( xxii ) 



CASUALTY RETURN OP SNAKE-BITE. 



Station : — ■ . 



Sex : . 



Age : . 



Date and hour of bite : 

 Hour of admission : — 

 Part bitten : 



Species of snake :- 

 Result : . 



If 



fatal, 



method of death, syncope or 



asphyxia : . Time 



elapsed since bite : . 



Symptoms : Local : — 

 (a) Pain : . 



(&) Swelling : 



(c) Sanious oozing :— 



(d) Appearance of 

 when cut into: - 



tissues 



(e) Characters due to mecha- 

 cal causes : . 



General : — 



(a) Consciousness : 



(6) 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) Haemorrhages : 



(/) Other symptonis : 



Treatment : . 



