FORM C
(See rule 5)
Alcohol Examination Certificate
No.R of................... M. I. Case No Dated From,
(Here mention name, designation and address of testing officer.)
(Here mention the name, designation and address of registered medical practitioner)
Your letter No dated forwarding a phial containing blood of Shri/Smt./Kumari of bearing Serial No labelled received here on by post/with messenger Shri of sealed/unsealed, seal perfect and as per copy sent/seals intact device no copy sent.
Result of the test of the blood The blood contained per cent. W/V of ethyl-alcohol.
Method, Factual Data and Reasons leading to the Result of Blood analysis
(I) Method of Analysis.—Modified Cavette's Method Journal Analytical Chemistry, 1959, 31, 1908. It is based on oxidation of alcohol by chromic acid as that in Cavette's Method but the oxidation is carried out in vacuum and at room temperature. It takes only a fraction of a minute instead of a few hours to complete the reaction. Ketonic bodies are volatile acids do not interfere in this method. All usual precautions essential in microanalytical work mentioned in the paper referred to above have been strictly followed, e.g., all chemical used in the test were of reagent quality the apparatus was first cleaned with hot chromic acid, then repeatedly with tap water and finally with distilled water. 1[It was then dried in hot air oven.]1 No grease was used anywhere in the apparatus. The atmosphere of the room where the test was carried out was free from all gases or suspended impurities. Fresh glass-distilled water used throughout the test.
(2) Factual Data and Reasons for arriving at the findings pertaining to the blood sample in question.— Analysed on Smell: Nothing to note/Has characteristic smell of Quantity of blood taken for analysis: 0.5 ml. Quantity of N/20 dichromate taken: 5.00 ml. Quantity of N/20 dichromate used up in oxidising alcohol in the sample ml. 1 ml. of N/20 dichromate oxidises 0.000575 gramme of ethyl-alcohol. 1[Therefore, 100 ml. of blood contained. 0.000575 x ml. of dichromate used x 100 ———————————————————————————————————————————————— gramme of 0.50 ethyl-alcohol.]1
Signature and Designation of testing officer.
Note.— (1) W/V = grammes of ethyl-alcohol in 100 c. c. of blood. (2) The blood sample was stored in refrigerator from the time it was received in the laboratory till it was taken for analysis.