Natural history of sea-snake bite and poisoning: a clinical study

Abstract

The toxaemia of snake-bite in man remains a challenge to the clinician. Fear of snakes and their bites is universal and colours the reaction of both patient and doctor. In each case the fear stems mainly from ignorance and a conditioned - contrary to popular belief, fear of snakes is not instinctive ( Klauber, 1956) - exaggeration of the danger snake-bite represents to man. Few doctors have studied patients in adequate numbers because bites are mostly received in remote districts; even if a hospital is available the victim often enough will not use it. Of the many variables in snake -bite the amount of venom injected is of paramount importance. It is not commonly known that poisonous land- and sea - snakes often bite human victims without injecting significant venom. To the clinician the first question should not be was it a poisonous snake? but, how much venom (if any) was injected? Some types of venom - most viper venoms for instance - cause a local reaction from which it is possible, even soon after the bite, to make a clinical estimate of the dose of venom injected. In contrast, sea - snake venom has virtually no local effects. One of the main purposes of the present study has been the evaluation of clinical observation in estimating venom dose and deciding on appropriate treatment. Specific antivenene which might affect the course of toxaemia, was not available for the victims studied here; any antiserum used was made from land-snake venoms and experimentally such antivenenes have been found ineffective in neutralizing sea-snake venoms. The problems I have set out to examine may be summarized as follows: 1. Incidence and circumstances of sea-snake bites. 2. Clinical features, course, effect of treatment and sequelae with their pathogenic, prognostic and therapeutic significance.