Health
Fangs
Now is the time to unlearn everything you’ve ever heard about snakebite.
The first snakebite I was involved with happened years ago on the back porch of a house in South Austin, and I remember it like people recall political assassinations and earthquakes. I was asleep when I heard the screams, and not wanting to wake up, incorporated them into the fabric of my dream: Bill and Elaine, the couple downstairs, were having a terrible fight. The reality was much worse. Bill’s little Western diamondback had escaped during the night and, using the expandable-collapsible strategy that has made rattlesnakes such successful predators, fold its two-footed length into one of his tennis shoes. When he stuck in his thumb, he pulled out the rattler. By the time I got there he had shaken the snake loose and collapsed on the floor. I had just hauled him to his feet when Elaine plopped him back down, on the theory that one should move as little as possible after a snakebite. It was the only rule we could remember with certainty. Cutting Bill’s finger open was more than I could steel myself for on a moment’s notice, and while using a tourniquet seemed like a good idea, we weren’t sure where to put it. There’s not much meat on a thumb and we were dealing with a particularly skinny one, so we settled for an ice cube on the bite instead.
Bill seemed willing to accept any treatment with the same depressed equanimity: like some dying general, he had grown oblivious to everything except charging me with the responsibility of locating the vanished rattlesnake. A more immediate problem was that we couldn’t find the keys to any of the four available cars, and digging through the pile of jeans on the floor, listening simultaneously for the jangle of keys and the whir of the hidden diamondback, was such touchy going that at last we had to rely on the help of a fourth party to drive us to the hospital.
This sort of confusion is typical of the emotional chaos following the majority of venomous snakebites. Most of the panic, of course, comes from the traditional notion that the victim is going to die, but with the exception of a small child deeply bitten by a big rattler, that’s simply not the case. Even with no treatment at all, the vast majority of people bitten by Texas’ venomous snakes would not die, and with modern medical care less than one per cent do. Almost none are well-read, prepared backpackers, hunters, or campers. Those who get bitten most often are herpetologists, snake buffs like Bill, laborers working in overgrown areas around old farm buildings, and kids.
Almost all bites are inflicted by pit vipers. This group of snakes includes Texas’ ten rattlesnakes as well as its three kinds of copperheads and the cottonmouth, all of which inject their hydraulically compressed toxins well beneath the surface of the skin through curved hypodermic fangs. Crotalus atrox, the Western diamondback, is responsible for nine out of ten bites in the state. Diamondback venom is virulent and plentiful; the largest rattlers carry as much as a sixth of a teaspoon of it, although because of the spongelike internal structure of the venom glands, no pit viper can squeeze out more than a quarter of its capacity per bite. A few bites are recorded every year by East Texas canebrake rattlers and High Plains prairie rattlers, which also have a good deal of slightly less toxic venom. Getting bitten by any other species is—at least statistically—only a theoretical danger, though feisty black-tailed rattlers are common in the Chisos, Davis, and Guadalupe mountain parklands. Pygmy rattlesnakes and massasaugas have little venom, of moderate potency, but are reclusive and seldom bite anybody except reptile collectors. By far the most virulent of the rattlers is the Mojave, a desert snake of the southwestern U.S. and northern Mexico. Its venom is exceptionally high in neurotoxins, making it ten times more potent than that of the Western diamondback. But being bitten by a Mojave in Texas is about as unlikely as being struck by lightning, since they are very rare and live only in inhospitable parts of the Trans-Pecos.
Diamondback bites are most common in Central and West Texas, while copperhead bites occur more often in wooded areas east of the Edwards Plateau, especially in new suburban neighborhoods, where the previously resident snakes encounter newly enfranchised people. Copperheads are ordinarily so docile, however, that they rarely strike unless actually stepped on or prodded. Cottonmouths are abundant along the edges of lakes, rivers, and rice fields in the eastern half of the state, but few people are bitten by them because they are fairly wary and, folklore to the contrary, almost always try—if slowly—to escape when approached. Even their notorious white-mouthed warning gape is mostly bluff—cottonmouths seldom strike from this posture unless physically molested. Though cottonmouths carry a lot of venom, they have only slightly more virulent toxins than the closely related copperheads, and are somewhat less than half as dangerous as the larger species of rattlers. (Incidentally, no one has ever been killed by tumbling off water skis into a mass of cottonmouths. I’ve heard that story about more people—always a friend of a friend—than have died from all the snakebites in the state in the last ten years.)
Texas’ only poisonous serpent that is not a pit viper is the coral snake, whose venom is even more toxic than that of the Mojave. “Red and yellow, kill a fellow” is usually too extreme a prognosis, but it’s the best way to recognize this potentially lethal reptile, which, though fairly common in most parts of Central and East Texas, is shy and seldom encountered. Because coral snakes have small teeth and lack the big injector muscles of rattlers and moccasins, they rely on chewing to introduce their venom into prey, which they grab rather deliberately; they never strike out like pit vipers and almost never bite anyone who hasn’t picked them up first. If you should be bitten by a coral snake, there is one thing that might help: since few people let the snake chew for long, much of the venom often remains in scratches on the surface of the skin, so at least part of it can be flushed away with water during the first few seconds after the bite. However, the victim still needs the quickest possible hospital care.
Wear boots and don’t stick your hands where you can’t see, and your chances of being nailed by a venomous snake approach zero. However, if you violate the statistics and get bitten—as long as it’s not by a coral snake or a Mojave—the first and foremost thing to be concerned about is permanent nerve and muscle damage from destruction of tissue around the bite. (During the Depression, when many people received no medical treatment at all, crippling rather than death accompanied the majority of even the most severe snakebites.) A small child bitten by a big rattler may still be in grave danger of death, however. In this case, binding the limb above and below the wound and quickly getting the victim to a hospital where antivenin treatment is available are appropriate emergency measures.
Otherwise, you shouldn’t spend time even trying to administer first aid. What’s almost always best for the limb is to leave it alone and get good medical treatment as soon as possible. By merely immobilizing the extremity, removing rings or shoes before swelling makes that impossible, and then getting the victim to a medical facility, you’ve done nothing wrong and a lot that’s right. Most of the right involves picking a good hospital. Smaller ones generally do little for snakebite except observe the patient and treat various symptoms as they arise. Occasionally they surgically open the entire limb to let it drain, which is called fasciotomy and which is unwise regardless of the severity of the bite. In the field, any radical first aid treatment, either tourniquets or incision and suction, is always a mistake. There’s little or no benefit to be derived, and the chance of causing substantial additional damage, including loss of the limb, is high. It also hurts like hell to slice yourself open after a snakebite, when the skin is often so sensitive, that even the touch of cloth is abrasive, and the crude cuts of the old incision-and-suction method became nearly unthinkable. Although the Red Cross still recommends incision and suction as a first aid procedure, most medical authorities concerned with snakebite treatment are adamant that little pocketknife cuts are worse than useless.
This is especially true since envenomation happens only in some cases—at the option of the snake, which, in a split second, chooses whether or not to inject its venom and, if so, how much to pump in. Fortunately, it often chooses not to give you all it’s got. Even fang punctures by the hot-tempered rattlers are free of venom about 20 per cent of the time and result in little or no toxic reaction. If the snake is feeling especially threatened and ejects a good deal of venom, there is never any question as to what’s happened. Pain-producing proteins are released from the body’ own fluids, like they are in insect bites, and, just as in an all-time whopper bee sting, burning and swelling begin to develop immediately. Even coral snake bites, which don’t swell much, are frequently characterized by alternating waves of pain and numbness. Stories of people being bitten unknowingly by rattlers and moccasins only to keel over hours later are simply untrue.
What does happen in the minutes after venomous snakebite is far less nebulous—and ordinarily extremely unpleasant. Reddening, followed by the bruiselike darkening of internal bleeding, usually characterizes the rapidly growing swelling, which may, over several hours, bloat a hand or foot to twice its normal size. This process is accompanied by an array of more generalized symptoms—usually exaggerated by galloping anxiety. The commonest are clammy skin, faintness, tremor, dry mouth, heart palpitations, and almost immediate nausea, which can sometimes cause vomiting so violent as to be dangerous in itself.
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