423 nant, when, by their own admission, they ought to have realised that they were, or else they realised that they were pregnant but hoped that if they ignored it it might go away. In six cases pregnancy was initially not unwelcome, but a change of circumstances-usually the break-up of a steady relationship-led to a request for abortion. Three women delayed because they could not afford an abortion and believed the N.H.S. would not help them. In three cases delay was entirely due to the failure of doctors to diagnose pregnancy at an early stage when they ought to have done so. I have reported an example of this kind of error (Jan. 1, p. 46). Two women had had negative pregnancy tests. One university student was referred by her general practitioner for an N.H.S. abortion at 11 weeks’ gestation, but was refused, and three other patients had unsuccessfully tried to obtain an N.H.S. abortion. Although an N.H.S. refusal might be seen by some as proof that there was no indication for abortion, in one case a woman with disseminated cancer was refused, though it is difficult to see how she could have been properly treated had the pregnancy continued. This study indicates that the causes of late abortion are more numerous than might have been thought. In only a minority of cases could the lateness be blamed on unrealistic attitudes, and, bearing in mind the age of the sample, such

attitudes

are not

really surprising.

Department of Psychiatry, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH

COLIN BREWER Psychiatric Adviser, British Pregnancy Advisory Service

ABORTION ON REQUEST

SIR,—We are not told who paid for the survey of gynæcologists which has just been distributed by Social Surveys (Gallup Poll) Ltd, but a glance at the questions is suggestive. The survey is concerned with what is referred to throughout as "abortion on demand". This is a good emotive phrase guaranteed to raise the hackles of every gynaecologist. This is why it has been preferred to "abortion on request". I expect that on Feb. 25, during the House of Commons debate on the proposed restrictions to the Abortion Act or at the subsequent committee stage, an M.p. will cite the "fact" that 99% (or some such figure) of gynaecologists are opposed to abortion on demand, implying that gynaecologists are in favour of Mr William Benyon’s Bill. Perhaps this is the moment to remind people of the replies consultant gynaecologists gave to very clear and specific questions in a survey carried out by the Institute for Social Studies in Medical Care. The survey asked whether gynaecologists would be prepared to carry out abortions on very young girls (87% said yes), for unmarried college students in their final year (53% agreed to this), for married women with many children (72% agreed) and for "an unmarried poorly paid working girl", probably the most common case of all (56% and many more are contained in agreed to this). These figures Marjorie Waite’s book.’1 17 Dunstan Road,

MADELEINE SIMMS

London NW11 8AG

KITCHEN BOILERS AS SOURCE OF LEAD AND CADMIUM

SIR,-Beverages prepared with water heated in boilers of the kind commonly used in catering establishments are liable to contamination by lead and cadmium. Samples of water from the inlet (cold) and outlet (hot) were taken from 48 boilers in kitchens of hospitals where lead and cadmium levels of the water supply to the boilers were within the World Health Organisation limits for drinking water (0.11 1. Wane, M. Consultant Gynæcologists and Birth Control. Birth Control Trust, 1974.

LEAD AND CADMIUM CONCENTRATIONS IN INLET AND OUTLET WATER OF HOSPITAL KITCHEN BOILERS

parts per million [p.p.m.] for lead and 10 parts per billion [p.p.b.] for cadmium). Lead and cadmium were estimated by a flameless atomic-absorption technique. 95% of the boilers showed an increase in lead levels of the water at the outlet, with 60% over the W.H.O. limit (see table). For cadmium, 85% showed increased levels at the outlet, with 8% over the W.H.O. limit. The differences were significant (p