A TOUCH OF FRANCE: Cooking with heart, for the heart

Cooking with heart, for the heart:
The French recipes of the ESC European Cook Book –Tidbits of history and etymology
R. Ferrari , Italy

Illustration from the French weekly magazine La Cuisine des Familles (Family Cooking), dated 1905-1908.

© Stefano Bianchetti/Corbis.
France’s masterpiece of intangible heritage goes global:
French master chefs abroad
I . Spaak, France

Conclave of French chefs.
From left to right, seated: Paul Bocuse, Daniel Boulud, and US, but francophile Thomas Keller, at the 2009
“Bocuse d’Or” international cooking competition.

© Owen Franken/Corbis.
Cooking with heart, for the heart:
R. Ferrari , Italy

The European Cook Book: Healthy Diets, Healthy Hearts was published in 2010 by the European Society of Cardiology (ESC) as part of the European Heart for Children (EHC) initiative, as one of the ways to raise income for this newly founded humanitarian nonprofit organization. It called on contributions fromallmember cardiological societies of the ESC, the largest cardiological society in the world, with more than 65 000 members representing 53 countries in Europe and around the Mediterranean, including a number of Affiliate Societies in more distant parts of the world. The European Cook Book, edited by Roberto Ferrari and his wife, Claudia Floria, starts by giving solid science, with an overview of the major cardiovascular diseases and thorough dietary explanations. This is followed by the recipes, with 44 countries having contributed a heart-friendly menu consisting each of a complete meal, with first course, main course, and dessert, all of which epitomize their respective countries’ culinary traditions and prove that dietary cooking by no means need be a dreary, boring, and bland chore, but that it can be both exciting and a mouth-watering offering to the taste buds. This article focuses on the recipes provided by one country, France, to explore their cultural, historical, and etymological underpinnings, with surprising findings!

Medicographia. 2011;33:458-467 (see French abstract on page 467)

European Heart for Children (EHC)* is a humanitarian nonprofit organization aimed at addressing the plight of children with congenital heart disease (CHD) in the poorer member countries of the European Society of Cardiology (ESC)†, the world’s largest cardiological society, totaling more than 65 000 members from 53 National Societies in Europe and the Mediterranean and 36 Affiliated Societies throughout the world. The original idea for EHC came to my wife, Claudia Florio, an erstwhile linguist and translator who went on to become a screenplay author and film director. As I started my presidency of the ESC (2008-2010), she became interested in CHD and realized that it’s treatment was suboptimal in several of the ESC National Societies’ countries. She convinced me and the incoming ESC President, Michel Komajda, to establish a foundation whose mission was “To promote knowledge and treatment of CHD and related disorders in children and young adults in the ESC member countries and beyond.” This project was presented at the entire membership of the ESC at the Annual Congress in Barcelona in September 2009, was approved by the ESC Board, and the project was launched.1

One of the ideas that was triggered by this project was to publish a book—European Cook Book: Healthy Diets, Healthy Hearts2—that would deal with the prevention of cardiovascular diseases, and give advice on how to improve our lifestyle, in particular our eating habits. This book, edited by myself, Claudia Florio, and lavishly illustrated with photos by Paolo Zappaterra, was to be dedicated to the EHC, with income raised from its sale going directly to the newly established organization. The guiding idea was to avoid writing a dreary book with uninspiring dietary advice, and instead encourage a healthy diet without losing the pleasure of eating.

Each ESC National Society and Affiliate was invited to contribute a typical menu that they would recommend as healthy. All menus were scrutinized by a nutritionist to make them more healthy where needed, following the instructions laid out in the first, scientific part of the book. This formed the basis of the European Cook Book. This book is more than a mere collection of recipes, as it endeavors above all to serve an educational purpose, explaining what cardiovascular diseases are and providing suggestions on healthy ingredients and food preparation. Its table of ingredients allows the reader to prepare favorite recipes, making them healthier just by adjusting the proportion of “good” or “bad” ingredients.

One of the unexpected discoveries made while preparing this book was that it proved to be also a cultural adventure. One salient aspect is that European cuisine is a fusion of the Greek and Roman culture based on agriculture (fruit and vegetables), olive oil and wine—the forerunner of the much touted “Mediterranean diet,”3 and of the Nordic culture based on hunting (meat), beer, and butter. The gradient and consequently the interaction between the two cultures becomes very evident to the reader while sampling menus typically from northern Europe or those of the southern Mediterranean countries.

Recipes for a healthy heart from the European Society of
Cardiology (ESC) 2010. Photo courtesy of ESC.

Writing in the “Touch of France” cultural section of Medicographia, I thought it would be interesting to take a closer look— not at French culinary culture in general—but specifically at the recipes provided by the French Cardiological Society and, beyond the purely gastronomic aspects, hunt for some of the deeper cultural, historical, and even etymological underpinnings of those recipes. What I discovered was so fascinating, that it clearly calls for further forays into the cultural aspects of all the other countries represented in the European Cook Book—but that’s another story!

I start by giving a comprehensive list of the dishes proposed by the contributors (Table I, page 460 & 461), before focusing on the three recipes provided by the French Cardiological Society: Bouillabaisse, chicken in a pot, and Bourdaloue pear tart, and invite you to enjoy a gustatory and cultural voyage!


Bouillabaisse, France’s most celebrated soup—a stew really—( together with the no less famous “soupe à l’oignon” or onion soup) is the first course given in the European Cook Book by our colleagues of the French Society of Cardiology. It is redolent of Provence, lavender, anisette, Marcel Pagnol and his theater trilogy Marius, Fanny, and César,” and above all of its birthplace, Marseille and its “Vieux Port” (Old Port).

Table I. Recipes from the participating European Society of Cardiology (ESC) Societies, Associations, and Affiliates:
a mouth-watering reminder that diets needn’t be dreary.

The history of Bouillabaisse goes a long way back, to prehistoric times in fact, since fish soups/stews are attested as early as the Neolithic era. Bouillabaisse-like fish stews are also extremely widespread geographically: they are found throughout the countries bordering the Mediterranean like Greece, Spain, Italy (Roman mythology has Venus feeding such a soup to Vulcan), and further away in Portugal, Hungary, Russia, and Brazil. Its earliest appearance in France dates back to the foundation of Marseille by an ancient Greek people, the Phocaeans, in 600 BC, who called it kakavia (κακαβια, from the cauldron in which it was cooked). The dish is still popular in Greece today. Its strange name comes from the ancient Provençal variety of Occitan, from bolhir, meaning “to boil” and “abaissar;” meaning to reduce (the heat), let simmer: the idea was that, as soon as the soup started boiling, one had to reduce the flame (to avoid the fish disintegrating).

_ From simple fishermen’s stew to three-star–rated dish
Originally, Bouillabaisse was poor man’s fare, or rather, poor fisherman’s fare, seawater heated in a cauldron over a wood fire, with garlic and fennel, in which hungry fishermen returning to port would throw in their catch of the day of shellfish and common rockfish that were too bony for sale, saving the more marketable fish for their customers. In the 17th century, tomatoes, brought back from America, were added, then more herbs and spices such as saffron. From then onward Bouillabaisse grew increasingly sophisticated (and expensive to make) until it became the gourmet dish it is today. Its fans tend to wax emotional about it. One author, Alfred Capus, describes it as “fish with sun in it”; A. J. Liebling, writing for the New Yorker in 1962 reminisces: “Ever since 1918, when I ate my first bouillabaisse—an event that in my mind overshadowed the end of the First World War…”; Marcel Pagnol went irate upon hearing that a restaurant had added lobster to the ingredients, labeling this “heresy.”

The Old Port (Vieux Port) of Marseille, birthplace of the “real”

© Jon Hicks/Corbis

Platter of Bouillabaisse fish about to be filleted in front of the

© Owen Franken/Corbis.

Fishmonger in the Old Port of Marseille.

© George W. Wright/Corbis

Red rockfish, a potential Boullabaisse ingredient, in its natural

© Greg Ochocki/Corbis.

_ The Bouillabaisse Charter
Actually, the list of ingredients gives rise even today to heated debate, which often grows arcanely Linnaean in nature, with much bandying about of scientific binominal Latin designations. Non-French fledgling Bouillabaisse cooks can throw up their toque, apron, and ladle in despair over how to procure the requisite fish needed to produce the “real” thing. Fish names are notoriously complex in any given language, one fish often being called by numerous names, local names, or nicknames, and attempts at translation are often a nightmare. Also, since the 19th century, Bouillabaisse grew so popular that inspired chefs started improvising and adding ingredients at their whim and fancy. This brought about cries for a crackdown. Just as Cardinal Richelieu, in 1635, created the Académie Française to preserve and regulate the French language, a group of local restaurateurs from Marseille decided, in 1980, to draft a very official “Bouillabaisse Charter” to preserve the quality and noblesse of this dish. Charter signatories have by now been joined by members in other French cities, and abroad in other countries such as Switzerland and Morocco. The Charter states that any genuine Bouillabaisse should include at least four of the listed types of fish/shellfish/ crustaceans (I’m following the official translation provided by the Charter members, let no one blame me for any ichtyological faux-pas!—I would also add that several “official lists” coexist, which doesn’t always make things simple! Final point, in brackets and italic, I give the French names). I quote (Table II):

Table II
Table II. Ingredients for making Bouillabaisse.

_ The recipe
Peter Mayle, author of One Year in Provence, a book that propelled him instantly into world fame, writes of Bouillabaisse in Provence A-Z, his ultimate guide to the goodies, sights, and mores of Provence: “It has been invariably described as a stew, a soup of gold, a mystical experience, a magical synthesis, beach food, a divine seduction, or the reason God invented fish.” I would add that is also probably the reason God invented restaurants, as, to be quite frank, producing a real Bouillabaisse in one’s own kitchen is a daunting experience, both in getting the proper fish and because of the complexity of the recipe and the time involved! Also, it’s a sheer impossibility to prepare Bouillabaisse for fewer than 10 persons, seeing how many ingredients are necessary). Far easier for us harried cardiologists is to repair to a “Bouillabaisse Charter–certified” gastronomic temple such as, for example, “Restaurant Miramar” in Marseille, get the “real McCoy” and— as our Germans cardiologist colleagues like to say—“be happy as God in France!” However, for those not faint of heart who would like to take up the challenge of preparing their own Bouillabaisse according to the French Society of Cardiology recipe, I refer you to the relevant section in the European Cook Book as it would take up too much space to be reproduced here, and much would be redundant with the description I gave of the Bouillabaisse Charter ingredients!

Chicken in a pot, aka “poule au pot”

_ Good King Henry
Henry IV (1553-1610) is probably one of France’s most iconic kings, and arguably one of the best rulers the country ever had. He is credited with bringing peace and prosperity to France after more than forty years of religious wars between the Catholics and Protestants (Huguenots) and signing the Edict of Nantes (1598) which guaranteed the rights of the Huguenot minority. He restored a strong monarchy and—a genuine role model for today’s troubled economy—ruthlessly overhauled French finances, drastically reducing the national debt. He saved forests from devastation, built much-needed highways and waterways, promoted, agriculture, education, and the arts, financed Samuel de Champlain’s expedition to North America, thereby laying France’s claimto Canada. A considerate and conciliatory king, he was much loved by the populace, and has gone down in history as “Good King Henry.”

_ The King of the white plume and boiled chicken
King Henry IV is famously remembered for his tragic end. He was stabbed to death by Ravaillac, a fanatical catholic, on 14 May 1610. The blow pierced his left lung and severed the vena cava and the aorta, bleeding the king to death within minutes. Such a quick demise was not to be the fate of his murderer—an event that is deeply etched in the collectivememory of the French. Ravaillac was made to suffer a long, painful death over an entire day, tortured with pincers, molten lead and boiling oil and pitch poured into his wounds, his right hand coated with sulfur and set ablaze (an extra specifically reserved for regicides), before being dismembered by four horses, his body burnt and ashes scattered. Voilà!

Assassination of Henry IV by Ravaillac on 14 May 1610.
Painting by Charles-Gustave Housez (1822-1894). OIl on canvas,
1860, 140×118 cm, Musée du Château de Pau, Dépôt du Musée

© RMN/René-Gabriel Ojéda.

But Henry IV also remains well-remembered to this very day thanks to four famous historical quotes that are part of every French person’s historical heritage. The first is a rallying cry that the future king uttered while taking lead in a battle, exposinghimself to great personal risk: “Follow my white plume….” The second was his comment after having converted from Protestantism to Catholicism, which was the precondition for being accepted by the Parisians and acceding to the throne: “Paris is well worth a mass.” The third quote is actually from his visionary minister, Sully, but epitomizes the King’s economic priorities: “Plowing and grazing are the two teats of France.” (a quote guaranteed to elicit giggles in the classroom at the tender age at which this period of French history is usually taught). The fourth quote is a solemn vow for which Henry IV is most fondly remembered for and which directlyconcerns the main course cited by the French Society of Cardiology in the European Cook Book: “If God keeps me, I will make sure that there is no working man in my kingdom who does not have the means to put a chicken in the pot every Sunday.” His fame would have probably skyrocketed all the way up to lay sainthood in the eyes of present-day French school kids if he in fact had rather been the inventor of the all-time favorite “poulet-frites,” ie, roast chicken with (for readers across the Atlantic) French fries or (for those across the Channel) chips. Of course, it wouldn’t have been such a heart-friendly recipe in that case!

Chicken in the pot. The European Cook Book.

Photo courtesy of ESC.

Illustration from the French weekly magazine La Cuisine des
Familles © Stefano Bianchetti/Corbis.

Table III. Recipe of Chicken in a Pot.

_ The recipe
At his birth in 1553 in Pau, in the Province of Béarn in the Southwest region of France, the future king’s lips were rubbed with garlic and he was made to smell a cup of wine. This was a common practice with the newborn, to prevent disease. With hindsight: Southwest of France, garlic, and wine: wasn’t this the very first hint of the “French Paradox?” The recipe of “poule au pot,” a restorative chicken stew with vegetables, has been made even healthier in the European Cook Book with its suggestion to drop the originally included rich white sauce, use low-sodium salt, olive oil, and skin the chicken before cooking. This is how it goes (Table III).

Bourdaloue pear tart: surprising eponyms

_ Preaching in the “dessert?”
Louis Bourdaloue (1632-1704), from whom this dessert takes its name, was a 17th-century Jesuit and renowned preacher. His eloquence was compared to none other than that of Corneille and Racine. The philosopher Voltaire—no friend of the Church—praised him as surpassing even Bossuet at the pulpit, as much for his language as for his compelling reasoning and convincing proofs. He would preach with closed eyes and was nicknamed the “King of Preachers and Preacher to the Kings.” His style of speech has been praised as the most perfect in French history, and yet he was understood by all. Like Bossuet, many of his sermons were taken up in schoolbooks and became an integral part of French classical literature. Bourdaloue was repeatedly invited to deliver spiritual Advent and Lenten sermons at the court of King Louis XIV, a noteworthy total of eight times, which was all the more remarkable as preachers were called a maximum of three times to court. Even Protestants fell to his fiery eloquence and converted in droves. His secret was his knack of adapting to the most diverse of audiences, whether king or beggar. At the end of his life he devoted his ministry to the poor, prisoners, sick, and ailing in hospitals, prisons, and charitable institutions, still drawing crowds.

Statue of Jesuit preacher Louis Bourdaloue (1632-1704), by Louis Desprez.
Stone, before 1853. Passageway from Pavillon Richelieu to Pavillon Colbert, Cour Napoléon in the Louvre Museum.

© Marie-Lan Nguyen/Wikimedia Commons.

Volume 1 of the collected sermons of Louis Bourdaloue. Leather binding, 1707/1721. Malmaison, châteaux de Malmaison et Bois-Préau.

© RMN/André Martin.

_ Unexpected etymological developments
Bourdaloue was undoubtedly a spellbinding preacher, but also somewhat of a marathon talker, addicted to prolixity. So much so that his interminable sermons (often lasting over three hours) could be quite trying on parish bladders, particularly those of the gentler sex. As the story goes, some “canny” craftsman came up with just the right answer to keep the call of nature from jeopardizing the benefit of unabridged spiritual edification. Thus the more provident ladies—not unlike the Gospel’s wiser virgins with their lamps— would equip themselves with oblong portable (note the adjective, it’s relevance will be made clear very shortly) chamber pots, which they would conceal under their dresses (no miniskirts in those days!), and thus avoid having to leave their stalls or pews and lose the precious theological thread. Quite naturally, these chamber pots became eponymously known as “Bourdaloues.” From there it was a short step from undergoing corruption— perhaps by some English visitors lured to Paris by the preacher’s fame—to “portaloo” then “portable loo” and, as the British are known to like short crisp words, simply “loo”: QED, quod erat demonstrandum! Be that as it may, there are two other anecdotes that have been invoked to explain to the etymology of “loo,” for some unfathomable reason always linked to France.

One derives the word “loo” fromWaterloo, with the first recorded use coming from James Joyce’s Ulysses (1922): “Oyes,mon loup. How much cost? Waterloo. Watercloset.” Another theory derives the word “loo” from a French word of caution going back to the days when chamber pots were nonchalantly emptied out of windows directly onto the street: “gare à l’eau,” which translates as “watch out for the water” (water is a well-known euphemism for urine, as in “pass water”). Some poor sullied English tourist (perhaps a revenge for Waterloo…) misunderstood the phrase as “gardyloo,” which, again, was then shortened to “loo.”

Bourdaloue also left his name to a type of thick, corded ribbon used to stiffen seams, button bands and belts, and with which the preacher was wont to adorn his hats. In English, there is a similar eponymous derivation from Viscount Petersham (1780-1851), an army officer, with “petersham” also designating a ribbon as well as an overcoat made of heavy wollen fabric.

“Bourdaloues” were urinals shaped to the female anatomy and
used to relieve the pressure on pious ladies’ bladders during Louis
Bourdaloue’s long sermons. They were also called “coach pots” as
they helped ladies endure long coach journeys. Their heyday was
during the reigns of kings Louis XIV and Louis Philippe. In those
days ladies wore long crinoline dresses and lower undergarments
with unjoined legs, explaining their ease of use, hence yet a third
name: “crinoline slippers.” Some of these urinals had pattern-matching
china lids. Now coveted collectors’ items, they usually fetch between
€200 and €1000 at auctions. In 2006, a rare snail-shaped
bourdaloue dated 1752 changed hands for a hefty €25 000.
From top to bottom:

Bourdaloue made by Le Bel Jean-Étienne, l’Aîné, at the
Manufacture de Sèvres, 1767. © RMN (Sèvres, Cité de la Céramique)/Martine
Beck-Coppola. Boudaloue made in 1831 at the Manufacture de Sèvres, having
belonged to Princess Clémentine d’Orléans (1817-1907). © RMN, Versailles,
Châteaux de Versailles et du Trianon. Bourdaloue made around 1801-1810 by
Spode of Stoke-on-Trent, Staffordshire, England, with “Old Peacock” design.
Bourdaloue with “Pompadour” design, dated 1745, made in Jingdezhen, China
during the reign of Emperor Qianlong. © RMN (Sèvres, Cité de la Céramique)/
Martine Beck-Coppola.

Table IV. Recipe of Bourdaloue Pear Tart.

_ The recipe
But back to our topic of “Tarte Bourdaloue.” It will perhaps come to some readers as a double anticlimax to learn that although the name of this tasty pear-and-almond pie does hark back to Bourdaloue, it is in a somewhat removed way, since it has nothing to do with a particular delicacy characterizing the preacher’s possible proneness to the Sin of Gluttony, but simply to the fact that the confectioner—Monsieur Fasquelle—who invented this recipe in 1824, one hundred years after the preacher’s death, happened to have his bakery on the rue Bourdaloue in Paris.

The other cause for a feeling of anticlimax, is that the French Society of Cardiology included the recipe of “Tarte Bourdaloue” in the European Cook Book, albeit while issuing a strong caveat, since, to quote them: “This recipe is very rich in saturated fats and is not suitable for people with heart problems or those following a strict low-fat diet.” They do, however strike a note of optimism by adding, “However, we are including it here, as it is unlikely to do much harm if consumed once a year, on a special occasion such as Christmas, for example.” Thus the safe enjoyment of “Tarte Bourdaloue” depends on a proper sense of measure,—as do so many things—and Bourdaloue would certainly agree to that. He was much appreciated by his flock who well knew that “although austere in his behavior and character, he was, as a priest, as indulgent as his duties allowed him to be.

So, with Father Bourdaloue’s forgiveness and blessing, this is how to prepare your dessert (Table IV). _

Pear tart Bourdaloue.
The European Cook Book.

Photo courtesy of ESC.

1. Kirby T. ESC tackles child congenital heart disease in poor countries. Lancet. 2010;376(9740):501-502.
2. Ferrari R, Florio C, Zappaterra P. The European Cook Book: Healthy Diets, Healthy Hearts. Recipes From the European Society of Cardiology. © 2010, European Society of Cardiology.
3. Ferrari R, Rapezzi R. The Mediterranean diet: a cultural journey. Lancet. 2011;377(9779):1730-1731.