Sunday, February 12, 2012

A disease spread by doctors

(I just noticed that I'm jumping between posts on slow cooking pork shoulder to posts on "cadaverous particles." This makes for an appetizing blog)

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This is a post about a disease spread by doctors, the doctor who discovered how it happened, and the doctors who didn't believe him.

Childbed fever (also known as puerperal fever) is a bacteria infection of the uterus contracted during the birth of a child, an abortion, or miscarriage.  It can be deadly – if untreated, it can spread into the bloodstream and cause septicaemia (blood poisoning), which can kill in a matter of hours.

It was common in mid-19th century hospitals and was often fatal, with mortality rates ranging from 10% - 35% (which is 1 in 3 women!).  Nobody quite knew the cause of the sickness, just that it seemed to happen most often when it was a doctor who was handling the procedure. Incidences of childbed fever were low when it was a midwife delivering the baby, and almost nonexistent when the woman delivered the baby on her own – even if it was on the streets.

Streptococcus pyogenes (red-stained spheres) is responsible for most cases of severe puerperal fever.  Credit: Encylopedia Brittanica


In Europe during that time, maternity institutions were set up to address problems of infanticide of illegitimate children (making them a popular service for prostitutes). They'd offer their services for free; in return, these women would be subjects for training of doctors and midwives.

There were two such institutions at well-respected Vienna General Hospital. The First Obstetrical Clinic, which served as a training ground for medical students, had an average mortality rate of 10%, whereas the Second Clinic, which trained midwife students, had a drastically lower mortality rate of 4%.

A young Hungarian doctor, Ignaz Semmelweis, was appointed the chief resident of the First Clinic in 1846.  He was puzzled and disturbed by the number of women dying in his clinic (he'd witness women begging on their knees to be admitted to the Second Clinic).  He set out to find out the cause, first by attempting to eliminate all controllable differences between the two clinics, including medical technique and even religious practices.

Dr. Ignaz Semmelweiss

In 1847, Semmelweiss had his breakthrough.  That year, a colleague of his was accidentally poked by a student's scalpel during a postmortem examination and died. Semmelweiss, noting that his colleague had suffered the same symptoms as childbed fever prior to his death, diligently studied autopsy reports and discovered more similarities between his colleague's death and those of the women in the maternity clinics.

He concluded that somehow "cadaverous particles" had made their way from the corpses to the medical equipment to the hands of the students and eventually the uteruses of the women in the birthing wards.  In the mornings, the medical students would often go to the "Dead House," where they'd perform autopsies on women who had died the night before, wipe their hands on towels, and then head over to the clinics to take up duties as obstetricians in training.

This explained why there was a much lower mortality rate in women helped by student midwives, who were not engaged in autopsies.

These "cadaverous particles" were invisible – the only telltale sign of their presence was a putrid odor.  Semmelweiss figured if he could get rid of the smell, he could get rid of the particles.  He thus subjected all students to submerge their hands in a chlorine wash before seeing patients.  In six months, the mortality rate of childbed fever plummeted, eventually reaching zero in the year following his discovery.

Microbial growth on a blood agar plate without any procedure (sector A), after washing hands (sector B), and after disinfecting hands with alcohol (sector C). Credit

He published articles on his findings, but despite his success at Vienna General hospital, his theories on handwashing and cleanliness were largely rejected by the medical community.  Some doctors were offended at the suggestion that their hands were unclean – "Doctors are gentlemen, and gentlemen’s hands are clean." And remember, this was the time when diseases were thought to be caused by an imbalance of the basic "four humours" in the body, for which the main treatment was bloodletting.

Ultimately, Semmelweiss was unable to offer acceptable scientific explanations for his findings. In 1849, he was forced to leave his post at Vienna General Hospital and eventually, left Vienna altogether.  He began to suffer from several depression, attack his critics (which further undermined his professional credibility); there are also reports that he turned every conversation to the topic of childbed fever.

In 1865, he was commited to an insane asylum, where he was severely beaten by guards and set up with a straitjacket and a dark cell. He died two weeks later from (ironically) septicemia.

Well, he got a stamp 100 years after he died.

His practice only earned widespread acceptance years after his death, when Louis Pasteur confirmed the germ theory.  Now, the "Semmelweiss reflex" describes the reflex to reject new knowledge because it contracts established norms or beliefs.

Tuesday, February 7, 2012

January Highlights

– Watching the Wolf moon (the first full moon in January) rise from the Golden Gate Bridge. It was huge and glowing and appeared perfectly spherical (though it was 95% full at the time I saw it).


– Showing my little brother around my neighborhood (read: force-feeding him all the delicious things that exist within a 7 block radius of where I live *cackle*). He liked the Pirate Store a lot. He bought this shirt.

Charlie eating his cheese scone while a couple friends watch

– Purchasing a candy thermometer.  I no longer fear recipes that tell me to heat sugar to extremely precise temperatures, e.g., 248 ℉. It's pretty interesting how just a few degree differences will dictate whether or not heated sugar will have the consistency of fudge, caramel, marshmallows, or brittle.

One of my first experiments: English Toffee

– Purchasing a slow cooker. It is a ceramic tub of magic. In ten hours of applied heat, you can turn chunky tough meat into the tenderest thing that basically shreds itself into your lap at the slightest touch.  I love you, slow cooker.

– A weekend getaway in Mendocino for Ryan's birthday. Coastlines, gorgeous sunsets, whales and sea lions, cute little quails cooing while crossing the road...it's a really lovely, quirky, peaceful beach town.

View from Mendocino Headlands State Park

Mendocino sunset

– A quick stop at Gowan's Oak Tree – a little fruit stand along Highway 128 in Philo, CA – to drink their hot freshly-made cider. There were at least 500 blue ribbons hanging on the walls (I think for their apples). 

– Staying two nights at a beautiful B&B in Elk. The views there blew my mind. And the breakfast there blew my mind. Think: crab and spinach omelettes/quiche, corn pudding, bread pudding with whiskey bourbon sauce, bottomless mimosas with your choice of grapefruit or orange juice...etc.

Breakfast 1, Round 1. Steaming coffee (and a mimosa!) in the back. Love.

– Discovering the joy of walnut cracking. There is something so satisfying about the weight of a solid walnut cracker and the sound of a walnut cracking...I put it on the same level as bubble wrap.

Walnut brainz

– A very special dinner with Ryan at Quince.  :)

– Straining my eyes to find monarchs at Natural Bridges State Park in Santa Cruz, CA.  During the winter, the butterflies migrate from the Rocky Mountains to the California coast looking for milder temperatures, and up to 100K settle in the park's eucalyptus grove (though I think the docent mentioned there were only ~3K counted this season). On chilly days when the temperature drops below 60 degrees, the butterflies huddle together for warmth, resembling shingled rooftops; on warmer days, they'll flutter around.

I do not have a DSLR; thus, these are the best I could do.

– Celebrating Chinese New Year with my family.  Watching my mom whip up about six dishes (one of which includes homemade dumplings – filling AND dough made from scratch) within an hour. If you need a visual of that...think whirling dervish. With a butcher knife.


My mama, baller cook.


Best things I ate this month:

– Lahori chikkar choley (garbanzo beans cooked in a tomato and onion sauce) at Lahore Kahari.

– Cream biscuits at Citizen's Band. They also had a bacon coffee gravy for the biscuits (pictured on the right), but the cream gravy was f-ing glorious.


Candy cap mushroom ice cream in Mendocino.

– The house noodles at QQ noodle (酸辣臊子面) in Fremont: sour and spicy pork noodle soup with a hundred flavors I couldn't name.

House special noodles in the center there.

– Almost everything from Quince. In particular, this cute pasta in broth (fancy name: cappelletti paine farm squab and spiced consommé).

Capelletti means "mini hat" and I think that is very fitting.

– BBQ pork noodles with flat rice noodles from King of Thai Noodle.  I think it was six bucks. You should get it.

– Breakfast burrito on a sunny patio at Harbor Cafe in Santa Cruz. Mmm.

Filling: Scrambled eggs, hash browns, salsa, cheese, black beans, sour cream

– Vietnamese goodies that my friends brought in celebration of the New Year: beef jerky (khô bò) that was softer, sweeter, and spicier than its American counterpart, and a sliceable log of glutinous rice, filled with mung bean and meat, steamed in a banana leaf (bánh tét). (Note to self: gotta learn how to make these.)

– A sturgeon dish at Cafe Beaujolais in Mendocino, CA. It was pan-roasted and came with housemade tagliatelle (now my second favorite pasta), candy cap mushrooms, truffle sauce, and golden beets that I actually liked! They were sweeter and surprisingly, did not taste like dirt.

– Caramel mascarpone mousse that was actually a topping to a dessert, also at Cafe Beaujolais.  I'm not a frosting person but I could not stop eating this.

Warm gingerbread with vanilla braised apples and THE MOUSSE!

Monday, February 6, 2012

Sweet and spicy five-spice pork

A friend promised me that buying a slow cooker would change my life. And so it has.  There is nothing more satisfying than walking into the house filled with slow-cooker smells and consuming a meal that took an entire day to cook (but only 15 minutes to prepare).

I made this recipe four times last month. The meat becomes insanely tender stewing in the salty-sweet-spicy marinade for so long.  If you haven't tried five-spice powder before – it's very aromatic, a ground mixture of fragrant star anise and fennel, spicy Sichuan peppercorns, and sweet cloves and cinnamon. It's perfect when sweetened with brown sugar and paired with ginger, garlic, and soy sauce.

Recipe is for those hunks of meat at the top...ignore the other things.


Sweet and spicy five-spice pork
Adapted from Real Simple

Makes about 4 servings

Ingredients:
  • 1/2 cup low sodium soy sauce
  • 1/2 cup brown sugar
  • 3 tablespoons chili-garlic sauce
  • 2 tablespoons sliced ginger
  • 1 teaspoon Chinese five-spice powder
  • 1/2 teaspoon salt 
  • 1/4 teaspoon ground white pepper
  • 1/4 teaspoon black pepper
  • 2.5 lbs pork shoulder, trimmed of excess fat and cut into 2 inch pieces
  • 2 scallions, sliced

Instructions:
  1. Heat cooking oil in a skillet. Sear pork chunks until a brown crust is formed on all sides. Toss into slow cooker.
  2. Mix together soy sauce, brown sugar, chili-garlic sauce, sliced ginger, five-spice powder, salt, white pepper and black pepper. Pour mixture over pork.
  3. Cook, covered, on low for 8-9 hours (or on high for 5-6 hours) until pork is tender.
  4. Top with sliced scallions and serve with rice.