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NEPHROLOGY
FOURTH EDITION
EDGAR V. LERMA, MD, FACP, FASN, FNKF, FPSN (Hon)
Clinical Professor of Medicine
Section of Nephrology
University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center
Oak Lawn, Illinois
MATTHEW A. SPARKS, MD, FASN, FNKF
Assistant Professor of Medicine
Associate Program Director, Nephrology Fellowship Duke University Medical Center; Staff Physician
Durham VA Medical Center
Durham, North Carolina
JOEL M. TOPF, MD, FACP
Assistant Clinical Professor
Department of Medicine
Oakland University William Beaumont School of Medicine
Auburn Hills, Michigan
1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2012, 2003, and 1999.
Library of Congress Cataloging-in-Publication Data
Names: Lerma, Edgar V., editor. | Sparks, Matthew A., editor. | Topf, Joel M., editor.
Title: Nephrology secrets / [edited by] Edgar V. Lerma, Matthew A. Sparks, Joel M. Topf.
Description: Fourth edition. | Philadelphia, PA : Elsevier, [2019] | Includes bibliographical references and index.
Identifiers: LCCN 2017060071 | ISBN 9780323478717 (hardcover : alk. paper)
LC record available at https://lccn.loc.gov/2017060071
International Standard Book Number: 978-0-323-47871-7
Content Strategist: James Merritt
Content Development Specialist: Meghan Andress
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Rachel E. McMullen
Design Direction: Bridget Hoette
Printed in the United States of America
To all my mentors, and friends, at the University of Santo Tomas Faculty of Medicine and Surgery in Manila, Philippines, and Northwestern University Feinberg School of Medicine in Chicago, IL, who have in one way or another influenced and guided me to become the physician that I am . . .
To all the medical students, interns, and residents at Advocate Christ Medical Center whom I have taught or learned from, especially those who eventually decided to pursue nephrology as a career . . .
To my parents and my brothers, without whose unwavering love and support through the good and challenging times I would not have persevered and reached my goals in life . . .
Most especially, to my two lovely and precious daughters, Anastasia Zofia and Isabella Ann, whose smiles and laughter constantly provide me with unparalleled joy and happiness; and my very loving and understanding wife, Michelle, who has always been supportive of my endeavors both personally and professionally, and who sacrificed a lot of time and exhibited unwavering patience as I devoted a significant amount of time and effort to this project. Truly, they always provide me with motivation and inspiration.
Edgar V. Lerma, MD, FACP, FASN, FNKF, FPSN (Hon)
Editing the fourth edition of Nephrology Secrets has been both rewarding and educational. Thanks to Edgar and Joel for embarking on this journey with me. I could not ask for a better editorial team. Thanks to each of the chapter authors for taking time to research and write excellent chapters. Thanks to all of my mentors, especially Tom Andreoli, Bob Safirstein, and Tom Coffman. Thanks to the many undergraduates, medical students, residents, fellows, and my colleagues I have had the privilege to work with both at Duke University Medical Center and the University of Arkansas for Medical Sciences. You have all played an important role in my life and continue to inspire and motivate me. Thanks to my family, my siblings Jeff, Shannon, and my parents for their encouragement and support. Especially thanks to my wife, Neha, and the twins, Meera and Ishan, for their unequivocal support and love throughout this project.
Thank you to the many patients and family members I have had the privilege to care for over the years. I sincerely hope this book helps others on their journey in medicine.
Matthew A. Sparks, MD, FASN, FNKF
My hike through medicine and nephrology has been filled with teachers and mentors. It has been a rich and rewarding journey in ways that I could never have imagined. During this journey there have been particular people who have believed in me and have been willing to trust me on this somewhat unconventional path. Ernest Yoder at Wayne State School of Medicine, Mary Ciccarelli at Indiana University Med-Peds, and Patrick Murray at the University of Chicago Nephrology Fellowship immediately come to mind. After my formal education, Robert Provenzano has been a tireless cheerleader and more importantly, he built St Clair Specialty Physicians into the type of nephrology company where a physician who saw private practice a bit differently could thrive.
I probably owe the most to the online nephrology community that has blossomed in the last few years to be an always-on, all-hours, cocktail party, with interesting conversation and intelligent answers to the questions that bombard us all in clinical nephrology. #NephTwitter, you are the future of nephrology education. Don’t slow down; keep going full speed ahead.
I want to thank my wife, Cathy. Without her I wouldn’t be able to do any of this. She is understanding, helpful, and patient. She has excellent instincts and continues to be an awesome partner. She is better than I deserve. Thanks for everything. Cathy is a wonderful mother to our twins, Simon and Laura, who are great kids and always put a smile on my face. It has been a delight watching you mature into thoughtful and kind adults. Keep doing what you are doing, you are going to be the people this planet needs.
Finally, I am left with the impossible task of trying to express the amount of gratitude I have for my parents and how much they have given me. Nobody could have received a better childhood than my parents gave me and my sister. My mom and dad have always helped guide and support me. So many times they could have tried to block an unconventional decision, but instead, they understood what I was trying to do and supported and helped me along. Thanks.
Joel M. Topf, MD, FACP
CONTRIBUTORS
Rajiv Agarwal, MD Professor of Medicine Division of Nephrology
Indiana University School of Medicine Indianapolis, Indiana
Talal Alfaadhel, MBBS, FRCPC Assistant Professor Department of Medicine
King Saud University Medical City King Saud University Riyadh, Saudi Arabia
Martin J. Andersen, DO Assistant Professor of Clinical Medicine Division of Nephrology
Indiana University School of Medicine Indianapolis, Indiana
John Robert Asplin, MD Medical Director
Litholink Corp, Laboratory Corporation of Americ Holdings Chicago, Illinois
Rupali S. Avasare MD Assistant Professor of Medicine Department of Medicine Oregon Health and Science University Portland, Oregon
George L. Bakris, MD Professor and Director, ASH Comprehensive Hypertension Center Department of Medicine
The University of Chicago Medicine Chicago, Illinois
Amar D. Bansal, MD Division of Renal-Electrolyte Section of Palliative Care and Medical Ethics University of Pennsylvania Philadelphia, Pennsylvania
Pravir V. Baxi, MD
Assistant Professor of Medicine Division of Nephrology Department of Internal Medicine Rush University Medical Center Chicago, Illinois
Michael Berkoben, MD, FACP Associate Professor of Medicine Division of Nephrology Duke University Medical Center Durham, North Carolina
Scott D. Bieber, DO Clinical Associate Professor of Medicine University of Washington Seattle, Washington
Anna Marie Burgner, MD, MEHP Assistant Professor Department of Nephrology and Hypertension Vanderbilt University Medical Center Nashville, Tennessee
James Brian Byrd, MD, MS Assistant Professor Department of Medicine University of Michigan Ann Arbor, Michigan
Daniel Cattran, MD Professor of Medicine Department of Medicine University Health Network; Senior Scientist Toronto General Research Institute University Health Network Toronto, Ontario, Canada
Devasmita Choudhury, MD Chief Renal Section Salem Veterans Affairs Medical Center Salem, Virginia; Associate Professor Medicine University of Virginia Charlottesville Virginia; Virginia Tech Carilion School of Medicine Roanoke Virginia
Rolando Claure-Del Granado, MD, FASN
Professor of Medicine
Head Division of Nephrology
Hospital Obrero #2 - C.N.S.,
Universidad Mayor de San Simon School of Medicine
Cochabamba, Bolivia
Bradley M. Denker, MD
Associate Professor of Medicine
Harvard Medical School; Clinical Chief
Renal Division
Beth Israel Deaconess Medical Center; Chief of Nephrology
Harvard Vanguard Medical Associates Boston, Massachusetts
Vimal K. Derebail, MD
Assistant Professor of Medicine
UNC Kidney Center
University of North Carolina Chapel Hill, North Carolina
Robert J. Desnick, PhD, MD
Dean for Genetics and Genomic Medicine
Department of Genetics and Genomic Sciences
Icahn School of Medicine at Mount Sinai New York, New York
Luca di Lullo, MD
Department of Nephrology and Dialysis
L. Parodi–Delfino Hospital Colleferro, Italy
John V. Duronville, MD
Medical Instructor Division of Nephrology
Duke University Medical Center Durham, North Carolina
Garabed Eknoyan, MD
Selzman Institute of Kidney Health Section of Nephrology
Department of Medicine
Baylor College of Medicine Houston, Texas
Mina El Kateb, MD
Transplant Nephrology Fellow
St John Hospital and Medical Center Detroit, Michigan
William J. Elliott, MD, PhD
Professor of Preventive Medicine, Internal Medicine and Pharmacology
Chair
Department of Biomedical Sciences; Chief Division of Pharmacology
Pacific Northwest University of Health Sciences Yakima, Washington
Jennifer L. Ennis, MD, FACP
Medical Director
Litholink Corporation, a LabCorp Company; Clinical Assistant Professor of Medicine
Medicine, Division of Nephrology University of Illinois at Chicago Chicago, Illinois
Fernando C. Fervenza, MD, PhD Professor of Medicine Department of Nephrology and Hypertension Mayo Clinic Rochester, Minnesota
Robert A. Figlin, MD, FACP
Steven Spielberg Family Chair in Hematology Oncology; Professor of Medicine and Biomedical Sciences, Director Division of Hematology Oncology; Deputy Director Integrated Oncology Service Line; Deputy Director
Samuel Oschin Comprehensive Cancer Institute
Cedars-Sinai Medical Center
Saperstein Critical Care Tower Los Angeles, California
Zita Galvin, MD
Liver Transplant Unit
Toronto General Hospital University Health Network Toronto, Ontario, Canada
Pranav S. Garimella, MD Division of Nephrology-Hypertension University of California San Diego San Diego, California
Debbie S. Gipson, MS, MD Professor of Pediatrics Department of Pediatrics University of Michigan Ann Arbor, Michigan
Patrick E. Gipson, MD Professor of Pediatrics University of Michigan Ann Arbor, Michigan
David S. Goldfarb, MD, FACP, FASN, FNKF Professor of Medicine and Physiology
NYU School of Medicine; Interim Division Chief Department of Nephrology
NYU Langone Medical Center
New York, New York
Arthur Greenberg, MD
Professor of Medicine, Emeritus Division of Nephrology Department of Medicine
Duke University Medical Center Durham, North Carolina
Hermann Haller, MD Professor, Director
Department of Nephrology and Hypertension Hannover Medical School Hannover, Germany
Swapnil Hiremath, MD, MPH
Assistant Professor Department of Medicine University of Ottawa; Senior Clinical Investigator Clinical Epidemiology
Ottawa Hospital Research Institute Ottawa, Ontario, Canada
Edward J. Horwitz, MD
Metrohealth Medical Center
Case Western Reserve University School of Medicine Cleveland, Ohio
Susan Hou, MD Professor of Medicine Department of Medicine Division of Nephrology and Hypertension Loyola University Medical Center Maywood, Illinois
Lesley A. Inker, MD, MS
Associate Professor of Medicine Department of Medicine Tufts University School of Medicine Boston, Massachusetts
Maria V. Irazabal, MD
Assistant Professor of Medicine Division of Nephrology Department of Internal Medicine Mayo Clinic Rochester, Minnesota
Ashley Bruce Irish, MBBS, FRACP Consultant Nephrologist Department of Nephrology and Transplantation
Fiona Stanley Hospital; Clinical Professor Department of Medicine
University of Western Australia Perth, Western Australia, Australia
Kenar D. Jhaveri, MD Professor of Medicine Division of Nephrology
Zucker School of Medicine at Hofstra/Northwell Hempstead, New York
Jonathan Ashley Jefferson, MD, FRCP Professor of Medicine Division of Nephrology University of Washington Seattle, Washington
Kamyar Kalantar-Zadeh, MD, MPH, PhD Professor and Chief Division of Nephrology and Hypertension University of California Irvine Medical Center Orange, California
Elaine S. Kamil, MD
Health Sciences Clinical Professor of Pediatrics
David Geffen School of Medicine at UCLA; Department of Pediatric Nephrology Cedars-Sinai Medical Center Los Angeles, California
Jon-Emile S. Kenny, MD
Assistant Professor of Medicine Department of Internal Medicine Icahn School of Medicine at Mount Sinai New York, New York; Masters Candidate Department of Learning, Informatics, Management and Ethics Karolinska Institutet Stockholm, Sweden
Charbel C. Khoury, MD Fellow Department of Nephrology Brigham and Women’s Hospital; Fellow Department of Nephrology Massachusetts General Hospital Boston, Massachusetts
Jatinder Kohli, MD University of Pennsylvania School of Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
Eugene C. Kovalik, MD, CM, FRCP(C), FACP, FASN Associate Profesor of Medicine Department of Medicine/Nephrology Duke University Medical Center Durham, North Carolina
Csaba P. Kovesdy, MD
Fred Hatch Professor of Medicine Department of Medicine University of Tennessee Health Science Center; Nephrology Section Chief Memphis VA Medical Center Memphis, Tennessee
Warren Kupin, MD
Professor of Medicine
Miami Transplant Institute
Katz Family Division of Nephrology
University of Miami Miami, Florida
Ruediger W. Lehrich, MD
Associate Professor of Medicine, Program Director Nephrology Fellowship, Director of Home-Suitable Dialysis
Duke University Medical Center Durham, North Carolina
Edgar V. Lerma, MD, FACP, FASN, FNKF, FPSN (Hon)
Clinical Professor of Medicine
Section of Nephrology
University of Illinois at Chicago College of Medicine/ Advocate Christ Medical Center Oak Lawn, Illinois
Moshe Levi, MD
Professor of Biochemistry and Molecular & Cellular Biology
Georgetown University Medical Center Aurora, Colorado
Joseph L. Lockridge, MD
Medical Director
Kidney Transplant Program
Portland VA Health Care System; Director of Transplant Nephrology Fellowship Training Program, Assistant Professor of Medicine
Oregon Health & Science University Portland, Oregon
Jennifer Lopez, BS
Division of Pediatric Nephrology
NYU Langone Health New York, New York
Etienne Macedo, MD, PhD
Assistant Adjunct Professor University of California San Diego, School of Medicine San Diego, California
Rajnish Mehrotra, MBBS, MD, MS Professor of Medicine
Department of Medicine
University of Washington; Section Head Nephrology Department of Medicine
Harborview Medical Center Seattle, Washington
Ravindra L. Mehta, MBBS, MD, DM, FACP, FASN Professor of Clinical Medicine, Associate Chair of Clinical Research, Director CREST and MAS in Clinical Research Program Department of Medicine University of California San Diego San Diego, California
Patrick H. Nachman, MD
Marion Stedman Covington Distinguished Professor of Medicine
UNC Kidney Center University of North Carolina Chapel Hill, North Carolina
Carol Nadai, MD
Medical Oncologist Instituto de Oncologia do Parana Curitibia, Brazil
Lavinia Aura Negrea, MD Associate Professor of Medicine Department of Medicine University Hospitals Case Medical Center Cleveland, Ohio
Lindsay E. Nicolle, MD University of Manitoba Winnipeg, Manitoba, Canada
Keith C. Norris, MD, PhD Professor Department of Medicine
David Geffen School of Medicine, UCLA Los Angeles, California
Alexander Novakovic, MD Research Associate Division of Genitourinary Malignancies Department of Medical Oncology & Therapeutics Research
City of Hope Comprehensive Cancer Center Duarte, California
Ali J. Olyaei, PharmD Professor
Medicine and Pharmacy Practice Division of Nephrology and Hypertension
OSU/OHSU Portland, Oregon
Sumanta Kumar Pal, MD
Associate Professor Department of Medical Oncology and Experimental Therapeutics
Division of Genitourinary Malignancies
City of Hope Comprehensive Cancer Center Duarte, California
Paul M. Palevsky MD
Chief, Renal Section
VA Pittsburgh Healthcare System; Professor of Medicine and Clinical & Translational Science Department of Medicine University of Pittsburgh Pittsburgh, Pennsylvania
Ami M. Patel, MD
Assistant Professor of Medicine University of Maryland School of Medicine, Baltimore VA Medical Center Baltimore, Maryland
Vikram Patney, MD Nephrology and Hypertension Specialists, LLC St. Louis, Missouri
Mark A. Perazella, MD Professor of Medicine Section of Nephrology
Yale University School of Medicine; Director, Acute Dialysis Unit, Medical Director, Yale Physician Associate Program, Medical Director, Yale PA Online Program New Haven, Connecticut
Phuong-Chi T. Pham, MD
Olive View-UCLA Medical Center Los Angeles, California
Phuong-Thu T. Pham, MD
David Geffen School of Medicine at UCLA Ronald Reagan UCLA Medical Center Los Angeles, California
Joseph B. Pryor, BS School of Medicine
Oregon Health & Sciences University Portland, Oregon
C. Venkata S. Ram Director
Apollo Heart Institute for Blood Pressure Management and Apollo Blood Pressure Clinics Hyderabad, India
Mahboob Rahman, MD University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine Cleveland, Ohio
Nathaniel Reisinger, MD Instructor and Clinical Ultrasound Fellow Department of Emergency Medicine Penn Medicine; Moonlighting Nephrologist Division of Renal, Electrolyte, and Hypertension Penn Medicine Philadelphia, Pennsylvania
Michael V. Rocco, MD, MSCE Vardaman M. Buckalew Jr. Professor of Internal Medicine/Nephrology
Internal Medicine, Section on Nephrology
Wake Forest School of Medicine Winston-Salem, North Carolina
Claudio Ronco, MD Director Department of Nephrology San Bortolo Hospital; Director
International Renal Research Institute San Bortolo Hospital Vicenza, Italy
Mark E. Rosenberg, MD, FASN Vice Dean for Education and Academic Affairs University of Minnesota Medical School Lino Lakes, Minnesota
Mitchell H. Rosner, MD Professor of Medicine Department of Medicine University of Virginia Health System Charlottesville, Virginia
Michael R. Rudnick, MD, FACP, FASN Associate Professor of Medicine University of Pennsylvania School of Medicine; Chief Nephrology Division Penn Presbyterian Medical Center Philadelphia, Pennsylvania
Ernesto Sabath, MD Hospital General de Queretaro Universidad Autonomo de Queretaro Santiade Queretaro, Mexico
Mark J. Sarnak MD, MS Tufts Medical Center Boston, Massachusetts
Jane O. Schell, MD, MHS Assistant Professor of Medicine Division of Renal-Electrolyte University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
N. Winn Seay, MD Fellow, Division of Nephrology Department of Medicine Duke University Medical Center Durham, North Carolina
John R. Sedor, MD
Professor Molecular Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University; Staff
Glickman Urology & Kidney Institute; Staff
Department of Pathobiology
Lerner Research Institute Cleveland, Ohio
Akash Nair Sethi, DO Fellow
Renal, Electrolyte, and Hypertension Division
Hosptial of the University of Pennsylvania Philadelphia, Pennsylvania
Anuja Shah, MD Department of Medicine
Division of Nephrology
Harbor-UCLA Medical Center
Torrance, California; David Geffen School of Medicine at UCLA
Los Angeles, California
Lori Shah, DO Nephrology Fellow
Vanderbilt University Medical Center
Nashville, Tennessee
Benjamin A. Sherer
Clinical Fellow
Department of Urologic Surgery, Laparoscopy/Endourology
University of California San Francisco
San Francisco, California
Harpreet Singh, MD
Medical Instructor
Duke University Medical Center Durham, North Carolina
The University of Western Australia; Consultant Pathologist, Anatomic Pathology
Pathwest Laboratory Medicine
Fiona Stanley Hospital
Western Australia, Australia
James A. Sloand, MD, FACP, FASN
Senior Medical Director, Global Therapeutic Area
Lead, Peritoneal Dialysis
Renal Franchise
Baxter Healthcare Corporation
Deerfield, Illinois
Matthew A. Sparks, MD, FASN, FNKF
Assistant Professor of Medicine
Associate Program Director, Nephrology Fellowship
Duke University Medical Center; Staff Physician
Durham VA Medical Center Durham, North Carolina
Stuart M. Sprague, DO NorthShore University HealthSystem Evanston, Illinois; Clincal Professor of Medicine University of Chicago Pritzker School of Medicine Chicago, Illinois
Susan Patricia Steigerwalt, MD
Clinical Associate Professor Cardiovascular Medicine University of Michigan
Ann Arbor, Michigan
Hillel Sternlicht, MD
Assistant Professor of Medicine
Hofstra University School of Medicine Department of Medicine
Lenox Hill Hospital-Northwell Health New York, New York
Marshall L. Stoller, MD San Francisco, California
Beje Thomas, MD
Assistant Professor of Medicine Division of Nephrology
University of Maryland School of Medicine Baltimore, Maryland
Hakan R. Toka, MD, PhD, FASN Manatee Memorial Hospital Graduate Medical Education Bradenton, Florida
Joel M. Topf, MD, FACP Assistant Clinical Professor Department of Medicine
Oakland University William Beaumont School of Medicine
Auburn Hills, Michigan
Vicente E. Torres, MD, PhD Professor of Medicine
Department of Nephrology and Hypertension Mayo Clinic Rochester, Minnesota
Howard Trachtman, MD
Chief, Division of Pediatric Nephrology and Hypertension, Professor of Pediatrics Division of Nephrology
NYU Langone Medical Center New York, New York
Carol Traynor, MB, BCh, BAO, BMedSci
Medical Instructor
Division of Nephrology
Duke University Medical Center Durham, North Carolina
Bryan M. Tucker, DO, MS
Assistant Professor of Medicine
Department of Internal Medicine, Section of Nephrology
Wake Forest University School of Medicine Winston-Salem, North Carolina
Beth A. Vogt, MD
Associate Professor
Department of Pediatrics
Case Western Reserve University; Attending Physician
Division of Nephrology
Rainbow Babies and Children’s Hospital Cleveland, Ohio
Rimda Wanchoo, MD
Associate Professor of Medicine
Division of Nephrology
Zucker School of Medicine at Hofstra/Northwell Hempstead, New York
Matthew R. Weir, MD
Professor of Medicine Department of Medicine, Director, Division of Nephrology University of Maryland School of Medicine Baltimore, Maryland
Adam Whaley-Connell, DO
Associate Professor of Medicine Department of Medicine Division of Nephrology and Hypertension University of Missouri-Columbia School of Medicine; Division of Endocrinology and Metabolism, and the Research Service
Harry S. Truman Memorial Veterans Hospital Columbia, Missouri
William L. Whittier, MD, FASN Associate Professor of Medicine Division of Nephrology Department of Internal Medicine
Rush University Medical Center Chicago, Illinois
Jay B. Wish, MD Professor of Clinical Medicine Department of Medicine Indiana University School of Medicine Indianapolis, Indiana
Florence Wong, MB, BS, MD, FRACP, FRCPC Professor
Department of Medicine, Division of Gastroenterology University of Toronto Toronto, Ontario, Canada
David C. Wymer, MD, FACR, FACNM Associate Chair Radiology University of Florida; Chief of Service, Imaging Department of Radiology Malcom Randall VAMC Gainesville, Florida
David T.G. Wymer, MD Resident Department of Radiology Mount Sinai Medical Center Miami Beach, Florida
Ladan Zand, MD
Assistant Professor Department of Nephrology and Hypertension Mayo Clinic Rochester, Minnesota
PREFACE
“Questions you will be asked on rounds, in the clinic, and on oral exams.”
This was the subtitle to the first Medical Secrets textbook by Anthony Zollo from 1991. This was click bait before there was click bait. No medical student could resist a title like that. And it also is strangely compelling for attendings and teachers. Doctors don’t get to peer inside the bedside teaching of other attendings, and the chance to see the questions that others are asking is hard to resist.
The book in your hand is the fourth edition of Nephrology Secrets. It has been nearly a decade since Lerma and Nissenson edited the third edition. All aspects of nephrology have evolved, and some topics have been completely revolutionized. Since the third edition was published, the cause of idiopathic membranous nephropathy has been elucidated, a genetic mutation explaining the high rate of kidney disease in African Americans has been discovered. We have an effective therapy for hepatitis C and its downstream kidney effects. Home dialysis modalities have recovered from being on the ropes and are now resurgent in both peritoneal and hemodialysis. The biomedical revolution in oncology has uncovered novel kidney diseases. The molecular mechanism of preeclampsia, the most common glomerular disease on the planet, has been elucidated. Nephrology is no longer the slow, methodical specialty of yore; it is fast moving and constantly changing.
Parallel to the changes in the science there has been a revolution in how nephrology educators teach and are recognized. More and more teaching is shifting from the classroom and bedside to the smartphone and internet. Therefore the current edition includes contributions from several individuals who have honed their skills teaching in that space.
In keeping with the design of the original Medical Secrets, we have included questions on everyday topics in addition to some “zebras” of particular academic interest. We hope that this book will be used not only by nephrologists and nephrology fellows, medical residents and interns, and medical students but also by primary care providers with particular interest in the art of homeostasis.
From personal experience, we know that very few people read a textbook from cover to cover. For a variety of reasons, people skim through books as patient encounters and interests guide them. To accommodate this reality, we tried to ensure that each chapter would be complete in itself. As a consequence, there is unavoidable overlap among some of the information provided in many chapters. Indulge this luxury; paper is cheap, and this makes the book a better information retrieval appliance.
Though only three names are on the cover, this book could not have been produced without a battalion of contributors. First, and most obviously, we are in debt to all of the contributing authors who have spent hours in producing high-quality, up-to-the-last-minute information that was rewarded with telephone, e-mail and Twitter direct messages with suggestions, rewrites, and “spirited discussions.” The ISBN says fourth edition, but if you ask the authors, they will tell you it was closer to a clean-sheet rewrite. We express our sincere gratitude for all the authors’ openness to this collaboration. Namaste. Additionally, we would need to express the highest gratitude to all the staff of Elsevier, most especially Meghan Andress, our Developmental Editor, Rachel McMullen, our Senior Project Manager; and James Merritt, our Senior Acquisitions Editor, all of whom have been very patient with our procrastinations and stubbornness.
Lastly, and philosophically, we thank our own teachers and our mentors, who devoted their time to train and form us to become nephrologists and teachers. We thank the undergraduates, medical students, residents, and fellows who have taught us how to teach. Lastly, we recognize and thank the patients, who are the reason we are here. Knowledge without application is an empty vessel. Every page contains information gleaned off the backs of patients. Their illness created this book, and on behalf of all the contributors to this book, we fervently hope that the efforts may help alleviate their suffering, prevent others from becoming similarly ill, and perhaps lead to their recovery.
Edgar V. Lerma, MD, FACP, FASN, FNKF, FPSN (Hon) @EdgarVLermaMD
Matthew A. Sparks, MD, FASN, FNKF @Nephro_Sparks
Joel M. Topf, MD, FACP @Kidney_Boy
TOP 100 SECRETS
These secrets are 100 of the top board alerts. They summarize the concepts, principles, and most salient details of nephrology.
1. The urine protein to creatinine (using a random urine specimen) ratio has been shown to have a good correlation with the 24-hour urine protein determination.
2. The most common complication associated with a kidney biopsy is bleeding, though it is usually self-limited and rarely life threatening.
3. The differential diagnosis of AKI includes prerenal azotemia, obstructive nephropathy, and intrinsic forms of AKI.
4. Hepatorenal Syndrome (HRS) is a functional kidney failure that occurs in end-stage liver cirrhosis with ascites.
5. The pharmacological treatment for HRS is a combination of albumin and vasoconstrictors, but the definitive treatment is liver transplantation.
6. Due to the high incidence of drug-induced AKI, a thorough review of the medication list should be performed in a patient at risk for AKI.
7. Sepsis is an important cause of AKI in critically ill patients and is associated with high mortality rates.
8. Rapid (,3 hours after presentation) administration of appropriate antibiotics is associated with improved outcomes and fewer cases of sepsis-associated AKI.
9. Early and vigorous volume resuscitation of patients with rhabdomyolysis (even before extrication in crush syndrome) is important for preventing AKI.
10. AKI secondary to rhabdomyolysis usually occurs with creatine kinase levels greater than 10,000 U/L.
11. Acute glomerulonephritis is a kidney injury syndrome characterized by the sudden onset of edema, new or worsening hypertension, and an active urinary sediment.
12. Rapidly progressive glomerulonephritis is a clinical syndrome characterized by rapid loss of kidney function that often results in ESKD.
13. Primary nephrotic syndrome is caused by one of the following four diseases—minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or membranoproliferative glomerulonephritis—and the diagnosis is made based on a combination of clinical features, kidney biopsy findings, laboratory findings, and genetic testing.
14. Diuresis after relief of urinary obstruction may result from a physiologic excretion of water and urea, but can become pathologic. Patients should have electrolytes checked and replaced regularly, with free access to oral fluids. If necessary, the type and amount of intravenous fluids should be determined by serum and urinary electrolyte levels.
15. Struvite stones are due to infection with bacteria that contain the enzyme urease; Proteus mirabilis often has urease, Escherichia coli almost never has urease activity.
16. Uric acid stones are radiolucent on routine x-ray but are easily visualized by computed tomography scan.
17. Uric acid stones are almost always due to overly acidic urine and therefore the treatment of choice is alkali salts, not allopurinol.
18. Enteric hyperoxaluria requires that the patient have an intact colon because it is the sight of pathologic oxalate overabsorption.
19. Low calcium diets are not recommended in the treatment of patients with hypercalciuria, because a low calcium diet may contribute to bone demineralization.
20. The leading causes of CKD are diabetes, hypertension, glomerulonephritis, and cystic kidney disease, with about 40% of all cases due to diabetes.
21. The target hemoglobin level for patients receiving erythropoiesis-stimulating agent (ESA) therapy should be individualized based on transfusion avoidance, quality of life, physical activity, and ESA responsiveness, and should not exceed 12 g/dL.
22. Most patients receiving ESAs will require iron supplementation; however, oral iron supplements are often ineffective because of poor absorption and the magnitude of iron requirements.
23. Decreased kidney function is associated with abnormalities of mineral metabolism that results in decreased skeletal strength, bone pain, and abnormal calcification of the blood vessels and soft tissues.
24. Cardiovascular disease is the primary cause of death in patients with CKD, and is dramatically accelerated in CKD. Unfortunately, much of what is known about CVD may not apply to patients with CKD, so physicians should prioritize evidence performed in this special population.
25. Dyslipidemia is nearly universal in CKD and transplant. Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend that patients with CKD over the age of 50 and patients with a kidney transplant be treated with a statin.
26. Patients with progressive CKD opting for hemodialysis should have a timely evaluation for vascular access to ensure it is ready when dialysis starts. An arteriovenous fistula requires several months to mature.
27. Minimal change disease (MCD) is the cause of nephrotic syndrome in approximately 90% of children younger than 6 years of age, in approximately 65% of older children, and in approximately 20% to 30% of adolescents. In adults, only approximately 10% to 25% of nephrotic syndrome results from MCD, but it represents the third most common cause of primary nephrotic syndrome in adults after membranous nephropathy and FSGS.
28. Categorizing focal segmental glomerulosclerosis (FSGS) as genetic, secondary, or primary may inform type of treatment offered and influence posttransplant disease recurrence.
29. Patients with FSGS and high-risk APOL1 are at greater risk of ESKD than patients with a low-risk APOL2 genotype.
30. Membranous nephropathy is a cause of nephrotic syndrome that can be either primary or secondary to other diseases (malignancy, hepatitis B, lupus). Eighty percent of idiopathic (primary) membranous has increased anti-PLA 2 R antibody levels.
31. IgA nephropathy is the most common primary glomerulonephritis. It is a nephritic syndrome that classically presents with hematuria. There is wide variability in kidney outcomes, from benign microscopic hematuria to rapidly progressive crescentic glomerular nephritis.
32. MPGN develops secondary to immune complex deposition or abnormalities in the alternate pathway of complement; it can progress to ESKD over 10 to 15 years.
33. There is no proven therapy for MPGN. It can recur in up to 30% of kidney transplant recipients.
34. Diabetic retinopathy is present in almost all patients with type 1 diabetes mellitus and diabetic nephropathy.
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Title: The greedy book
A gastronomical anthology
Author: Frank Schloesser
Release date: June 12, 2024 [eBook #73816]
Language: English
Original publication: London: Gay and Bird, 1906
Credits: Carol Brown, Charlene Taylor and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)
THE GREEDY BOOK
“How admirable and beautiful are eating and drinking, and what a great invention the human digestive system is! How much better to be a man than an alligator! The alligator can fast for a year and a half, whereas five hours’ abstinence will set an edge on the most pampered human appetite. Nature has advanced a little since Mesozoic times. I feel certain that there are whole South Seas of discovery yet to be made in the art and science of eating and drinking.”
JOHN DAVIDSON
LES SENS: PAR BERTALL
[Frontispiece
THE GREEDY BOOK
A GASTRONOMICAL ANTHOLOGY BY
F R A N K S C H L O E S S E R
AUTHOR OF
“
THE CULT OF THE CHAFING DISH”
LONDON
G A Y A N D B I R D
12 & 13 HENRIETTA STREET, STRAND
Theyalsoservewhoonlystandandwait
Milton’s Sonnet “On his Blindness”
II.
III.
IV.
VI. Menus
VII. Oysters
LIST OF PLATES
Les
Les
Les Audiences d’un Gourmand
My thanks are due to the Editors of the St. James’s Gazette, the Evening Standard, the Academy, the Daily Mail, the Daily Express, the Globe, the Tribune, and Vanity Fair for permission to reproduce certain portions of these papers.
CHAPTER I
COOKS AND COOKERY
“In short the world is but a Ragou, or a large dish of Varieties, prepared by inevitable Fate to treat and regale Death with.”
‘Miscellanies: or a Variety of Notion and Thought.’ By H. W. (Gent.) [Henry Waring] 1708.
THE only thing that can be said against eating is that it takes away one’s appetite. True, there is a French proverb to the contrary, but that really only applies to the horsd’œuvreand the soup. We all eat three meals a day, some four, and a few even five, if one may reckon afternoon tea as a meal. Yet the art of eating—that is to say, how to eat, what to eat, and when to eat it—is studiously neglected by those who deem they have souls superior to the daily stoking of the human engine.
Whosoever simply wants to eat certainly does not require to know how to cook. But whosoever desires to criticize a dinner and the dishes that compose it and enjoyment without judgment is unsatisfactory—need not be a cook, but must understand what cooking implies; he must have grasped the spirit of the art of cookery.
Cooks themselves almost always judge a dinner too partially, and from the wrong point of view; they are, almost without exception, obstinately of the opinion that everything they cook must taste equally good to everybody. This is obviously absurd (but so like a cook), for allowance must be made for the personal equation. Nothing tastes so good as what one eats oneself, so it is not to be
expected that one and the same dish will please even the most fastidious octette. Still there have been occasional instances.
The late Sir Henry Thompson once had a new cook, and, in an interview with her after the first dinner-party, she expressed herself as being delighted that everything had been so satisfactory. “But how do you know it was?” asked Sir Henry. “I’ve not given you my opinion yet.” “No, Sir Henry,” said the cook, “but I know it was all right, because none of the salt-cellars were touched.”
It is a mistaken idea that a man-cook can be a cordon-bleu. That title of high distinction is reserved for the feminine sex. According to Lady Morgan (Sidney Owenson, 1841), in her “Book without a Name,” a cordon-bleuis defined as an honorary distinction conferred on the first class of female cooks in Paris, either in allusion to their blue aprons, or to the order whose blue ribbon was so long considered as the adequate recompense of all the highest merit in the highest classes.
The Fermier Général who built the palace of the Elysée became not more celebrated for his exquisite dinners than for the moral courage with which he attributed their excellence to his female cook, Marie, when such a chef was hardly known in a French kitchen; for when Marie served up unpetitdinerdélirant she was called for like other prime donne, and her health drunk by the style of Le Cordon Bleu.
One of the most famous of the bearers of the title was undoubtedly that wonderful Sophie who is so charmingly described in LaSalle-à-mangerduDocteurVéron. She was cook and politician too, and even Alexandre Dumas père did not disdain to dine with her at a dinner of her own cooking; and moreover eminent statesmen of the period consulted her about politics, her clear-headed simplicity and wide experience of popular sentiment rendering her opinions of considerable value. The editor adds that her name was not Sophie, but that her many friends will nevertheless easily recognize her.
The value of a good chef in a well-ordered household cannot be over-estimated. His tact, his experience, and his art go far to make life pleasant and easy. Moreover, a good cook is a direct aid to good health, for he uses none but the best materials, and, if he be of the highest rank of his order, knows just how to assimilate those suave and subtle suggestions and flavourings which go so far to make cookery such as the great Careme (1828) called le genre mâle et élégant. Cooks were held in the highest estimation in Venice in the sixteenth century. Here is the beginning of a letter from one Allessandro Vacchi, a Venetian citizen, to an acquaintance of his, a cook and carver by profession: “Al magnifico Signor Padron mio osservandissimoilSignorMatteoBarbini,CuócoeScalcoceleberrimo della città di Venetia.” In our own time honour to the profession is not lacking, for a little while ago the King decorated M. Ménager, his maître-chef, with the Royal Victorian Medal.
At the same time the competition of many rich folk for the services of some of the best-known chefs has made these artists, in some cases at least, place an extortionate value upon their ministrations. A very clever chef, reliable in everything except his sauces, in which he is slightly heterodox, was recently engaged by a nouveau riche at a salary far exceeding that which he paid to his private secretary.
In one of Matthew Bramble’s letters from Bath (“Humphry Clinker”) he refers to such a one as “a mushroom of opulence, who pays a cook seventy guineas a week for furnishing him with one meal a day.” Mushroom of opulence is good. That species of fungus is always with us. Dr. Kitchiner in his “Housekeeper’s Oracle” (1829) quotes from “The Plebeian Polished, or Rules for Persons who have unaccountably plunged themselves into Wealth.” A work of this nature, if published nowadays, should surely command a large sale, for the number of people who have “unaccountably plunged themselves into Wealth” seems to be multiplying rapidly. Most of them know how to feed. Few of them seem to have mastered the mystery of how to dine. “Man ist was man isst” says the German
proverb, and there is no valid reason for spending fabulous sums on a dinner of out-of-the-season delicacies, when the good reasonable and seasonable things of this earth are ready and ripe for consumption.
At the same time, meanness has nothing to recommend it. There is no credit in starving yourself or your guests. The difference between mere parsimony and economy has never been more deftly illustrated than in those pregnant sentences from Edmund Burke: “Mere parsimony is not economy. Expense, and great expense, may be an essential article in home economy. Economy is a distributive virtue, and consists, not in saving, but selection. Parsimony requires no providence, no sagacity, no powers of combination, no comparison, no judgment. Mere instinct, and that not an instinct of the noblest kind, may produce this false economy in perfection.”
This is very solid wisdom, because it bears in mind the great element of perspective in expense, which is so often forgotten or overlooked.
To revert to the preciousness and rarity of the really good female cook, to the artist in pots and pans. It was in 1833 that the Prince de Ligne, who had just lost his second wife, came to Paris to seek consolation. He lived temporarily in the Rue Richelieu. One evening in passing the lodge he became aware of a peculiarly alluring odour of cooking. He saw the concierge, an old woman of sixty, bending eagerly over a battered stewpan on a small charcoal fire, stirring some mess which evidently was exhaling this delicious odour. The Prince was one of the affable kind. He asked the poor old lady for a taste of her dish, which he liked so much that he gave her a double louis, and asked her how it happened that with such eminent culinary genius she was reduced to the porter’s lodge. She told him that she had once been head cook to a cardinal-archbishop. She had married a bad man who had spent all her savings. Although very poor, she added with conscious pride, and no longer disposing of the full batterie of an archiepiscopal kitchen, she flattered herself she could manage with a few bits of charcoal and a méchantecasserole
to cook with the best of them. Next day the lodge was vacant, the old concierge being on her way to Belœil, the Prince de Ligne’s residence, near Mons, in Belgium, where she presided for fifteen years over one of the best-appointed kitchens in the world.
Less fortunate than the Prince de Ligne was a middle-aged bachelor in Paris, a few years ago, who gave away an odd lottery ticket to his cook, a worthy and unprepossessing spinster. Shortly afterwards, to his amazement, he saw that this particular ticket had drawn the gros lot. He could not afford to part with such a valuable and valued servant, so he proposed marriage, was accepted, and duly became one with his cook before the maire with as little delay as possible. Directly after the marriage he asked his wife for the lottery ticket. “Oh, I gave that away,” she said, “to Jean, the coachman, to compensate him for our broken engagement.”
It has been the ambition of many highly placed men to become cooks. According to Miss Hill’s interesting book on Juniper Hall, and its colony of refugees, M. de Jaucourt is recorded to have said: “It seems to me that I have something of a vocation for cookery. I will take up that business. Do you know what our cook said to me this morning? He had been consulting me respecting his risking the danger of a return to France. ‘But you know, monsieur,’ he said, ‘an exception is made in favour of all artists.’ ‘Very well then,’ concluded M. de Jaucourt, ‘Iwill be an artist-cook also.’”
A notable instance of the chef who took a pride in his art and could not understand any one referring to him as “a mere cook” is the delightful hero of Mr. H. G. Wells’s story of “A Misunderstood Artist” in his “Select Conversations with an Uncle.” “They are always trying to pull me to earth. ‘Is it wholesome?’ they say;—‘Nutritious?’ I say to them: ‘I do not know. I am an artist. I do not care. It is beautiful.’—‘You rhyme?’ said the Poet. ‘No. My work is—more plastic. I cook.’”
There was a famous cook too, Laurens by name, who was chef for a long time to George III, and who combined with his culinary
skill a wonderful flair for objects of art, so that the King bought a large number of the beautiful things which are even now at Buckingham Palace and Windsor Castle on the advice of this same Laurens. It has been said of him that he rarely made a mistake in buying, and that he attended the principal picture and art sales on the Continent on behalf of his royal master.
Some cheerful noodles have had much to say anent the want of imagination of the modern chef. This is the most arrant blatherumskite. The chef, who is only, after all, a superior servant, paid (and well, too) to carry out the gastronomic ideas of his master, or, if he lack such ideas, to pander to his ignorance, too frequently arrogates to himself a culinary wisdom which is not justified by results. The chef need only be a thoroughly good cook. The ideas, the suggestions, the genius behind the pots and pans, come from the gastronomic student. Neither Brillat-Savarin nor Grimod de la Reynière was a cook—nor was Thomas Walker, G. A. Sala, or E. S. Dallas, but they were all notable authorities. And they inspired the culinary art of their times by their knowledge, invention, and discrimination.
As a matter of fact, our chefs are unimaginative—and a good job too; because when a chef, be he never so clever, begins to launch out on novelties of his own invention, he almost invariably comes to grief. A really good maître d’hôtel may occasionally suggest a new dish, but in ninety-nine cases out of a hundred it is merely a slight variation of something perfectly well known and appreciated. There may be a new garnishing, a trifling alteration in the manner of serving, and there is invariably a brand-new (and usually inappropriate) name, but the dish remains practically the same, despite its new christening-robe.
A fine joint of Southdown mutton has been recently renamed Béhague, but it remains sheep, and nothing is gained by the alteration save a further insight into the ignorance of the average chef. This is only a simple example, but it might be multiplied indefinitely. I have been served at a well-known restaurant with
cutlets àlaTrianon, which turned out to be our old and tried friend cutlets à la Réforme under a new title. In a like manner, but at another restaurant, an ordinary and excellent mousse de jambon paraded as jambon à la Véfour; Heavens and the chef only know why; and the one won’t tell, and the other doesn’t know.
Béhague, by the way, is, so to say, chefs’ French, which has much in common with dog Latin, if one may be allowed the comparison. Béhague will not be found in a French dictionary, but it is the new nom de cuisine for fine-quality mutton (such as Southdown); it has only lately come into use, and there seems no particular reason for it. Probably it was invented in “a moment of enthusiasm,” as the barber-artist remarked when he made a wig that just fitted a hazelnut.
There are several different kinds of bad language. That used by chefs and maîtres d’hôtel on their menus is one of the worst. They are incorrigibly ignorant and glory in it. It is an undeniable fact that the average menu, whether at a club or restaurant, contains usually at least a brace of orthographic howlers, while at the private house, an it boast a chef who writes the dinner programmes, the average is distinctly higher. I have encountered on an otherwise quite reputable card the extraordinary item Soufflet de fromage. The kind hostess had no intention of inflicting a box on the ears to the cheese, but had mistaken soufflet for soufflé. By such obvious errors are social friendships imperilled.
But I should like to go much further than this comparatively harmless example. No less an authority than Æneas Dallas in Kettner’s “Book of the Table” says: “It is a simple fact, of which I undertake to produce overwhelming evidence, that the language of the kitchen is a language ‘not understanded of the people.’ There are scores upon scores of its terms in daily use which are little understood and not at all fixed, and there is not upon the face of this earth an occupation which is carried on with so much of unintelligible jargon and chattering of apes as that of preparing food. Not only cooks, but also the most learned men in France have given
up a great part of the language of the kitchen as beyond all comprehension. We sorely want Cadmus amongst the cooks. All the world remembers that he taught the Greeks their alphabet. It is well-nigh forgotten that he was cook to the King of Sidon. I cannot help thinking that cooks would do well to combine with their cookery, like Cadmus, a little attention to the alphabet.”
It is easy, of course, to ridicule such obvious ineptitudes as a dish of “breeches in the Royal fashion with velvet sauce” (Culotte à la Royale sauce velouté) or “capons’ wings in the sun” (ailes de poularde au soleil), but these are but trifling offences compared to the egregious lapses of grammar, history, and good taste which disfigure our menus. There is no culinary merit in describing an otherwise harmless dish of salmon as saumon Liberté au Triomphe d’Amour. It is simply gross and vulgar affectation. Let the cooks do their cooking properly and all will be well. Their weirdly esoteric naming of edible food is an insult of supererogation to the intelligence of the diner.
At the same time, due credit must be given to the chef for the part he has played in the general improvement of gastronomics and the art of feeding during the past two decades. The mere multiplication of restaurants is nothing; but the general improvement of the average menu is everything. Here, for instance, is the menu of a dinner of the year 1876, recommended by no less an authority than the late FinBec, Blanchard Jerrold, whose Epicure’s Year Books, Cupboard Papers, and Book of Menus are by way of being classics.
MENU.
Crécy aux Croûtons. Printannier. Saumon bouilli, sauce homard. Filets de soles à la Joinville. Whitebait. Suprême de Volaille à l’écarlate. Côtelettes d’Agneau aux concombres. Cailles en aspic.
Selle de Mouton. Bacon and beans. Caneton.
Baba au Rhum. Pouding glacé.
This was the dinner given by the late Edmund Yates on the occasion of the publication of the World newspaper. Observe its heaviness, clumsiness, and want of delicacy. Three fish dishes are ostentatious and redundant; three entrées simply kill one another; the quails are misplaced before the saddle; the bacon and beans is, of course, a joke. Altogether it is what we should call to-day a somewhat barbarian meal. Contrast therewith the following artistically fashioned programme of a dinner given by the Réunion des Gastronomes; it is practically lederniermotof the culinary art.
MENU.
Huîtres Royales Natives. Tortue Claire. Filets de Soles des Gastronomes. Suprême de Poularde Trianon. Noisettes d’Agneau à la Carême. Pommes Nouvelles Suzette. Sorbets à la Palermitaine. Bécassines à la Broche. Salade. Haricots Verts Nouveaux à la Crème. Biscuit Glacé Mireille. Corbeille de Friandises. Dessert.
Nothing could be lighter or more graceful. There is naught that is over-elaborate or indigestible; on the contrary, the various flavours are carefully preserved, and there is a subtle completeness about the whole dinner which is very pleasing.
It was the late lamented Joseph, of the Tour d’Argent, the Savoy, and elsewhere, who once said: “Make the good things as plain as
possible. God gave a special flavour to everything. Respect it. Do not destroy it by messing.”
Joseph, who, by the way, was born in Birmingham, was a mâitre d’hôtel of genius, though even he had his little weaknesses, and merely to watch the play of his wrists whilst he was “fatiguing” a salad for an especially favoured guest was a lesson in inspired enthusiasm. His rebuke to a rich American in Paris is historic. The man of dollars had ordered an elaborate déjeuner, and whilst toying with the hors-d’œuvre carefully tucked his serviette into his collar and spread it over his waistcoat, as is the way with some careless feeders. Joseph, rightly enough, resented this want of manners, and, approaching the guest, said to him politely, “Monsieur, I understand, wished to have déjeuner, not to be shaved.” The restaurant lost that American’s custom, but gained that of a host of nice and delicate feeders.
CHAPTER II
BYWAYS OF GASTRONOMY
“La Cuisine n’est pas un métier, c’est un art, et c’est toujours une bonne fortune que la conversation d’un cuisinier: mieux vaut causer avec un cuisinier qu’avec un pharmacien. S’il n’y avait que de bons cuisiniers, les pharmaciens auraient peu de choses à faire, les médecins disparaîtraient; on ne garderait que les chirugiens pour les fractures.”—N
ESTOR ROQUEPLAN.
I AM going to be very rude. Not one woman in a hundred can order a dinner at a restaurant. I’ve tried them, and I know. Not only can she not order a dinner with taste, discretion, and due appreciation of season, surroundings, and occasion; but she inevitably shows her character, or want of it, if she be allowed to choose the menu. The eternal feminine peeps out in the soup, lurks designedly in the entrées, and comes into the full glare of the electric light in the sweets and liqueurs.
Let me explain. As a bachelor who is lucky enough to be asked out to many dinner parties, I have cultivated a slight reciprocative hospitality in the shape of asking my hostesses (and their daughters, if they have any) to dine with me at sundry restaurants. It is my habit to beg my guests to order the dinner, “because a woman knows so much more about these things than a mere man”; and all unwittingly the dear ladies invariably fall into the innocent little trap, wrinkle up their foreheads and study the carte, while I sit tight and study character.
Luckily my digestion is excellent. I have survived several seasons of this sort of thing, but I feel that the time is coming when I must
really give it up and order the dinners myself.
The wife of a very important lawyer was good enough to dine with me at the Savoy recently. She is, I believe, a thoroughly good wife and mother, and, moreover, she has a happy knack of humorous small talk. She graciously agreed to order our dinner after the usual formula. The crêmesantéwas all right—homely and healthy, if a trifle dull and uninteresting; but when we went on to boiled sole, mutton cutlets, and a rice pudding, I felt that the sweet simplicity of the Jane Austen cuisine was too much with us, and I recognized sadly that she was not imbued with the spirit of place; she mistook the Savoy for the schoolroom. Her forte was evidently decorous domesticity. Nevertheless, I had a good dinner.
Less fortunate was I in my experience with the eldest daughter of a celebrated painter. She was all for colour. “There is not enough colour in our drab London life,” she said; so, at the Carlton, she ordered Bortsch, because it was so pretty and pink; fish à la Cardinal, because of the tomatoes; cutlets à la Réforme, because she liked the many-coloured “baby-ribbons” of garnishing; spinach and poached eggs—“the contrast of colour is so daring, you know”; beetroot salad; a peach à la Melba—“so artistic and musical”; and, of course, crême de menthe to accompany the coffee. It was a feast— of colour—and the food was thoroughly well cooked; but I was reminded of Thackeray’s chef, M. Mirabolant, who conceived a white dinner for Blanche Amory to typify her virginal soul.
Then there was an amiable and affected widow, whose mitigated woe and black voile frock were most becoming. She presumed, however, on her widowhood to order everything en demi-deuil, which meant that every dish from fish to bird was decorated with mourning bands of truffles. The thoughtful chef sent up the ice in the form of a headstone, and we refrained from Turkish coffee because French cafénoirwas so much blacker.
The great Brillat-Savarin, speaking of female gourmets, said, “They are plump and pretty rather than handsome, with a tendency
to embonpoint.” I confess that my experience leads me to disagree; the real female gourmet (alas, that she should be so rare!), broadminded, unprejudiced, and knowledgeable, is handsome rather than pretty, thin rather than stout, and silent rather than talkative. This, however, by the way.
Two schoolgirls did me the honour of dining with me at Prince’s not long ago, before going to the play. I gave them carte blanche to order what they liked, and this was the extraordinary result:
Langouste en aspic. Meringues Chantilly. Consommé à la neige de Florence.
Selle de Chevreuil. Gelée Macédoine. Faisan en plumage. Bombe en surprise. Nid de Pommes Dauphine.
I ventured to suggest that there was a certain amount of fine confused feeding about this programme, that it was so heavy that even two hungry schoolgirls and a middle-aged bachelor might find it difficult to tackle, also that the sequence of dishes was not quite conventional. Eventually they blushingly explained that they had ordered all these things because they did not know what any of them meant, and they wanted to find out—“besides, they’ve got such pretty names, and it will help us so much in our French lessons.” I reduced the formidable dimensions of the dinner, and there were no disastrous results.
I once had the temerity to invite a real lady journalist to dine with me at the Berkeley. I think that she writes as Aunt Sophonisba, or something of the sort, and her speciality is the soothing of fluttering hearts and the explaining of the niceties of suburban etiquette. Anyhow, she knows nothing about cookery, although I understand she conducts a weekly column entitled “Dainty Dishes for Delicate Digestions.” It was in July, and she said we might begin with oysters and then have a partridge. When I explained that owing to official
carelessness these cates happened to be out of season, she waxed indignant and said that she thought “they were what the French call primeurs.” Nevertheless, she made a remarkably good hot-weather dinner, eating right through the menu, from the melon réfraichie to the petits fours. Women who golf, lady journalists, and widows, I observe, have usually remarkably good appetites.
I recollect also an American actress who sang coon songs—and yearned for culture. We lunched at the Cecil, and when she espied on the card eggs à la Meyerbeer, she instantly demanded them because “he was a composer way back about the year dot, and I just love his music to ‘Carmen.’” She hunted through the menu for celebrated names, preferably historical, and ordered successively Sole à la Colbert, Poulet Henri Quatre, and Nesselrode pudding, because they reminded her of the time when she was studying French history.
With the keenest desire not to be thought disrespectful or ungallant, I really believe that, however well a woman may manage her household, her cook, her husband, and her kitchen expenses, she cannot order a dinner at a restaurant. Whether it be the plethora of choice, or the excitement of the lights and music, or awe of the maître d’hôtel and the sommelier, I do not know, but I am sure that the good hostess who gives you a very eatable little dinner at her own house will make hash of the best restaurant cartedujour in her endeavours to order what she thinks is nice and appropriate.
In referring just now to the excellent Miss Jane Austen, I am reminded that eating and drinking play no small part in her delightful novels. Who does not remember Mrs. Bennet, who dared not invite Bingley to an important dinner, “for although she always kept a good table, she did not think anything less than two courses could be good enough for a man on whom she had such anxious designs, or satisfy the appetite and pride of one who had ten thousand a year.” The dinner eventually served consisted of soup, venison, partridges, and an unnamed pudding. And a very good meal too!
An American critic is of opinion that there is a surfeit of mutton in English literature. “It is boiled mutton usually, too.” Now boiled mutton is, to the critic, a poor sort of dish, unsuggestive, boldly and flagrantly nourishing, a most British thing, which “will never gain a foothold on the American stomach.” This last is a vile phrase, even for an American critic, and suggests a wrestling match. The critic goes on: “The Austenite must e’en eat it. Roast mutton is a different thing. You might know Emma Woodhouse would have roast mutton rather than boiled; it is to roast mutton and rice pudding that the little Kneightleys go scampering home through the wintry weather.”
From Miss Austen to Mrs. Gaskell is no such very far cry. “We had pudding before meat in my day,” says Mr. Holbrook, the oldfashioned bachelor-yeoman in “Cranford.” “When I was a young man we used to keep strictly to my father’s rule: ‘No broth, no ball; no ball, no beef.’ We always began dinner with both, then came the suet puddings boiled in the broth with the beef; and then the meat itself. If we did not sup our broth, we had no ball, which we liked a deal better, and the beef came last of all. Now folks begin with sweet things, and turn their dinners topsy-turvy.”
What would such a one have said to our modern dinners, at home, or at a restaurant; a place which he probably would not comprehend at all, for, at any rate with us, the fashion of dining in public, especially with our women-folk, is a very recent innovation. The hearty individual of Mr. Holbrook’s time and type would have more sympathy with the frugalities of the La Manchan gentleman Cervantes drew, with his lean horse and running greyhound, courageous ferret, and meals of “duelos y quebrantes,” that strange dish, which Mr. Cunninghame Graham tells us “perplexed every translator of the immortal work.”
The modern restaurant is, I suppose, part and parcel of the evolutionary trend of the times. It has its advantages and its drawbacks. Its influence on public manners or manners in public (which are not altogether the same thing), are not entirely salutary. He was a wise person who once said, “Vulgarity, after all, is only the
behaviour of others.” Go into any frequented restaurant at dinnertime, watch the men and women (especially the latter), how they eat, talk, and observe their neighbours—et vous m’en direz des nouvelles! Our forbears, although, or perhaps because, they dined out less, or not at all, had a certain reticence of table manner which has been lost in succeeding generations. Be good enough to note the reception of a party of guests entering a full restaurant and making their way to their reserved table. Notice how every feminine eye criticizes the new-comers. Not a bow, nor a frill, nor a sleeve, nor a jewel, nor a twist of chiffon is unobserved. Talk almost ceases whilst the progress through the already filled tables takes place. The men of the party ask polite questions, and endeavour to continue the even tenor of the conversation, but the feminine replies are vague and malapropos. No woman seems able to concentrate her attention on talk whilst other women are passing. She must act the critic; note, observe, copy, or deride. These are our table manners of to-day. Not entirely pretty, perhaps; but typical and noteworthy.
