Tuesday, December 22, 2009

A Case of Snakebite

Maybe 20 years ago I was working in a hospital in rural Wales. It was a warm, fine summer Sunday afternoon. I was on call, in my office, writing a letter on my new-fangled personal computer. I was interrupted by an urgent call to casualty.

A woman of 19 had been bitten by a snake. She and her mother were walking on the hills above the town, on a well used footpath, wearing sandals. She had trodden on the snake, which struck her right great toe.
In great distress and increasing pain she had taken maybe 45 minutes to get back to the car, with her mother's help. They came straight to the hospital.

She was sitting up on the trolley, terrified; white, tear-stained face, trembling. Her mother was collapsed in a chair, in severe shock and distress, being comforted by a nurse.
Her lips and tongue were swollen, and she had a noisy wheeze. Her right great toe and the adjacent foot was red and swollen, and very painful. One of the snake's fang marks was on the top of the toe, just behind the nail; the other was underneath, and must have penetrated deeply into the soft ball of the toe. It was a big snake - most adders we see in Britain are around a foot long, so their gape is too small to include an adult great toe.

Adder bite was an easy, instant diagnosis - adders are the only venomous snake species wild in Britain. The puffy lips and asthma were caused by the well-known histamine-releasing properties of adder venom.

Reassurance was urgent. My first words were loud and firm, on these lines.
'You are not going to die. You have been bitten by an adder, but the bite will not kill you. You will have a very painful foot for several days, and you will need hospital treatment. But you will be all right, I promise you.'

I gave her an injection of hydrocortisone, and watched the wheezing and puffiness subside. She had a tablet of pethidine for the pain.
The crisis was over. She relaxed and was much more comfortable. Her mother's panic settled.

Infection of the bite is the big hazard: snakes don't clean their teeth before striking. The bitten area was washed and swabbed with Hibitane, for what that is worth - the bugs have been injected with the venom. She took 2 tablets of oxytetracycline, 500 mg total, to continue 250 mg. four times daily for 5 days.
Fortunately we had a vacant bed in a 4-bedded bay, by the window with views of the mountain, with three other young women.

Her progress was rapid and uneventful, so she was fit for discharge on the third day. As she left my proffered handshake was overtaken by a big hug and a kiss, and she was a strikingly handsome woman, with dark curls and rich brown eyes. Well, even English physicians have human responses; fortunately sister did not see.

Some days later, in the late afternoon, I was walking on the mountain path. On the path ahead I saw  a very large adder - the biggest I have ever seen, heavy bodied, and more than 2 feet long. It was a pale grey variant, with back markings so dark they appeared black. It saw me and crawled off into the heather, leisurely, so I was able to follow it's progress for some time. Snakes are reputed to have second sight, perhaps it knew my history, and was not alarmed.

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