MISCELLANEOUS NOTES. 523 



the Civil Surgeon arrived from Broach and found the patient quite con- 

 scious, free from any nervous disturbance, but very exhausted. The breath- 

 ing was distressed, and there was some congestion of the lungs. The pulse 

 was thin and weak. The extremities were cold and livid. The gums were 

 blue, spongy, and bleeding, and expectoration blood-stained. There were 

 extravasations of blood beneath the skin of various sizes on the face, chin, 

 neck, chest and back, and a very large one over the right buttock, and 

 another on the inner side of the left (right ?) thigh. The right foot was 

 swollen to twice the size of the left, the tissues round the bitten part were 

 sloughing and there was cellulitis of the foot and ankle. 



The abdomen was tender and swollen. He saw a tarry stool that had 

 been recently voided. In spite of every endeavour to save the patient, 

 he continued to grow weaker, and died from heart failure at 2 a. m. on 

 the 21st May. 



Remarks. — The symptoms detailed above are all due to diminished coagu- 

 lability of the blood, such as we know is induced by the poisons of both 

 vipers and colubrine snakes. The absence of any nervous phenomena, 

 negatives the idea that the culprit was a colubrine species, whilst the 

 severity of the symptoms arising from the altered state of the blood, which 

 we know are specially pronounced in viperine toxaemias, strengthens the 

 assumption that it was a viper that inflicted the injury. The casualty 

 occurring near Broach clearly points to the offender being either the 

 " Phoorsa " (Echis carinata), or Russell's viper (Vipera russelli), but we 

 cannot be certain which. 



The symptoms are just those that might be seen in a case of scurvy, 

 a disease in which the coagulability of the blood is profoundly altered. 

 Visible haemorrhages occurred from the gums, which were just in the same 

 state that is so typical of that disease, from the bowel and beneath the 

 skin. Invisible haemorrhages account for the pain, tenderness, and swel- 

 ling of the abdomen, and vomitting which recall to the physician's mind 

 the identical state of affairs one sees in Henock's purpura, another 

 disease affecting the coagulability of the blood. The pain, swelling and 

 tenderness of the right hip joint is similarly explained reminding one 

 of the kindred state — arthritic purpura. Further invisible haemorrhages 

 explain the swelling and pain in the muscles of the calf and thigh. 

 Death was due to exhaustion from constant hemorrhages. 



F. WALL, c.M.z.s., 

 Chitral, Wi June 1910. Major, i.m.s. 



No. XIX.— FOOD OF CROCODILES. 

 With reference to Captain Forsyth's inquiry in the last Journal, I have 

 also frequently found large numbers of round stones in the' stomachs of 

 Charials (Gavialis gangeticus), shot on the C4ogra River. 

 34 



