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The Sjögren’s Book
The Sjögren’s Book
Fifth Edition

Edited by
Daniel J. Wallace, MD
Associate Editors
Alan N. Baer, MD
Steven E. Carsons, MD
Nancy L. Carteron, MD
Katherine M. Hammitt, MA
Matthew A. Makara, MPH
 Oxford University Press is a department of the University of Oxford. It furthers the
University’s objective of excellence in research, scholarship, and education by publishing
worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and
certain other countries.

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America.

© Sjögren’s Foundation 2022

All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, without the prior permission in
writing of Oxford University Press, or as expressly permitted by law, by license, or under
terms agreed with the appropriate reproduction rights organization. Inquiries concerning
reproduction outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above.

You must not circulate this work in any other form and you must impose this same
condition on any acquirer.

Library of Congress Cataloging-in-Publication Data

Names: Wallace, Daniel J. (Daniel Jeffrey), 1949– editor.
Title: The Sjögren’s book / Daniel J. Wallace.
Description: 5th edition. | New York, NY : Oxford University Press, [2022] |
Includes bibliographical references and index.
Identifiers: LCCN 2022000249 (print) | LCCN 2022000250 (ebook) |
ISBN 9780197502112 (hardback) | ISBN 9780197502136 (epub) | ISBN 9780197650417
Subjects: LCSH: Sjögren’s syndrome—Popular works.
Classification: LCC RC647.5.S5 N49 2022 (print) |
LCC RC647.5.S5 (ebook) | DDC 616.7/75—dc23/eng/20220203
LC record available at https://lccn.loc.gov/2022000249
LC ebook record available at https://lccn.loc.gov/2022000250

DOI: 10.1093/oso/9780197502112.001.0001

This material is not intended to be, and should not be considered, a substitute for medical
or other professional advice. Treatment for the conditions described in this material is highly
dependent on the individual circumstances. And, while this material is designed to offer
accurate information with respect to the subject matter covered and to be current as of the
time it was written, research and knowledge about medical and health issues is constantly
evolving and dose schedules for medications are being revised continually, with new side
effects recognized and accounted for regularly. Readers must therefore always check the
 product information and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most recent codes of
conduct and safety regulation. The publisher and the authors make no representations or
warranties to readers, express or implied, as to the accuracy or completeness of this
material. Without limiting the foregoing, the publisher and the authors make no
representations or warranties as to the accuracy or efficacy of the drug dosages mentioned
in the material. The authors and the publisher do not accept, and expressly disclaim, any
responsibility for any liability, loss, or risk that may be claimed or incurred as a consequence
of the use and/or application of any of the contents of this material.
Contents

Contributors
Introduction: Why Write a Book on Sjögren’s? by Daniel J. Wallace

PART I WHAT IS SJÖGREN’S AND WHO IS THE

SJÖGREN’S PATIENT?
1. The Sjögren’s Foundation: The Patients’ and
Professionals’ Key Resource and Advocate
Janet E. Church
2. What Is Sjögren’s?
Frederick B. Vivino
3. Who Develops Sjögren’s?
Christine H. Lee and Daniel J. Wallace
4. The Impact of Living with Sjögren’s
Matthew Makara
5. The Cost of Living with Sjögren’s
Simon J. Bowman and Benjamin Fisher

PART II THE SCIENCE OF SJÖGREN’S

6. Sjögren’s and the Immune System
Robert I. Fox and Steven E. Carsons
7. Environmental Effects
Jeffrey W. Wilson, Peter Olsson, and Thomas Mandl
8. Genetics and Sjögren’s
Kathy L. Sivils
9. The Gut Microbiome and Sjögren’s
Anat Galor, Kara M. Cavuoto, and Santanu Banerjee
10. Causes of Exocrine Gland Dysfunction in Sjögren’s
Efstathia K. Kapsogeorgou, Michael Voulgarelis, and Athanasios
G. Tzioufas

PART III HOW IS THE BODY AFFECTED?

11. Diagnosis of Fatigue
Daniel J. Wallace, Richa Mishra, and Frederick B. Vivino
12. Musculoskeletal Manifestations of Sjögren’s
Donald E. Thomas Jr.
13. Sjögren’s and Central Nervous System Disorders
Arun Varadhachary
14. The Internal Organs in Sjögren’s
R. Hal Scofield, Fotini C. Soliotis, Stuart S. Kassan, and
Haralampos M. Moutsopoulos
15. Dry Mouth
Ava J. Wu and Troy E. Daniels
16. Dry Eye
Cintia S. de Paiva, Reza Dana, and Gary N. Foulks

PART IV DIAGNOSIS
17. Diagnostic and Classification Criteria for Sjögren’s
Matthew Makara
18. Laboratory Tests
Alan N. Baer
19. Assessing the Salivary Gland Component in Sjögren’s:
Biopsy and Imaging
Malin V. Jonsson, Kathrine Skarstein, and Chiara Baldini
20. The Difficult-to-Diagnose Sjögren’s Patient
 Astrid Rasmussen
21. Diseases Associated with Sjögren’s
Janet Lewis and Frederick B. Vivino
22. Childhood Sjögren’s
Scott M. Lieberman, Sara M. Stern, and Jay Mehta

PART V MANAGING SJÖGREN’S

23. Management of Dry Eye in Sjögren’s
Peter Donshik
24. Management of Dry Mouth in Sjögren’s
Vidya Sankar
25. Management of Other Sicca Symptoms in Sjögren’s:
Dry Ears, Nose, and Sinuses
Soo Kim Abboud and Leila M. Haddad
26. Management of Vaginal Dryness in Sjögren’s
Jolien F. van Nimwegen and Rita Melkonian
27. Management of Chronic Musculoskeletal Pain in
Sjögren’s
Lan Chen
28. Management of Pulmonary Complications in Sjögren’s
Augustine S. Lee
29. Management of Peripheral Nervous System
Complications in Sjögren’s
Shalini Mahajan and Daniel J. Wallace
30. Management of Central Nervous System Complications
in Sjögren’s
Pantelis P. Pavlakis, Theresa Lawrence Ford, Janet Lewis,
Shalini Mahajan, Steven Mandel, and Daniel J. Wallace
31. Management of Cognitive Dysfunction and Central
Nervous System Involvement in Sjögren’s
 Edward Maitz and Stephen Maitz
32. Management of Fatigue in Sjögren’s
Nancy L. Carteron
33. Management of Depression and Anxiety in Sjögren’s
Valerie G. Loehr and E. Sherwood Brown
34. Management of Gastrointestinal Manifestations in
Sjögren’s
Katerina Shetler
35. Management of Gynecologic and Urologic Aspects of
Sjögren’s
Rita Melkonian
36. Management of Vasculitis in Sjögren’s
Ghaith Noaiseh
37. Management of Lymphoma and Other Cancers in
Sjögren’s
Kieron Dunleavy and Katherine M. Hammitt
38. Management of Hepatic and Pancreatic Involvement in
Sjögren’s
Chadwick R. Johr
39. Management of Kidney-Associated Involvement in
Sjögren’s
Daniel J. Wallace
40. Complementary, Alternative, and Integrative
Approaches to Health in Sjögren’s
Matthew Makara
41. Vitamin D and Sjögren’s
Jeffrey W. Wilson

PART VI TAKING CHARGE OF YOUR SJÖGREN’S

42. Sjögren’s: The Self and Others
 Teri P. Rumpf and Lynn C. Epstein
43. Enhancing Resilience Through Mind–Body Interactions
Margaret Baim
44. Sleep Disorders
H. Kenneth Fisher and Daniel J. Wallace
45. Sex and Sjögren’s
Anne E. Burke
46. Vaccinations in Sjögren’s
Richard D. Brasington Jr.
47. Disability
Thomas D. Sutton and Katherine M. Hammitt

PART VII THE FUTURE

48. Recent and Promising Scientific Developments
Steven E. Carsons, Mabi Singh, Nancy McNamara, and
Katherine M. Hammitt
49. Sjögren’s Foundation Clinical Trials Consortium
Theresa Lawrence Ford
50. Clinical Trials: What They Are, How to Get Involved,
and the Current State in Sjögren’s
Matthew Makara and Daniel J. Wallace
51. International Collaboration and the Information
Technology That Fuels It: Keys to a Brighter Future
Katherine M. Hammitt

Glossary
Index
Contributors

Soo Kim Abboud, MD

Associate Professor
Chief, Otorhinolaryngology, Penn Presbyterian Hospital
Clinical Director of Otolaryngology, Penn Medicine University City
Philadelphia, PA, USA

Alan N. Baer, MD
Professor of Medicine
Director, Jerome L. Greene Sjögren’s Syndrome Center
Johns Hopkins University School of Medicine
Baltimore, MD, USA

Margaret Baim, MS, ANP-BC

Clinical Director, Center for Training
Director, Stress Management and Resiliency Training Program,
Benson-Henry Institute for Mind Body
Medicine, Massachusetts General Hospital
Boston, MA, USA

Chiara Baldini, MD, PhD

Associate Professor
Rheumatology Unit
University of Pisa
Pisa, Italy

Santanu Banerjee, PhD

Assistant Professor, Department of Surgery
University of Miami Miller School of Medicine
Miami, FL, USA
Simon J. Bowman, MBBS, PhD
Professor, University Hospitals Birmingham, UK
Biomedical Resource Centre, University of Birmingham, UK
Milton Keynes University Hospital, UK
Birmingham, UK

Richard D. Brasington Jr., MD

Emeritus Professor of Medicine
Washington University in St. Louis School of Medicine
St. Louis, MO, USA

E. Sherwood Brown, MD, PhD

Professor of Psychiatry
Vice Chair for Clinical Research
Chief of the Division of Clinical Neuroscience
Director of the Psychoneuroendocrine Research Program
The University of Texas Southwestern Medical Center
Dallas, TX, USA

Anne E. Burke, MD, MPH

Associate Professor of Gynecology and Obstetrics
Director, Family Planning Division
Johns Hopkins University School of Medicine, Bayview Medical
Center
Baltimore, MD, USA

Steven E. Carsons, MD, FACR

Professor, Department of Medicine at NYU Long Island School of
Medicine
Program Director, Rheum Fellowship Program
Senior Associate Dean, Translational Science Integration, NYU Long
Island School of Medicine
Chief of Rheumatology, Allergy and Immunology, NYU Langone
Hospital-Long Island
Mineola, NY, USA
Nancy L. Carteron, MD
Associate Clinical Professor
Department of Medicine, Rheumatology
University of California, San Francisco & Berkeley
San Francisco, CA, USA

Kara M. Cavuoto, MD
Associate Professor of Clinical Ophthalmology
Bascom Palmer Eye Institute
University of Miami Miller School of Medicine
Miami, FL, USA

Lan Chen, MD, PhD

Former Clinical Associate of Medicine and Attending Rheumatologist
Division of Rheumatology, Penn Presbyterian Medical Center
Penn Sjögren’s Center, University of Pennsylvania School of Medicine
Philadelphia, PA, USA

Janet E. Church
President & Chief Executive Officer
Sjögren’s Foundation
Reston, VA, USA

Reza Dana, MD, MPH, MSc

Professor of Ophthalmology
Director of Cornea Service, Massachusetts Eye and Ear Infirmary,
Harvard Medical School
Boston, MA, USA

Troy E. Daniels, DDS, MS

Professor of Oral Medicine and Pathology
School of Dentistry and Medicine, University of California, San
Francisco
San Fransciso, CA, USA

Cintia S. de Paiva, MD, PHD

Associate Professor of Ophthalmology
Baylor College of Medicine—Ocular Surface Center
Houston, TX, USA

Peter Donshik, MD
Ophthalmologist (Retired)
Bloomfield, CT, USA

Kieron Dunleavy, MD
Chair, Division of Hematology
Director, Lymphoma Program
Lombardi Cancer Center
Georgetown University
Washington, DC, USA

Lynn C. Epstein, MD, DLFAPA, FAACAP

Clinical Professor of Psychiatry
Tufts University School of Medicine
Boston, MA, USA

Benjamin Fisher, MD(Res)

Senior Lecturer in Clinical Rheumatology
University Hospitals Birmingham, UK
Biomedical Resource Centre, University of Birmingham, UK
Institute of Inflammation and Ageing, University of Birmingham
Birmingham, UK

H. Kenneth Fisher, MD, FCCP

Professor of Clinical Medicine (Retired)
University of California
Los Angeles, CA, USA

Gary N. Foulks, MD, FACS

Emeritus Professor of Ophthalmology
University of Louisville School of Medicine
Louisville, KY, USA

Robert I. Fox, MD, PhD

Chief of Rheumatology, Scripps Memorial Hospital and Research
Foundation
La Jolla, CA, USA

Anat Galor, MD, MSPH

Staff Physician, Miami Veterans Affairs Medical Center
Associate Professor of Clinical Ophthalmology
Bascom Palmer Eye Institute University of Miami Miller School of
Medicine
Miami, FL, USA

Leila M. Haddad
Clinical Assistant
Penn Medicine, University of Pennsylvania Health System
Philadelphia, PA, USA

Katherine M. Hammitt, MA
Vice President of Medical & Scientific Affairs
Sjögren’s Foundation
Reston, VA, USA

Chadwick R. Johr, MD
Director, Penn Sjögren’s Center
Associate Program Director, Combined Internal Medicine and
Pediatrics Residency Program
Associate Professor of Clinical Medicine, Division of Rheumatology
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, PA, USA

Malin V. Jonsson, DMD, PhD

ProfessorDepartment of Clinical Dentistry
Section for Oral and Maxillofacial Radiology
University of Bergen
Bergen, Norway

Efstathia K. Kapsogeorgou, PhD

Assistant Professor of Immunology
Department of Pathophysiology
School of Medicine, National and Kapodistrian University of Athens
Athens, Greece

Stuart S. Kassan, MD, FACP, MACR

Distinguished Clinical Prof of Medicine
University of Colorado School of Medicine
Denver, CO, USA

Theresa Lawrence Ford, MD

CEO & Medical Director
North Georgia Rheumatology Group, PC
Lawrenceville, GA, USA

Augustine S. Lee, MD
Pulmonologist, Critical Care Specialist
Mayo Clinic
Jacksonville, FL, USA

Christine H. Lee, MD, MPH

Attending Physician
Cedars-Sinai Medical Center
Beverly Hills, CA, USA

Janet Lewis, MD
Associate Professor
Chief of the Division of Rheumatology
University of Virginia
Charlottesville, VA, USA

Scott M. Lieberman, MD, PhD, FACR

Associate Professor of Pediatrics
Division of Rheumatology, Allergy, and Immunology
University of Iowa Carver College of Medicine
Iowa City, IA, USA

Valerie G. Loehr, PhD

Assistant Professor
Department of Psychiatry
The University of Texas Southwestern Medical Center at Dallas
Dallas, TX, USA

Shalini Mahajan, MD
Assistant Professor
Department of Neurology
Cedars Sinai Medical Center
Los Angeles, CA, USA

Edward Maitz, PhD

Clinical Neuropsychologist
Clinical Neuropsychologist Associates
Philadelphia, PA, USA

Stephen Maitz, PsyD

Neuropsychology Postdoctoral Fellow
Penn Medicine, University of Pennsylvania Health System
Philadelphia, PA, USA

Matthew Makara, MPH

Director of Research & Scientific Affairs
Sjögren’s Foundation
Reston, VA, USA

Steven Mandel, MD
Clinical Professor of Neurology
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Adjunct Professor of Medicine
New York Medical College
New York City, NY, USA

Thomas Mandl, MD, PhD

Associate Professor of Rheumatology
Lund University
Malmö, Sweden
Nancy McNamara, OD, PhD
Professor, UC Berkeley School of Optometry
Associate Dean for Academic Affairs
Chief, UC Berkeley Sjögren’s Clinic
Co-Chief, UC Berkeley Dry Eye Clinic
Berkeley, CA, USA

Jay Mehta, MD, MS

Attending Physician, Division of Rheumatology
Associate Program Director of the Pediatrics Residency Program
Children’s Hospital of Philadelphia
Philadelphia, PA, USA

Rita Melkonian, MD, FACOG

Physician, Marin Health
Marin County, CA, USA

Richa Mishra
Rheumatology Fellow University of Pennsylvania
Philadelphia, PA

Haralampos M. Moutsopoulos
Professor and Director
Department of Pathophysiology, School of Medicine
National University of Athens
Athens, Greece

Ghaith Noaiseh, MD
Associate Professor of Medicine
Division of Allergy, Clinical Immunology & Rheumatology
University of Kansas
Kansas City, KS, USA

Peter Olsson, MD, PhD

Department of Clinical Sciences
Lund University
Malmö, Sweden
Pantelis P. Pavlakis, MD, PhD
Assistant Attending
Department of Neurology
Hospital for Special Surgery
New York, NY, USA

Astrid Rasmussen, MD, PhD

Research Associate Member
Genes and Human Disease Research Program
Oklahoma Medical Research Foundation
Oklahoma City, OK, USA

Teri P. Rumpf, PhD

Psychologist
Newton Highlands, MA, USA

Vidya Sankar, DMD, MHS

Associate Professor and Division Director for Oral Medicine
Department of Diagnostic Sciences
Tufts University School of Dental Medicine
Boston, MA, USA

R. Hal Scofield, MD, FACR

Member, Arthritis & Clinical Immunology Program
Oklahoma Medical Research Foundation
Oklahoma City, OK, USA
Professor, Department of Medicine, College of Medicine
University of Oklahoma Health Sciences Center
Oklahoma City, OK, USA
Staff Physician, Associate Chief of Staff for Research, Medical Service
United States Department of Veterans Affairs Medical Center
Oklahoma City, OK, USA

Katerina Shetler, MD
Physician
Division of Gastroenterology
Palo Alto Medical Foundation
Mountain View, CA, USA

Mabi Singh, DMD, MS

Associate Professor
Assistant Director, Oral Medicine Service
Department of Diagnostic Sciences
Tufts University School of Dental Medicine
Boston, MA, USA

Kathy L. Sivils, PhD

Former Member, Arthritis & Clinical Immunology Research Program
Former Adjunct Associate Professor, Department of Pathology,
University of Oklahoma Health Sciences Center Director, Oklahoma
Sjögren’s Center of Research Translation
Former Director, OMRF Sjögren’s Research Clinic
Oklahoma, OK, USA

Kathrine Skarstein, DMD, PhD

Professor, Department of Clinical Medicine—Gade Laboratory for
Pathology, University of Bergen
Department of Pathology, Haukeland University Hospital
Bergen, Norway

Fotini C. Soliotis, MD, MRCP

Rheumatologist, Euroclinic
Athens, Greece

Sara M. Stern, MD
Associate Professor of Pediatrics
University of Utah School of Medicine
Salt Lake City, UT, USA

Thomas D. Sutton, Esq.

Partner, Leventhal Sutton & Gornstein
Bucks County, PA, USA
Another random document with
no related content on Scribd:
 4 eggs
1 cup sweet milk
1 tea-spoon baking powder
1 heaping table-spoon grated chocolate
1 dessert-spoon milk
Cream the butter. Add the sugar. Beat well. Add the well-beaten
eggs and the flour, in which the baking powder should be mixed.
Take out a tea-cup of the mixture and add the chocolate and the milk
to it.
Butter a tin and fill it to the depth of an inch with the white mixture.
Drop two or three spoonfuls of chocolate mixture on to this in circles
and spots. Add another layer of the white mixture and on to it drop
more of the brown, and so on until both mixtures are finished.

Nut Cake

1¹⁄₂ cups sugar

¹⁄₂ cup butter
2 cups flour
³⁄₄ cup milk
Whites of four eggs
1 cup broken nuts
2 tea-spoons baking powder
Cream the butter. Add the sugar. Beat well. Mix the baking powder
with the flour. Add it to the mixture with the milk, beating well all the
time. Mix in the nuts thoroughly. Lastly add the whites, which should
be beaten as stiff as possible. Bake in shallow square tins. Ice.

*Shortbread—I
1 lb. flour
¹⁄₂ lb. butter
3 ozs. sugar
 Knead all together until smooth. Roll out an inch thick. Prick all
over with a fork. Bake quickly in shallow buttered tins.

*Shortbread—II

¹⁄₂ lb. flour

¹⁄₂ lb. sugar
¹⁄₂ lb. butter
4 eggs
2 ozs. comfits
Grated rind of a lemon
Beat the butter to cream. Add the flour, sugar and eggs alternately
in small quantities. When thoroughly mixed, add the grated rind and
mix again lightly. Pour into a greased oblong tin (the mixture should
be about an inch and a half deep). Sprinkle the comfits over the
surface. Do not allow the cake to colour deeply in baking.

*Walnut Cake

¹⁄₂ lb. butter

¹⁄₂ lb. sugar
4 eggs
4 ozs. flour
4 ozs. pounded dry walnuts
Cream the butter. Add the sugar. Beat well. Beat the yolks and
whites separately. Add the yolks to the cake. Mix the flour and the
walnuts, which must be pounded as fine as possible. Add to the
mixture. Stir in the whites. Bake in a shallow square tin. Ice.
 Fruit Cakes
PAGE
Black Cake (Wedding Cake) 51
Cider Cake 52
Currant Cake 52
Fruit Cake—I. 53
” ” II. 54
Genoa Cake 55
Imperial Cake 55
Pitcaithley Bannock 56
Seed Cake 56
Simnel Cake 57
Soda Cake 58
Spice Cake 59
Sultana Cake—I. 59
” ” II. 60
” ” III. 61
Sultana or Seed Cake 61
White Fruit Cake 62

General Directions
In making fruit cakes always mix the fruit thoroughly with a little of
the flour before adding to the cake.
Mix the spices with the sugar or flour.
 For directions for cleaning currants, stoning raisins, and blanching
almonds (see pp. 3 and 4).

Black Cake
(Wedding Cake)
10 ozs. butter
¹⁄₂ lb. powdered sugar
¹⁄₂ lb. flour
6 large eggs
1 gill brandy and sherry mixed
¹⁄₂ grated nutmeg
1 tea-spoon cinnamon
¹⁄₄ tea-spoon mace
1 ground clove
¹⁄₂ lb. finely chopped almonds
1 lb. currants
1¹⁄₂ lbs. raisins
Beat the butter to a cream. Add the powdered sugar. Beat again
very thoroughly. Stir in quarter of a pound of flour. Beat the eggs
together until light. Add them and the rest of the flour to the mixture
alternately. Beat well. Add the brandy, sherry and spices. Add the
currants, raisins and peel, which should all be well floured, gradually,
mixing thoroughly. Bake in two tins lined with greased paper, in a
moderate oven, for four hours. Let the cakes cool in the tins. This
cake, if iced first with almond icing (see p. 67), and then with plain
icing (see p. 65), is suitable for a wedding cake.

Cider Cake
1 cup of sugar
¹⁄₂ cup butter
1 egg
 ¹⁄₂ pint cider
1 level tea-spoon carbonate of soda
2 cups flour
1 cup stoned raisins
Beat the butter and sugar to a cream. Add the well beaten egg and
the flour. Dissolve the carbonate of soda in a table-spoon of boiling
water. Add it to the cider. Stir it into the mixture. Beat well together.
Add the raisins. Bake in a moderate oven in a buttered tin.

*Currant Cake

¹⁄₂ lb. sugar

¹⁄₂ lb. butter
6 eggs
³⁄₄ lb. flour
³⁄₄ lb. currants
¹⁄₄ lb. sultanas
¹⁄₄ lb. mixed peel
¹⁄₄ lb. ground almonds
1 heaping tea-spoon baking powder
Beat butter and sugar for twenty minutes. Then add the eggs one
at a time, beating hard all the time. Add the flour and fruit and mix
thoroughly. Bake in a well greased tin in a moderate oven for about
three hours. Leave in the tin to cool.

Fruit Cake—I

¹⁄₂ cup butter

1¹⁄₂ cups powdered sugar
3 cups flour
Yolks of four eggs
 ¹⁄₂ cup milk
1 tea-spoon cream of tartar
¹⁄₂ tea-spoon carbonate of soda
1 wine-glass brandy
1 cup raisins
1 cup currants
Beat the butter to a cream. Add the sugar and beat well. Add the
yolks and beat again. Dissolve the soda in the milk and sift the flour
and cream of tartar together. Add the milk and flour alternately to the
mixture. Stir in the brandy and the fruit and mix well. Bake in two
greased tins in a moderate oven.

*Fruit Cake—II
2 scant cups butter
3 cups dark brown sugar
4 cups sifted flour
6 eggs
1 lb. raisins
1 lb. currants
¹⁄₂ lb. citron, finely chopped
¹⁄₂ cup molasses or treacle
¹⁄₂ cup sour milk
¹⁄₂ grated nutmeg
1 table-spoon ground cinnamon
1 tea-spoon ground cloves
1 tea-spoon ground mace
1 wine-glass brandy
1 level tea-spoon soda
Beat butter and sugar to a cream. Add the spices, molasses and
some milk. Stir all well together. Beat the yolks and whites of the
eggs separately. Add the yolks and the brandy. Beat thoroughly. Add
the flour and stiffly beaten whites alternately. Dissolve the soda in a
little water. Add it to the mixture. Mix the fruit together with two table-
spoons of flour. Stir it thoroughly into the mixture.
Line two tins with greased paper. Bake in a moderate oven two
hours. Let it cool in the pan.

*Genoa Cake
10 ozs. sifted flour
8 ozs. sugar
8 ozs. butter
6 ozs. finely cut peel
4 ozs. chopped almonds
12 ozs. sultanas
5 eggs
1 tea-spoon baking powder
Beat the butter to a cream. Add the sugar. Drop in one egg at a
time, beating hard all the time. Add the fruit and almonds and lastly
the flour. Mix very well. Bake in an oven which is rather quick at first,
then moderate.

Imperial Cake
1 lb. powdered sugar
1 lb. flour
³⁄₄ lb. butter
¹⁄₂ lb. chopped almonds
¹⁄₂ lb. chopped citron
1 lb. raisins
¹⁄₂ grated nutmeg
10 eggs
1 wine-glass brandy
Beat the butter to a cream. Add the sugar. Beat again. Beat the
yolks. Add them to the mixture. Add the flour gradually, beating hard
continually. Add the fruit, chopped almonds, nutmeg and brandy, and
the whites beaten to a stiff froth. This cake will keep a year.

Pitcaithley Bannock
1 lb. flour
¹⁄₂ lb. butter
2 ozs. blanched almonds
2 ozs. candied orange peel
2 ozs. sugar
2 ozs. carraway seeds or comfits
Melt the butter and mix it with the flour, which should have been
dried and sifted. Slice the almonds and cut up the orange peel finely.
Add them with the sugar to the flour and butter. Mix very well. Bake
in a slow oven for an hour.

*Seed Cake
1 lb. butter
³⁄₄ lb. powdered sugar
1 lb. flour
6 eggs
³⁄₄ oz. carraway seeds
1 wine-glass brandy
Beat the butter to a cream. Add the sugar. Beat well together. Beat
the whole eggs and brandy together until very light. Add them and
the flour alternately to the mixture, beating well, and then the
carraway seeds. Bake in a greased tin in a moderate oven.

Simnel Cake

¹⁄₂ lb. butter

¹⁄₂ lb. sugar
 2 ozs. rice flour
4 eggs
7 ozs. flour
¹⁄₂ lb. currants

For the Paste

2 ozs. bitter almonds

10 ozs. sweet almonds
2¹⁄₂ ozs. powdered sugar
Whites of two eggs
Rose water
Beat the butter to a cream, and add the sugar. Beat the yolks and
whites separately. Add the yolks and the rice flour to the mixture,
beating continually, and then the flour and currants. Mix well and stir
in the stiffly beaten whites.
Prepare the almond paste beforehand. Blanch and pound the
almonds, adding a little rose water to them. Beat the whites to a stiff
froth, add the sugar, stir lightly together and then add the almonds.
Line two small tins with greased paper and put a layer of the cake
mixture in each, and then a layer of the almond paste, then another
layer of cake and almond paste. Bake in a moderate oven.

*Soda Cake
1 lb. flour
¹⁄₂ lb. crushed lump sugar
¹⁄₂ lb. butter
1 lb. sultanas
¹⁄₄ lb. mixed peel
3 eggs
1 small tea-cup milk
 1 small tea-spoon carbonate of soda
1 full tea-spoon cream of tartar
Beat the butter to a cream. Add the sugar, which need not be too
finely crushed. Beat the eggs well. Add them to the butter and sugar,
beating hard. Mix the soda with the milk and the cream of tartar with
the flour. Add to the mixture alternately. Add the sultanas and finely
cut peel. Mix all very well. Bake for two hours or more in a tin lined
with greased paper. The oven should be fairly hot at first and then
moderate for the rest of the time.

Spice Cake

³⁄₄ lb. butter

1 lb. sugar
1 lb. flour
10 eggs
1 wine-glass brandy
1 ” sherry
1 ” molasses or treacle
1 ” milk
4 lbs. raisins
2 lbs. currants
1 lb. citron-peel
1 tea-spoon soda
1 table-spoon cinnamon
2 tea-spoons cloves
1 grated nutmeg
¹⁄₄ lb. chopped almonds
Beat the butter and sugar to a cream. Add the well beaten eggs,
brandy, wine, molasses and milk, in which the soda should be
dissolved. Then the spices and flour. Stir well together and then add
the fruit, which must be well mixed. Bake in two large tins for three or
four hours.
 *Sultana Cake—I

¹⁄₂ lb. butter

¹⁄₂ lb. flour
¹⁄₂ lb. sultanas
3 ozs. lemon peel
3 eggs
1 tea-spoon vanilla
1 level tea-spoon baking powder
Soften, but do not melt the butter. Beat well. Sift the baking
powder with the flour. Add the sugar to the butter, then the flour. Beat
the yolks well and add them. Add the fruit and vanilla. Beat
continually. Stir in the beaten whites. Bake in a greased tin in a quick
oven for one and a half hours.

*Sultana Cake—II
4 eggs
Their weight in flour, castor sugar and butter
The rind of a lemon grated
3 ozs. sultanas
1 oz. finely chopped citron
Beat the butter to a cream. Put the sugar into another pan, and
break the four eggs on to it. Beat the eggs and sugar together, with a
steel carving-fork, until thick and creamy. It will take twenty minutes
to half-an-hour. Stir in the flour lightly and quickly, then the butter,
and lastly the fruit and grated lemon. Bake in a shallow oblong tin
lined with buttered paper.
This cake is better if kept a day or two before eating.

Sultana Cake—III
 ³⁄₄ lb. flour
¹⁄₂ lb. sultanas
6 ozs. butter
6 ozs. sugar
3 eggs
1 level table-spoon baking powder
1 oz. candied peel
A little milk
Rub the butter lightly into the flour, in which the baking powder
should be mixed. Then add the sugar, sultanas, and chopped peel.
Beat the eggs together until creamy and light, and add them to the
flour, etc., mixing in the ingredients with a little milk. Bake in a
greased tin in a moderate oven.

Sultana or Seed Cake

¹⁄₂ lb. flour

¹⁄₄ lb. butter
¹⁄₄ lb. castor sugar
3 eggs (or 4 eggs if small ones)
2 ozs. sultanas (or carraway seeds)
A little finely-chopped candied peel
Beat the butter to a cream. Add the sugar, flour and fruit, by
degrees, then the eggs, previously well beaten. Beat all well together
for ten minutes. Bake in a round cake tin lined with buttered paper
for rather less than an hour.

*White Fruit Cake

1 cup butter
2 cups sugar
3 cups flour
¹⁄₂ cup milk
 Whites of three eggs
3 tea-spoons baking powder
1 wine-glass brandy
¹⁄₄ lb. chopped citron
¹⁄₂ lb. blanched and chopped almonds
¹⁄₄ lb. grated cocoanut
Beat the butter to a cream, add the sugar. Beat well together. Sift
the flour and baking powder together. Add the butter and sugar,
moistening the mixture with the milk and brandy. Add the cocoanut,
almonds and citron. Mix well and stir in the stiffly beaten whites.
Bake in a tin lined with greased paper in a moderate oven.
 Icings
PAGE
Plain Icing 65
Boiled Icing 66
Gelatine Icing 66
Icing without eggs 66
Almond Icing 67
Chocolate Icing—I. 67
” ” II. 68
Cocoanut Icing 68
Orange Icing 68
Tutti Frutti Icing 69
Yellow Icing 69
 General Remarks
In all icing that is not boiled it is necessary to use “icing” sugar,
which is very fine and flour-like in appearance.

Plain Icing
Whites of 2 eggs
¹⁄₂ lb. icing sugar
Flavouring, lemon, vanilla, or almond, etc.
Break the whites into a good sized dish. Add two heaping table-
spoons of sugar and stir it in steadily. Beat for a few minutes. Add
the sugar gradually, beating well. The making should take about half-
an-hour. When thick enough it should not run together again after
being cut with a knife. If flavoured with lemon juice, a little more
sugar should be added or the icing will not be stiff enough.
Pour the icing on to the cake by large spoonfuls and allow it to
settle itself as much as possible. When using a knife, dip it first in
cold water.
Ice a cake two or three hours before it is to be eaten. It can be set
to harden in a moderate oven for five minutes if needed quickly: but
it is best to dry it slowly in a warm, sunny place.

Boiled Icing
1 cup powdered sugar
1 cup water
Whites of two eggs
Flavouring
Boil the sugar and water together until it spins a thread from a
spoon. Then take the syrup off the fire and pour it into a basin. Add
the whites (beaten to a stiff froth) to it gradually, beating hard all the
time. Continue beating until the mixture is cold. Add flavouring.

Gelatine Icing
1 tea-spoon gelatine
1 table-spoon cold water
2 table-spoons hot water
1 cup icing sugar
Soak the gelatine in the cold water for half-an-hour. Add to it the
hot water and dissolve it in the same. Add it to the sugar and beat till
smooth and firm.

Icing without Eggs

1 cup powdered sugar
5 table-spoons milk
Add the milk to the sugar in a saucepan. Stir it till it boils. Then set
it where it can boil gently for five minutes. Do not stir. Take off the
fire. Put into a basin. Flavour. Beat constantly until cold.

Almond Icing
2 whites of eggs
¹⁄₂ lb. powdered sugar
¹⁄₂ lb. sweet almonds
5 bitter almonds
Rose water
Blanch the almonds and let them dry. Pound them in a mortar and
moisten them with a little rose water. When perfectly smooth and fine
add them to an icing made as above (see p. 65), of the sugar and
white of egg. Spread thickly upon the cake. Place it near a sunny
window, allow it to dry partly and cover with a coating of plain sugar
icing.

Chocolate Icing—I
1 cup sugar
1 cup water
3 ozs. chocolate
1 tea-spoon vanilla
Boil the sugar and water together until it forms a syrup which will
spin a thread. Add the chocolate and vanilla. Take off the fire and
beat well together.

Chocolate Icing—II
Melt two ozs. of chocolate. Add it to the plain icing (see page 65).
Flavour with a few drops of vanilla.

Cocoanut Icing
To the plain icing (see p. 65), made with rather less sugar than is
given, add half a cup of grated or desiccated cocoanut.

Orange Icing
Grate the thin outer rind of an orange. Put it in a cup. Cover it with
four tea-spoons orange juice. Let it soak for half-an-hour. Squeeze
the juice through a fine cloth. Add to the plain icing (see p. 65).

Tutti Frutti Icing

1 oz. blanched and chopped almonds
¹⁄₂ cup stoned and chopped raisins and sliced citron
 2 whites of eggs
¹⁄₂ lb. icing sugar
Mix the whites and the sugar as for plain icing (see p. 65). Beat for
about twenty minutes. Work in the almonds and fruit gradually.

Yellow Icing
2 yolks
¹⁄₂ lb. icing sugar
Flavouring
Beat the yolks until frothy and light. Add the sugar very gradually,
beating hard in one direction for about half-an-hour. Flavour.
 Gingerbread
PAGE
American Soft Gingerbread—I. 72
” ” ” II. 73
” Hard Gingerbread 73
Gingerbread Loaf 74
Portuguese Gingerbread 74
Scotch Gingerbread 75
Yorkshire Parkins 76

*American Soft Gingerbread—I

12 ozs. flour
1 cup black treacle or West India molasses
1 cup brown sugar
1 cup sour milk
¹⁄₂ cup melted butter
¹⁄₂ cup melted lard
2 eggs
1¹⁄₂ tea-spoons ground ginger
1¹⁄₂ tea-spoons ground cinnamon
¹⁄₂ tea-spoon ground cloves
1 good tea-spoon carbonate of soda
Salt-spoon salt
Beat the eggs well in a large basin. Add the sour milk, treacle and
sugar. Mix well with a wooden spoon. Add the spices and soda, and
beat well. Then add the melted butter and lard and last of all the
flour. Beat quickly and bake at once in two small dripping pans about
8 inches by 10 inches, in a very moderate oven for forty minutes.

American Soft Gingerbread—II

1 cup butter
¹⁄₂ cup brown sugar
2 cups molasses
1 cup sour or sweet milk
1 table-spoon ginger
1 tea-spoon ground cinnamon
3 eggs
4 cups sifted flour
Tea-spoon soda
1 table-spoon hot water
Beat the butter to a cream. Add the sugar. Beat again. Add the
molasses, milk and spices. Beat all very well together. Add the eggs,
yolks and whites beaten separately. Add half of the flour. Beat. Add
the soda, which must be thoroughly dissolved in the hot water. Add
the rest of the flour. Beat till thoroughly mixed. Bake in two square
tins lined with greased paper in a moderate oven for forty minutes to
an hour.

Hard Gingerbread
Follow the above receipt, omitting the eggs. Roll out and cut into
squares half an inch thick. While hot rub over the top with molasses.

*Gingerbread Loaf
1 cup butter and lard
1 cup brown sugar
1 cup treacle
1 cup milk