There are still many myths and superstitions about snakebites, says Johan Marais. First aid for snakebite and the treatment of bites are equally misunderstood
I recently spoke about snakebites in southern Africa at a Travel Doctor’s workshop, and after my presentation a woman doctor from Limpopo asked me how effective traditional medicines were for snakebites. She was referring to herbs and tree bark.
The doctor had heard of a case in which a person was treated by a traditional medicine, and after receiving the medication, threw up a smelly black substance, presumably containing venom, and then recovered fully.
The story reminded me of the 100-year-old Bushman in the central Kalahari with whom I discussed snakebite treatment. He told me that Bushmen gave the victim Condy’s crystals (potassium permanganate) mixed up in a glass of water. The victim then “threw up the venom”. I wanted to know how effective this treatment was, and was told that some victims survived and others died. Amazing!
There is absolutely no evidence that traditional medicine has any benefit in the treatment of snakebite. One must bear in mind that many victims of bites from venomous snakes who were injected with no or very little venom would survive in any case. Up to 80% of all snakebite victims survive without anti-venom treatment. So don’t be fooled.
Some people firmly believe in many of the first aid measures that do not work. Indeed, some of these measures are downright dangerous. Among them are tourniquets.
Snake venom is absorbed largely through the lymphatic system, not through veins and arteries, and by applying a tourniquet to cut off blood circulation you will not slow down the rate at which venom is absorbed. But you may well cause serious damage with a tourniquet, and doctors in Zululand often have to deal with snakebite victims where tourniquets have done serious damage, even leading to amputation.
In bites from the puff adder and spitting cobra, where cytotoxic venom is involved, tissue damage is the biggest problem. You are not going to save anyone’s life by applying a tourniquet, so do not use one.
Cutting and sucking are also popular, fuelled by cowboy movies in the past. Until recently, one could still buy cutting and sucking devices from camping stores. Fortunately, most of these products are no longer available. They just don’t work, and this has been shown by extensive tests.
You cannot remove a significant amount of venom by cutting around the site of the bite and applying suction. Even worse, the last thing you want is an open wound that is exposed to infection.
One often hears that more people die from shock and the anti-venom treatment than from the actual bite. This is not true.
Yes, some people are allergic to anti-venom serum and a small percentage of them may go into anaphylactic shock if treated intravenously, but doctors counter that by injecting adrenaline. Of all the experienced snakebite doctors I know, not one has had a patient die of anaphylaxis after anti-venom treatment.
It is also wrongly believed that allergic effects of anti-venom can be prevented by administering cortisone and antihistamine prior to the anti-venom. Again, this is not true.
Another popular myth is that being exposed to anti-venom can cause a severe allergic reaction the next time around – so much so that some snake handlers who have been bitten would rather try to “sweat it out” without anti-venom as they might need such treatment for a more serious bite later.
I have just returned from a snakebite seminar in Spain and discussed this possibility at length with Spanish and Mexican toxicologists. It turned out that this was just another myth (which I have believed for many years!). Receiving anti-venom will not make you more sensitive and will not increase the chances of an allergic reaction in the future.
The same applies to the venom itself. Many people who work with snakes and venom become sensitive to venom and will start sneezing excessively the moment they are exposed to it, or even when cleaning snake cages. (This happens to me.) But sensitivity to snake venom has nothing to do with bites and will not make you more vulnerable to the effects of venom or allergies if you get bitten. These are two entirely different issues.
What may happen to a snake handler who is bitten and receives anti-venom is that in a subsequent bite that is treated with anti-venom he may well need more anti-venom than with the first bite as the body becomes more resistant to the neutralising effects of the serum.
So, in summary, in serious snakebites that justify the use of anti-venom, the treatment may well be life-saving, and experienced snakebite doctors are using it aggressively and with very good results.
Even in animals there are many myths and stories. I often hear farmers saying that if your dog is bitten, cut a little bit of its ear off so that the venom can bleed out. Or give the dog a little bit of petrol. Absolute rubbish!
And if you have a dog that kills a lot of snakes and gets the odd bite, don’t think you have a super dog that has super powers to combat snake venom. The reality is that the dog did not receive enough venom to kill it, hence the full recovery. But it is only a matter of time!
All of this and more is covered in my new book, Snakes and Snakebite in Southern Africa, that will be on the shelves in September.