Introduction
In many parts of India, snake is worshipped and in some areas special prayers
are performed. In Northern India on Naga Panjami day people worship snake idol. In
certain areas of Maharashtra and Goa the live snakes, rarely live cobras are brought
for worship. Snake charmers carry snakes especially cobra, door to door for worship.
At every house the snake’s mouth is forced open and some milk is poured down in
its throat though milk is not snake food. It is also believed that snakes bite people
who harmed them in their previous birth. When snakes are killed, people offer special
prayers and bury them. People also believe that snakes take revenge against those who
harmed them.
In view of their strong beliefs and many associated myths, people resort to magicoreligious
treatment for snake bite thus causing delay in seeking proper treatment. As a
result, valuable time is lost in some of the deserving cases. It is poignant to note that
some of the cinema and TV serial stories even now propagate non-scientifi c ideas on
snakes and snakebites, and display traditional treatment. Hence, there is a need for
the health department to disseminate the scientifi c aspects related to snakebites to the
community.
Magnitude of the problem
Recently global burden of snake bite was assessed using available published data
and modeling technique. From that it is estimated that 4,21,000 envenomations and
20,000 deaths occur annually. These fi gures may be as high as 18,41,000 envenomation
sand 94,000 deaths.
Snake bites contribute to health problem in India and continue to be a major
medical concern. India alone contributes to 81,000 envenomations and 11,000 deaths
annually. Based on the above statistics, it appears that every 10 seconds one individual
is envenomed and one among four dies due to snake bite. Many deaths occur before
the victim reaches the hospital. Actually up-to-date national data, on the morbidity
and mortality due to snakebite is not available. Moreover there is no national snake
bite registry in India. So the available statistics is incomplete and not systematically
collected. In 1972, Dr. Sawai and Dr. Homma of the Japan Snake Institute studied
snakebite in about 10 hospitals in India. They reported that about 10% of snakebite
deaths are among the victims who come to the hospital and about 90% die outside,
having gone for other remedies like mantra, magic, and so on. However things are
very different now, after 35 years.
Government General Hospital, Chennai, from January to December 2006 has
treated 281 cases of snakebites. Among them, there were 182 males and 99 females.
Treatment Guidelines for Snakebite and Scorpion sting
2 Tamil Nadu Health Systems Project, H&FW Dept, Govt of Tamil Nadu, Chennai.
94 were referred after treatment in different hospitals and 187 were brought to the
hospital directly. 274 (97.5%) survived and 7 died due to various complications of
snakebite while they were in the hospital. The details on the type of snakes, clinical
signs, complications, number referred, number who received supportive therapy and
death are provided below (Table no.1).
| Type ofsnake | Numbertreated | Local signs | Neuro Toxicity | Hemo.Toxicity | Supportive | NumberExpired | |||
| Mechnicalventilation | Hemo-Dialysis | Fasciotomy. | |||||||
| Cobra | 118 | 80 | 118 | – | 90 | – | – | 2 | |
| Krait | 82 | – | 51 | 82 | 60 | 30 | – | 2 | |
| Russell’sviper | 42 | 42 | – | 42 | 6 | 23 | 1 | 1 | |
| Hump- nosedviper | 4 | 4 | – | 4 | – | 4 | – | 1 | |
| Saw scaledviper | 16 | 16 | – | 16 | – | 3 | – | 1 | |
| Seasnake | 3 | 3 | – | – | – | – | – | – | |
| Non poisonous | 16 | 6 | – | – | – | – | – | – | |
An equal or more number of snake bite cases were admitted and treated at other
Government Medical College Hospitals. Patients go to private hospitals mostly for
fi rst aid purposes. Very few get adequate treatment in these hospitals.
In Tamil Nadu the total number of snake bite cases admitted (and expired) in the
secondary care hospitals alone during 2005 – 2006 and 2006 -2007 were 19321(85)
and 20677(75) respectively. The total number of ASV vials used in these hospitals
during the respective periods were 94481 and 96800 (Annexure I). Over all analysis
revealed that the snakebites and ASV usage in West, North, East, Central, South zone
of Tamil Nadu were 13, 17, 20, 24 and 26% respectively.
The Government is spending a huge sum of money in procuring and supplying anti
snake venom. On an average, Government hospitals spend a minimum of Rs.5,000/- per
case of Snake bite and patient spends an equal amount for socio-cultural and magicoreligious
aspects. The money lost due to loss of job and earning as well as loss of lives
is huge, and thus has an impact on the national economy.
Deaths due to snakebite can be prevented, if some simple fi rst aid measures are undertaken by the public and / or by
the health care providers. So, there is an urgent need to take effective steps to contain
these issues.
Many of the fi rst aid measures carried out at present are ineffective and dangerous.
The research also concluded that the other traditional methods followed for snake
bite are not appropriate. It is gratifying to note that the traditional snake catchers in
Tamil Nadu, the Irulas with their own sophisticated herbal medicine system, have now
understood the problems? They know that the snake injects venom which goes deep
into the system and this can be neutralised only by injection of Anti snake venom
(ASV) and not by oral or locally applied remedies, no matter how famous. But this
information needs to reach other communities also.
Hence, the need to recommend the most effective fi rst aid to the victims bitten by
snakes and to recommend effective steps in the management of this problem. Poisoning
due to cobra and viper groups are seen frequently in the state of Tamil Nadu. Very
rarely sea snakebite cases are reported. Hence, this hand book focuses on the fi rst two.
Though the specifi c antidote is not available for sea snake, the same general principles
for other snakebites are applicable here too.
Epidemiology of snakebite
Snakebite is observed all over the country with a rural / urban ratio of 9:1. They
are more common during monsoon and post monsoon seasons. Snakebites are seen
often among agricultural workers and among those going to the forest. Many of the
susceptible populations are poor living below poverty line, living in rural areas with
less access to health care. The male / female ratio among the victims is approximately
3:2. Majority are young and their age is between 25 to 44 years. Most of the bites (90
to 95%) are noticed on the extremities (limbs). The hospital stay varies from 2 to 30
days, with the median being 4 days. The in-hospital mortality varies from 5 to 10%,
and the causes are acute renal failure, respiratory failure, sepsis, bleeding and others.
Ecological aspects:
By destroying forests for creating agricultural land, the prey base of the snake
(that is frogs and rats) has increased. The rice fi elds, which harbour millions of rats
attract a lot of snakes. The number of snakes per acre in a rice fi eld is abnormally
high when compared to the natural population in the forest. Humans go into the fi eld
every morning and come out in the evening, just the time when snakes are active.
Thus, the chance of an encounter between farmer and snake is very high. As more
areas are inhabited at the periphery of towns, even there the chances of human / snake
interaction increase.
Cobras fl ourish as long as there are rice fi elds; there they feed mainly on the mole
rat (varapu eli in Tamil), live and lay their eggs in the rat burrow networks. Kraits also
get by very well in rice fi elds because they like the plentiful small rodents such as thefi eld mouse (sundeli in Tamil) and rock mouse (kallu eli in Tamil). Kraits are also found
in the mounds of earth and rubble near wells. The Russell’s viper lives in the rocky
outcrops and hedgerows of cactus and other bushes which often form the boundaries of
agricultural land. There, on the high ground, they have a plentiful supply of common
gerbil (velleli in Tamil) which are also attracted to the wealth of food humans provide
by their farming activities! But thanks to snakes, we are not overrun by rodents.