Snakes of Medical Importance in India

With this post, I am going to begin to make regular use of the journal Wilderness & Environmental Medicine, published by the Wilderness Medical Society, in order to bring you cutting edge information. I will condense and translate from articles of interest, so that the knowledge presented can be disseminated beyond the health care providers who are subscribers to the journal. In subsequent posts, I will offer summaries from other important medical journals, such as High Altitude Medicine & Biology, the New England Journal of Medicine, and so forth.

In Wilderness & Environmental Medicine, 18, 2-9 (2007) appears an article entitled Snakes of Medical Importance in India: Is the Concept of the "Big 4" Still Relevant and Useful? by Drs. Ian Simpson and Robert Norris. In this article, they point out that snakebites continue to be a major medical concern in India, but little rigorous epidemiology to support exactly which snakes are the culprits for the majority of envenomations. This is a significant issue, as it has been estimated by the World Health Organization that there may be as many as 50,000 snakebite deaths per year in India.

Traditionally, the snakes of medical importance have been listed as the Indian cobra Naja naja, the common krait Bungarus caeruleus, the Russell's viper Daboia russelii, and the saw-scaled viper Echis carinatus. However, the observation that the hump-nosed pit viper Hypnale hypnale is commonly misidentified as the saw-scaled viper leads the authors to conclude that the hump-nosed pit viper is of medical significance and perhaps should be included in current efforts to develop and refine antivenoms used to treat victims of venomous snakebites. This is particularly important given the fact that the antivenom currently used in India to treat snakebite victims does not appear to be particularly effective against the bite of the hump-nosed pit viper.

The authors further note that hospitals can be a rich source of epidemiological data in order to identify other species of snakes that may be causing severe injuries and death. In North America, we teach snake bite victims to capture and transport venomous snakes with extreme caution, if at all, in order to avoid additional bites. It would appear that in India, it may be more important for biting snakes to be captured and identified, in order for clinicians and snakebite experts to better understand the clinical syndromes associated with the bites of specific snakes, and to better prepare life and limb saving antivenom products.

photo of hump-nosed viper courtesy of Ian Simpson and the Wilderness Medical Society

Tags: snake bite, snakebite, venomous snakebite, antivenom, India, viper, wilderness medicine, outdoor medicine, healthline