Macaroni is also, as the same careful observer points out, an article of diet greatly neglected by the English, and would be valuable in the cases we are considering. The methods of cooking macaroni, as recommended by Sir Henry Thompson, are, as I have found from personal experience, so excellent that I find it impossible to abridge them, and quote them in full.

"Put four ounces of good macaroni (Genoa or Naples), as little broken as possible, into a saucepan with three or four pints of boiling water. Boil ten minutes, not longer.

Then pour off all the water, and place the macaroni in a stewpan with a pint of good and well-flavoured stock made from beef or veal, or both (or from a well-furnished stock pot), adding a saltspoon of salt and half that quantity of pepper, and let it simmer at the corner of the fire until the macaroni is tender; it is never to be soft and flabby. The time necessarily varies, according to the kind and size of the macaroni, e.g., fifty or sixty minutes for the best Genoese, from twenty-five to thirty minutes for Neapolitan. Its condition, however, should be tested by trying a small piece. Most of the stock is absorbed by the macaroni by this time; but that which remains, probably a fourth part of the original quantity, may be strengthened, if necessary, by the third or the half of a teaspoonful of the genuine Liebig's Extract of Meat, and thickened by adding a little baked flour (baked quite brown), which is preferable for this purpose to the brown roux often used, which contains butter in a somewhat indigestible form. The above constitutes macaroni an jus in the simplest form.

"For those who can digest cheese and butter, an ounce of grated Parmesan, and, perhaps, half an ounce of good English cheese may be added, gradually stirring well during the latter half of the process, towards the end of which a little pat of butter may be added, with a sprinkle of Parmesan over the dish when filled, before serving. The macaroni ought now to 'spin' well, that is delicate threads should extend from one portion to another when moved. Lastly, hot tomato sauce may be poured over it, or be supplied separately, since some prefer the macaroni without this addition. Serve on a hot dish provided with a cover. It is now a dish of macaroni a l'Italienne.

"If there is only a weak stock, chiefly made from bones, etc., in the stock pot, use it, but add rather a larger portion of the Liebig's Extract. In such a case a little flour of lentils, well boiled to thicken the stock with, would be a suitable addition. The Liebig's Extract should never be added until the end of the process, and merely be well stirred in immediately after removing from the fire to serve.

"If, instead of stock, milk is used, an agreeable change may be made; and this form constitutes macaroni au maigre, the foregoing recipes being au gras. To prepare this, boil four ounces as before, ten minutes; drain and place in a stewpan with a pint of milk, simmering as above directed until sufficiently tender. Serve hot. Any milk remaining unabsorbed by the macaroni may be thickened with baked flour (white). Flavour with a little cinnamon or vanilla, or otherwise to taste, and sweeten with sugar or saccharin, if desired. For those who prefer a savoury dish, and can take cheese and butter, a tablespoonful of grated Parmesan and a small pat of butter should be gradually added, stirring it in during the latter part of the simmering process, according to the directions just given for macaroni a l'Italienne."

Foods Allowed

These recipes are illustrative of the kind of diet which should be prepared for an albuminuric. Many of the recipes which have already been given for gout and rheumatism would be also applicable. I must state, in conclusion, that the following list of dishes and articles is permissible. All kinds of farinaceous food, rice, tapioca, arrowroot, hominy, oatmeal, cornflour, gruel, etc., cooked with milk or made into puddings. All kinds of well-cooked vegetables, avoiding in serious cases, peas, beans, and lentils. Soups made of fish; purees of vegetables and thin bone stock; cocoa, coffee, and chocolate; cooked fruit, koumiss and junket, and fish and white meats in small quantity.