( xxii ) 



CASUALTY RETURN OF SNAKE-BITE. 



Station :- 



Sex : 



Age:- 



Date and hour of bite 

 Hour of admission :— 

 Part bitten : 



Species of snake :- 

 Result : . 



U 



fatal, 



method of death, syncope or 



asphyxia :- . Time 



elapsed since bite : . 



Symptoms : Local : — 

 (a) Pain :- 



(b) Swelling : 



(c) Sanious oozing :— 



(d) Appearance of 

 when cut into :- 



tissues 



(e) Characters due to mecha- 

 cal causes : . 



General : — 



(a) Consciousness : 



(b) Respiration : 



(c) Syncope, pallor : 



Warmth and activity 



skin : . 



Pulse : 



Vomiting 



of 



Onset of weakness : . 



(d) Paralysis, onset of weak- 

 ness : . 



Sequence : . 



Drooping head :- 

 Drooping eyelids 



Articulation : 



Phonation : 



Deglutition : 



Salivation : 



(e) Hemorrhages : 



(/) Other symptoms : 



Treatment : . 



