Power-packed with detailed information is the latest book on snakes that comes from Prof. Senanayake Abeysinghe M. Kularatne. The second edition of ‘Snakes, Snakebite and Envenoming in Sri Lanka – A Handbook on the Management of Snakebite’ is a much improved version and has been meticulously put together essentially for doctors who are faced with the emergency of snakebite but makes interesting reading for any Sri Lankan as these reptiles are found not only in villages but also in towns and cities. It is timely in the light of snakes slithering into Parliament and the need for the correct identification of these creatures.

For Prof. Kularatne, his “fascination” with snakes had begun in his childhood where he encountered them in his ancestral village of Nikaweratiya and under the guidance of his family members and village elders became adept at distinguishing between the cobra and the Russell’s viper and other venomous and non-venomous snakes.

Having witnessed victims of snakebite both alive and dead, and how they were treated by native physicians, the foundation had been laid in his young mind for him to take up herpetology as a hobby.

However, there had also been the confusion which came from the numerous horror stories, folktales, myths and beliefs related to him by the simple village folk. Even though this confusion was dispelled by the few lectures on snakes he heard as a medical student at the Peradeniya University, he had not been confident about his knowledge to treat snakebite victims when he began his clinical practice.

The confidence had built up when he was compelled to manage these victims as Consultant Physician at the Anuradhapura General Hospital in the heart of venomous snake country and through interaction with experts in the field such as Anslem de Silva whom he calls “a pioneer in snake research”, Dr. Kolitha Sellahewa and Prof. David Warrell from the Oxford University who carried out research here in the 1990s.

Now with the second edition in the public domain, this Professor in Medicine at the Department of Medicine of the Peradeniya Medical Faculty & Consultant Physician attached to the Peradeniya Teaching Hospital himself is considered an expert. Currently he is also Chairman of the Expert Committee on Snakebite of the Sri Lanka Medical Association.
This is a valuable book with detailed sketches and colour photographs produced by a Sri Lankan for a Sri Lankan readership – a sharing of experiences and knowledge on the management of snakebite.

Much of the book is based on published work and work that he himself has done, but the value of it lies in the fact that it is very much evidence-based. The advice administered through the book with regard to management under the western medical system can be tried out and contested if it does not work.

Under the section on ‘Management of snakebite’ both at peripheral and tertiary-care hospitals, Prof. Kularatne begins from the basics and builds up gradually.

Reiterating that management should start irrespective of first-aid given, he refreshes the memory of the clinicians about the A, B and C, by stating that “assessment of vital parameters and establishment of vital functions such as airway (A), breathing (B) and circulation (C) must be done immediately. Blood pressure, pulse rate and respiratory rate must be recorded. The level of consciousness must be assessed”.

The checklist on the assessment given in the book would be an ideal reference tool in any medical emergency room.
While the detailed sketches and colour photographs of snakes in different positions ease the heaviness of the scientific and medical information, they also become an attention-grabber and learning tool for both doctors and non-doctors. The ‘Identification of venomous snakes in a nutshell’ courtesy of Anslem de Silva is a quick-glance guide which should help many across the country as will the boxes with brief descriptions about each venomous snake and other nuggets of crucial information in bullet points.

The section on ‘First aid’ is invaluable for non-medical people who may have to attend to a snakebite victim before he/she is taken to hospital, while the stress on what to avoid, “harmful invasive procedures and treatments such as incision of the site of bite and application of medicines, traditional medicines, nasal insufflations of medicines, application of tourniquet, aspirin and alcohol” should be followed to the letter.

This slim, easy-to-carry book has a wealth of information, where no stone is left unturned to make it as compact and comprehensive as possible……..from Prehistoric Man’s view of snakes to how Balangoda Man had snake-suppers; from snake feeding to reproductive habits; which snake has fangs and which solid teeth; how venomous snakes inject venom to disable prey and defend themselves while non-venomous snakes need physical power to subdue their prey; and the “soup” that is snake venom.

A word of caution is also thrown in, with the writer’s conviction that conservation of snakes is the responsibility of man as they are an important part of the ecosystem, becoming apparent.

Who matters: Medically speaking

Snakes which cause severe envenoming and are thus medically important, Prof. Kularatne lists as follows: Russell’s viper (Daboia russelii), Common krait (Bungarus caeruleus), Cobra (Naja naja), Hump-nosed viper (Hypnale hypnale, H. Nepa, H. Zara), Saw-scaled viper (Echis carinatus), Ceylon krait (Bungarus ceylonicus), Green pit viper (Trimeresurus trigonocephalus) and Sea snakes (Enhydrina schistosa, Hydrophis spiralis, H. cyanocinctus, Lapemis curtus).

However, no deaths have been reported from the two species of Saw-scaled viper and Green-pit viper, according to Prof. Kularatne.

Referring to sea snakes, he is quick to point out that they are “highly venomous” and may bite people who are swimming, diving, bathing, washing, wading, paddling or handling fishing nets and lines.

Pointing out that they bite only under extreme provocation, he warns though that species such as Enhydrina schistosa (beaked or hook-nosed sea snake) which commonly inhabit lagoons, estuaries and river mouths are very vicious and provocative and their bite causes severe envenoming.

They are “fairly common” in the coastal brackish water from Bentota to Chilaw and “very common” in the Puttalam lagoon.