Descriptions of Cachexia Africana or dirt eating, a mysterious affliction of enslaved populations, peppered medical treatises and plantation guidebooks that circulated throughout slave societies of the Atlantic World. Dirt eating was notorious for leaving slaves so debilitated that they could no longer work; it caused panic among planters concerned with productivity and left white physicians largely powerless to treat it. Competing theories about dirt eating abounded, alongside suspicions of slaves who fell victim to it. Aside from sounding alarm over dirt eating’s alleged prevalence on plantations and frustration over its refractory nature, treatises on plantation health and on diseases of the tropics, provide insights into slaves’ own understanding of the practice. By reading these sources against the grain, with an eye towards centering enslaved people’s own visions of wellbeing, this talk seeks to answer questions about the motivations for dirt eating. Was it a means of resistance, an act of desperation, an articulation of spiritual practices with the power to heal and harm, or a manifestation of something else? Definitive answers to such questions are elusive but raising them and interrogating the circumstances behind dirt-eating orients us towards imagining slaves’ resourcefulness and expertise in managing the ills of their own bodies and communities. Attentiveness to the types of earths, clay, and substances white physicians associated with this slave affliction highlight enslaved communities’ potent materia medica, as well as practices related to the preservation of their wellbeing that posed palpable challenges to medical authorities and the slave system broadly speaking.