Waterloo, 21 August 1857 

Dear Moor, 

You will have received the articles this morning.'”” 

I do, indeed, regard your theses as OPEN To SOME OBSERVATIONS. That 
iron takes effect in 3 weeks as compared with 3 months for 
cod-liver oil is surely not to be taken literally. There could be 
absolutely no question of a disease of this kind being cured in 3 
weeks; on the contrary, I should say that, iron or no iron, cases 
have more often been known to take 3 years rather than 3 weeks 
to cure. 

That lack of iron in the blood is a primary characteristic of 
scrofula is certainly news to me. But whatever the literature on the 
subject, there is no doubt that, for some time past, it has become 
increasingly the fashion to reduce all diseases to lack of iron in the 
blood, a fashion which is already beginning to evoke a reaction; as 
to the disease of which, more than any other, this is known to be the 
primary characteristic—anaemia—some Frenchmen have latterly 
declared that iron has nothing at all to do with it. Exactly what the 
primary characteristic of scrofula is would seem to be still far from 
clear. 

That iodine is one amongst others of the principal elements 
responsible for the effect of cod-liver oil is not in doubt. But it is 

by no means the only one. If one takes iodine in other forms one 
doesn’t make such good progress. Besides, cod-liver oil contains 
chlorine and bromine, both of which have a direct or indirect 
effect on the disorder, and to what extent that effect is helped by 
the gall constituents and volatile fatty acids has not yet been 
established. All I know is that Norwegian cod-liver oil, which 
has the bitter taste of gall, has done me more good than 
the Newfoundland or English product, which does not taste 
of it. 

I took iron iodide all the time I was in Manchester (in between 
London' and Waterloo '*’) along with cod-liver oil, and the 
inflammation grew steadily worse until finally it became chronic. 
Since I have been here I haven’t taken any more iron iodide and 
Heckscher and I agreed long ago that either iron iodide or 
Quévenne’s iron should be used in after-treatment. 

The fat in cod-liver oil is, pour le moment, by no means useless 
ballast so far as I am concerned. Since regaining my strength, I 
am again accumulating fat. Needless to say, my diet may contain 
only a small proportion of ready-formed animal fats. Consequently 
I have to eat more starch flour and, in fact, I sometimes feel a 
positive craving for bread; I am eating twice as much meat, but 
four times as much bread as I usually do. The fat in cod-liver oil is 
an invaluable aid to this battening process, being taken in an 
exceedingly innocuous form and less of an irritant than animal fat 
or things cooked in fat. 

So you see, iron has never been completely out of our view and, 
even after I had been taking it for more than 3 weeks without any 
result (and it may, indeed, in the then circumstances, have made 
matters worse), we have nevertheless already reserved it for my 
after-treatment. Heckscher, to whom I spoke about iron last 
Sunday, was definitely against my taking it again at this juncture, 
in view of previous experience, and I must agree with him. Later, 
of course. I repeat that, despite the unanimity of the literature on 
the subject, I shall continue to entertain grave doubts about the 
reduction of all diseases to iron shortage until we know more than 
we now do about the condition and the normal level of iron in the 
blood. At all events, I had sufficient iron in my blood at the start 
of this business, as any of the doctors who saw me at the time can 
testify. I am perfectly willing to believe that people of definitely 
scrofular habit—pallor, transparent skin, etc-—may be suffering 
from a shortage of iron. 

a at the moment 

But admis* that this is the basic character, the indiscriminate and 
immediate use of iron is by no means indicated. It is extremely 
difficult to introduce iron into the blood otherwise than in the 
small amounts contained in ordinary food. Assuming, then, that 
the nature of my disease was the inability of the blood to assimilate 
the iron in food, how much less would it assimilate the iron in 
medicine? Sea air and sea bathing so invigorate the system as to 
restore the blood’s ability in this respect. Thus it again assimilates 
the iron in meat and bread and, since I am eating more than 
formerly, concomitantly more iron. It is now, when this ability has 
been restored, that iron taken medicinally can help, although I 
believe that °/i9 of it passes through the body unused and, even if 
one accepts the iron theory, the use of iron during every phase of 
the disease has been shown to be incorrect. On top of which one 
has to consider the wide variety of individual cases and constitu- 
tions. I myself, for instance, appear to be particularly sensitive to 
all metals; even the external application of quicksilver to prevent 
the local spread of the inflammation took effect very rapidly,in my 
case, and it is quite possible that iron iodide, taken at a time when 
my blood was too disorganised to assimilate it, helped aggravate 
the inflammation. 

At all events, and even admitting the iron theory, I don’t see 
how your theses materially confute the assumptions in my 
previous letter,” in which I was, by the way, considering only the 
immediate use of iron, not in any specific form, and ruling out 
cod-liver oil. 

Today I bathed in the sea for the first time. It did me no end of 
good and made me ravenously hungry. For the time being I am to 
bathe only every other day. 

But now it’s time for the post. Am working on ‘Army’. 

Many regards to your wife and children. 

Your 
F. E.