Peter R. Martin: Historical Vocabulary of Addiction, Vol. II
Breathalyzer
According to the current electronic version of the Oxford English Dictionary (OED), the noun breathalyzer was formed within English by clipping or shortening of the nouns breath and analyzer. The noun breath was inherited from the Germanic word meaning, “The air exhaled from the lungs, especially when discernible by smell, or by being visible in cold weather. Also, with preceding modifying word specifying something which makes the breath smell, as in beer breath, coffee breath, etc.” The noun breath first appeared in Middle English in the 13th century and was used by the English poet Geoffrey Chaucer (c1340–1400) in the Pardoner’s Tale, which is part of his Canterbury Tales (Chaucer 1872): “Sour is thy breeth.”
The noun analyzer (“A person who engages in analysis”; “A device for performing analysis”) was formed within English by derivation and combination of the verb analyse (“To differentiate or ascertain the elements of [something complex] in order to determine its structure or nature, and hence to explain or understand it; to examine closely and methodically for the purpose of interpretation; to subject to critical or computational analysis”) and suffix -er (“added…to nouns, forming derivative nouns with the general sense ‘a man who has to do with [the thing denoted by the primary noun]’, and hence chiefly serving to designate persons according to their profession or occupation”). An example of the first use of noun analyzer in the English language is by Joseph Hall (1574–1656), Bishop of Norwich, a religious writer and satirist, in A common apologie of the Church of England against Brownists (Hall 1647): “I neede no better Analyser then your selfe.”
The noun breathalyzer is defined in OED as: “Any of various devices used to measure the concentration of alcohol vapour in a person's breath, especialy as a test for intoxication carried out by a law enforcement officer in order to establish fitness for driving a motor vehicle. Frequently as a modifier, especially in breathalyser test.” The noun breath alcohol is defined in OED as: “the concentration of alcohol vapour in air exhaled from the lungs, which correlates with blood alcohol concentration and is used as the basis of a non-invasive test for intoxication.” An early example of the use of the term breath alcohol is found in an editorial in The Lancet (Anonymous 1938): “Harger and his colleagues... demonstrated a good correlation between the blood alcohol and the breath alcohol.”
The notion of detecting alcohol in body fluids, including the breath, was anticipated by Francis Edmund Anstie (1833 –1874), an English physician and medical author and journalist, notable for “Anstie's limit,” an amount of alcohol that could be consumed daily with no ill effects, as described in his monograph Stimulants and narcotics, their mutual relations: with special researches on the action of alcohol, aether, and chloroform on the vital organism (Anstie 1865).
Emil Bogen (1896-1962), an American physician and researcher who studied alcoholism and contributed to the invention of the breathalyzer, provided a useful explanation of the necessity in clinical medicine for quantifying alcohol concentrations in body fluids (Bogen 1927):
“In view of the difficulty in making the diagnosis of acute alcoholic intoxication from the clinical evidence alone, as may be confirmed from a review of the data in the cases above presented, and in view of the constancy of the findings as to the concentration of alcohol in the urine and in the breath with reference to the degree of alcoholic intoxication, it is concluded that the examination of patients to determine the state of intoxication should in every case include some quantitative determination of the amount of alcohol present in the urine, breath, or body fluids. It is not expected that such test should supersede and entirely replace all of the other clinical evidence presented, but, as any laboratory test, it must be interpreted in the light of the findings in the individual case. A study of the results in the series of cases just analyzed, however, as well as those reported by many other observers, notably Nicloux [(Nicloux 1931)], Widmark [(Widmark 1932)], Schweisheimer [(Schweisheimer 1913), Miles [(Miles 1922)], Mellanby [(Mellanby 1920)], Southgate [(Southgate 1925)] and Carter [(Carter 1926)], and many others, leads us to rely upon the alcoholic concentration in the urine, breath or tissues as the most important single factor in arriving at a correct conclusion as to the degree of intoxication of a patient.”
Many of the investigators mentioned above contributed significantly over a century to elucidation of the disposition of alcohol in the body and determination of the correlation of alcohol concentrations in body fluids to the pharmacological effects of this agent. However, the development of a serviceable instrument to determine breath alcohol concentrations in a practical manner, the Breathalyzer™ (a genericized trademark), was not developed until 1954 by the American inventor Robert Frank Borkenstein (1912–2002). When an individual who has consumed alcohol exhales into the breath analyzer, any ethanol present in the breath is oxidized to acetic acid and water at the anode, producing an electric current which can be accurately measured. The instrument reliably and noninvasively (without venipuncture) estimates the level of alcohol in the bloodstream (Voas 2003). This is accomplished by accurately analysing the concentration of alcohol in air exhaled from the lungs and then using this measured value to derive the blood alcohol concentration (Bogen 1927; Harger, Hulpieu and Lamb 1937; Harger, Raney, Bridwell et al. 1950).
The major medicolegal application of blood alcohol concentration (BAC) stems from its reliable association with impairment of performance of a range of brain functions (see Intoxication), in particular, attention, reaction time and motor skills required for driving an automobile in individuals and in the population (Anonymous 1924; Smith and Popham 1951). Borkenstein carried out the initial research that supported BAC determinations in predicting the legal limit above which it was statistically considered unsafe to drive (Borkenstein, Crowther and Shumate 1974). This work, the so-called Grand Rapids study, established the relationship of BAC to crash risk.
By comparing the BAC of crash-involved drivers with non-crash-involved drivers who were using the roads at the same times and in the same places and incorporating various other risk factors in the multivariate analysis, Borkenstein et al. demonstrated that BACs over 0.04% are definitely associated with an increased accident rate and the probability of accident involvement increases rapidly at BACs over 0.08%, and becomes extremely high at BACs above 0.15%. These findings spurred legislative adoption in many countries around the world of distinct BAC limits above which a person is considered to be driving under the influence (DUI). This concept of DUI provided the foundation for legal prosecution of those deemed unable to drive due to drinking alcohol as well as the contemporary legislative challenge of considering driving capacity with use of other drugs of abuse alone or in combination with alcohol (Voas 2003; Romano, Torres-Saavedra, Voas et al. 2014; Beaulieu, Naumann, Deveaux et al. 2022).
The estimate of BAC derived from breathalyzer determinations is used to calculate the dose of alcohol consumed upon ingestion of an alcoholic beverage as well as to correlate this with the resulting pharmacological effect. However, when breath alcohol and BAC are measured simultaneously in an individual over time, the blood/breath partition coefficient was found to vary substantially from the commonly accepted value of 2100, indicating likely differences between direct and derived values for blood alcohol concentration even in the same individual over time (Alobaidi, Hill and Payne 1976).
Once BAC has been estimated, subsequent calculations to determine the dose of alcohol consumed can be determined based on pharmacokinetic parameters of absorption, metabolism and elimination from the body of alcohol that originate from the pioneering work of the Swedish physician and chemist Erik M. P. Widmark (1889-1945). Widmark published numerous papers on alcohol, methyl alcohol and acetone (Andréasson and Jones 1996), culminating in his monograph Die theoretischen Gundlagen and die praktische Verwendbarkeit der gerichtlich-medizinschen Alkoholbestimmung (Widmark 1932). In this monograph, he discussed the pharmacokinetics of alcohol in detail and derived the “Widmark formula” for determination of the amount of alcohol in the body which continue to be used to this day with only minor modifications (Andréasson and Jones 1996; Maskell and Korb 2021).
In addition to identifying the blood level of alcohol in the population that should be considered as driving under the influence, blood alcohol concentrations determined by breathalyzer can be correlated with performance of various psychophysiologic tasks in individual subjects to better characterize the pharmacological effects of alcohol (Howells 1952; Martin, Lovinger and Breese 1995). The issue of inter-individual differences in susceptibility to alcohol has been suspected for some time in forensic medicine (Southgate and Carter 1926):
“It is difficult to reduce a varying group of symptoms and appearances to a formula which can be stated; still more so to a definition which will convince a lay bench of magistrates that the symptoms described are really due to alcoholic consumption, and may not, individually and collectively, be ascribed to other causes; and yet the recognition of indulgence in alcolhol presents few difficulties at the time. Every member of a social group can say with accuracy when a member of that group ceases to be normal and gives definite indications that sobriety has passed into insobriety. The picture is made up of many changes, subtle yet recognizable, in speech, appearance, manner, and conduct. It is something we can sense, but analyse and subsequently describe with difficulty.
“When for legal purposes it comes to applying a number of tests—such as standing poised, toeing the line, standing inmmobile with closed eyes, repeating certain words or phrases, smelling the breath, and testing the memory of lapse of time, etc.—the results are very unsatisfactory. We have recently had experience of nerve specialists disagreeing with practitioners in court on the question of drunkenness, and all agreeing that our tests are inadequate and inconclusive.
“No two men behave exactly alike under the influence of alcohol, or present the same combination of objective symptoms. The result is that many cases of accusation in the courts on the charge of drunkenness, where serious motor accidents have occurred, are wrongly dismissed for want of evidence which would be unanimously convincing to the bench.”
In individual subjects, the impairment resulting from acute alcohol intoxication depends on several variables, including body weight, the volume and period of alcohol ingestion, the percentage of alcohol in the beverage, whether alcohol was taken on an empty stomach or with food, which delays the absorption and the activity of alcohol metabolizing enzymes in the stomach and the liver (Martin, Lovinger and Breese 1995). Perhaps more important, there are differences in innate tolerance to alcohol with genetic underpinnings so that the pharmacological effects of alcohol are blunted and more drinking can be tolerated with less impairment (Schuckit and Rayses 1979; Macgregor, Lind, Bucholz et al. 2009).
Additionally, tolerance is commonly acquired with repeated consumption of alcohol through neuroadaptation as well as change in metabolism (see Tolerance). Both of these phenomena (innate or acquired tolerance) diminish the degree of impairment observed with a given level of blood alcohol and have been related to the development of alcoholism (see Alcoholism). Experiments studying the determinants of inter-individual differences in response to alcohol have been greatly facilitated by availability of the breath alcohol analyzer.
In summary, as methods for reliable measurement of alcohol in body fluids were being implemented, inter-individual differences in susceptibility to alcohol intoxication were considered more a source of error in existing methodologies rather than the exciting research question it has become in recent years that is likely to lead to elucidation of contributing factors to development of alcoholism.
References:
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Andréasson R, Jones AW. The life and work of Erik M. P. Widmark. Am J Forensic Med Pathol 1996;17(3):177–90.
Anonymous. Alcoholic intoxication in automobile drivers. Can Med Assoc J 1924;14(4):326–7.
Anonymous. Police tests for alcohol. The Lancet 1938;231(5979):794.
Anstie FE. Stimulants and narcotics, their mutual relations: with special researches on the action of alcohol, aether, and chloroform on the vital organism. Philadelphia: Lindsay and Blakiston; 1865.
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Martin P, Lovinger D, Breese G. Alcohol and other abused substances. In: Munson P, Mueller R, Breese G, editors. Princ Pharmacol Basic Concepts Clin Appl. New York: Chapman & Hall; 1995. pp. 417–52.
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Romano E, Torres-Saavedra P, Voas RB, Lacey JH. Drugs and alcohol: their relative crash risk. J Stud Alcohol Drugs 2014;75(1):56–64.
Schuckit M, Rayses V. Ethanol ingestion: differences in blood acetaldehyde concentrations in relatives of alcoholics and controls. Science 1979;203(4375):54–5.
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Smith HW, Popham RE. Blood alcohol levels in relation to driving. Can Med Assoc J 1951;65(4):325–8.
Southgate HW. The effect of alcohol, under varying conditions of diet, on man and animals, with some observations on the fate of alcohol in the body. Biochem J 1925;19(5):737–45.
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September 15, 2022