74 
DIGESTIVE SYSTEM. 
LIPS, GUMS, TEETH, AND TONGUE, 
See p. 66. 
NAUSEA. 
Nausea was not noticed. Sandwith (1894, p. 11) states that vomiting- 
and nausea are rarel}" complained of. 
APPETITE. 
The appetite may be light or ravenous. According to Sandwith, 
the appetite is invariably affected, sometimes ravenous at beginning, 
but later alwa^^s capricious and diminished. The English nurses 
report to him that the patients were always begging for medical com- 
forts or cigarettes, even in the middle of the night, when other 
patients were asleep. Among 40 men carefully examined, 16 said that 
their appetite was once greatly exaggerated, 16 pleaded diminution 
from the beginning of their illness, and 8 believed that their appetite 
was normal until the anemia became very marked. 
Perverted appetite^ Dirt-ecdincj — The most important point to be 
noticed in connection with the appetite is the abnormal desire for some 
particular article of food. Frequentl}" this is a preference for some- 
thing sour or bitter. 
Man\^ patients with uncinariasis are known throughout the village 
or county as being especiall}" fond of pickles. I have seen boys and , 
girls in advanced cases of this disease who would greedily devour an | 
entire bottle of pickles. Some patients are especiall}" fond of sucking 
lemons, or lemons and salt, or salt alone. Others are known for their 
desire to chew coffee, or to drink large quantities of strong coffee 
without milk or sugar. Some are abnormally fond of buttermilk. ; 
Others are noted as ‘‘ resin-chewers.” Some are accused of “lapping ; 
sand.” Many are accused of eating clay or dirt. 
Dirt-eating has been discussed by a number of authors, opinion 
being divided as to its status. Some writers look upon it as the cause 
of the disease; others view in the habit onh" a symptom or a result; 
still others consider it nature’s treatment of a diseased condition. 
Among helminthologists there seems to be the impression that dirt- 
eating is especially likeh" to lead to infection with parasites. Among 
Southern physicians I found the idea quite prevalent that dirt-eating | 
was one of the causes of the condition which I have classed as extreme j 
uncinariasis. * 
I 
During the trip now under discussion, I have had opportunity to | 
observe many so-called dirt-eaters. As most authors state, it is j 
exceptional that one will acknowledge that he eats dirt. 1 believe the n 
explanation of this denial is very clear, namehq not onh" is there a I 
certain amount of disgrace connected with the reputation of being |f 
a dirt-eater, but probably -not over one person in ten, or possibty | | 
