609

to the 1967 Act it was estimated that some 100 000

backstreet abortions were performed every year, often withfatal or other disastrous outcomes. Women in Ireland have

the opportunity to go to the UK so there is no call forwidespread clandestine practice in their country. Instead,each year several thousand women go in stealth and

secrecy to the UK for abortions not allowed in Eire, and thepro-life lobby has been encouraging the Irish courts to banall counselling and assistance with a view to procuringabortions abroad. However, last October, the power of theIrish courts to ban the supply of addresses with a view toobtaining abortions in the UK was challenged in the

European Court.The decision of Mr Justice Costello to impose a travel ban

purported to dispose of the EC requirement on freedom oftravel by drawing analogies with the right of EC countries torefuse entry to Scientologists or those with criminal

convictions thought likely to re-offend (eg, "undesirablealiens"). However, this analogy does not bear scrutiny in thecontext of a woman travelling from one EC member state toanother which is happy to receive her.

In last year’s European Court case the Irish Governmentdid not dispute the statement made to the court that it didnot prohibit a pregnant woman from exercising her right totravel and receive services of termination of pregnancyabroad and that its ban on provision of abortion informationdid not extend to measures to restrict the movement of

pregnant women. Thus last month’s Irish High Court banon travel was not only oppressive, cruel, and beyond therequirements of Irish law, but it was also in conflict with EClaw.The precise reasons for the Irish Supreme Court’s

decision have not yet been released. A reference for further

guidance by the European Court is probable.Diana Brahams

Noticeboard

Return to Lamaze?

What factors determine the pain experienced by women duringlabour? Lowe! questioned 165 women at term gestation and foundthat the two major predictors of both sensory and affective pain inthe first stage of labour were the degree of confidence they had intheir ability to handle the delivery and the severity of their periodpain. The adverse predictive influence of dysmenorrhoea mightreflect a similar mechanism modulating uterine activity in bothmenstruation and labour. Pain in the second stage of deliverydepended largely on concern about the outcome of the pregnancyand a fear of the pain that might be endured. An understanding ofthese types of anxiety should enable intervention to limit the needfor analgesia and anaesthesia. Lowe’s data seem to offer support forthose who advocate the Lamaze technique. This method of

psychoprophylaxis involves abdominal and pelvic floor exercises,relaxation and breathing techniques, and comfort aids. To increaseconfidence about, and reduce fear of, the outcome of pregnancy-which the Lamaze technique intends to do-is the logical step thatfollows from Lowe’s work. Whatever method is adopted, a greateremphasis on this aspect of pregnancy is certainly justified.

1 Lowe NK Critical predictors of sensory and affective pain during four phases of laborJ Psychosom Obstet Gynecol 1991; 12: 193-208

Whose right to choose?The risks that certain religious views pose to public health are

highlighted by a series of pertussis outbreaks in Massachusetts,USA.1 Between 1981 and 1988, the incidence of whooping coughincreased in the US from 05 cases per 100 000 to 1-4 cases per100 000. The increasing rates of infection reflect parental concern

about the safety of the pertussis vaccine and a malpractice-drivenoverinterpretation of the guidelines for medical contraindications.Four outbreaks (113 patients in all) that took place among schoolcommunities are described in the latest report. In one school, 24cases came from families who had adopted macrobiotic diets andclaimed religious exemption from immunisation. In another group,the attack rate among those who were unvaccinated on similar

religious grounds was 3-3 times greater than in children who werevaccinated. State immunisation laws allow exemption for bothreligious and philosophical reasons, but these may be inappropriatebecause they have been applied only to the pertussis vaccine.

1. Etkind P, Lett SM, MacDonald PD, Silva E, Peppe J. Pertussis’s outbreaks in groupsclaiming religious exemptions to vaccinations. AJDC 1992; 146: 173-76.

Of moose and men and motor cars

The moose (Alces alces), or elk as it is called in Europe, is thelargest living deer. An average male moose weighs 450 kg, stands180 cm high at the shoulder, and causes quite a bump when hit by amoving vehicle. In Newfoundland, Canada, in 1987-88 there were661 motor-vehicle accidents involving a moose (3% of all motor-vehicle accidents in that period), resulting in injuries to 133 peopleand 3 fatalities. The health-care cost (in Canadian dollars) ofmoose-vehicle accidents was$377 000. Most injuries were to thehead, neck, and upper extremities, and were minor. However,patients involved in a secondary collision (other objects hit afterhitting, or avoiding, the moose) had more injuries to thethoracolumbar spine, abdomen, or chest, and all the deaths were inthis group. Injuries to moose were not recorded. The legs of a mooseare long, giving it a high centre of gravity-thus when hit by a carthe animal’s body tends to fly up into the car’s windscreen, resultingin the characteristic pattern of injuries seen in moose-vehiclecollisions. Most accidents involving moose were in the summer andautumn, and shortly after sunset. In Sweden, where moose are also adriving hazard, the car company Volvo has come up with a way ofavoiding night-time collisions. They propose fitting cars with

headlamps that emit ultraviolet radiation-apparently moose furfluoresces naturally in ultraviolet light.2

1. Rattey TE, Turner NE. Vehicle-moose accidents in Newfoundland. J Bone Joint SurgAm 1991; 73A: 1487-91.

2. Anon. The night nders of the black lights. Economist 1992; 322: 100 (Jan 18).

The bicycle age"Pedestrians should be given priority and cycle bells rung, or a

shout given in a considerate way to alert them when necessary".1The pecking order of London traffic is too fierce for such niceties.With bizarre clothing, helmet, and mask the urban cyclist, so long avictim himself, today hurtles down marked cycle lanes like somemedieval knight but without the gallantry, jousting with the humblefoot soldier. Miraculously only five pedestrians were killed bycyclists in the UK in 1989. The British Medical Association hasdiscovered the bicycle and finds it good. And so it is:

environmentally friendly and healthy, but potentially dangerous ifadvice is not heeded. A BMA steering group (what else?) presents astrong argument for two-wheeled non-motorised transport andcovers all the ground from cycle maintenance to air pollution. Weare also told three different ways of making a right turn, a

manoeuvre in which the BMA itself has lately demonstrated smoothpolitical skill. Much advice was sought from the Netherlands wherethere are many bikes and few hills. The university city of

Cambridge is bicycle laden and gradient-free too, but some localworthies there are fed up with that mode of transport and wouldrestrict it. If cycling is to fit comfortably into urban transport in the21st century a lot of rethinking will have to be done, as this reportshows-and that may mean addressing the non-illuminatedthree-abreast brigade that so worry the burghers of

Cambridgeshire.

1 British Medical Association Cycling: towards health and safety. Oxford and NewYork Oxford University Press. 1992 Pp 159. £5.99 ISBN 0-192861514.