Venomous and poisonous animals are feared, hated, avoided, prized and even venerated – whatever their status, they are fellow inhabitants of the most varied environments on land, in water and in the air. They are part of the biological diversity, and many of them are of direct benefit to us. In some parts of the world, famines would be even more severe if there were no snakes to keep the rodent populations in check. Spiders and scorpions also feed on animals that humans consider pests.
Like many other creatures, venomous and poisonous animals are being affected by rapid changes in environmental conditions. Some species are under the threat of extinction, while others are able to occupy new man-made habitats. The living spaces of venomous and poisonous animals naturally overlap with those of humans, both domestically and at work. For example, rice farmers in Asian countries are particularly exposed to the risk of snakebites during the harvest period. In many regions of the world, children are at danger of being stung by scorpions while playing in and around the home. Such accidents are associated with considerable rates of morbidity and mortality.
Confrontations between humans and venomous and poisonous animals are unavoidable. Preventive measures can of course substantially reduce the incidence of accidents with such animals, but they cannot eliminate them altogether. Additional to this are the self-imposed dangers to which terrarium and aquarium owners expose themselves when they keep venomous or poisonous animals at home.
Accidents with venomous and poisonous animals are extraordinary occurrences for both patients and doctors alike. Even if the accident does not actually lead to clinically relevant envenoming or poisoning, such an event can be profoundly traumatic for a patient. Doctors with no experience in the treatment of such accidents may similarly feel alarmed and uncertain in these situations. This is due in part to the nature of such accidents but also to the lack of diagnostic-therapeutic manuals tailored to the particular characteristics of accidents with venomous and poisonous animals. In addition to the medical problems that a doctor faces when treating a patient following such an accident, they are also confronted with problems of a biological nature. Thus, for example, the correct choice of a specific therapeutic, a so-called antivenom, may require identification at the species level of the animal that caused the accident.
With this manual, it is our intention to offer doctors an instrument that is able to ensure the appropriate medical care of patients under the diverse conditions in which accidents with venomous and poisonous animals occur. We have attempted to develop a systematic diagnostic and therapeutic scheme for such accidents. In this process, we were guided by the idea that a doctor should be able, with simple criteria, to successfully undertake taxonomic differentiation of the animal that caused the accident to the level required for the purposes of treatment. Moreover, we were convinced that a problem-oriented guide to first aid, diagnosis and treatment represented the best way to lead a doctor through the complexities presented by accidents with venomous and poisonous animals. We believed it was important to create a structure for the diagnostic-therapeutic strategies that was as uniform as possible, so that the same guiding principles are recognisable whether dealing with fish poisoning, jellyfish stings or snakebites, and to simplify the approach to the great diversity of such accidents. Finally, we also thought it extremely important to provide a data bank (Biomedical database) in which can be found verified information on the biology of venomous and poisonous animals and clinical data on envenoming/poisoning at the level of smaller taxonomic units (e.g. genus, species, subspecies). One of the main difficulties in the systematisation of accidents with venomous and poisonous animals lay in categorising the observations on which our knowledge regarding the course of envenoming/poisoning, diagnosis and treatment rests. Our basic data gathering was performed in adherence with a list of criteria that required, on the one hand, unambiguous taxonomic identification of the animal that caused the accident, and on the other, took into account the quality and quantity of the clinical observations (intervention studies, analytical and descriptive studies, study size).
Through our visits to colleagues in various parts of the world, we endeavoured to incorporate, as extensively as possible, specific local experience into the evaluation of biological aspects of venomous and poisonous animals and strategies for the diagnosis and treatment of patients.
The active and amicable nature of our encounters with these colleagues from both of our areas of expertise helped shape our work on the book. We were shown great hospitality in hospitals and institutes in many countries.
We are most particularly indebted to Prof. D.A. Warrell, Oxford (UK), Dr. J. White, Adelaide (Australia), Dr. P. Arunothayaraj, Anchal (India), Prof. S.A. Minton, Indianapolis (USA), Prof. F.A. Russell, Tucson (USA) and Prof. T.A. Freyvogel, Basel (Switzerland). We would also like to thank our friends and colleagues at the Swiss Tropical and Public Health Institute, Basel, for providing the academic setting and amiable environment in which this book came to life.
For bedside conversations, field excursions and scientific discussions, we wish to thank Dr. L.V. Boyer Hassen, N. Bucknall, Dr. R.C. Dart and Dr. N.B. Egen, Tucson (USA), Dr. Sooi Lin Geh, Kuala Lumpur (Malaysia), Dr. D.C. Hardy, Tucson (USA), J. Huber, Basel (Switzerland), Dr. M.N. Hutchinson, Adelaide (Australia), Dr. C.S. Kitchens, Gainsville (USA), Dr. D.B. Kunkel, Phoenix (USA), the curator of the Arizona-Sonora Desert Museum, H.E. Lawler (USA), Dato Dr. Lim Yu Hoe and Dr. E. Muthusamy, Penang (Malaysia), Dr. J.T. McNally, Tucson (USA), Prof. Visith Sitprija, Bangkok (Thailand), Dr. G.G. Soppe, Encinitas (USA), Dr. S. Sutherland, Melbourne (Australia), Dr. G. Watt, Dr. N. White and Prof. H. Wilde, Bangkok (Thailand), Dr. H. Wille, Bremen (Germany), and Dr. J. Williamson, Adelaide (Australia).
We are grateful to the following organisations for providing financial support for this project: the Swiss Tropical and Public Health Institute, Basel, the Rudolf Geigy Foundation, Basel, the Stanley Thomas Johnson Foundation, Berne, the Geigy Jubilee Foundation, Basel, the Swiss Serum and Vaccine Institute, Berne, the Sandoz Foundation for the Advancement of Medical-Biological Science, Basel, and the Swiss Academy of Medical Sciences, Basel.
We thank Mr. J. Meier, PD, Aesch (Switzerland), for providing information that enabled us to update the addresses of numerous antivenom manufacturers.
Very special thanks go to Georg Thieme Publishers, who, with our book, took up a subject whose significance extends beyond the emergency medical facilities of the northern hemisphere and which, in particular in economically disadvantaged countries, plays an important but still neglected role. Warm thanks go to Dr. G. Volkert and Mr. R. Zepf for their commitment to this project. We express our gratitude to Mr. M. Zepf for the technical work, the typographical design and the make-up, and Dr. L. Stammler, Basel, for the graphical conversion of the illustrations. The complex structure of the book demanded close collaboration, ingenuity and patience. All those involved contributed together to the success of this project.
Our most personal gratitude is felt for those who accompanied us throughout the years during which this book came into being: Bettina G.J. and Lilian A.
Basel, January 1996