Snake bite: a homoeopathic approach

Dr Deepthi MK
Dr CH K Suma

ABSTRACT
Snake bite is the very common problem faced in rural area. Treatment for snake bite include giving antivenom therapy. Although many people are not aware about the success rate in treating in hospital because of so many myths in the society. With Homoeopathy, we can reduce the fatality and first aid as an immediate measure.

KEY WORDS: Snake bite, Homoeopathy, management

INTRODUCTION
Snakes are carnivorous reptiles of the suborder serpents. There are more than 3500 species of snake, but only 250 are venomous. Common Krait is the most common venomous snake. Our nation accounts for half the total number of deaths in the world due to snake bite. Snake bites are common in rural areas, poor communities, agricultural workers, fisherman and hunters. In the total snake population eighty percent of them are non-poisonous.

About snake venom
Venom is saliva of snake. The enzymatic components present in snake venom cause local and systemic effects, and non enzymatic components provide lethality. The concentration of venom manifest diurnal and seasonal variation. Bites caused at night and after hibernation are the most fatal. Venoms advance in the body  through superficial veins  and lymphatics.

Non poisonous Snakes: Red Rat snake, Emerald Tree Bao, California King Snake, Bull snake, Garter snake, Western Hogbnose

Poisonous snake:

• Neurotoxic venom: Common Krait, King Cobra
• Myotoxic venom: Sea snakes
• Haemotoxic venom: Pit viper

Fatal dose:

• Russel’s viper venom – 15 mg
• Cobra venom – 12 mg
• Echis venom  – 8 mg
• Krait venom –  6 mg

Fatal period:

• Viper bite – 1- 2 days
• Cobra bite – half to 6 hours

CLINICAL FEATURES

Cobra bite
Local symptoms start within six to eight minutes. Systemic symptoms appear after 30 minutes

Reddish wheal at the site of bite which tender with burning sensation, oozing of blood stained fluid from the body. Swelling may be minimal or absent is found. Weakness of muscles. Paralysis of lowerlimbs which ascends. Vomiting, headache, vertigo, paraesthesia. After about 2 hours paralysis complete. Coma sets in and the respiration stops with or without convulsions and heart stops its action.

Krait
Symptoms resemble those of cobra bite in nature, but there is no swelling or burning pain at the site of bite can be observed, and the convulsions are milder. Feeling of drowsiness and intoxication are more intense in krait bite.

Russels viper & Echiscarinate
Bite site- severe pain at the site of bite within 8 minutes, which becomes red and painful. Swelling starts within 15 minutes and blood stained discharge from the wound is seen. Persistant bleeding from the site of bite is a constant feature. Blisters formed within 12 hours

Limbs become swollen and red. Swelling spreads as far as the trunk in 1 to 2 days. There is local extravasation of blood

Extensive necrosis may occur followed by haemoptysis, ecchymosis, epistaxis intracranial and sub conjunctival haemorrhages, internal  bleeding of organs.

In severe cases the important feature is the persisting shock. Death is usually due to haemorrhage and shock

Sea snakes
Bite causes by sea snakes show little or no local reaction. After half to one hour the patient develops pain, weakness and stiffness of the skeletal muscles. Marked polymyositis with a limb girdle distribution come about. Death may happen due to cardiac arrest or paralysis of respiratory muscles.

General management of snake bite

• Convey the patient that there are venomous and non-venomous snake
• Allaying of the anxiety and fear
• Immobilization of bitten limb
• Bite mark – venomous – 2 clear puncture marks. Non venomous – 2 rows of teeth marks.
• Identification of snake
• Do not apply tourniquets, ligature s unless the snake is a neurotoxic.
• Transport the patient to a medical facility immediately

Diagnosis in tertiary centre

• For Neuroparalytic envenomation: ABG (Arterial blood gas analysis)
• In Vasculotoxic venomation – BT, CT,PT, APTT, Serum fibrinogen, D-dimer,
• In Myotoxic venomation-CPK, SGOT, Urine myoglobin
• In Cardiotoxic-CPK-MB, 2D Echo.

Homeopathic therapeutics of snake bite:

• Echinecia

Haemotoxic venomous bite. Eases pain at last stages. Blood purification.

Given as intramuscular injection.

• Apis melifica

Burning stinging sharp pain. Allergic oedema of face, eyelids, lips, mouth and throat.Rosy red, sensitive, sore skin.

• Arsenicum album:

Great fear of death. Extreme restlessness, marked weakness, lack of vital heat.

• Camphor: shock, state of collapse observed. Icy coldness of whole body, sudden sinking of strength is found. Pulse small and weak is seen. Convulsion with blue lips.
• Cedron

Specific for the bites of venomous snakes. Symptom returns exactly at the same hour every day. Icy coldness of extremities.

• Hypericum

Hyperhydrosis. Lymphangitis with red lines extrending up the arms or legs. Neuritic, tingling, burning pain, numbness and glossy skin.

• Lachesis

Excessive sensitiveness of the skin with intolerance to touch. Pain as if burned. Cynosis.

• Ledum palustre:

The area affected by the bite turns bluish. The area feels cold and there is a pricking pain and inflammation.

• Aconite:

Useful in the initial stages of disease, when the person has great fear of death with anxiety or panic and restlessness, it is indicated

• Carbo vegitabilis:

Bite reactions that have progressed into shock, coldness, blue discolouration of skin weak pulse, clammy sweat and collapse of the body.

Some Rubrics for Snake Bite;

1. GENERALS – WOUNDS – bites, snakes ( SYNTHESIS9.0)
2. GENERALITIES – WOUNDS – bites, snakes ( COMPLETE REPERTORY)
3. Generalities, bites, insects, snakes, dogs (O.E BOERICKE REPERTORY)

CONCLUSION
When the appropriately chosen Homoeopathic remedy is administered early and judiciously in potentially life threatening circumstances, the necessity  for anti-venom or surgical mediation  may be minimized or even avoided entirely.

LIST OF REFERENCES:

• Narayan Reddy, KS, 2014. The essentials of Forensic medicine and Toxicology. 3rd ed. New Delhi: The Health Sciences Publishers, pp.554-565.
• G Rao, Nageshkumar., 2010. Textbook of Forensic Medicine & Toxicology. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, pp.482-491.
• Standard Treatment guidelines, Management of snake bite. Ministry of Health & Family Welfare Government of India.
• Boericke W. Pocket manual of Homoeopathic Materia medica & Repertory comprising of the characteristic and guiding symptoms of all remedies (clinical and pathogenetic) including Indian drugs. New Delhi: B. Jain publishers (P) Ltd; 2012; 1-979.
• Subrahmanyam BV, Parikh CK. Parikh’s textbook of medical jurisprudence, forensic medicine and toxicology for classrooms and courtrooms. New Delhi: CBS Publishers & Distributors; 2019.
• Modi JP, Franklin CA. Modi’s textbook of medical jurisprudence and toxicology. Bombay: N.M. Tripathi; 1988.
• VIJ K. Textbook of Forensic Medicine & Toxicology: Principles & Practice. ELSEVIER INDIA; 2014.
• Nandy A. Principles of Forensic Medicine: Including Toxicology. London: New Central Book Agency; 2012.

Dr Deepthi MK, MD (HOM)
Asst. Professor, Department of Forensic medicine and Toxicology
MNR Homeopathic Medical College and Hospital Sangareddy
Email id:deepthimk818@gmail.com

Dr CH K SUMAN, MD (HOM)
Asso. Professor & HOD
Department of Forensic Medicine and Toxicology
MNR Homoeopathic Medical College and Hospital Sangareddy
Email:drsumanchittikanna@gmail.com