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ALCOHOL                                                              633

Alcohol acts differently on different individuals and also on the same \
individual at different times. The action depends mostly upon the environ- ,
ments and temperaments of the individuals and upon the degree of dilution !
of the alcohol consumed. The habitual drinker usually shows fewer effects '
from the same dose of alcohol.

In order to ascertain whether a particular individual is drunk or not a
medical practitioner should bear the following points in mind: —

1.    The quantity taken is no guide.

2.    An aggressive odour of alcohol in the breath, unsteady gait, vacant
look,   dry   and   sticky  lips,   congested   eyes,   sluggish  and  dilated  pupils,
unsteady and thick voice, talks at random and want of perception of the
passage of time are the usual signs of drunkenness.

A Special Committee n of the British Medical Association was appointed
to " revise and bring up-to-date its reports on tests for drunkenness (1927)
and the Relation of alcohol to Road Accidents (1935)". The Committee has
rewritten the 1927 report under the title of " The recognition of Intoxica-
tion". (The second report is yet to be published.) In it the medical pro-
fession is given the following guidance in the practical aspects of the medical
examination of persons suspected of being under the influence of alcohol: —

I.    The Committee would define alcoholic intoxication as the condition
produced in a person who has taken alcohol in a quantity sufficient to cause
him to lose control of his faculties to such an extent that he is unable to
execute the occupation on which he is engaged at the material time.   Drivers
of motor vehicles often fail to realise that although after a drink they may
experience a sense of well-being and feel that they are driving well, their
critical faculties are in fact impaired and that as a result they are liable to
take risks they would never accept at other times,

II.    The doctor should examine the suspected person thoroughly and
keep full notes.   He should also exclude any pathological condition which
may simulate or exaggerate alcoholic intoxication as apart from odour of the
breath there is no single symptom or sign due to the consumption of alcohol
which may not also be found in some pathological states,

The following are the chief pathological conditions which may simulate alcoholic
intoxication: —

(1)  Severe head injuries.

(2)  Metabolic disorders, e.g. hypoglycsemia, diabetic precoma, uraemia, hyperthyroi-

(3)  Neurological conditions associated with dysarthria, ataxia, tremor, drowsiness,
e.g.   disseminated  sclerosis,   intracramal  tumours,   Parkinson's  disease,   epilepsy,   acute
aural virtigo.

(4)  The effects of some drugs—particularly when there is an unexpected reaction,
when taken for the first time or in an unusually large dose, e,g< Insulin; the barbitu-
rates ; most of the antihistamimc group of drugs; morphine; hyoscine.

Extreme cold, exposure or fatigue may also render a subject unduly susceptible to
the effects of alcohol,

III.    The  Committee  recommends  the  following   scheme   of  medical
examination: —

Record date and time of examination.
Exclude any injuries and pathological states.

Take a short history-—Enquire if he feels well, what food and drink did
he take last. Enquire regarding fits, any other disease or disabilitiy. If a
diabetic, does he take insulin—its dose and when taken last.

11,   Report of a Special Committee of the British Medical Association, The Recognition
of Intoxication, 1954.