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28 Medico-Legal J. 1 (1960)

handle is hein.journals/medlgjr28 and id is 1 raw text is: EDITORIAL ALCOHOLIC IMPAIRMENT AND DRIVING WITH the background of the appalling loss of life on the roads three factors have stirred up interest in the drinking driver. The Medical Research Memorandum (No. 38) on the effects of small doses of alcohol on a skill resembling driving repro- duces, with additions, the paper by Professor Drew and others which we recently reprinted (Medico-Legal J., 1958, p. 94). This was followed by the British Medical Association report on alcohol and road accidents, in which similar conclusions to the Medical Research Council Memorandum are reached. Finally, point was added to the renewed interest by the increase in road traffic deaths over the Christmas Holiday of 1959. It is now a moral certainty that there will be legislation to enforce chemical tests in cases of drinking driving. Already a private member's Bill on the subject has been tabled. The emphasis is all the time on alcoholic impairment, not gross drunkenness. Unfortunately, the term drunk in charge is still in the minds of the lay public, and probably always will be. As the majority of people who drive while alcoholically impaired do not come from the criminal classes, and often are highly respectable citizens, this is unfortunate, for it bears a stigma of disgrace. Both Memorandum and B.M.A. report deal with the effects of small doses of alcohol. They show that at no time after taking alcohol is driving skill improved, there is steady deterioration from the first drop. This confirms what is already well known about the effects of alcohol. They underline the well known fact that individual reaction to alcohol varies enormously, especially in small doses. The third, less well recognized fact, is the extreme variation between doctors trying to assess the degree of alcoholic impairment by clinical examination. It is questionable whether clinical judgment is an appropriate basis on which to assess the effects of alcohol on the performance of a skilled task such as driving a car. Penner and Coldwell (Canad. Med. Ass. J., 1958, 79, 793-800) paid special attention to assessment by experienced doctors of drivers who negotiated a test course after known amounts of alcohol. Blood alcohol figures rarely exceeded 150 mg. per cent. There was little correspondence between the findings of the two medical examiners. One found driving ability impaired in 27% and the other in 58% in comparable cases. The relationship between the blood alcohol and signs of impairment was likewise poor. From their findings it is plain that physical exam- ination alone will not reveal lesser degrees of alcoholic impairment. In this country the relevant offence is driving while under the influence of drink or drugs to such an extent as to be incapable of having proper control of the vehicle (Road Traffic Act, 1930, section 15). The issue is the question of incapability, and experience shows how opinions on this differ. Most experienced police surgeons agree that the doctor's duty should only go so far as excluding illness as a cause of disability. This is not always easy, but if it can be done they feel that the decision on drink is one for the experienced layman, guided by general evidence in the case. This is the practice in the Royal Navy. A physical examination is none the less important for this reason. Conclusion 6 of the British Medical Association's Report says A clinical examination is an essential part of the examination of persons suspected of driving vehicles under the influence of alcohol, since it is the only way of detecting physical illness and the presence and extent of any injury. Is a chemical test the answer? Experimental error apart, we at once meet the individual variation in response to alcohol. At what level should the threshold blood alcohol be fixed? If there is no alcohol the situation is easy. If the person is

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