76 
occasionally eat dirt, and I know of one such case where the habit 
ceased when the worms were expelled. 
In view of the comparisons cited, it would seem that the idea of 
considering dirt-eating as a manner of infection with parasitic worms, 
although conceivable for some cases, is hardly correct as applied to 
most instances. That dirt-eating is an abnormal appetite due to a 
diseased condition (anemia and a disordered digestive system) as sug- 
gested by several authors as early as the first half of last century, 
seems to me to be an explanation of much more general application; 
and that this anemia and enteritis or gastritis may be produced by 
parasitic worms is an established fact. In this connection, it is inter- 
esting to note that Hancock (1831, p. 67), in discussing dirt-eating, 
mentions “worms preventing the nourishing effects of food:” Imray 
(181:3, p. 310) remarks that “worms in considerable numbers were not 
uncommonlv accumulated in the intestinal canal.” Further, it is sig’- 
niffcant that various authors, in discussing the treatment of dirt-eating, 
attribute more or less success to certain drugs which are in fact used 
more or less in treating for intestinal parasites. Thus, Cotting (1836a) 
refers, as stated above, to the decrease of dropsy and of dirt-eating 
corresponding to the more general use of calomel; sulphate of iron is 
mentioned by Cragin (1836a), Pollard (1852), and others; according to 
Pollard (1852), copperas is a popular and successful remedy among 
the negroes; Hancock (1831) refers to a remedy containing arsenic 
as having had great success; Jordan (1832) states that dirt-eating 
decreased upon destroying the huts and moving the families to some i 
other location. 
To summarize: While it would seem decidedly extreme and unwar- 
ranted to maintain that dirt-eating is necessarily an indication of 
infection with intestinal worms, still I believe the conclusion is justi- 
fied that it is undoubtedly a more or less common tendenc}'^ in such 
infections, not onh" in man but also in other animals. It ma}" be 
classed with the chewing of slate pencils, resin, coffee, sucking of 
lemons and salt, etc. , as an abnormal appetite due to the anemia and 
abnormal condition of the intestinal tract. Further, for all practical 
purposes it is not much of an exaggeration to look upon most, if not 
all, so-called dirt-eaters of the sand areas of our Southern States as 
representing severe cases of uncinariasis. 
Sandwith (1891) states that 26 per cent of his patients confessed to 
eating earth, and he refers to “earth hunger” as sometimes the cause \ 
and sometimes the effect of hookworm disease. | 
PAIN IX THE stomach; INDIGESTION. I 
Many patients complain of colicky pains “in the stomach,” and ^ 
will indicate the region between the navel and the ensiform cartilage 
as the seat of the “miseiw.” Indigestion is frequently mentioned, ' 
and the tongue is occasionally coated. 
