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EAT FAT HEN CAREFULLY?
223 FETAL "SOAP" ADDICTION
SIR,-Dr Hepper (June 11, p 1347) reports infants quietening while listening to television "soap" theme tunes they had "heard" in utero while their mother relaxed. Mary Birch and her husband (July 2, p 40) report that a noise "heard" during labour would cause their baby to wake and cry if heard postnatally. During my recent pregnancy my 6-year-old son practised his violin every morning while I was busy around the house; only occasionally would he play to me while I rested. My new baby adopted the quiet alert state when he heard the pieces that my son had been practising. He ceased to cry and listened quietly to my son playing and would also quieten if a tape of the music was played. This effect persists 7 months after birth. It seems that the auditory signals heard prenatally need not be associated with maternal relaxation to produce the quiet alert state in an infant. Nuffield Health Centre, Witney, Oxon OX8 7HQ
NIMMI NAIDOO
SIR,-Dr Hepper reports the possibility of prenatal learning and conditioning the fetus by repeated daily exposure to auditory signals. I have just finished an investigation which confirms that prenatal exposure to certain sounds offered can be recognised by the newborn baby. In a pilot study 28 newborn babies (24-48 h old, mean 38 h) were observed by three independent observers and a videocamera to see if they would "pay attention" to their own mother’s voices and to the voice of another woman. Reactions to an offensive tooter noise (startle) and to a simple lullaby produced by a musical box (attention) were also observed. 15 mothers had produced a tooter noise (T) and 13 had played a musical box (M) during the last 4 weeks of their pregnancy at least twice daily. The fetus’ own mother’s voice was an unlimited sound. Practical restraints and the fact that a newborn baby does not have a regular waking and sleeping rhythm meant that the baby was not always awake when the experiment was due. Although "attention" can only be monitored when a baby is awake, "startle" can be observed when the baby is asleep. The experiment was done regardless of the state of consciousness of the baby. Of the 15 babies who were awake, 9 paid attention to their mother’s voice, as indicated by their behaviour. None of these 15 babies paid attention to any other woman’s voice. 10 or the 15 T babies did not "startle" any time when the noisy tooter sounded, neither when sleeping nor when awake. The remaining 5 were only slightly startled. Of the 13 M babies, who had not been conditioned to the tooter noise, 10 were notably startled the first time they were confronted with this sound, either sleeping or awake. But when the noise was repeated shortly afterwards they were startled not at all or only a little. None of the 6 M babies who were awake displayed any special attention to the lullaby their mothers had played for them during pregnancy. The experiment dealt with circumstances that occur naturally. It shows that a baby can become familiar prenatally to the daily turmoil of life after birth. This study did confirm that a newborn baby can recognise his own mother’s voice. van Ketwich Verschuurlaan 5, 9721 SB Groningen, Netherlands
S. M. I. DAMSTRA-WIJMENGA
1 DeCasper AJ, Fifer WP. Of human bonding: newborns prefer their mothers’ voices. Science 1980; 208: 1175-76.
EAT FAT HEN CAREFULLY?
SIR,-Your note (July 2, p 59) warns against "gastrointestinal upset, weakness, and coma" caused by eating just a few fresh elderberries. I enjoy both elderflower and elderberry drinks, as unfermented cordial rather than wine, and when picking elderberries I normally eat some-and have never suffered as suggested. Such suffering could occur from eating a few berries of a plant of the nightshade family by mistake, but I should be interested to know whether anyone has ever actually been made ill by fresh ripe elderberries. I also enjoy rowan and apple jelly, despite a widespread myth that rowan berries too are poisonous.
In regard to the wasteland plant "fat hen", Platt’s nutritional tables1 call Chenopodium album "quinoa" and list the seeds among the cereals, with no warning of toxicity, with 345 kcal and 12 g protein per 100 g portion, much the same as better known cereal grains. Davidsonz gives a different specific name, C quinoa, for quinoa and mentions it as a "hardy millet" used in South America. Platt also mentions Chenopodium leaves as being high in carotene. There are many foods which, while safe for most people in moderate quantities under normal circumstances, may cause reactions in some people at any time and may adversely affect others if eaten under abnormal circumstances-such as in a famine, without other foods to balance them. Cassava(Manihot esculenta)is an example of a very valuable and widely eaten crop which can also poison people. Different varieties contain varying amounts of cyanogenic glycosides. Some can cause fatal poisoning if eaten without careful preparation to remove the poison. Communities which make widespread use of these varieties have developed methods of soaking, pounding, and drying the roots, to provide a cyanide-free flour. The use for food of under-used edible plant products, but with care and with concern for the pitfalls which traditional users may already know about, should be encouraged. Department of International Community Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA
DAVID STEVENSON
1. Platt BS. Tables of representative values of foods commonly used in tropical countries. London: HM Stationery Office, 1962: 6, 14 2. Davidson S, et al. Human nutrition and dietetics, 7th ed. Edinburgh; Churchill Livingstone, 1979: 175.
PULMONARY HYPERTENSION IN GESTATIONAL CHORIOCARCINOMA: A WEST LONDON SYNDROME?
SIR,-Your June 11 editorial on contributions from necropsy studies to pulmonary hypertension prompts me to refer to a cause of pulmonary hypertension first identified at necropsy and described in detail in The Lancet almost 30 years ago.’ Occlusive disease of the pulmonary arteries occurs in a rare form of gestational choriocarcinoma in which both a uterine mass and conventional metastatic disease may be lacking. Perhaps it is worth drawing this to the attention of cardiologists and respiratory physicians again since these cases rarely have gynaecological presentations and both the tumour and hypertension are curable if treated before irreversible changes occur. Curiously, the syndrome has only been recognised at hospitals within a few miles of each other in west London, and six of the eight patients seen here have been local residents. None appear to have been reported in life and few at necropsy elsewhere in Britain, or indeed elsewhere in the world. At the time of diagnosis a recent case had no perfusion of the right lung and only limited perfusion of the left. She had been under investigation for 2 years and only insistence by the radiologist on a pregnancy test under the 10-day rule led to the diagnosis. The essential features which call for assay of human chorionic gonadotropin are exertional dyspnoea without obvious cause in a woman who has been or could have been pregnant during the preceding five years or so and whose chest radiograph, carefully examined, shows loss of vascular markings in one or more areas of the lung. Pleuritic pain, clinical evidence of pulmonary hypertension, and the electrocardiographic changes of right heart strain may or may not be present. At necropsy the condition is likely to be mistaken for thromboembolism affecting pelvic veins and pulmonary arteries unless the thrombotic material is carefully examined
microscopically. Recognition of the syndrome only on the west side of London seems likely to have implications other than a local environmental
hazard. CRC Laboratories, Department of Medical Oncology, Charing Cross Hospital, London W6 8RF
K. D. BAGSHAWE
1 Bagshawe KD, Brooks WDW. Subacute pulmonary hypertension chorionepithelioma. Lancet 1959, i: 653-58
due
to
SIR,-Dr Hepper (June 11, p 1347) reports infants quietening while listening to television "soap" theme tunes they had "heard" in utero while their mother relaxed. Mary Birch and her husband (July 2, p 40) report that a noise "heard" during labour would cause their baby to wake and cry if heard postnatally. During my recent pregnancy my 6-year-old son practised his violin every morning while I was busy around the house; only occasionally would he play to me while I rested. My new baby adopted the quiet alert state when he heard the pieces that my son had been practising. He ceased to cry and listened quietly to my son playing and would also quieten if a tape of the music was played. This effect persists 7 months after birth. It seems that the auditory signals heard prenatally need not be associated with maternal relaxation to produce the quiet alert state in an infant. Nuffield Health Centre, Witney, Oxon OX8 7HQ
NIMMI NAIDOO
SIR,-Dr Hepper reports the possibility of prenatal learning and conditioning the fetus by repeated daily exposure to auditory signals. I have just finished an investigation which confirms that prenatal exposure to certain sounds offered can be recognised by the newborn baby. In a pilot study 28 newborn babies (24-48 h old, mean 38 h) were observed by three independent observers and a videocamera to see if they would "pay attention" to their own mother’s voices and to the voice of another woman. Reactions to an offensive tooter noise (startle) and to a simple lullaby produced by a musical box (attention) were also observed. 15 mothers had produced a tooter noise (T) and 13 had played a musical box (M) during the last 4 weeks of their pregnancy at least twice daily. The fetus’ own mother’s voice was an unlimited sound. Practical restraints and the fact that a newborn baby does not have a regular waking and sleeping rhythm meant that the baby was not always awake when the experiment was due. Although "attention" can only be monitored when a baby is awake, "startle" can be observed when the baby is asleep. The experiment was done regardless of the state of consciousness of the baby. Of the 15 babies who were awake, 9 paid attention to their mother’s voice, as indicated by their behaviour. None of these 15 babies paid attention to any other woman’s voice. 10 or the 15 T babies did not "startle" any time when the noisy tooter sounded, neither when sleeping nor when awake. The remaining 5 were only slightly startled. Of the 13 M babies, who had not been conditioned to the tooter noise, 10 were notably startled the first time they were confronted with this sound, either sleeping or awake. But when the noise was repeated shortly afterwards they were startled not at all or only a little. None of the 6 M babies who were awake displayed any special attention to the lullaby their mothers had played for them during pregnancy. The experiment dealt with circumstances that occur naturally. It shows that a baby can become familiar prenatally to the daily turmoil of life after birth. This study did confirm that a newborn baby can recognise his own mother’s voice. van Ketwich Verschuurlaan 5, 9721 SB Groningen, Netherlands
S. M. I. DAMSTRA-WIJMENGA
1 DeCasper AJ, Fifer WP. Of human bonding: newborns prefer their mothers’ voices. Science 1980; 208: 1175-76.
EAT FAT HEN CAREFULLY?
SIR,-Your note (July 2, p 59) warns against "gastrointestinal upset, weakness, and coma" caused by eating just a few fresh elderberries. I enjoy both elderflower and elderberry drinks, as unfermented cordial rather than wine, and when picking elderberries I normally eat some-and have never suffered as suggested. Such suffering could occur from eating a few berries of a plant of the nightshade family by mistake, but I should be interested to know whether anyone has ever actually been made ill by fresh ripe elderberries. I also enjoy rowan and apple jelly, despite a widespread myth that rowan berries too are poisonous.
In regard to the wasteland plant "fat hen", Platt’s nutritional tables1 call Chenopodium album "quinoa" and list the seeds among the cereals, with no warning of toxicity, with 345 kcal and 12 g protein per 100 g portion, much the same as better known cereal grains. Davidsonz gives a different specific name, C quinoa, for quinoa and mentions it as a "hardy millet" used in South America. Platt also mentions Chenopodium leaves as being high in carotene. There are many foods which, while safe for most people in moderate quantities under normal circumstances, may cause reactions in some people at any time and may adversely affect others if eaten under abnormal circumstances-such as in a famine, without other foods to balance them. Cassava(Manihot esculenta)is an example of a very valuable and widely eaten crop which can also poison people. Different varieties contain varying amounts of cyanogenic glycosides. Some can cause fatal poisoning if eaten without careful preparation to remove the poison. Communities which make widespread use of these varieties have developed methods of soaking, pounding, and drying the roots, to provide a cyanide-free flour. The use for food of under-used edible plant products, but with care and with concern for the pitfalls which traditional users may already know about, should be encouraged. Department of International Community Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA
DAVID STEVENSON
1. Platt BS. Tables of representative values of foods commonly used in tropical countries. London: HM Stationery Office, 1962: 6, 14 2. Davidson S, et al. Human nutrition and dietetics, 7th ed. Edinburgh; Churchill Livingstone, 1979: 175.
PULMONARY HYPERTENSION IN GESTATIONAL CHORIOCARCINOMA: A WEST LONDON SYNDROME?
SIR,-Your June 11 editorial on contributions from necropsy studies to pulmonary hypertension prompts me to refer to a cause of pulmonary hypertension first identified at necropsy and described in detail in The Lancet almost 30 years ago.’ Occlusive disease of the pulmonary arteries occurs in a rare form of gestational choriocarcinoma in which both a uterine mass and conventional metastatic disease may be lacking. Perhaps it is worth drawing this to the attention of cardiologists and respiratory physicians again since these cases rarely have gynaecological presentations and both the tumour and hypertension are curable if treated before irreversible changes occur. Curiously, the syndrome has only been recognised at hospitals within a few miles of each other in west London, and six of the eight patients seen here have been local residents. None appear to have been reported in life and few at necropsy elsewhere in Britain, or indeed elsewhere in the world. At the time of diagnosis a recent case had no perfusion of the right lung and only limited perfusion of the left. She had been under investigation for 2 years and only insistence by the radiologist on a pregnancy test under the 10-day rule led to the diagnosis. The essential features which call for assay of human chorionic gonadotropin are exertional dyspnoea without obvious cause in a woman who has been or could have been pregnant during the preceding five years or so and whose chest radiograph, carefully examined, shows loss of vascular markings in one or more areas of the lung. Pleuritic pain, clinical evidence of pulmonary hypertension, and the electrocardiographic changes of right heart strain may or may not be present. At necropsy the condition is likely to be mistaken for thromboembolism affecting pelvic veins and pulmonary arteries unless the thrombotic material is carefully examined
microscopically. Recognition of the syndrome only on the west side of London seems likely to have implications other than a local environmental
hazard. CRC Laboratories, Department of Medical Oncology, Charing Cross Hospital, London W6 8RF
K. D. BAGSHAWE
1 Bagshawe KD, Brooks WDW. Subacute pulmonary hypertension chorionepithelioma. Lancet 1959, i: 653-58
due
to