Bring water to a boil in a large pot.
Put the butter and cream in a large skillet over medium high heat and boil, stirring frequently until the cream has reduced almost by half. Add the freshly grated nutmeg, some salt and a generous amount of fresh black pepper. Remove from the heat and set aside.
Add 1 tablespoon of salt and the pasta to the boiling water. Stir well. When the pasta is cooked al dente, drain it and add to the sauce in the skillet.
Add the fresh grated cheese to the skillet, then toss until the pasta is well coated with the sauce. Season with more pepper and serve immediately.