
others salty dishes and again others earth, egg shells or
ashes’16.
|
THE MIDDLE AGES
|
|---|
Fewer reports of geophagia are available 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 AD), also
known as Avicenna, compiled one
of the most widely used medical textbooks and
made detailed
mention of geophagia. To cure geophagia in young boys Avicenna
recommended
imprisonment
12,
but
more gentle treatment was advocated during
pregnancy
17.
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
but treatable problem in pre-delivery care:
‘But if she should seek to have potter's earth or chalk or coals, let
beans cooked with sugar be given to
her’18.
|
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
work
19.
Geophagia
was often observed as a symptom of another disease,
chlorosis. The
‘green disease’, also known as
febris alba, mainly
affected pubescent girls and spread widely through
Europe during the 16th
century
20. In
France, Libault described
geophagia in maidens suffering from chlorosis in
1582
21. 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
geophagia
7,
Libault's observations
are not surprising.
More information can be 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. We must be cautious, however, in
taking them at face value. Indeed, it has been speculated that some of these
reports originally stem from mocking descriptions in songs and jokes of
wandering
minstrels22. Among
the authors of these theses, Boetius was the first to advocate iron
treatment23.
Ledelius, in turn, made attempts to explain the pathogenesis of the disorder:
he believed that pieces of leftover food rotted in the stomach and
subsequently spoiled the sense of taste and caused craving for all sorts of
substances24.
Veryser in Utrecht was the first to regard pica as a mental disorder:
‘In this disorder, two sites are affected, namely stomach and
mind’25. Many
of these authors, 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 bread’ (Figure
2)26.
But geophagia was not only observed in young women suffering from
chlorosis. An astonishing report of geophagia as 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
five’27.
Finally, geophagia was also mentioned by scientists travelling abroad
during the 17th century. Dr John Covel, travelling the Levant, reported in
great detail on the use of terra sigillata, the sacred earth, to facilitate
childbirth and alleviate disorders of
menstruation28.
|
ANTHROPOLOGISTS, COLONIAL PHYSICIANS AND EXPLORERS
|
|---|
Geophagia remained common in Europe during the 18th and 19th
centuries; in
particular, it was still observed in young girls
with
chlorosis
20. Even
more reports, however, were compiled
by anthropologists, colonial physicians
and explorers. One of
these authors who came to wide attention 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 eat 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 explain this behaviour. In particular, he observed that dried earth
was piled up in heaps to serve as 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 (see
Figure 1). In Africa,
Livingstone later described safura, a disease of earth-eating among
slaves in Zanzibar. Livingstone refuted poverty as a possible explanation
after observing that wealthy people were also affected. The course of the
disorder was described as invariably
fatal30. Similar
reports from colonial physicians are discussed in great detail
elsewhere22. Here,
the disorder was often viewed as a matter of great concern among plantation
owners, in that slaves who were addicted to geophagia became progressively
more lethargic and debilitated until they eventually died. Plantation owners
went so far as to have face masks fitted to prevent the slaves from eating
earth31,32
(see Figure 3). Similar habits
developed among slaves in southern parts of North America, where geophagia was
known as cachexia
Africana33;
the disorder is still seen in Georgia and Louisiana. Finally, reports are
available from
India34 and the
remainder of
Asia20.
|
CONCLUSION
|
|---|
All the concepts of geophagia—as psychiatric disorder,
culturally
sanctioned practice or sequel to famine—fall
short of a satisfying
explanation. The causation is certainly
multifactorial; and clearly the
practice of earth-eating has
existed since the first medical texts were
written. The descriptions
do not allow simple categorization as a psychiatric
disease.
Finally, geophagia is not confined to a particular cultural
environment
and is observed in the absence of hunger. Might it be an atavistic
mode
of behaviour, formerly invaluable when minerals and trace elements
were
scarce? Its re-emergence might then be triggered by events
such as famine,
cultural change or psychiatric disease. A beautiful
description of the latter
can be found in Gabriel García
Màrquez'
novel,
One Hundred Years of
Solitude, where he describes geophagia
in a woman who is madly in
love:
‘Rebecca got up in the middle of the night and ate handfuls of earth
in the garden with a suicidal drive, weeping with pain and fury, chewing
tender earthworms and chipping her teeth on snail
shells’35.
|
Acknowledgments
|
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We are indebted to staff at the British Library, London, for
excellent
service, and to Dr Wolfgang Woywodt for help with
German sources.
|
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TOP
INTRODUCTION
GEOPHAGIA
