Is setting yourself on fire a good way to treat snakebite?

December 16, 2011

Dear Cecil:

There’s a common belief that "sucking the poison out" is an effective snakebite remedy. I also heard journalist Stephanie Nolen talk about a man in Sudan who set his foot on fire after a snake bite, which he claimed saved him from the poison. Is either of these treatments effective?

Cecil replies:

I treasure questions like yours, Dyer, because of the insight they give me into the human mind. Ninety-nine out of a hundred people, on hearing about some birdbrain who sets himself on fire to combat snakebite, think: what an amusing anecdote. Then there’s you, solemnly wondering: is this something I should try?

Quick answer: no. However, I don’t mean to make sport of you, for this simple reason. Although the Sudanese fellow’s grasp of the fine points left a lot to be desired, the therapeutic regimen to which he evidently subscribed was the standard treatment for snakebite for more than 2,500 years. It involved both suction and cauterization, which of course is the sober medical term for setting part of yourself (or someone) ablaze. We’ll refer to this overall approach as the suction method. Minus some of its more alarming features, it appeared in the Boy Scout manual until at least 1963.

The suction method is the premier example of what I call the duct-tape school of emergency medicine. For reasons perhaps already evident, this approach to healthcare is largely the province of males. It has three defining characteristics: first, it involves dramatic — some would say foolhardy — gestures; second, there’s an underlying logic to it, although this may not be evident in application; and third, it’s best carried out while drunk.

The suction method, like all duct-tape techniques, addresses a genuine need. Snakes have been messing with humans since the days of Adam and Eve. Even now they bite as many as 5 million people worldwide per year (estimates vary widely), of which something like 100,000 cases are severe. In the U.S. alone venomous snakes bite 4,000 to 6,000 people annually. Few American victims die, but the odds tilt against you elsewhere. India alone may have 30,000 deaths annually, and thousands more succumb throughout the rest of the developing world.

Given this grim reality, it’s no surprise human ingenuity devised ways to deal with snakebite early on. The suction method made its way into the body of traditional Indian medical wisdom known as Ayurveda somewhere between 1000 and 600 BC, in writings attributed to the surgeon Susruta. First, you applied a tourniquet above the wound to contain the venom. Second, you sliced the wound open, typically usually with an incision between fang punctures, to facilitate draining. Third, you sucked out the venom, by mouth if necessary, although the squeamish might opt for a suction cup. Fourth, you cauterized the wound, in hopes of destroying any toxin that remained.

Cauterization is the part that historically has charged the imagination of males opting for the suction method. Browsing through the literature we find mention of branding irons, hot coals, gunpowder, cigars, and even acid to burn the venom out. A few took matters further. In an account of snakebite treatment in 19th-century Illinois, one fellow claimed to have saved 50 bite victims by stabbing the wound with a penknife until the blood flowed freely, presumably carrying the poison with it. A doctor of the era recommended cutting the wound out entirely. Amputation was occasionally recommended, with an extreme case being a Mississippi man who in 1948 shot off a bitten finger.

In the developed world, or at any rate in the U.S., cauterization and other radical treatments didn’t much outlive the Wild West as an approved medical practice. The Boy Scout manual of my childhood, for example, wisely refrained from advising America’s youth to set one another on fire.

But drastic techniques didn’t disappear. After stun guns hit the market they were touted by some hikers, hunters, and others as providing an up-to-date method of snakebite cauterization. This daft idea was so widely accepted that in 1992 a research team felt obliged to put it to the test. Their conclusion: a full 90 seconds of continuous shock didn’t accomplish squat.

Eventually all aspects of the suction method, not just cauterization, fell into official disfavor. True, experiments with radioactively tagged venom showed suction could remove more than 50 percent of the poison if done within three minutes. But other research found that as a practical matter suction produced no demonstrable improvement and often made matters worse. The dangers of tourniquets and incisions using unsterilized instruments require no further explanation. Merely attempting to suck out poison sounds harmless but may delay more effective measures. The recommended medical procedure nowadays is to keep snakebite victims calm and immobilized and get them to a hospital fast.

Despite professional disapproval, I don’t expect the suction method to die out soon — the call of testosterone is too strong. “If this was good enough for people who were dust in Alexander the Great’s day,” it tells one’s inner caveman, “it’s good enough for you.”

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References

Ahmed, Syed Moied et al. “Emergency treatment of a snake bite: Pearls from literature“ J. Emerg. Trauma Shock 1.2.(2008): 97–105.

Allen, John W. Legends and Lore of Southern Illinois Southern Illinois University Press, 1963.

Boyd, Jeff J. et al. “Venomous Snakebite in Mountainous Terrain: Prevention and Management” Wilderness and Environmental Medicine 18 (2007): 190-202. The citation they use is Holstege, C.P. and Singletary, E.M. "Images in emergency medicine. Skin damage following application of suction device for snakebite".Annals of emergency medicine 48.1 (2006): 105-113.

Chippaux, J.-P. “Snake-bites: appraisal of the global situation” Bulletin of the World Health Organization, 76.5 (1998): 515-524.

Currie, Bart J. “Snakebite in tropical Australia, Papua New Guinea and Irian Jaya” Emergency Medicine 12 (2000): 285–294.

Dart, Richard C. and McNally, Jude. “Efficacy, Safety, and Use of Snake Antivenoms in the United States” Annals of Emergency Medicine 37.2 (2001): 181-188.

Davis, D. et al. “The effect of an electrical current on snake venom toxicity” Journal of Wilderness Medicien 3 (1992): 48-53.

Gold, Barry S. et al. “North American snake envenomation: diagnosis, treatment, and management” Emerg Med Clin N Am 22 (2004): 423–443.

Halford, George Britton. The New Treatment of Snake Bite with Plain Directions for Injecting Melbourne: Stillwell and Knight, 1869.

Weinstein, Scott A. et al. “Envenomations: An Overview of Clinical Toxinology for the Primary Care Physician” American Family Physician 80.8 (2009): 794-802.

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