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 REPTILES – CLASSIFICATION, EVOLUTION
AND SYSTEMS

Additional books in this series can be found on Nova’s website at:

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 REPTILES – CLASSIFICATION, EVOLUTION AND SYSTEMS

VENOMOUS SNAKES - ENVENOMING,

THERAPY

JIRI VALENTA

Nova Science Publishers, Inc.

New York
2nd revised edition (1st edition in Czech: Galen Publishing, Prague 2008)
Photos: Ing Vladislav T. Jirousek - www.zoo-foto.cz, Petr Velensky, Dr Jiri Valenta
Figures: Karel Vavra
List of venomous snakes, zoological cooperation: Dr Ivan Rehak, CSc.

Copyright © 2010 by Nova Science Publishers, Inc.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or
transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical
photocopying, recording or otherwise without the written permission of the Publisher.

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NOTICE TO THE READER

The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or
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liability is assumed for incidental or consequential damages in connection with or arising out of
information contained in this book. The Publisher shall not be liable for any special,
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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Valenta, Jiri, 1960- Venomous snakes : envenoming, therapy / Jiri Valenta. -- 2nd rev. ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-61209-217-1 (eBook)

Published by Nova Science Publishers, Inc.  New York

 CONTENTS

Preface vii
Introduction ix
List of Abbreviations xiii
Chapter 1 Zoological Basis 1
Chapter 2 Epidemiology of Snakebites 17
Chapter 3 Snake Venoms 27
Chapter 4 Snake Antivenoms 51
Chapter 5 Snakebite: Therapy and Prevention 59
Chapter 6 Envenoming and Snakebite Treatment in Specific Snake Groups 85
Chapter 7 List of Venomous Snakes 235
Glossary 289
Author’s Affiliation 301
Index 303
Pictures 323
 PREFACE

This is a comprehensive monograph on the problems of intoxication incurred by snake

venom. This publication is primarily intended for those at all levels of health care, for
members of rescue teams, surgeries and emergency hospitals, as well as specialized
workplaces and intensive care units. Providing didactic instructions for first aid and treatment
procedures, information is also presented on venomous snakes, the fundaments of their
morphology and behavior, snakebite prevention, the composition of snake venom, symptoms
of envenoming, plus first aid in the event of snakebite for non-professionals, travelers, terrain
biologists, and breeders. This book features an updated alphabetical list of types and sub-
types of all venomous snakes, including their home ranges, as well as a comprehensive index,
list of abbreviations, glossary, and color picture insert with one hundred photographs of
venomous snakes.
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 INTRODUCTION
Few creatures in the history of man have attracted more attention than snakes. One of the
first attempts to describe a snake in literature can be found in the Bible, where it is described
in the Old Testament as ‘‘more shrewd than any of the wild animals that the Lord God had
made’’ (Gn 3:1). The serpent is shown as a deceiver, luring Man to fall by eating from the
Tree of Life, for which Adam and Eve were banished from the Garden of Eden. For doing so,
the snake is castigated by God with punishments it bears still. ‘The Lord God said to the
serpent, “Because you have done this, cursed are you above all the wild beasts and all the
living creatures of the field! On your belly you will crawl and dust you will eat all the days of
your life. And I will put hostility between you and the woman and between your offspring and
her offspring; her offspring will attack your head, and you will attack her offspring’s heel.”
(Gn 3:14-15). As is evident from the Old Testament, the snake acts neither as Satan nor for
him at this point. Indeed, it does so on its own behalf, saying to Eve, ‘‘Surely you will not die,
for God knows that when you eat from it your eyes will open and you will be like divine
beings who know good and evil.’’ (Gn 3:4-5) In no case should this be viewed as temptation
or a satanic notion, but rather as a step towards another stage of evolution for mankind. In
fact, let this be the start of the biblical serpent’s reformation. After all, it was only an enticer,
for did not Woman perform what was forbidden?
The cult of the snake has played a part or is visible in many cultures, religions, and
traditions. Examples not only include cave paintings in Spain and France, but also others by
the Bushmen of South Africa and Australian aborigines, as well as in prehistory and more
recent times.
Mention should be made of the vital role played by the cobra in the history of Egypt. Its
intrinsic link to the cult of Imhotep - the builder and healer - was in the form of Ureus. This
sacred serpent became a potent symbol of the divinity and power of Egyptian pharaohs,
indeed it was the insignia of the kings - the headband shaped as an upright cobra with an
outstretched hood. Furthermore, snakes were important as ritual animals in antiquity: be it in
the Greek rooms of healing known as asclepieions, or Roman temples to Vesta, where snakes
were kept by the Vestal Virgins. The serpent symbolized fruitfulness and wisdom both for the
antique world and ancient Egypt.
Greek myths attribute the origin, or at least the occurrence of snakes in North Africa, to
the hideous and deadly creature of Medusa as a result of her death at the hand of Perseus,
poetically described by Ovid as: ‘‘For the one achieved high heaven, and the other, (as he
bore the viperous monster-head) on sounding wings hovered a conqueror in the fluent air,
over sands, Libyan, where the Gorgon-head dropped clots of gore, that, quickening on the
x Jiri Valenta

ground, became unnumbered serpents; fitting cause to curse with vipers that infested land.‘‘
(Metamorphoses, Book IV, Ovidius Naso, Brooks More edition, Cornhill Publishing Co.,
1922)
Elsewhere, the role of god was assigned to the serpent in Aztec culture, thereby
transformed into the feathered serpent known as Quetzalcoatl. Moreover, snakes proliferate in
Asian religions. According to myth, it was a snake - probably the king cobra - that revealed
the meaning of life and faith to Buddha. Other examples include the Indian god Vishnu, who
rested upon the body of a multiheaded cobra in the sea of milk, whilst Shiva wears a cobra
wrapped around his neck. Some temples in Kangra Valley, North India, are dedicated to
nāgas, deities in the form of great snakes, which are depicted with cobra fans on their heads.
Moreover, many places in India celebrate certain days of the year that are consecrated to
cobras. One fable tells that killing a snake, especially a cobra, will bring trouble that must be
redressed via a ritual, something which rural Indians still abide by today.
Therefore, the role of snakes in the history of mankind is evident, much like their
influence on the state of the human mind. The fear of snakes is incomparable to anything
posed by other animals. Beside arachnophobia - the fear of spiders, ophidiophobia, which
refers to the fear of snakes, is the widest form of pathological reaction to animals. In heavily
affected persons, it is not restricted to exclusion of a real threat; feelings can also be
associated with just seeing an animal or merely a depiction of one. Sometimes fear is
amplified by a physical experience, as in a vegetative response. Whether such extreme
reactions are determined by evolution (phylogeny) or are genetic in nature remains unclear. It
might even be stated that snakes create feelings of fear in zoo-based primates, including apes.
Nevertheless, the epidemiology of snakebites in children reveals a certain lack of fear and
respect for venomous snakes, which is probably due to unfamiliarity or assurance. Whatever
the case, attempts at physical exposure to snakes, as observed in certain children, did not
reveal any connection with atavism or a satisfactory educational influence. However,
indigenous peoples, such as in Africa, commonly associate fear with snakes and usually
consider any such creature as highly venomous. Responses like these are easily substantiated;
in addition to a lack of education and information, it is natural that any tribesperson
attempting to be heroic by belittling the danger of venomous snakes would not survive long in
the wild.
Why is that snakes are so mythologized? Answering this question is not simple. There
may be several factors involved: their venomousness, the imminent mortal danger, and
potential loss of life or impact on health even following a minor bite; these are sure to be
amongst the most important to humans. In fact, it is these which distinguish snakes from other
much larger animals that pose a threat to Man, creatures whose attack would result in visible
physical devastation to tissue, unlike the ‘godlike’ bite of a venomous snake, and explaining
this is far from easy. Consequently, a number of other points must have contributed to placing
snakes in this most lofty of positions. Returning to one of the factors listed earlier, venom
causes prey to be killed by a single rapid bite, added to which snakes are able to devour catch
many times bigger than their mouths, plus they move without legs, even in trees and
underground. However, such explanations are insufficient when investigating the
extraordinary interest snakes possess for humans, which can but underline their truly mythical
nature.
A host of folk tales are associated with snakes. For example, the Czech version of
Goldilocks, by K J Erben, boasts a hero with the magic ability to understand animal speech
 Introduction xi

after eating some snake meat. In the 19th and early 20th centuries, notions abounded in rural
communities of snakes biting their tails and rolling down hills, and of a snake wedding
complete with the crowning of a queen. The superstition of snakes sipping milk from cows is
also widespread, although it is plain that snakes do not actually drink milk and visit cowsheds
only to get warm and catch rodents. Another falsehood is that snakes are slimy and clammy,
but this is true of eels and yet they are not generally despised by people. Moreover, the myth
of snakes hypnotizing prey is just that - only a myth. If a snake’s prey were to be paralyzed
via hypnosis, the snake’s ability to see their potential catch would weaken. Nevertheless,
rumors and misconceptions like these continue to shape how snakes are perceived.
Despite the reverence held for snakes by some ethnic groups, the eating of their meat
does occur amongst the indigenous peoples of a number of African, Asian, and South
American countries, as well as being served as a delicacy in local restaurants. This trade in
meat - catching, selling, and consuming it - relates mostly to larger non-venomous snakes like
pythons and boas, but even venomous snakes such as cobras are not immune to such
treatment. Snake meat itself is said to be delicious and reminiscent of fine game or chicken.
The entrails of creatures are used in soup, including a Chinese immunity-boosting variety
made of snake gall bladders. Other uses of venomous snakes in gastronomy include special
alcoholic beverages called snake liquor and health potions, which are produced by pickling
venomous snakes in spirit, an example being Japanese mamushi saké.
Alongside all manner of myths, cults and superstitions, a real interest in venoms has
developed, be it causes, duration and possible therapy. Notes on the effects and treatment of
snakebites, in addition to the use of venom as medicine, appear in Egyptian papyruses, as well
as in works by Aristotle, Nicandros of Colophon, Plinius, Hippocrates, Celsus, Pedanius
Dioscorides, Galenus, and Avicenna. In the Renaissance period, snakebites were investigated
by the French scientists Ambroise Paré and Jacques Grévin. The first ever work of
methodology conducted on venomous snakes was produced by a Florence physician,
Francesco Redi (1621-1697), which outlined the venom apparatus of snakes. This served as
the foundation for a later study on animal toxinology by Italian Felice Fontana (1720-1805).
At the cusp of the 20th century and in the years that followed, interest in such work rose
dramatically, accompanied by an increasing number of studies dedicated to toxins, toxinology
and the therapy of envenoming-related cases. However, not every scientific paper was wholly
based on reality. The threats associated with the venomous nature of snakes, which in Central
Europe relates to the rather less venomous common viper, used to be largely overestimated in
the otherwise reliable literature of the day, and still is to a point at the present. A venerable
Czech journal, Vesmir, published the following in 1895: ‘‘To prevent the terrible
consequences of snakebite, the aid given below shall be used. First, venom should be
eliminated from the wound, which is done by cutting off the place so affected and dripping
ammonia, chromic acid, fuming nitric acid, or tincture of iodine into the wound; alternatively
the wound may be burnt using a hot iron …’ Using such a therapeutic procedure, no one
would wonder at such ‘terrible consequences’.
To some extent, the special position reserved for snakes in the human psyche may also
have a bearing on the attraction of capturing and keeping snakes. It cannot be ignored that the
act of owning snakes possesses vague phallic connotations, or at least lends their owners
some kudos based on their reptiles’ alleged or very real risk. Some might even acquire a
snake based on the single fact it is highly perilous or mortally so.
xii Jiri Valenta

However, reflecting on the various qualities of breeders and owners should not serve as a
distraction. In general, such people are well-informed enthusiasts and lovers of nature in all
its bounty, which certainly includes snakes. They expand our horizons by building upon
present knowledge on snake behavior and reproduction, requirements and habits, as well as
via regrettable cases of bites caused by misfortune or careless handling.
‘‘Within the period of six months, I was bitten by a number of reptiles including the black
mamba, the African boomslang, the cobra, and the rattlesnake. I found myself at ICU four
times. Several times, venom was sprayed into my eyes. Nevertheless, I always pulled through
without any lasting effects’’ (Marais, 1995). J. Marais is surely one of the foremost snake
experts and keepers, although such incomprehension of the danger posed by a snakebite is by
no means recommended. In stark contrast, the following comment by Czech herpetologist
Zdenek Vogel is full of wisdom, ‘‘Keepers of this kind of reptile should never get used to
their snakes more than the snakes can get used to them. Any bravura or snake charming are
unacceptable in the husbandry of snakes... All sorts of such intimacies with cobras,
rattlesnakes and other dangerous reptiles will eventually lead to the cemetery.’ Which is in
my particular case, speaking from personal experience, ‘...or at least intensive care.’
 LIST OF ABBREVIATIONS
AAPCC American Association of Poison Control Center
ACE angiotensin-converting enzyme
ACh acetylcholine
AChE acetylcholinesterase
ADPase adenosine diphosphatase
AF Afrikaans
ALI/ARDS acute lung injury / acute respiratory distress syndrome
ALT alanine aminotransferase
APC activated protein C
APTT activated partial thrombin time
ASA acetyl salicylic acid, e.g. Acylpyrin
AST aspartate aminotransferase
AT antithrombin III
AV-block atrioventricular block. Failure of conduction from atria to ventricles.
app. approximately
BP blood pressure
CC creatine cinase
CLD certain lethal dose, see also LD100
CNS central nervous system
CPAP continuous positive airway pressure
CRP C-reactive protein
CRRT continual renal replacement therapy: hemofiltration, hemodialysis
CVF cobra venom factor
D-dim D-dimer, fibrin degradation product
Da Dalton, atomic mass unit
DIC disseminated intravascular coagulation
DRC Democratic Republic Congo
DTX dendrotoxins
ECG electrocardiograph
EEG electroencephalograph
EN English
ES Spanish
EVLW extravascular lung water
Fab Fab (fragment antigen binding) fragments
xiv Jiri Valenta

FBG fibrinogen
FDP fibrin degradation products
FF (FV, FVII,…) coagulation factors
FPA fibrinopeptide A
FPB fibrinopeptide B
FR French
FTL fatal time limit
GIT GI tract, gastrointestinal tract
GMT glutamyl transpeptidase
Hb hemoglobin
Hct hematocrit; the ratio of blood volume that is red blood cells
HE Hebrew
HF hemorrhagic factors
ICU intensive care unit
IM intra musculum, within a muscle
INR international normalized ratio, a method for reporting PT results
IP intra peritoneam, within the peritoneal cavity
IV intra venam, within a vein
in part. partially
in vivo experimentation using a whole, living organism
JA Japanese
kat katal, SI unit of catalytic activity
kDa kilodalton, atomic mass unit
LD lactate dehydrogenase
LD0 median or average dose at which no mortality occurs, see also MLD
LD50 lethal dose 50%
LD100 lethal dose 100%, see also CLD
LMT last mortality time
LMWH low molecular weight heparin
MB fraction muscle brain fraction of CC
MLD minimal lethal dose: a maximum quantity that will kill no animal
MODS multiple organ dysfunction syndrome
nACh Nicotinic acetylcholine receptors
ng nanogram, SI unit of mass
p.o. per os, orally
PAF platelet-activating factor
PAI plasminogen activator inhibitor
PAWP pulmonary artery wedge pressure
PF1.2 prothrombin fragment 1.2
PGI2 prostaglandin I2
PI pressure immobilization bandage
PKS plasmatic coagulation system
PLA2 phospholipase A2
PLT platelets
PT Portuguese
PT prothrombin time
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