Talk:Snakebite

Delisting GA

I am delisting this as a good article, for the reasons in the to-do list above. If the article failed only one of those criteria I would not delist it, but I feel the prose/SP&G problems and a significant aspect of the topic being missing are major enough problems. Joe D (t) 05:18, 16 April 2006 (UTC)

Prevention

This paragraph states that king cobras and black mambas will defend their terrtories in the context of creating ground vibration while walking. I think this is a bit misleading. The sources (national geographic) say "Black mambas are shy and will almost always seek to escape when confronted." and "Fortunately, king cobras are shy and will avoid humans whenever possible, but they are fiercely aggressive when cornered." The easter brownsnake of australia is known to be territorial as well. But I read in this article that brownsnakes advanced towards the observer in an offensive way in only 3 out of 455 close encounters during research, which gives a different picture. There seem to be a lot of myths around about the agressiveness of snakes so I think it is important to be extra cautious which such statements. 80.171.228.210 (talk) 19:15, 7 January 2013 (UTC)

Venom Immobilization

What is the problem with a tourniquet or with ice? Shouldn't a tourniquet be a better immbilizer than an elastic bandage? Icek 00:41, 19 April 2006 (UTC)

A tourniquet can localize the venom, and cause more harm than good by aggrivating swelling and necrosis, and studies have shown that often they're not applied properly or they're left on for too long resulting in ischaemia.[1] Ice also does not slow the spread of the venom through the system, and has been shown to have similar effects to an improperly applied tourniquet, including increased necrosis.[2] When I first started working with venomous snakes every professional told me that your best possible treatment is a spare set of car keys next to the phone, so you can call for help and/or be driven to the hospital immediately. -Dawson 02:57, 19 April 2006 (UTC)

Yes, but what about properly applied tourniquet's? Article could explain the proper amount of interval between slight release, then retightening, etc? What if no pressure bandages are available? Should not an article on snakebites not just give vague overly general info, and, rather, give info on (apparently) two category's of venom treatment in the field, ie localize venom vs somewhat distribute venom (pressure bandage) prior to medical attention? I whole-heartedly agree with the "spare set of keys" treatment, but even in the U.S. I have experienced bothered (very large) rattler's a good two hours away (via speeding auto or air-rescue helicopter) from medical treatment.12voltlighting (talk) 22:05, 5 February 2014 (UTC)

'Application of ice. The process of chilling the wound area or the affected limb should certainly be avoided. This procedure would have the effect of slowing the blood flow to the area, thus preventing the natural dissipation of the venom and likely increasing its damaging effects.' This is misleading; while allowing the venom to dissipate is commonly-given advice when dealing with most US species, containment is generally preferred when dealing with elapid bites (cobras, coral snakes, most Australian species). I haven't seen ice advocated as a way of dealing with these, but the article should be careful not to present US-specific information as more general than it is. --Calair 23:41, 26 January 2007 (UTC)

Again (see my above comment) would it be too cumbersome to make the distinction in the article about treatment of most bites around the world, and bites in the US? A properly applied (men's belt) tourniquet, with occasional loosening--then retightening in the field, along with gentle chilling; to localize venom, in say a western diamondback bite, seems to be still preferable to a pressure bandage--assuming one knows what they are doing to avoid gangrene, edema, frostbite, etc., on the way to a hospital or other source of anti-venom. And, of course tourniquet and chilling only works for extremities like hands-arm and foot-ankle-leg. I understand an article is going to be read by large numbers of people around the world, and any advice must be tempered against misinterpretation or people becoming overzealous with a shoelace tourniquet, etc. Perhaps in the heading an alternate link could be provided to a separate article, that could be easily discerned, regarding the less common type of bite that does well with containment, versus the many many more people around the world where this article is right on the mark? Or maybe a link to a "containment" or "dissipate" treatment page appropriate to specific snake pages? Just some thoughts here to perhaps improve WP, no criticism of current article page, understanding that for the vast majority of snakes bites around the world, this article gives good info.12voltlighting (talk) 22:38, 5 February 2014 (UTC)

A shoelace tourniquet may damage the arteries. A 2cm bandage to the upper leg or upper arm can stop the blood, but if kept on for more than 20 minutes you might later need to amputate the limb. (40 years ago the recommendation was take it off for a minute every 20 minutes, but don't blame me if you get gangrene. Last time I looked, no-one outside Australia had researched the topic much.) Wrapping the entire limb from digits to above the wound can slow the sub-surface lymphatic system enough to manage the amount of the (larger?) neurotoxic(?) poisons of Australian elapids(?) reaching the torso, and it can be left on for many hours. btw, ice is recommended for one species of Australian spider, the Redback - just as well, as a constrictive bandage wouldn't be much use if you get a Redback on the bum while sitting on your dunny. But from memory, for some species, e.g. rattlesnakes, pressure immobilsation is contra-indicated.

Pressure immobilization uncertainty

Just how much pressure needs to be used is unclear. Everyone cites a 1994 study (D.M. Howarth; A.E. Southee; I.M. Whyte. "Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation". Med J Aust. 161 (11–12): 695–700. ISSN 0025-729X. Retrieved 2006-06-25. {{cite journal}}: Unknown parameter |affiliation= ignored (help)) that claims that a fairly narrow (and high) range of pressures is required. Another study (Robert L. Norris, MD; Jessica Ngo; Karen Nolan, MD; Giles Hooker, PhD. "Physicians and Lay People Are Unable to Apply Pressure Immobilization Properly in a Simulated Snakebite Scenario". Wilderness and Environmental Medicine. 16 (1): 16–21. Retrieved 2006-06-25.) claims that people are unable to achieve these pressures following written instructions.

However, other authors (Stuart Gray, Mcsp, B App Sc (Phty), Grad Dip Sports Physiotherapy, Grad Dip Recreation, Grad Dip App Sc (Outdoor Pursuits). "Pressure Immobilization of Snakebite". Wilderness and Environmental Medicine. 14 (1): 73–73. Retrieved 2006-06-25.{{cite journal}}: CS1 maint: multiple names: authors list (link)) claim that, with proper immobilization, the need for any external pressure at all is unclear.

Certainly (sorry, no citation handy) it's widely observed to be highly effective in practice, which the first two articles say isn't to be expected. I'm doing some research to try to understand this issue better. 192.35.100.1 17:28, 25 June 2006 (UTC)

Just in case you don't have access to the studies mentioned, let me please put some selected quotes to further the point from the very complete abstracts:

• "Howarth et al." -- pressures outside these ranges actually enhance central spread of venom
• it's not just people btw but "two groups of individuals (those with no prior formal medical training [lay subjects] and emergency medicine physicians [medical subjects])".

It's a bit besides the point, but Norris et al. suggest a nice alternative («: Alternatively, it might be possible to develop devices specifically designed for use following the bite or sting of a venomous creature that would ensure that appropriate pressures are generated. Such a device might consist of a sleeve designed to be slipped over the bitten extremity and then inflated, with a pop-off valve designed to signal correct inflation and to prevent excess pressures.») which has found its way into a patent ([3]) so this technique may develop higher success rate.

Rdavout (talk) 16:45, 25 February 2010 (UTC)

Inconsistancies

The article says this: Approximately 85% of the natural snakebites occur below the victims' knees And then in the next paragraph this: approximately 65% of snakebites occur to the victims’ hands or fingers One of them has to be wrong.

Why not simply remove both numbers? topace10 14:34, 17 December 2006 (UTC)

I see nothing wrong with the statement. The first percentage refers to natural snakebites, while the second applies only to pet owners and people trying to capture snakes. No reason to change anything. --Jwinius 15:56, 17 December 2006 (UTC)

While it should be better worded, I can say with certainty that there is no contradiction (I authored much of the article). What is Jwinius is saying is true.--Mad Max 06:21, 15 January 2007 (UTC)

Immune System

I want to ask this question for every possivble "bite" or "sting" from an animal. Exactly why is it that the immune system is unable to eradicate the threat from the venom of whatever creature it was that injected the venom?

That's not completely true. It's possible to build up immunity against poisons like snake venoms by regularly injecting yourself with venom, starting with very small doses and building that up over time. Bill Haast is a famous example. However, when you stop the regular injections, the immunity begins to disappear. The venom vs. immune systems battle has been going on for many millions of years in an evolutionary arms race with natural selection always favoring venoms that are stronger than most of the immune systems around them. The immune systems are always playing catch-up. --Jwinius 12:20, 18 November 2006 (UTC)

Snake Stones

Hi, I'm looking for help on the Snake-Stones article. Desipte the advice given here against using black stone to treat a snake bite, it seems like it's still a widely used treatment promoted by state health care, charities and the International Labour Organization. One medical study found benefits in using black stone.

If you can help with the medical aspects or the article in general (it's the first that I've made major edits to) then I'd be very grateful. I'm monitoring Talk:Snake-Stones regularly. Thanks, Hamster128 10:45, 8 March 2007 (UTC)

I've cleaned up that Snake-Stones article. (I finally got around to creating a login to do so coz it needed so much re-arranging - I had just been doing some anonymous edits on Snakebite as 202.159.176.143.) If you actually read the cited references, you realise that the article was shockingly misleading and inspired by POV. The only study that found black stone benefits found that rope or cloth 'tourniquets' and other Tradition Medicine were better than black stone treatment. Reading between the lines, imho it seems that any procedure that calms and stills the patient would have the same or better effect as a black stone. BenevolentUncle (talk) 12:23, 27 May 2013 (UTC)

Unclear fottnote in "Global evaluation of snakebite" table

The "Global evaluation of snakebite" table has a footnote that says "Population at risk". This footnote is rather vague. Which population - snakes or people? At risk in what way? --B.d.mills 22:46, 10 March 2007 (UTC)

I added an important elaboration about suctioning, as it is worth noting that the study referenced demonstrated that suction did not prove efficient when used 3 minutes after a bite occurence, but it would be interesting to see the same study done with the suctioning occuring at much faster intervals to look at its effectiveness.Wikismart 05:28, 7 May 2007 (UTC)

Suction Study Methodology Recommendations

Regarding suctioning by the use of pumps, it is true that several organizations have updated the snake bite treatment to exclude suctioning based on the results of the one study, cited below and in the references to the main article. There is no reference provided to support the statement that suctioning may cause harm or accelerate or facilitate the spread of venom. That sentence should be referenced. Wikismart is on the mark when wondering what happens within three minutes, as many first aiders assume that the suctioning is effective under three minutes, while that remains unverified.

On the other hand, the experiment was a simulation in a controlled environment, and not a representation of the real life performance of the Sawyer pump extracting venom. Where is the scholarly discussion about in what sense is saline solution with albumin, used in the experiment, similar in chemical and physical properties to the actual snake venom? A mere difference in density or flowability might explain the results. What if the chemical properties of the complex organic compounds known to be present in venom cause the venom to be much slower in spreading (than the mock venom)? What if the venom's compounds were of such a nature as to be much more easily withdrawn through pneumatic action?

Finally, to change the "modus operandi", the treatment algorithm for snake bite because of the results of one study, which appears to date not to have been reproduced, is not good practice, unless there were clear and convincing evidence of injury from the practice. What if after the published results regarding cold fusion, everybody in the world canceled their electric service in expectation of unlimited nearly free energy? Of course the results were not reproduced. In this case, we have one experiment which is being interpreted to mean far beyond what it actually proved: very little.

At risk of being attacked, I recommend trial of actual venom in animal subject of proven human-like physiology, such as small mammals. The trials need not be fatal. In this way, the effectiveness of suction devices could be compared nearly "apples to apples." 74.165.119.53 17:06, 28 June 2007 (UTC) ^ Alberts M, Shalit M, LoGalbo F (2004). "Suction for venomous snakebite: a study of "mock venom" extraction in a human model". Ann Emerg Med 43 (2): 181-6. PMID 14747805.

Alas, learning never ends... Apparently such research has been conducted with actual venom and survival rates following suction, see for example: http://www.llu.edu/llu/grad/natsci/hayes/research-b-snakebite.html

It seems the original article could improve by providing more complete references. 74.165.119.53

Tautology

Wow... that's quite the tautological first sentence... "A snakebite, or snake bite, is a bite inflicted by a snake." O RLY! --Hyperbole 08:37, 23 August 2007 (UTC)

It helps search engines find it, wuh.

Need for a section on medical treatment

I am amazed to find an article on snakebite with many lines about outmoded treatment and first aid but without even a single mention of antivenom. Obviously a person needs to know what is possible and available. AshLin 19:31, 21 September 2007 (UTC)

Regarding the medical treatment, it seems that sections of the article contradict itself when refering to treatment. Major copy edit, and more cohesive section on medical treatment is needed. 75.67.92.148 (talk) 07:51, 24 January 2008 (UTC)

Well, the entire first aid section should probably be rewritten due to WP:NOTGUIDE, but the problem is more of format than anything else. The fact that antivenom exists really should only cover a sentence or two. 130.64.73.98 (talk) 23:21, 21 April 2008 (UTC)

I think someone should address the common practice of using high voltage direct current (hvdc) treatment on snake bites. This is usually done with low voltage stun guns (25-50kv). There is a lot of information out there about the use of stun guns, or even spark plugs on a combustion engine, on the site of a snake bite to greatly reduce anaphylaxis. Ordosingularis (talk) 00:40, 6 May 2008 (UTC)

Additional sections

How about something on history and culture of snake bits? They do play a prominent role in human history.Doc James (talk · contribs · email) 02:58, 2 September 2009 (UTC)

Hi there, I add a section but it could probably use some expanding, but I don't have that much free time these days. I think with the addition of this section, though, this article pretty comprehensive, covering every important topic I can think of. Cheers! --98.232.98.144 (talk) 18:26, 4 September 2009 (UTC)

Tissue Necrosis Image

Um, could we possibly move this image off the page and perhaps link to it for those who are really curious about what it looks like? It nearly made me empty my stomach. 92.41.57.189 (talk) 02:26, 9 November 2009 (UTC)

I agree. It's horrific. —Preceding unsigned comment added by 94.2.37.140 (talk) 09:12, 12 March 2010 (UTC)

I would really like someone to remove the image. It belongs on the page for Tissue Necrosis, but I think it's too graphic for a page talking about snakebites, especially since all snakebites do not cause tissue necrosis. KyleECronin (talk) 09:43, 22 May 2010 (UTC)

I say keep it. WP is not censored, and frankly, people need something to show them just how bad a bite can be - 80%+ of US snakebite is due to dipshits picking the snake up, trying to catch it or trying to kill it. Besides, it's not even close to too much gore. Mokele (talk) 13:42, 22 May 2010 (UTC)

I know Wikipedia's not censored but it's always really annoying to run into that kind of image on a page where I wouldn't expect it. 216.170.23.235 (talk) 05:05, 26 September 2010 (UTC)

Why would you not expect it on a page about snakebite? Mokele (talk) 15:57, 26 September 2010 (UTC)

It seems unnecessarily graphic, and isn't indicative of all snakebites. If it were a more standard picture of pinpricks and swelling, or even a smaller sore, it wouldn't be so bad. A child's limb rotting off might be a bit excessive. —Preceding unsigned comment added by 68.108.208.207 (talk) 02:06, 24 October 2010 (UTC)

The image is extreme, this is a general encyclopedia, not a pathologist's encyclopedia,administrators please remove it or move it to a more specialized section! — Preceding unsigned comment added by 79.130.95.15 (talk) 17:47, 11 June 2012 (UTC)

This image is seriously unnecessary in this article. There is no need to show an eleven year old's limb rotting off, especially with no warning. That image doesn't even represent the majority of snakebites. The person who keeps putting the image back up is clearly on some sort of deranged, obsessive power trip as it is the same person every time. Administrators, please get rid of this picture. 12.196.41.122 (talk) 19:46, 9 May 2013 (UTC)

Snake bites actually result in a fair number of deaths worldwide. While they may not be an issue in North America they are in other countries and yes this happens. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:52, 9 May 2013 (UTC)

I think that encouraging better medical responses and dissuading people from playing with snakes is more important than preserving the contents of readers' stomachs, not that anyone has actually reported vomiting. They say a picture is worth a thousand words, and if that picture does anything to reduce the number of kids needing amputations then the real world will be better. In Australia, we have pictures like that on the sides of cigarette packages - sometimes you need to tell it like it is. I think a bit of personal discomfort is less important than reducing the incidence of amputations.

The image is totally unnecessary in relation to this article and such things will probably increase the scare factor. This should be removed . Such necrosis after snakebite is extremely rare in snakebite in India. Also most people in this thread want this removed. Can someone please remove it.? Drsoumyadeepb (talk) 13:27, 19 May 2015 (UTC)

Many of the sources comment that amputation is occasionally required due to snake bites plus snake bites kill nearly 100,000 people a year. People who are bitten should not be too reassured and should be made to realize that treatment may be needed and may save their life. I think this image makes it clear that not all snake bites are benign. IMO a reasonable compromise is to not put it in the lead but I am not sure we should remove it. Doc James (talk · contribs · email) 05:11, 20 May 2015 (UTC)

snake bite on children

hi,

there is myth that if snake bite any infant(human child) who has not consumed salt yet the infant will not be afftected by snake bite.Is it true? —Preceding unsigned comment added by Sanjeev75 (talk • contribs) 14:17, 5 April 2010 (UTC)

Yes, that's true, but only for children born during full moon 188.97.149.113 (talk) 06:01, 24 October 2011 (UTC)

Believe it or not, many cultures have no concept of 'pulling your leg', so it is best not to be facetious on such a serious topic - many people die as a result of ridiculous myths like this one, like good old Condys Crystals. @Sanjeev, that is not true at all. How could it be? - every infant gets the same sorts of salts via their mother's milk or any sustaining replacement milk.

But it is far better for any child if they have nothing but mother's milk for the first 6 months (until their gut lining becomes more discriminating circa 4 - 5 months). source: Maureen Minchin's 1998 book Breastfeeding Matters

"most venomous" = TV over-hyped documentary crap

Ok, all of this "Site x has the _ most venomous snakes" needs to be completely removed. As I've detailed on other pages, these lists are utter crap. Even the page linked to by the IP editor says as much. Venom toxicity varies with species, subspecies, region, population, family line, and even within the lifetime of an individual. And that's not counting that different species will have different deliveries - a tiny elapid may be capable of only subcutaneous injection, while some of the large vipers are easily capable of intramuscular injection (and Bushmasters are large enough with long enough fangs to possibly manage an intraperitoneal injection on a thin victim). And finally, the lists of species are woefully sparse - proclaiming the "10 deadliest" is like saying "We had 10 people out of 100 run this race, and will proclaim with winner the fastest, even though it's very possible that someone in the other 90 is faster". Any sort of "Ten Deadliest ____" is the sort of schlock you get from low-budget TV documentaries short on science and long on hype - no serious academic wastes time on such drivel, and neither should we. Mokele (talk) 01:34, 23 September 2010 (UTC)

Four days ago I registered on the Venomdoc forum to have the site's owner, Dr. Bryan Grieg Fry, clarify how he obtained the data for his list. Since he's an authority on this matter I also wanted to provide him a link back to this article to encourage his feedback, but so far haven't been able to post anything because the forum's admin hasn't confirmed my account. Dr. Fry states that the relevant "publication list will be up shortly," but the publication list has not been added for at least a year, so I don't exactly have my hopes up that it will suddenly appear (I understand that he's a busy man, so all due respect). Now, since the Venomdoc chart has not been formally published anywhere and its sources are not known to us, the chart cannot be used as a reference as per WP:RS. User 76.78.238.204 (talk · contribs) insists on adding it, but apparently is either unwilling to follow WP guidelines—especially considering that I provided a link in an edit summary—or either doesn't understand them or missed the link before. I'm now letting him know of this discussion through his talk page. In any case, I think it is fair to reinstate the old sources once the article protection expires in the case of 76.78.238.204's absence, especially considering that Molecular & Cellular Proteomics is the leading scientific, peer-reviewed journal in proteomics and cites the 2001 book Australian Animal Toxins by Drs. Struan Keith Sutherland and James Tibballs as its source for the venom claims.--71.121.211.26 (talk) 22:21, 24 September 2010 (UTC)

I haven't been able to reach Dr. Bryan Grieg Fry yet nor successfully register at his site's forums, and without 76.78.238.204 (talk · contribs) participating in this discussion I believe the best thing to do would be to simply add the old citation back. Any input? --71.121.211.26 (talk) 07:22, 6 October 2010 (UTC)

I can't remember what the original wording was, but as long as we stay away from "___th most venomous" and suchlike, it'll be fine. Mokele (talk) 12:05, 6 October 2010 (UTC)

Not to mention the snake venom test is done on MICE!!! Mice are not humans and to claim that humans would react exactly like mice do to snake venoms is stupid and reflexs your lack of knowledge on the subject.. Mice and humans can react way different to certain toxins and the whole "australian snakes are the most venomous" is absolutely ridiculous and inaccurate. I can post about 10 examples that show that mice and humans and cat and dogs etc etc react differently to different toxins and that claiming that Australia has the most venomous snakes based on tests done on mice is incredible stupid and false. The only way to know how toxic snake venom is to humans is either to test it on humans[ obviously wont happen] or to do actual research and read studies on snake bites on humans. Let me tell you the australian snake are overrated and to claim that Australian snakes are the most "dangerous" or "venomous" does not match the results from studies of bites on actual humans. Asian snakes seem to inflict the most severe and potent bites on humans. —Preceding unsigned comment added by 76.78.238.24 (talk) 05:41, 31 October 2010 (UTC)

And what, exactly, do you suggest? Yes, mice are not humans, but differences are pretty minor, and the vast majority of the time, mice are an accurate reflection - why do you think we use them in drug testing? Any other species is either unethical to use (humans) or far too expensive (lab mouse = $0.50, lab monkey = $5000). And just seeing what happens in real bites doesn't actually tell you anything. How many are dry bites (often a substantial portion, anywhere in the world)? How do you know how much venom is delivered (impossible to ascertain from a wild bite)? And what about individual variation in body size, resistance, etc.? Mice aren't perfect, but a controlled lab study is a thousand times better than handwaving through actual bites on humans with no knowledge of the most important factors. Mokele (talk) 15:27, 31 October 2010 (UTC)

76.78.238.24, based on your edits I'm assuming you're the same editor as 76.78.238.204? If so, please notice the wording of both article versions: "10 of the world's most venomous snakes, as measured by LD50 in mice..." cf. "as measured by LD50 in mice..." Notice anything? Both make it perfectly clear that measurements are based on LD50 in mice. Your edit did nothing to solve the "problem", so I'm not entirely sure where you want to go with this one. The issue at hand is that you replaced a perfectly valid source with a self-published source. The issue is not that the relevant toxicity measurements weren't conducted on human subjects (and thank goodness for that!). Ad hominem attacks won't change this. Granted, I'm not a herpetologist nor a medical researcher, but I can assure you that I'm informed enough to know that mice aren't people. I wrote the cautionary "Most venomous snakes" section at the venomous snakes article, although I see you've edited that as well. The point I wanted to make clear is that the former source, MCP, is preferred according to Wikipedia guidelines — I also want to encourage better editing practices on your part. In any case, I'm glad to see you're finally participating in the discussion. While I was initially planning to reinstate the old version, I now wouldn't mind if that entire sentence (and any mention of "most venomous") were removed outright. --71.121.211.26 (talk) 04:12, 3 November 2010 (UTC)

Comment

This is by no means critical and I think the article is just fine without it, but how about a quick sentence explaining the term "snakebitten?" Ya know, unfortunate, having no luck...--NYMFan69-86 (talk) 23:53, 1 January 2011 (UTC)

Remove "Number of snake envenomings" image?

This image is not accurate - it portrays countries such as New Zealand and Ireland, which have no snakes at all, as having more than 1000 snake bites per year. I think it needs to be removed or have changes made to it, as it is very misleading. 121.98.223.66 (talk) 08:28, 10 January 2011 (UTC)

Technically, the way the map is set up the information isn't necessarily inaccurate. Instead of presenting statistics on individual countries, the map presents regional data (the countries are organized by the Global Burden of Disease grouping). Thus, while Ireland may have no snakes — and as far as I know, neither does New Zealand, Greenland, Madagascar — the territory falls within Group 10 (Western Europe). While this may not be ideal, it is the way the authors of the cited study presented their data (cf Figure 5, essentially the same map). Perhaps the map could be changed in some way to clarify the information, such as highlighting of regional borders instead of individual country borders, or else the file summary might clarify some relevant points.--76.121.180.74 (talk) 02:56, 15 January 2011 (UTC)

In the context of the study you refer to the map isn't inaccurate as the rationale behind it is explained. Indeed, the same study shows further maps which make it clear that certain countries within GBD regions have no snakebites. In Wikipedia no such explanation is given. I don't think casual users of Wikipedia should have to consult source material to give them an accurate key for an image.202.180.74.185 (talk) 23:40, 24 January 2011 (UTC)

What are your suggestions? Anyway, as a Wikipedia user you're free to edit the map if you're familiar with vector graphics. (Edit: I went ahead and edited the map without changing too much, but as my vector graphics skills are a little amateurish there may be some code errors. Hopefully it renders correctly for everyone.)--24.89.159.250 (talk) 11:17, 30 January 2011 (UTC)

AAFP review

A review of envenomation: [4] Doc James (talk · contribs · email) 18:32, 15 January 2011 (UTC)

Legitimate vs. Illegitmate

The article doesn't discuss the difference between legitimate versus illegitimate snakebites although it would seem that this is the place to do so.

Any suggestions as to where to add that discussion on this page?

-- J. Wong (talk) 22:59, 20 July 2011 (UTC)

Would it go under the Epidemiology section? You're right: there should be some commentary on the proportion of bites due to handling the snakes intentionally (illegitimate bites), provides the sources exist for it. —C.Fred (talk) 03:04, 21 July 2011 (UTC)

Yes, that looks right. There's several online links, but most seem to be quoting Whit Gibbons from various online articles by him. This one seems particularly relevant [SNAKEBITES COME IN TWO TYPES: LEGITIMATE AND ILLEGITIMATE] or also [How Dangerous Are Venomous Snakes in America?].

I also have a reference from a book to quote:

Epidemiologists make a useful distinction between legitimate bites--those accidentally incurred during normal activities--and illegitimate bites--those sustained while purposely interacting with snakes.

from Green, Harry W. (1997). Snakes The Evolution of Mystery in Nature. Berkeley: University of California Press. p. 89. ISBN 0-520-20014-4

The book includes the above definition and notes that more than half the bites to young men in the U.S. were illegitimate compared to Costa Rica where a similar demographic had more legitimate bites. The second Whit Gibbons reference both defines legitimacy and reports the fact that most bites in the U.S. are illegitimate (although using the definition of illegitimate but not the word itself) but without reference. I am leaning toward using the book although online references are easier to access.

-- J. Wong (talk) 07:10, 21 July 2011 (UTC)

GA review

I have a few concerns. One being that the section on first add is sort of "how to" and is not referenced. The other is that the antivenon section is poorly referenced. Unless these can be addressed will nominate for a formal review. Doc James (talk · contribs · email) 03:35, 1 September 2011 (UTC)

Also needs a section on cause. And the references need formatting... Doc James (talk · contribs · email) 03:36, 1 September 2011 (UTC)

Doc, looking thru the article, it seems to be kept clean of at least the grosser inaccuracies by folk even if they don't bother to reference comprehensively. I removed the HowTo warning on the First Aid stuff for the reasons given in the edit (i.e. if someone is desperately trying to look up life-or-death First Aid they will not thank you if you have moved the relevant stuff to an obscure wiki, plus it is more a summary than detailed pedagogy).

Last time I looked circa 2009, even USA Red Cross could give no firm recommendations on treatment for USA snakes. So that leaves WWW snake-oil merchants or WP; imho, WP serves a very useful social purpose in summarising what poorly defined consensus there is. I agree that referenced npov would be nicer, but if you take away the First Aid list from WP then the only stuff left on the web would be unreferenced POV that is never critically reviewed, and WP at least corrects the obviously wrong. — Preceding unsigned comment added by 202.159.176.143 (talk) 06:54, 27 May 2013 (UTC)

There was no ref for " and for other snakes in other countries, pressure immobilization may be contra-indicated." thus removed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:49, 27 May 2013 (UTC)

Doc, I was a science teacher teaching international school students 2008 - 2010. Before teaching re venoms, First Aid etc (probably in 2009), I double-checked latest protocols, and learnt for the first time that different countries have radically different protocols, because the toxins are different. e.g. in Australia the firm consensus is Pressure Immobilisation (which is distinct from a 1 inch bandage which is distinct from a 5mm tourniquet). Hardly any other country had firm protocols that I could find, and from memory the USA Red Cross officially said they don't know what to recommend; however from what I could discern at the time there were some species (rattlesnakes?) where it was thought that PI would localise the poison at the expense of wasting the limb. Part of the problem is that most of the world (especially Asia) has widely varying snake taxa (whereas Oz snakes are sufficiently similar that PI can be made as a firm general recommendation). I also discerned that in Australia: 'if in doubt, PI', despite that ice was the protocol for redback spider, and that PI on redback inflmation could be needlessly painful (but not fatal).

From a very quick perusal, it now seems that research is being done for snakebite using pigs (though fwiw I dunno that pig limbs are a close approximation of human limbs re PI) and that the USA might be ready to exclusively firmly recommend PI. If so, then please give the reference; if not, then let me indicate doubt (which I did as 202.159.176.143 - sorry, I have only just created an account after years of lurking - it was necessary for the snake-stones article). Those weren't weasal words, they were indicating accurate doubt (which this area necessarily has).

One area beyond doubt afaik is that PI is appropriate for all Australian snakes, so please don't insert weasle words unless you have a counter-reference.

I am also reverting the date back to 2009, because that presumably reflects the knowledge of the contributor who made it.

My only expertise is a BSC with a biology minor and spending several hours circa 2009 reviewing what was known then. If you know more, feel free to inform us. But don't muddy the waters with WP kneejerk reactions (see my earlier comment above as 202.159.176.143), don't assume that one size fits all countries. This article will risk lives unless it

• unequivocally informs australians that they should use PI for snakebite
• refrains from implying support for PI in situations where PI could cause limb-loss.

BenevolentUncle (talk) 23:02, 27 May 2013 (UTC)

On Wikipedia references to high quality sources are needed. Much of this article is unrefs and it does not meed GA. Added an interesting ref from the British military. We should be using secondary sources per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:19, 28 May 2013 (UTC)

I only edited it because too much had been extrapolated from the refs given. I think you have now reinstated this extrapolation - I disagree that we can say the only evidence for PI is anecdotal, because that is based on just one 2008 paper that I have not read. — Preceding unsigned comment added by BenevolentUncle BenevolentUncle (talk) 04:08, 28 May 2013 (UTC)

Doc, could you please email me the Darwin article if you have access - there are number of statements in the article which seem to be drawing a long bow. Also, I suggest a bit of past imperfect, as the field seems to be moving. The article is Currie, Bart J.; Elizabeth Canale, Geoffrey K. Isbister (2008). "Effectiveness of pressure-immobilization first aid for snakebite requires further study". Emergency Medicine Australasia 20 (3): 267–270(4). BenevolentUncle (talk) 04:08, 28 May 2013 (UTC)

Sure email me and I will send it to you, likely tomorrow. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:14, 28 May 2013 (UTC)

Okay just figured out that their is a subpage about pressure immobilisation. Greater detail on the technique can be discussed their. Have also found a few more recent review articles which discuss. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:56, 28 May 2013 (UTC)

I missed the subarticle too - have now added a 'main article' template.

Thanks Doc for the Currie et al .pdf. Actually, it has elements of secondary review in it, e.g.

"Of note, the only prospective study to show objective evidence of benefit from first aid is a study from Burma which assessed blood venom levels before and after release of compression pad first aid. In that study, the central movement of Russell’s viper (Daboia russelii siamensis) venom was retarded by the compression pads in 13 of 15 cases.[ref] However, the applicability of this study to Australasian snakebites remains to be evaluated."

(don't know if that means PI is recommended for that Burmese snake). Also:

"The critical importance of immobilization in addition to pressure bandaging has been shown in lymphoscintigraphy studies, with movement of a limb quickly resulting in mock venom absorption irrespective of the rapidity of bandaging.15" - Howarth DM, Southee AE, Whyte IM. Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med. J. Aust. 1994; 161: 695–700.

There was other stuff suggesting the criticality of putting on the PI ASAP, and having broad elastic bandages.

If you can find more comprehensive review articles, that would be great. Otherwise, anyone know how we can communicate that our (Doc's) search for secondary sources has turned up nothing? (This would be important info, and it would save other wpedians from futile effort until new research has been done.)

BenevolentUncle (talk) 00:32, 29 May 2013 (UTC)

It from references above, it seems that immobilization / non-contraction of the local skeletal muscles may be even more important than PI, at least for poisons that travel thru the lymphatic system. If so, this should be added to the list of consensus first aid measures. BenevolentUncle (talk) 01:40, 29 May 2013 (UTC)

There are a bunch of other reviews I will look at. May take me a few days though. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:20, 29 May 2013 (UTC)

Doc, I reckon the Pressure immobilization technique article should be linked by a Details template rather than a Mains template. (I initially set it up as Mains because, like you, I didn't see it at first; I then changed it to Details (and will now revert) for the following reasons. An old IT application of Murphys Law is that if info is in more than one place then one of those places will become incorrect. Imho, info as to whether/when PI is applicable for different snakes should go in the Snakebite article, and this is likely to change with research. Info re applicability of PI for spiders / marine stingers / blue ring octopi etc etc should go into those articles. Details on 'howto' can go in the 'PI Techniques' article, which should be what it says, i.e. techniques, which is not the main article for whether it should be used for various snakes. And the Pressure immobilization technique article won't just be howto - there is substantial primary/secondary research still required on

• how tight the bandage
• how much of the limb (especially if only limited fabric available)
• whether non-elastic bandages can actually work
• relative importance of bandaging vs ensuring stillness / no limb muscle contractions.

BenevolentUncle (talk) 02:41, 29 May 2013 (UTC)

The main think IMO is that we should remove the primary research and replace it with secondary research. May take some time. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:48, 29 May 2013 (UTC)

Agree completely. Good luck re finding it. Doing so would be great - there is a dearth of info that causes needless suffering. I am happy to help present it.BenevolentUncle (talk) 02:58, 29 May 2013 (UTC)

Hey Doc, when you are doing that reading, could I suggest (with apologies if this is obvious) that you look out for info for the following types of readers:

• ambulance officers & ER Drs (who have access to medical facilities within minutes)
• intelligent laypeople in 3rd world countries or who are hiking in wilderness areas days away from help
• simple guidelines suitable for general 1st aid recommendations

Stuff I would like to know includes:

1. How critical is 'time to put on PI' vs 'minimising limb muscle contractions'? E.g. for a lone bushwalker without an long elastic bandage, should they cut up clothing to make a bandage, or concentrate on lying still?
2. For PI days away from medical facilities, how long does it take humans to produce enough antibodies? i.e. how long would you have to keep the limb still?
3. Is splinting only recommended to stop frightened uneducated patients from running about and give 1st aiders something to do? I.e. if the patient is smart enough to lie completely still, should you move the limb to splint it, or concentrate on encouraging stillness? My guess is that a patient straining against a splint could rapidly pump the lymph.
4. Can PI increase necrosis / gangrene / muscle wasting for some types of snake? (The UK Army might be more concerned with preserving life than quality of life??)
5. Is a 2 - 3 cm bandage over the upper limb (held 20 minutes with 1 minute in between) ever appropriate for pit vipers? And if so, would it mean saving life at the cost of amputation? (I thought this was ridiculous, but the Nigerian study refed in Snake-stones indicated that rope/cloth "tourniquets" had some benefits (with insignificantly increased necrosis).)
6. In Oz, they recommended against wound washing - from memory this was because specific antivenins were better than polyvalent ones. Is this still best practice? In USA? Oz? the world?
7. It might be nice to keep an eye out for other animals, e.g. Box Fish Jellyfish no, Cone-snails yes, Blue-ringed octopus yes, etc. I'm sure you have nothing better to do...
8. For people at risk of bee-sting etc anaphylaxis, should the bandage go over the actual wound? I guess there could be some advantage to letting the wound weep, but it is more important to clamp down on inflamation so as to minimise lymph movement?
9. My understanding is that the bandage should be wrapped right down to the digits? If so, is this to minimise the pain of swollen extremities?
10. Exactly how tight to wrap?
11. Can non-elastic fabric work (e.g. a long-sleeved shirt), or will it come loose not be even enough in pressure?
12. Are there inflatable sleeves that can provide 'perfect PI'? Do they work?

I know that this is getting close to HowTo, but I can't see this info authoritatively assembled anywhere else, and I think there is scope for WP to assemble such info to WP:MEDRS standards. I think there is ample precedent re encyclopedias giving extra detail on First Aid - even our telephone White Pages includes a page on CPR.

BenevolentUncle (talk) 07:28, 29 May 2013 (UTC)

Review articles

• Madsen, W (2010 Oct). "Snake bites". The Journal of hand surgery. 35 (10): 1700–2, quiz 1702. PMID 20888509. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Warrell, DA (2010 Jan 2). "Snake bite". Lancet. 375 (9708): 77–88. PMID 20109866. {{cite journal}}: Check date values in: |date= (help)
• Alirol, E (2010 Jan 26). "Snake bite in South Asia: a review". PLoS neglected tropical diseases. 4 (1): e603. PMID 20126271. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Gutiérrez, JM (2010 Dec 15). "Snakebite envenoming from a global perspective: Towards an integrated approach". Toxicon : official journal of the International Society on Toxinology. 56 (7): 1223–35. PMID 19951718. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Calvete, JJ (2010 Dec 15). "Antivenomics and venom phenotyping: A marriage of convenience to address the performance and range of clinical use of antivenoms". Toxicon : official journal of the International Society on Toxinology. 56 (7): 1284–91. PMID 20036274. {{cite journal}}: Check date values in: |date= (help)
• Weinstein, S (2009 Oct 15). "Envenomations: an overview of clinical toxinology for the primary care physician". American family physician. 80 (8): 793–802. PMID 19835341. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Isbister, GK (2010 Feb 9). "Antivenom efficacy or effectiveness: the Australian experience". Toxicology. 268 (3): 148–54. PMID 19782716. {{cite journal}}: Check date values in: |date= (help)

Doc James (talk · contribs · email) 11:01, 3 September 2011 (UTC)

Epidemiology - facts and figures

I precised the given ratios as ratios given for USA only, since the given references are only showing USA figures. For other countries, the male/female ratio as well as age structure can be different due to different lifestyle etc. (e.g. going to toilet outside the house, female workforces on the fields or mainly ladies collecting firewood, etc.). I didn't find so far a valid global figure for male/female ratios or age structures, but it seems the ratios/age figures vary widely from country to country (predominant male victims but at different ratios), a reference for Asia could be e.g. http://www.indjst.org/archive/vol.2.issue.9-10/oct09meenakshisun-30.pdf , there especially p. 70, in case someone wants to add Bangalorius (talk) 16:34, 27 February 2013 (UTC)

GA Reassessment

This discussion is transcluded from Talk:Snakebite/GA2. The edit link for this section can be used to add comments to the reassessment.

Much of this article is 1) unreffed 2) supported by primary research 3) is supported by research that is really old. Thus IMO it no longer meets GA criteria. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:02, 28 May 2013 (UTC)

Will delist until issues addressed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:36, 8 June 2013 (UTC)

LD50 discrepancies

References of those LD50 values should be displayed clearly since they vary from source to source. According to the tables on this page, the book called "Snakes in Question: The Smithsonian Answer Book" seems to give a much more toxic value to almost every venomous species than the Australian Venom and Toxin Database (as shared through Dr. Fry's website as well) does.

Further, I don't think different sources' statistics should be combined to yield those rankings of cobras' toxicity as the way done here on the article because, as patently described on the page of venomous snake, scales in use may be very different. Let's say: Snakes A, B and C are with S.C. LD50 of 0.1, 0.2 and 0.3 mg/kg respectively in report A while Species A, B, D got values of 0.02, 0.04 and 0.08 respectively in report B. So, both sources agree that A and B are more toxic but when we seek to create a comprehensive toxicity ranking by singly combining D's value in report B to that of A , it comes out that D is even the most toxic one. We can't guess if the absent D is more venomous than C in report A or not and that's why the venomous snake page gives two separate lists of toxicity rankings with their authors clearly shown. Therefore, I believe the table of a cobras' ranking here should be actually deleted. — Preceding unsigned comment added by 14.136.71.181 (talk) 06:33, 7 November 2013 (UTC)

As I was editing the Inland taipan (Oxyuranus microlepidotus) article i noticed this confusing discrepancy as well. so i did some digging up, and I found the basis for these different values:

In the case of the inland taipan, both Fry and the AVU are correctly stating The standard median lethal dose (LD50), Subcutaneous for mice as 0.025 mg/kg.

The "Snakes in Question: The Smithsonian Answer Book" is giving the LD50 of 0.01 mg/kg Subcutaneous too, BUT injected via Bovine serum albumin solution not the usual Saline solution.

Hence the more toxic result.

You can see the citation of the two measurements together on this detailed report from the International Programme on Chemical Safety (section 7.2.2) :

http://www.inchem.org/documents/pims/animal/taipan.htm#SectionTitle:7.2%20%20Toxicity79.182.209.100 (talk) 15:27, 7 November 2013 (UTC)

I made the table of the top 10 venomous Naja species and I have been thinking of deleting myself for the past several days. I am not comfortable with it because as you have correctly pointed out, there is too much variation in the toxicity of venoms at all levels: interfamily, intergenus, interspecies, intersubspecies and intraspecies, geographical variation, between individual specimens, and in individual specimens, due to seasonal variation, diet, habitat, age-dependent change, and sexual dimorphism. This is why I list the different results obtained from different studies for each species in the body of the article. There is no consistency in the toxicity/lethality of venom at all levels, especially not intraspecifically. The variation in lethality of venom within a single species in different regions of its geographical range is common in all species of venomous snakes, and in some species the differences can be drastic. Mukherjee et al. conducted a study on intraspecific venom lethality in two species of snake: Naja naja and Daboia russelli and found signifcant variation not only in the potency/lethality of the venom, but also in the composition (which results in different effects and has a role in the difference in lethality) between specimens collected from Western India and Eastern India. The average murine venom lethality (LD₅₀) for Western and Eastern N. naja was 0.7mg/kg IV and 0.44mg/kg IV, respectively. Variation within D. russelli was similar: Average LD₅₀ for Western and Eastern specimens was 0.92mg/kg IV and 0.74mg/kg IV, respectively. Other research studies have found even greater variation within the lethality of intraspecific venom (eg, LD₅₀ for Echis carinatus venom ranges from 0.44mg/kg IV to 24.1mg/kg IV; another study lists an average murine LD₅₀ of 0.151mg/kg SC and the venom obtained from females is more than twice as lethal as those from males). Depending on the geographical location which specimens come from, age, sex, seasonal variation, diet and the methods employed in the research to determinine the lethality of venom in mice, you will a lot of different numbers for each species. So one black mamba from South Africa might have a venom that is 10x as lethal or potent as one from Zambia and this can be due to several factors (eg, this difference can be due to a difference in prey items - the South African specimen could have a diet that consists of prey items which have a higher higher natural resistance to the snakes venom than the Zambian specimen, etc). With that said, I am going to delete the table. --DendroNaja (talk) 19:35, 7 November 2013 (UTC)

 Just gave the talk section a more distinctive name for the topic109.66.110.51 (talk) 04:14, 8 November 2013 (UTC)

Thanks for all of your attention here. Now please go and see the inland taipan page where I believe some references aren't scientific enough to support those claims of the time between death and evenomation and the capability of killing 100 full-grown men in a single bite. Many of them are simple news reports only. This animal was exaggerated. — Preceding unsigned comment added by 14.136.71.181 (talk) 16:04, 8 November 2013 (UTC)

The " 100 full-grown men " is a correct statement and not exaggerated. it is a standard calculation of the known LD50 in mice. 1 bite has the amount and power of venom to kill 218,000 mice. which is equivalent to 100 men. i added a good scientific reference there.

The "30-45 minutes" can happen in a severe envomation especially if bitten in a bad place. i added this reservation to the sentence + a quote from the INCHEM reference.

Overall the second paragraph in the lead puts everything in perspective. It's a good article. 109.64.109.17 (talk) 23:05, 8 November 2013 (UTC)

Mice aren't humans and how do we know that we react with the venom in the same way as mice do? This statement itself isn't scientific. Yes it does be supported by two simple news articles but there're also lots of such websites claiming that 50% mortality rate was caused by krait bites even with anti-venom while no specific species or original medical literature is cited there.

No documented fatality has been caused by this species so how do we know that time between 30-45 minutes is the fastest span between death and envenomation? Yes, it can be estimated from some severely envenomated clinical patients but all in all this is just estimation not real occurrence, unlike those snakebites caused by, say, the black mamba which truly posed rapid fatalities on record. To be a more responsible editor, statements like "it is estimated that..." should be put ahead that span.

By the way, I'm not sure whether the lead of the page should be that long because it's just the introduction and details are there on the corresponding sections. — Preceding unsigned comment added by 14.136.71.181 (talk) 06:14, 9 November 2013 (UTC)

LD₅₀ measurements

According to this paper, the studies which Ernst & Zug (1996) conducted on the median lethal dose (LD50) of almost every single medically important species of snake is more accurate than what was reported by the Australian Venom and Toxin Database (AVTD). The utilisation of 0.1% bovine albumin has proven to produce consistent results over and over again. Saline used as a diluent produced vastly differing toxicity ratings in studies conducted not just by the Australian Venom and Toxin Database, but by Spawls & Branch, Shermin A. Minton, and even Brown. For example, Naja nivea has a 0.72 mg/kg via subcutis according to the AVTD, while Brown lists a value of 0.4 mg/kg subcutis. Brown administered doses of a multitude of venomous snakes in the same species of mice of the same weight - and guess what? He got such varying results that he couldn't list a single approximate LD50 value for any of the species he used as part of the study. He listed all the wildly varying values in his work. It is generally now accepted among the herpetological community at large that 0.1% bovine albumin is what should be used in such toxinology research as the results of the testing is consistent and not wildly ranging in its results. --DendroNaja (talk) 04:39, 29 December 2013 (UTC)

The AVTD is an established and consensus list. one cannot just erase it from the article. you erased it by commenting that a new study is here , and yet you bring a study from 1979. The consensus most venomous snakes appear on both lists.79.182.111.44 (talk) 22:43, 2 January 2014 (UTC)

User:79.182.111.44 your ability successfully argue a position is hampered by changing IP addresses. I suggest you create an account and seek consensus as it appears you have some knowledge in this area. Flat Out let's discuss it 09:04, 4 January 2014 (UTC)

The only reason DendroNaja wants to dump this Authoritative list, is because his favorite snake (Black mamba) is not listed in it. Pure vandalism.79.182.49.102 (talk) 13:27, 4 January 2014 (UTC)

Today, they use this "old 1979 research" you talk about as standard in researching such things as toxicity of venoms, drugs, etc. Only now they use Cohn method using albumin (fraction V) with chromatoography which results in a 98% precitate albumin (so 98% purity of the dried/solidified crude venom). It is why it i more accurate than any other list. Ernst & Zug are two of the foremost herpetologists that have studied toxicity in reptile venoms, especially among snakes. It is the highest purity you can achieve. Saline solution doesn't give such purity. If you were educated, you would've known all of that that. That is why even User:Jmh649, who is a physician, left only the Zug et al. list. I didn't make the change. He did. But you are just harassing me now because I discovered all your violations on the Inland taipan page and had an admin protect it from you. --DendroNaja (talk) 16:46, 4 January 2014 (UTC)

Most venomous snakes of the world list - Ernst and Zug (1996). Snakes in Question: - Totally not reliable

I have been looking at the list that Ernst and Zug published in their book "Snakes in Question: The Smithsonian Answer Book" from 1996. and it simply didn't make sense.

First of all the list posted in the article is not the list published in the book. This is the list in the book, you can verify it in google books (see the first 3).

As you can see , this list is very strange. it is widely known that the inland taipan has the highest LD50 in mice. so what's with the Hook-nosed sea snake (Enhydrina schistosa) and even Russel's Viper (Vipera russelii) doing above it? with crazy LD50. and other snakes don't belong there like the black mamba, boomslang or Tiger rattlesnake (Crotalus tigris). I was scratching my head about this.

I found the answer from Associate Professor Bryan Grieg Fry the venom expert. he answered somebody on his blog regarding that exact list in the book :

Question: " ...I was talking to another herpatolagist and he said the hook nosed sea snake was the most venomous of all" Fry Answers: "The hook nosed myth was due to a fundamental error in a book called 'Snakes in question'. In there, all the toxicity testing results were lumped in together, regardless of the mode of testing (e.g. subcutaneous vs. intramuscular vs intravenous vs intraperitoneal). As the mode can influence the relative number, venoms can only be compared within a mode. Otherwise, its apples and rocks."

I will give few examples you'll get the picture:

• Tiger rattlesnake (Crotalus tigris) , 'Snakes in question' quotes it LD50 of 0.06. if you go to a peer reviewed paper you see what they did : "This is based upon its venom’s high lethality, rated the highest of all rattlesnake venoms (LD50 value for mice is 0.07 mg/kg intraperitoneal, 0.056 mg/kg intravenous, and 0.21 mg/kg subcutaneous)7–9."

• Inland taipan (small scaled snake), 'Snakes in question' quotes it 0.03. published peer review paper 0.01 (bovine serum albumin) and 0.025 (saline) both subcutaneous.

• Hook-nosed sea snake/Beaked sea snake (Enhydrina schistosa), 'Snakes in question' quotes it 0.02. published peer review paper 0.173 (bovine serum albumin) 0.164 (saline) both subcutaneous. another peer review here is the same. Another scholarly paper 0.1.

• Black mamba, 'Snakes in question' quotes it 0.05, every other published source quotes subcutaneous LD50 around the same level Dr. Brian Fry 0.32 subcutaneous, 0.25 intravenous, 0.941 intraperitoneal, Spawls & Branch and Minton & Minton both listed the SC 0.28 and so does reptile magazine 0.28,

The best place to see the difference quotes between subcutaneous/intramuscular/intravenous/intraperitoneal is Dr. Fry List put in categories http://web.archive.org/web/20120413182323/http://www.venomdoc.com/LD50/LD50men.html

So there's our problem.

I agree with the above post, LD50 is most accurate to 'real life' when tested using bovine serum albumin. This peer reviewed paper indeed says this as well and gives a good list, mostly are australian snakes: http://www.kingsnake.com/aho/pdf/menu5/broad1979b.pdf

The Australian research Unit lists more snakes, but only with Saline solution http://web.archive.org/web/20140111053927/http://www.avru.org/compendium/biogs/A000084b.htm

Fry list is also very good but I'm guessing its using Saline http://web.archive.org/web/20120413182323/http://www.venomdoc.com/LD50/LD50men.html

What i suggest for the wikipedia article is to make a list Using Fry's categories + Saline and bovine serum albumin subcutaneous quotes side by side. The "Snakes in Question: The Smithsonian Answer Book" from 1996 is useless and misleading.109.66.173.51 (talk) 02:13, 8 April 2014 (UTC)

The study of snake venom toxicity list done by Ernst & Zug et al is the most accurate and comprehensive list ever compiled, based on the method that was used to determine LD50 values. I am going to remove the "lists of most venomous snakes" due to the variation in toxicity that occurs from study to study based on a number of factors. It is also unencyclopedic. The quantity and quality of venom from a snake can be influenced by the age of the snake, diet, season and climate, altitude, as well as various other factors which in turn affect the lethality of the venom. Furthermore, venom processing such as drying and storage may also affect the biological activity of the venom following collection. Apart from the venom itself, the LD₅₀ determined in experimental animals is also affected by the varying characteristics of the animals being used for lethality assessment and the methodology employed. The varying animal characteristics comprise species, strain, age, weight, sex, animal health, diet, food deprivation and season. The methodology aspects are application route, application volume, ambient temperature, housing conditions and solvent used (we know bovine serum albumin or Fraction V produces the most consistent, reliable and stable results for venom lethality. Using the Chinese cobra (Naja atra) as one example, the subcutaneous LD₅₀ tested on a mammal (domestic cat - felis catus) was 1 mg/kg and the a LD₅₀ of 0.4 mg/kg on a chicken by the same route of administration (Source: Simpson, L.L., and D.R. Curtis. (1971) "Neuropoisons: Their Pathophysiological Actions" New York, Plenum Pub. Corp. Vol. 1. p. 21 ISBN 0-30-637121-9). The same species, N. atra produced a subcutaneous LD₅₀ value of 0.43 mg/kg on a pigeon (C.Y. Lee, L.F. Tseng. "Species differences in susceptibility to elapid venoms" Toxicon. Volume 7, Issue 2, September 1969, Pages 89–93). Still yet, the Chinese cobra's subcutaneous LD₅₀ value against mice is 0.67 mg/kg (Engelmann, Wolf-Eberhard (1981). Snakes: Biology, Behavior, and Relationship to Man. Leipzig; English version NY, USA: Leipzig Publishing; English version published by Exeter Books (1982). p. 53. ISBN 0-89673-110-3). This is something that is repeatedly seen over and over again among all snake venomous snake species worldwide, whether elapids, viperids, crotalids, or venomous colubrids. Determining which is the "most venomous snake" in the world is not a simple task, nor are any studies going to be consistent with one another. You can have one black mamba in the Transvaal that produces a venom that's 0.05 mg/kg lethality rate, while one in Kenya that may produce a LD₅₀ value of 0.25 mg/kg. It is far too variable to make a "list", thus it is unencyclopedic in my opinion. We can only go by the facts on human mortality rates, which snakes cause the highest mortality rates, which snakes tend to be aggressive, which snake produces rapid onset of symptoms and death, which snakes are the major cause of bite incidents, etc. --Dendro†Naja^{Talk to me!} 01:11, 26 April 2014 (UTC)

User:DendroNaja, has removed the scientific consensus LD50 list. and gamed the system to lock the article. as mentioned in the detailed review above. Ernst & Zug Never did a study (there is nothing published). and is erroneous and should not be used. The article should be reverted back prior to User:DendroNaja edit. totally not representing the reliable sources data. He is willing to dismiss the whole scientific consensus because his favorite snake (black mamba) is not listed79.176.152.55 (talk) 01:51, 27 April 2014 (UTC)

Not done: This is not the way to encourage discussion to acheive a consensus about such things. Please request a 3O or use the WP:DRN. Thank you. — {{U|Technical 13}} ^{(t • e • c)} 14:00, 27 April 2014 (UTC)

RfC:Should the List of most venomous snakes by LD50 from reliable sources stay in the article?

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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Should the table showing the list of most venomous snakes LD50 by route of injection stay in the article? 79.176.152.55 (talk) 06:19, 27 April 2014 (UTC)

See detailed explanation https://en.wikipedia.org/wiki/Talk:Snakebite#Most_venomous_snakes_of_the_world_list_-_Ernst_and_Zug_.281996.29._Snakes_in_Question:_-_Totally_not_reliable

The editor -Dendro†Naja who removed it, did it, and not in good faith, because his favorite snake Black mamba is not listed in it. he is quoting wrong data on that article too 79.176.152.55 (talk) 06:22, 27 April 2014 (UTC)

You are immature and petty. I have all the LD50 values listed, whether they are "potent" or not. What is it about that that you cannot understand? Top 10 lists belong in children's books, not in encyclopedias. --Dendro†Naja^{Talk to me!} 06:42, 27 April 2014 (UTC)

Let's expose User:DendroNaja motivation and academic fraud:

• First, User:DendroNaja removed one list out of two, stating the most accurate venom testing is done via Saline mixed with 0.1 bovine serum albumin and not saline alone.
• Secondly, now that list cited from peer review literature doesn't cite his favorite snake, the black mamba (he wrote much of that article) also in 0.1 bovine serum albomin he wants it removed completely "top sanke venom list is not encyclopededic". Yet he uses this very sentence in the black mamba article:

Based on extensive and most comprehensive toxinological study conducted the toxicities of snake venoms by Ernst & Zug et al (1996), the black mamba is the fourth-most-venomous snake species in the world with a subcutaneous median lethal dose (LD50) rating of 0.05 mg/kg..

• So now he pushed for leaving only the mortality/venom dose list here. why? off-course because he put the black mamba to be number two most lethal.
• As I demonstrated above, "Ernst and Zug (1996)" is the most amateur list mixing all ways of injection together (SC, IV etc) without telling as what is what, and doesn't say whether it is Saline alone or 0.1 bsa. Ernst and Zug Never conducted a study of their own. there is nothing published in the scientific literature. they just gathered from different sources but made a fatal error in mixing all the data up.
• The same editor quotes black mamba 0.05 mg/kg SC from that unreliable source. He quotes (from a different source) 0.01 mg/kg IP, which talks about Eastern green mamba and testing pure Dendrotoxin and not the venom as a whole. and quotes 0.02 mg/kg IV, while no source tells this.
• The above editor is discarding scientific consensus material in a fraudulent way and trying to game the system, and he is corrupting other articles (venomous snake) in order to fit with his false input to the black mamba article. it is really academically shameful and unacceptable. more editors should comment on this, and administrative action should be taken against User:DendroNaja. (same ip user)109.66.179.239 (talk) 13:38, 27 April 2014 (UTC)

• The work of Ernst & Zug is absolutely not an "amateur list" that was just made up out of thin air. The particular book, Snakes in Question: The Smithsonian Answer Book is a piece of work that is cited and referenced in hundreds of other technnical/text-books and journalistic studies and research. The list compiled used the most effective method of extracting the venom in tact with all its componenets. It is a highly regarded piece of work and no matter how much you don't like it, it is just too bad for you. If it's good enough to be cited and referenced in scientific research, then it's good enough to be used as a source here. I also have to clue you in on a thing - Jean-Philippe Chippaux, Carl Ernst, and George R. Zug are the foremost experts on snake venom toxicity and variation. Venom, even within a single species, can vary and range tremendously depending on diet, geographical location, age-dependent, gender-dependent, weather, altitude and the list can go on and on. So these "lists of most venomous" are meaningless when it pertains to humans because how do you ascertain the amount of venom injected in a bite? Your psychological reaction, your resistence, and so many other factors play a role. --Dendro†Naja^{Talk to me!} 05:18, 28 April 2014 (UTC)

Fairy tales. Not even 1 citation of this book in pubmed http://www.ncbi.nlm.nih.gov/pubmed/?term=Snakes+in+Question%3A+The+Smithsonian+Answer+Book. you have no clue what methods they used, because they didn't write it. and as i showed they mixed up method of injections. Dr. Brian Fry noted this thing himself. look at the other snakes they listed it's all mixed up79.180.57.209 (talk) 06:20, 28 April 2014 (UTC)

Again, you're showing you aren't interested in "conflict resolution" - you are interested in getting your way. Well, you are simply wrong about the Ernst & Zug et al study. It is a highly regarded piece of work, the fact that you don't like that or agree is not anyones problem but yours. Anyways, why are you so hung up on these "venomous lists'? What is such a big deal about it that you are obsessing over it like its a matter of life and death to you. Get over it. --Dendro†Naja^{Talk to me!} 06:44, 28 April 2014 (UTC)

The hypothetical debate is over

I have a direct quote from Ernst & Zug book, page 120 regarding their venomous snake list: "also, the LD50 values are mixed data, derivd from different studies using different sites of venom injection (intermascular, intraperitoneal and subcutaneous)". http://books.google.co.il/books?ei=iidDU6TqKqKv4AT_wIDQBg&hl=iw&id=TuY5AQAAIAAJ&dq=Snakes+in+question%3A+the+Smithsonian+answer+book&focus=searchwithinvolume&nfpr=1&q=Subcutaneous

On the other hand, Minton book does exactly what is needed for accurate citation, he has a table of modes of injection. for the black mamba it's 0.32 SC and 0.25 IV. Here you can see the head of the table : http://books.google.co.il/books?ei=m4JeU4PTMMa1yAPU1YD4BA&hl=iw&id=aEtrAAAAMAAJ&dq=black+mamba+ld50&focus=searchwithinvolume&nfpr=1&q=ld50 And here the black mamba quotation: http://books.google.co.il/books?ei=m4JeU4PTMMa1yAPU1YD4BA&hl=iw&id=aEtrAAAAMAAJ&dq=black+mamba+ld50&focus=searchwithinvolume&nfpr=1&q=%22black+mamba%22+0.32

We also have a clear quotation for intraperitoneal injection "The IP murine LD50 averaging 0.30mg/kg" taken from "Venomous” Bites from Non-Venomous Snakes: A Critical Analysis of Risk and Management of "Colubrid” Snake Bites... by Scott A Weinstein, David A. Warrell, Julian White and Daniel E Keyler (Jul 1, 2011) page 246 http://books.google.co.il/books?id=tjDQnbmJu0kC&pg=PA246&dq=black+mamba+ld50&hl=en&sa=X&ei=D4FeU8HlIKLq4gSLuoF4&redir_esc=y#v=onepage&nfpr=1&q=black%20mamba%20ld50&f=false

User Talk:DendroNaja has deliberately and fraudulently manipulated this article in order to push false information in the black mamba article . Ernst & Zug did not do the venom studies themselves. Ernst & Zug did not note differnce if Saline or Bovine serum albomin, Ernst & Zug never say that the quote for the black mamba is subcutaneous, which it's clearly not.

The original list should go back to the article, and the LD50 quote for the black mamba fixed. (same ip editor)109.65.184.69 (talk) 17:51, 28 April 2014 (UTC)

Due to an ANI https://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/Incidents#Disruptive.2C_authoritarian_editor_in_Snake_articles., User:DendroNaja has been banned indefinitely (for the 5th time) he has a long history of misrepresentation and misinformation "for long-standing abuse of editing privileges, including insidious vandalism, misrepresentation of references, and abusing multiple accounts. " (quote from his original banned account talk page). The corruption of this article by his hands will be amended soon (same ip editor) 79.179.106.114 (talk) 18:55, 1 May 2014 (UTC)

Comments

While it seems that the IP editor's position that Dendro was cherry-picking and misrepresenting sources seems to be have been validated by ANI (along with evidence of socking via SPI), I would point out that some of the points he made were not altogether invalid. For one, on this project, lists of the sort being debated (in articles which are not themselves list articles) are generally avoided as unencyclopedic content. I see the content under debate has now been spun out to List of dangerous snakes by Jmh649 and while in principle, I think this could be a useful article, I have to note that the present version has some rather serious issues, and I can see how this content led to disruptive discussions here. For starters, that new article does not exactly hold tight to WP:SUMMARYSTYLE; a huge eyesore of a table tops the article, containing detailed clinical information that is of dubious encyclopedic value / questionable use to our readers -- given further that about 70% of it's cells lack any information at all, I question it's usefulness. In addition to this table, numerous sections bellow contain massive, unbroken, and unformatted blocks of text with nothing but clinical details and little in the way of context. Compounding the issues with readability further is the fact that the prose itself (that which is not dedicated to technical specification on venom amounts and potency) is incredibly weak and sub-par to our general project standards. If it is to stay, this article is going to need significant improvement utilizing the perspectives of new contributors. As such, I advise the IP that, though he has come out on top of this recent row (which, I might note, neither party approached in strictest manner as regards civility), he should be prepared for the fact that the article may need to be significantly parsed down to meet summary style, or at least improved drastically or readability. Snow talk 04:58, 7 May 2014 (UTC)

It was definitely too detailed for this overview article. Summarizing the information in the subarticle further and making it more clinically relevant would be useful. The more esoteric bits can go in the article about the snake itself IMO. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:06, 7 May 2014 (UTC)

Oh, hey Doc; didn't realize that was you! Never seen your actual username before, I guess. I take that as a credit to you that with all the broad area of topics you work on, I've never had cause to go to your talk page to talk about further revisions on your contributions. :) Anyway, I've replicated my comments on the talk page for the new article, and added the appropriate headers and Wikiproject templates. I suggest to other contributors that further conversation along these lines take place there. Snow talk 05:12, 7 May 2014 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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Photo at the top of the article

It would be nice to have a photo at the top of the article that is more relevant to the content. The article is primarily concerned with dangerous bites by venomous snakes, but the current photo at the top shows a bite from a Montpellier snake. Although nominally somewhat venomous, as the article on that snake says, "The Montpellier snake is not a dangerous snake for humans", and the bite looks rather harmless. The photo shows no clear fang marks or swelling – it looks roughly like a bite from a small rat snake, which is not what the article is primarily about. Although I agree that the picture at the top should not be something completely horrific, like the picture of the necrotic leg shown later in the article, it would be much better to illustrate the article with a picture of a bite that looks more significant. I looked around on Wikimedia commons and found several pictures of snake bites, but none of them seemed very good to put at the top of this article (although one of these might be somewhat of an improvement: File:Snake bite 5.jpg or File:Snake Bite injury.jpg or File:Ictus serpentis 02.JPG). —BarrelProof (talk) 20:19, 15 May 2017 (UTC)

Foot image bite looks good. Doc James (talk · contribs · email) 22:08, 15 May 2017 (UTC)

Most bites are on the hands or arms?

The article says that "Most bites are on the hands or arms." This might indeed be true, but I am skeptical. The cited source is an article that is about "bites ... encountered in North America". North America is not typical. Snakebites are relatively uncommon in North America, and the victims there, as the article notes, are typically young men, and the circumstances there often involve the handling of snakes kept as pets or some other form of deliberate recreational interaction rather than accidental encounters such as merely stepping on a snake without knowing it was there (and often involve alcohol consumption), and people in North America generally wear sturdy footwear and long pants when they go walking around outside where they are likely to encounter venomous snakes. My impression is that outside of North America, cases may more often involve the feet and legs. It would be nice to find a source that has a more worldwide view on the subject. Also, I don't have a copy of the cited article so I don't know exactly what it says. The abstract does not include such a statement. —BarrelProof (talk) 23:50, 15 May 2017 (UTC)

I have heard the same regarding other areas. Most occur among farmers during work in long grass etc. They thus occur most often on the legs and arms.

I am currently travelling and will need time to look at it more fully. Doc James (talk · contribs · email) 18:06, 16 May 2017 (UTC)

My impression fits what you said: "legs and arms" (and the associated feet and hands). The current article doesn't mention legs or feet at all. —BarrelProof (talk) 21:39, 16 May 2017 (UTC)

I will look in a week when I get home. Doc James (talk · contribs · email) 19:01, 17 May 2017 (UTC)

@Doc James: Any update on that? —BarrelProof (talk) 23:19, 23 May 2019 (UTC)

Ref says "Ninety-eight percent of bites are on extremities, most often the hands or arms"

So "arms and legs" would also be accurate. Do you have other sources secondary sources that comment on this User:BarrelProof? Doc James (talk · contribs · email) 06:51, 24 May 2019 (UTC)

This ref says "Studies show that most bites involve limbs/extremities, and snakebites cause up to 400,000 amputations worldwide each year"[5] Doc James (talk · contribs · email) 07:03, 24 May 2019 (UTC)

Your edit resolves my concern, which was about whether arms/hands are really more common than legs/feet (esp. outside the U.S.). Thank you. I don't have any particular sources to cite about this – I just have the impression that North America is an anomaly when considering snakebite as a significant matter of public health, and that people in warm climates who wear flip-flops seem likely to encounter camouflaged snakes with their feet and not so much with their hands. —BarrelProof (talk) 20:59, 24 May 2019 (UTC)

New global snakebite initiative

Hello wiki community.

I'd like to draw attention to the new Snakebite initiative launched by Wellcome - an £80m investment into modernising treatment, making it cheaper and raising awareness of the issue globally. This also coincides with the World Health organisation launching the global strategy to half snakebites by 2030 and the UK Department for International Development's £9m investment to find the 'Holy Grail' of antivenom.

Declaring a conflict of interest as I work at Wellcome.

The announcement today spans from Science news to international. The links are here:

Reuters BBC Feature on the issue in The Telegraph Article in Science mag. Outline by Wellcome The WHO strategy

— Preceding unsigned comment added by Melancholy2004 (talk • contribs) 08:30, 16 May 2019 (UTC)

@Doc James: I noticed your revert related to this topic. Are you going to revert me again if I cite the WHO source identified above? And how about the Science article – is that OK? —BarrelProof (talk) 21:08, 24 May 2019 (UTC)

User:BarrelProof Happy to see the WHO souce used. The Washington Post is however not very good for medical content.

Which Science articles? Is it a review article or a primary source? Doc James (talk · contribs · email) 07:44, 25 May 2019 (UTC)

@Doc James: This Science article. —BarrelProof (talk) 16:27, 25 May 2019 (UTC)

Not a great article for the stats. Unclear were they got the "138,000" number from. WHO is better for those details. What do you want to use it for? Doc James (talk · contribs · email) 21:55, 25 May 2019 (UTC)

Well, one thing I wanted to use it (and the WHO source) for was to revise the upper bound of the range given for people being killed by snakebite from 125,000 to 138,000 (a change by me that you reverted a few days ago due to me citing The Washington Post). That same number is also in the the WHO source. The 125,000 number currently given in the article seems to be from an older WHO report (the same organization that is now providing the larger number). The current Wikipedia article is describing a range of 20,000 to 125,000 deaths, and the new WHO source is describing a range of 81,000 to 138,000 deaths. —BarrelProof (talk) 04:16, 27 May 2019 (UTC)

Global mapping

Is this article in The Lancet a suitable source as per WP:MEDRS for adding information on global incidence of snakebite? Zeromonk (talk) 07:45, 30 May 2019 (UTC)

Snake pit

It says "In medieval Europe, a form of capital punishment was to throw people into snake pits, leaving people to die from multiple venomous bites." But if you look at snake pits, you will only find "legends and fairy tales" mentioned. I do not want to imply anything with respect to different parts of the world, but I know Europe, and we just don't have snakes that are poisonous enough (or enough of them) to be able to do this. In any case, you would need a dedicated breeding institution for that, which in medieval Europe definitely did not exist. Let's drop that. And also for the other instances reported as factually, better sources would be welcome -- the one about India does not seem to be particularly trustworthy (it also only reports hearsay). Seattle Jörg (talk) 06:37, 9 October 2021 (UTC)

Cleopatra reportedly committed suicide by the bite of an asp. You are welcome to believe or disbelieve Plutarch.

"Snake pit" is often a metaphor for corrupt and vile institutions. Snakes get a bad reputation in the animal world. Large predators (bears and Big Cats in Imperial Rome, and dogs in Nazi concentration camps) have been used more reliably for homicidal purposes.

The biggest danger from snake bite, except for those species most aggressive and venomous is that one does not get first aid and medical treatment swiftly enough. I noticed at one point that death is more likely from an infection from COVID-19 than from rattlesnake bite (early during the plague). Snake bite is not a reliable means of killing people in executions. Pbrower2a (talk) 01:55, 31 October 2022 (UTC)

Science

Man 45.117.51.76 (talk) 16:23, 16 September 2022 (UTC)

Drunkenness and harassment

Venomous snakes typically avoid contact with humans. Given the choice, both retreat. Humans are not prey of any venomous snake, so snakebite is usually a defensive reaction. See also dogs and cats, potential predators of venomous snakes.

A large proportion of persons who have endured a snakebite have deliberately and recklessly confronted a venomous snake are drunk at the time.

This suggests drunkenness and harassment of venomous snakes is a risk factor -- more than would be expected among fishing, hiking, and camping as activities or such activities as farming, ranching, utility work, or oilfield work. Pbrower2a (talk) 01:39, 31 October 2022 (UTC)