From n_shiva_kumar@HOTMAIL.COM Sat Jun 19 14:06:42 2004
Date: Mon, 14 Jun 2004 14:41:59 +0530
From: shiva kumar 
To: nathistory-india@Princeton.EDU
Subject: When a cobra strikes

When a cobra strikes
...from the pages of THE HINDU News Paper.

Romulus Whitaker, India's leading herpetologist, has been doing a survey of
the incidence of snakebites in India. He points out that there are basically
four venomous snakes that feature in this ^× the cobra, the Russell's viper,
the saw- scaled viper and the krait. He calls them the "Big Four". Excerpts
from an interview with S. THEODORE BASKARAN.


HOW did this idea of a survey begin?

It began as an idea to do a film on snakebites in India. When I started
serious filmmaking in 1986, we made our first film titled "Snakebite". After
17 years I thought it would be a good idea to go back to the subject. We
travelled to areas in Tamil Nadu, Kerala, Rajasthan and West Bengal where
the incidence of snakebites is high and from there to specific places, where
different snakes are responsible for the bites. In Rajasthan it was the
saw-scaled viper. In northern Kerala it was mainly the bite of the Russell's
viper and down here in Tamil Nadu, it is a mixture of the cobra and the
krait. In Bengali it was a mix of all of the "Big Four" venomous snakes
except the saw scaled viper.

How serious a problem is snakebite in India?

The truth is when compared to many infectious diseases that kill people like
simple diarrhoea, the 15,000 to 20,000 deaths by snakes each year is not one
of the really big medical issues in India. In fact, statistics indicate that
you are twice as likely to die of rabies in India than by snakebite. To me
that's very scary! But a snakebite is also a traumatic experience that many
people in the villages think more about it than about other diseases. It is
still surrounded by mystery and is frequently associated with gods and
devils.

An international expert on snakebite, the late Dr. Alistair Reid of the
Liverpool School of Tropical Medicine found out that only 10 per cent to 15
per cent of venomous bites end in death. The possibility of survival, even
without treatment, is incredibly good. There are many reasons for this. One
is that the snake often causes a dry bite. That is, the snake does not
always inject venom. Sometimes, it might inject only a tiny bit of venom.
The snake can inject the quantity of venom it wants. This is an entirely
voluntary process. This I learnt doing thousands of venom extractions.
Sometimes the snake will not give any venom at all. But you never know how
much venom was injected into you except by the progress of the symptoms.

Do we have reliable data on snakebite?

Actually we do not really have up-to-date data, as the statistics are not
very clear or simply absent. But the latest survey we have is what was done
in 1972, by Dr. Sawai and Dr. Homma of the Japan Snake Institute. They
selected about 10 hospitals in India and estimated how many came to hospital
after a snakebite and how many died there; they also estimated how many died
outside the hospitals. But this of course could only be conjecture. The
report concluded that about 10 per cent of deaths are of the victims who
come to the hospital and about 90 per cent die outside, having gone for
other remedies like mantra, magic, station master and so on. It is very
different now, after 30 years.

Based on this recent preliminary survey that Janaki and I did in Kerala,
West Bengal and Rajasthan, we found that the awareness about anti-venom
serum is much higher now than it was in 1972 and most doctors think that a
majority of snake bite victims now come to hospitals (often after wasting
time on a village remedy). They think that the death rate might have reduced
greatly. What we do not know is whether the actual incidence of snakebite is
increasing. Let me explain this. By destroying forests and by creating
agricultural land, we are increasing the prey base of the snake, that is
frogs and rats. Basically I am talking about rice fields, which harbour
millions of rats and so attract a lot of snakes. The number of snakes per
acre in a rice field is abnormal when compared to the natural population in
the forest. So here you have the humans going into the field every morning
and coming 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.

Which is the species of snake whose bite is more common?

This varies from region to region. Wherever one species is more common and
the chances of humans coming into contact is higher, then the bite of that
snake will occur more there. In Maharashtra, the saw-scaled viper is in
plenty along the coast. There the vast majority of snakebites are from this
species. In parts of North Kerala, near the Kannur area, the Russell's viper
is very common and so most of the bites there are from this snake. We found
that in parts of Bengal also, the Russell's viper is very common. In a place
like this (Chinglepet district of Tamil Nadu) cobra bites are frequent
merely because this area abounds in that snake. So this issue is very
region-specific. This pattern tends to change also. One doctor in Bengal who
had handled about 3,000 snake bites told us that over the years, Russell's
viper bites are getting more common than cobra bites due to as yet unknown
ecological reasons.

Do you observe any increase in the awareness on snakebites and the need for
prompt treatment?

Based on the statistics we got from the Pappinisseri Visha Chikitsa Centre,
(Venom Centre) in Kerala, where they have treated 48,000 snakes bites, we
learn that non-venomous snakes had bitten more than half of the victims who
came here for treatment. But all the patients brought here are subjected to
observation. This shows an increasing awareness on snakebite and the need to
get anti-venom serum treatment. When we visited this centre I pointed out
the possibility of dry bites by venomous snakes. However, I still think that
we have a long way to go in awareness on this issue, especially in other
less literate parts of the country.

What is the percentage of venomous snakebites that go untreated?

It is very difficult to say. A cobra bite, a Russell's viper bite and the
saw scaled viper bite have all have different symptoms. The Krait bite is
much less obvious and it is very difficult for people to know that they have
been bitten at all. There may be no pain and no symptoms to be alarmed at;
one may not take it seriously and go to hospital, especially in the middle
of the night when most of such bites occur. So, unfortunately, the Krait
bite is more often fatal than bites from the other three of the "Big Four".

Is it correct to say that if a snake had bitten in the recent past, its
poison is less in the subsequent bite?

No. A snake never runs out of venom and it does not inject all the venom
from the sac. Those of us who have been extracting venom know this well.

Recently, it has been found that what was considered as a sub-species among
cobras in various parts of India, is in fact a separate species. Does this
have any implication on production of anti-venom?

The word is still not out on this issue as the research is not yet complete
in this area. But this certainly raises new problems. The big question being
will anti-venom made from the venom of one species effectively neutralise
another? It was found that anti-venom made from the Indian Russell's viper
is not too effective for the Russell's viper bite in Sri Lanka. Venom
variation is an interesting, but unstudied, subject. In India, we have three
species of cobras ^× the spectacled cobra, the monocled cobra, which is in
the North east, and the black cobra, which is way up in the Northwest
region.

What about the production of anti-venom in India?

Production is not adequate. In the rural areas, its distribution is not
adequate, though it is much better than what it was. The other day, a
Russell's viper bit a farmhand near our house when he was trying to catch a
monitor lizard. He was taken to a clinic at Tirukazhukunram and treated. If
you combine increasing quantity, with availability and also awareness there
will be far fewer deaths due to snakebites. Anti-venom, when lyophilised,
does not need refrigeration and can keep for five years. So we should have
all primary health centres stocking anti-venom.

Is dialysis resorted to as a treatment for snakebite?

Yes. The typical systemic reaction to a serious bite of a Russell's viper is
kidney breakdown. At that stage dialysis is essential to pull a victim
through.

Have you come across any case in which a known venomous snakebite has been
countered by traditional medicine?

First of all, many snakebites are by non-venomous snakes. Second, a large
percentage of venomous snakebites are dry bites. A cobra had once bitten me
and it was a dry bite. I did not develop any symptom of a cobra bite. We
know that at least 80 per cent to 90 per cent survival is guaranteed,
without any treatment. With that sort of success rate to any healer,
whatever method he follows ^× herbal, "snakestone" or mantra, or plain soda
water ^× most villagers would be happy to go to him, though he is a potential
serial killer. If he lost even one patient he is a murderer. He may be
successful without other ailments like fever, common cold and whatever. But
in a snakebite, you are looking at a person who is lying on the operating
table, as it were, with his body cut open ... I mean ... the equivalent to
that. And he has to be in the hands of someone who can deal with that and a
man who supplies some local medicine who cannot handle it. The Irulas, the
traditional snake catcher with their own sophisticated herbal medicine
system, have now understood the position. They know that the snake injects
you and the venom goes deep into your system and this can be neutralised
only by a similar injection, not by oral or locally applied remedies, no
matter how famous.

What is the status of venomous snakes in India?

Cobras flourish as long as there are rice fields; 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 fields because they
like the plentiful small rodents such as the field mouse (sundeli in Tamil)
and rock mouse (kallu eli in Tamil). We have found a lot of kraits in the
mounds of earth and rubble near wells. The Russell's viper lives in the
rocky outcrops and hedgerows of cactus and other bush 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 (as yet)!
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

N.Shiva Kumar
A-1, SECTOR-1, NOIDA-201 301, INDIA
Phone-0120-2532861, Fax-0120-2558090
alternate E-mail ID - shivakumar@iocl.co.in

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