1921
Volume s1-30, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645
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Abstract

Summary

An analysis of 306 cases of snake-bite accident admitted to Charity Hospital of Louisiana at New Orleans from 1907 through 1946 is presented. The distribution of admitted cases by years varied from 1 to 18. The largest number accidents occurred during the years 1929 to 1938. The period from April through October was the time of either greater hazard or exposure, or both, for over 80 per cent of the snake-bite accidents took place during these seven months. Over two-thirds of the bites occurred in individuals under 30 years of age. Sixty-one individuals were under 10 years of age, emphasizing the hazard in this age group. The ratio of males to females who received poisonous snake-bites was 5 to 1, respectively.

Children, farmers, fishermen, trappers, swampers and women engaged in activities about rural dwellings were most frequently involved in the accidents. A wide variety of activities, sometimes attended by carelessness and folly, exposed many individuals to attack by the reptiles.

The snakes involved included 5 of the 6 venomous species known to occur in Louisiana. Water moccasin and rattlesnake bites predominated.

More snake-bite accidents occurred during the afternoon and night than before noon. The great majority of bites took place during daylight hours, presumably due to greater activity of the individuals, with resultant increased exposure.

The feet and ankles received 150 injuries. The hands were wounded in 105 cases. The mouth was the site of two snake-bites. High-top shoes and stout gloves would have prevented a majority of the bites. Rubber boots and overalls did not afford complete protection from bites, since the fangs occasionally penetrated these articles of clothing.

One of the most significant facts extracted from this extensive series is that serious consequences arose from faulty first aid measures. Amputations of fingers, toes, arms and legs were necessitated as a result of improper use of tourniquets. Secondary infection of the wounds was common. A myriad of amusing, amazing and pathetic home treatment remedies were employed, which frequently produced more damage than that normally caused by the bite.

There were two fatalities in the series of 306 cases, which represents a mortality rate of less than one per cent. No fatalities occurred during the last 25 years. One of the fatalities resulted from septicemia subsequent to snake-bite.

A total of 114 deaths caused from poisoning by venomous animals are recorded for all of Louisiana from 1916 to 1945. Some of these deaths were caused by poisoning by the bites of black-widow spiders. Prompt medical treatment and hospital care probably contributed in part to the low fatality rate (less than one per cent) of cases of snake-bite poisoning admitted to Charity Hospital. The marked difference between the few fatalities at the hospital and the relatively large number throughout the state suggests additional factors for complete explanation.

Approximately one-half of the cases in this series arrived at the hospital within six hours after the bite occurred. In 136 patients in the series on whom urinalysis was done, only one had red blood corpuscles in the urine and none had evidence of hemoglobinuria.

Evaluation of methods of treatment is difficult in view of the low fatality rate and due to the fact that there was considerable change in the methods of treatment over the four decade period. Various combinations of the following procedures for treatment of snake-bite poisoning were employed: application of tourniquet, incision of the wound and of areas of swelling, suction of incised areas, injection of antivenin, use of tetanus antitoxin, injection of antigangrene serum (against ), intravenous fluids, elevation of swollen extremities, application of heat or hot compresses to affected parts, rest and symptomatic measures, particularly to allay anxiety. In view of the large number of infected lesions due to either the snake-bite or to the first-aid measures, treatment should anticipate bacterial contamination of the wound to prevent its progression.

The sequelae of poor first-aid measures in some cases exceeded that of the average pathology produced by the bite of some of the venomous snakes. This should not be misconstrued as an argument against employing first-aid, but definitely indicates the need for better instruction of the public in the use of correct first-aid measures.

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/content/journals/10.4269/ajtmh.1950.s1-30.575
1950-07-01
2017-11-18
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