Sunday, March 17, 2013

Focus . . . Snakes and snake bites . . .

Last week, NJH was part of a group of hospitals who were invited by the Christian Medical College, Vellore to look into snake bites and their management . . .

I leart quite a lot of things. It was a privilege to rub shoulders with who’s who in herpetology. Romulus Whitaker, Gerry Martin, Dr. Oommen V Oommen, Dr Bawaskar, Dr Punde . . .quite a lot of big names in the field.

Yesterday, I was talking to my staff in Community Health and Development about how fast we draw conclusions without looking into evidence.

Over the last month, I had put up the post on the clientele we serve at NJH. And later something about neurocysticercosis and their cause. Regarding the former topic, quite a good number of our staff thought that we serve a higher number of poor. I got quite a number of feedback about the ‘new information’ they received in the post on neurocysticercosis.

The common aspect about snakes and snake bites are the myths that surround them.

Couple of the myths that I harbored for long were given the boot after the meeting.

The first one . . . I was under the impression that a venomous snake bite late in the night or early daybreak would be less venomous compared to a bite in the evening. The reason . . . the snake would have already spent it’s venom on a prey and therefore a lesser amount only would be available to inject into the next victim. The same logic applying to snake bites on two consecutive victims by the same snake. The second victim would have lesser venom injected thereby causing lesser envenomation in the second victim.

The venom is the saliva of the snakes. Even after a biriyani, you’ll continue to secrete saliva if there is ice-cream after that. Similarly, the snake would continue to secrete the venom irrespective of the fact whether it had a prey before biting a victim.

The second one . . . a non-poisonous snake in your backyard means no poisonous snake in the same area. Absolutely wrong. Any snake seen means more snakes in the area. It was reported that it is not uncommon for a venomous and non-venomous snake to share the same hole!!! I remember someone tell me that it is not good to kill a non-venomous snake as it’s place in the habitat may be taken by a venomous one.

There is nothing like a territory for a snake. . . the way they have for tigers etc.

The third one . . . which is quite frightening. I used to believe that use of chemicals such as phenol would help keep out snakes. And after we had couple of snakes inside the house during our first year at NJH, we’ve not seen them inside after we started to regularly use phenol to wipe the floor. In fact, there is no evidence to support the fact that snakes dislike phenol. However, snakes don’t like clean places. They love dirt and areas with things like papers, leaves etc. piled up. The fact that snakes are not entering the house is because of cleanliness that accompanies a daily wipe with phenol and not the smell of the chemical.

However, the best ones . . .

Kindly see the snap below. The blue bordered regions are places where a proper taxonomy of existing snake species has not been done. Quite an exciting thing for mission hospitals in North India such as ours as we can be base for quite a lot of work on getting to know more about these creatures.

The final straw . . . The snap below. Kindly note the thing written in red. This is the number of vials of antivenom that will neutralise the maximum possible venom that is injected during a bite of the concerned snake.

The question is now going to be about how WHO has come up with a protocol of 20 vials to be used for any sort of snake bite. . .For units such as NJH, this has major implications . . . as a low dose protocol should theoretically be enough to salvage viper and krait bites . . .

We’re quite excited of the future . . . we could be part of path-breaking research on snake bite syndromes and their management.

Pray for us . . . 


  1. Having never worked in a rural area, I hardly know anything about snake bites.. I realized it while going through your post. Thanks for writing in such an informative way :)

  2. I am there in the group photo ( between Dr H S Bawaskar and Prof. Anand ) . Great experience. May I request Dr Sunil Deepak to visit my site ?