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Snake drama: Man moments from death:

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GemmaJF
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Posted: 15 Jul 2003

A snakebite from an adder left a single father-of-two fighting for life after he suffered a devastating allergic reaction to a normally harmless venom.

Patrick Bobbin, 47, of Knapton near North Walsham, says he is lucky to be alive after being struck in the leg by the snake as he carried out his work as a landscape gardener at a client's home in Mundesley.

He was barely conscious and could have been minutes from death when he received a life-saving injection of adrenaline from a paramedic.

Every year, around 20 people are bitten by adders, Britain's only venomous snake, and most suffer no adverse affects whatsoever. The last time someone died from an adder bite was in 1975, and 10 people have lost their lives after bites in the past 100 years.

Mr Bobbin, who has full custody of his children Chris, 17, and Georgina, nine, had been strimming an area of long grass at around 3.20pm on Thursday when he saw a creature dart from the grass and felt a "snapping" sensation on his left foreleg.

Within minutes he felt his lips and tongue tingling and was covered in an itchy rash. His breathing became more laboured and he started to feel faint and disorientated - all classic symptoms of anaphylactic shock, a severe allergic reaction which can be life-threatening.

With his son Chris, Mr Bobbin managed to get back to his home in Knapton where his mother, Olive Bobbin, who lives next door to her son, contacted the local GP surgery and spoke to one of the East Anglian Ambulance Service's community paramedics, Mark Eardley.

"As soon as I realised what was happening, I knew I had to get to this man straight away. When I saw him, it was obvious that he was a very sick man indeed, although he seemed very calm, especially for someone who could be dying," said Mr Eardley.

"In 20 years as a paramedic I have never seen an adder bite or any kind of snake bite. Normally you would expect adder venom to be about as powerful as a bee or wasp sting, but in this case Patrick was severely allergic to the bite which is what caused the problem."

After two injections of powerful adrenaline, Mr Bobbin's condition began to improve and he was able to be taken to the Norfolk and Norwich University Hospital for further treatment. After an overnight stay, he was discharged the next morning.

"It seems unbelievable that it happened. One minute I was strimming the garden, the next I was on the floor unable to walk, unable to see and finding it hard to breathe; I realised then that I had probably been bitten by a snake, but I thought I'd be OK after a while," said Mr Bobbin.

"I have never felt so ill in my whole life. I think I might have panicked if I had realised how ill I was, but I felt as if I was in a dream world. Lots of what happened is a blur; all I could think about was if my kids would be all right and about a stupid row I had had with a friend."

He added: "I have had a very lucky escape, thanks to Mark. I've never been scared of snakes but I think I'll watch my step next time I'm cutting long grass."

Norwich Evening News July 14th 2003

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Wolfgang Wuster
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Posted: 15 Jul 2003
Well.... I am glad that some newspapers don't dramatise the normal threat from adders. However, describing the venom as "normally harmless" and stating that most people bitten "most suffer no adverse affects whatsoever", or that "adder venom [is] about as powerful as a bee or wasp sting" is completely irresponsible and way off the mark. An adder bite remains a potentially life-threatening emergency that requires immediate medical attention, even though the majority of bites do indeed not cause major concerns.

I, for one, would rather see more realistic reporting of the danger posed by an adder bite than to face the negative publicity that would arise if someone actually did die from an adder bite, perhaps after not bothering to go to hospital for this "normally harmless" venom that is "no worse than a bee sting" and normally causes "no adverse effects whatsoever".

Cheers,

Wolfgang
Wolfgang Wüster
School of Biological Sciences, University of Wales, Bangor
http://sbsweb.bangor.ac.uk/~bss166/
GemmaJF
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Posted: 15 Jul 2003
My thoughts also, it appears the statistic that it is more likely that one will die from a bee or wasp sting in the UK is often confused and stated as "the vemom is no more severe", I hope the info on the ID page is a little clearer about how seriously the bite should be taken.
Gemma Fairchild, Independent Ecological Consultant
Wolfgang Wuster
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Posted: 15 Jul 2003
Yup, that statistic neglects the rather obvious fact that, whereas we get about 50-100 adder bites per annum in the UK, we probably get many hundreds of thousands, if not millions, of bee and wasp stings every year, and that only people who are allergic or are attcked by vast swarms of the hymneopterans stand any chance of dying of a bee sting, whereas everyone is at some risk of suffering severe envenoming from an adder bite.

Cheers,

Wolfgang
Wolfgang Wüster
School of Biological Sciences, University of Wales, Bangor
http://sbsweb.bangor.ac.uk/~bss166/
-LAF
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Posted: 15 Jul 2003
It's a catch 22 though, if the paper said they were likely to cause nausea, fainting, headache, arhythmia, severe abdominal pain, hypotension, convulsions, permanent muscle damage and potentially death I would imagine that local adder populations, especially those close to peoples gardens, would seriously suffer. Okay, there's probably a middle ground and there should have been a disclaimer such as "in case of adder bite always seek medical attention". I'm not sure what the legal liability would be after printing an article like this if someone did get bit.
Ultimately I can't see anyone staying away from medical assistance following a severe envenomation for too long. It must get far too unpleasant for the 'couple of paracetomol and a lie down' approach when the bite is serious. And when the victim decides that they are in the s*** there's probably time left for the medics to sort them out. I suppose the greatest worry would be that parents may dismiss bites to their children as inconsequential, where delayed treatment could be far more catastrophic.

In short, while some sort of advice to seek immediate medical attention, especially in children, would have been welcome I still think I prefer this kind of underexageration to the more frequent "deadly vicious evil reptile" approach. Ultimately both could lead to persecution, but I feel that this type of story is the lesser of two evils.

Just my thoughts, Lee.
Lee Fairclough
Tony Phelps
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Posted: 15 Jul 2003

Now is the time of year tolook out for press and TV items, headlines such as 'adders multiply in heatwave' followed by remarks that due to hot weather adders bred more often. Where that comes from I do not know, probably a carpark attendant in the New Forest.

I am on TV next week with the lovely Michaela Strachan, talking about snake mating systems, good opportunity to put the adder in a positive light.

About adder venom, my experience, painful, is that I have a feeling that immature snakes, those around 30-35cm have a more potent venom suggesting an ontogenetic change; this is true of other vipers, Wolfgang will correct me, but i think some work has been done on the Agkistrodon complex.
We were going to do something with adder venom, that is the Venom Research Unit at Liverpool, but no funding was available. Look at things, like potency at various times of the year, geographical differences. Subspecies bosniensis has a more potent venom and there have been a number of recent fatalities.
There is good info on venom in new book from Krieger, 'The True Vipers'.

Tony
Wolfgang Wuster
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Posted: 15 Jul 2003
Hi Lee,

Catch 22 indeed, and I agree with most of your comments. However, bear in mind that nasty symptoms can arise very quickly. In particular, serious cases of adder bite can result in sudden transient shock - not something you want to suffer while driving home after finishing your picnic, comfortable in the "knowledge" that no problems will arise after your 10 mg s.c. of "normally harmless" adder venom.

There has to be a middle way which is reassuring without giving rise to complacency. Something along the lines of "With modern treatment, adder bites are hardly ever fatal. However, any bitten person must be taken to a Hospital Emergency Department as soon as possible, as a precaution in case of rare serious symptoms" might be along the right lines. (admittedly a bit optimistic, since few medics have the foggiest idea of what they are doing when it comes tosnake bites, but let's not go there...)

The text in the species description on this site is pretty close to the mark, except for the statement of the statistics of wasp stings and adder bites - this confuses the risk of exposure and the risk from exposure. Certainly, more people die of wasp and bee stings than of adder bites, but then, most members of the population are exposed to them and get stung with some regularity. It is also certainly true that the average member of the public is extremely unlikely ever to get bitten by an adder. However, the average person who has just been bitten by an adder is much more likely to suffer severely or even end up with a tag on their toe than the average (non-allergic) person who has just been stung by a bee or wasp.

Let's just remember one thing: any excess persecution suffered as a result of more realistic reporting of the hazards posed by adders now are as nothing compared with what would happen if someone does die and the death gets splashed over the front pages nationwide. "But everyone said they were no worse than bees" would certainly be a phrase that would come to haunt us.

Cheers,

Wolfgang
Wolfgang Wüster
School of Biological Sciences, University of Wales, Bangor
http://sbsweb.bangor.ac.uk/~bss166/
GemmaJF
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Posted: 15 Jul 2003

Hi Lee,

I've often thought the bite is understated, I would rather see more emphasis put on the adders shy and retiring nature rather than playing down the very real and serious symptoms of the venom.

 I've often argued with those who have said that the venom is no worse than a bee sting, thank god that most of us in the field with them know better. I know from my time spent with them that if left alone they pose no danger, even when in very close proximity, if more people understood this and the fact that they are only likely to be bitten if they provoke the snake that would be a more realistic message.

Tony,

I did hear of some research concerning berus venom being more potent immediately after hibernation, I think based on vet reports of dog fatalities early in the season.

Wolfgang,

The ID page will be amended, I agree the statistic is misleading, as is the fact more people are seriously injured by horse bites in the UK each year than by adders, it isn't relevant knowledge for someone who has been bitten.

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Gemma Fairchild, Independent Ecological Consultant
-LAF
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Posted: 15 Jul 2003
Hi Gemma, Wolfgang,

I agree with your points entirely. I can't imagine where the 'no worse than a bee sting' analogy comes from (though bees kill 2-9 people here every year so I suppose in the UK mortality rate over the last 20 years are Bees - a tiny fraction of a percent, Adders - zero. Like they say, lies, damn lies and statistics). Many people I speak to are under the impression that adder bites aren't serious when that is certainly not the case. A quick trawl of the s.c. LD50's shows that the adder keeps some notorious peers in terms of venom lethality (albeit much bigger ones). It would certainly be interesting to see mortality rates in untreated bites. Thankfully though, unless you pick one up, step on it, or attack it with a strimmer you're extremely unlikely to get bitten.

Tony,

I've seen somewhere that V. b. bonsiensis was going to be assigned full species status and I think this may now be the case.

Cheers, Lee.

Lee Fairclough
-LAF
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Posted: 15 Jul 2003
Hmmm, just had a look at the original story and the puncture mark on his leg are VERY close together - much narrower than finger width. My guess is this was a small snake (if that photo's genuine).

Cheers, Lee.
Lee Fairclough
GemmaJF
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Posted: 15 Jul 2003

Thanks for putting the link up Lee, I should have put it with the original posting.

Does an adder have a wide enough gape to inflict a wound in this position???? I was tagged on the forearm by a big female years ago, and presumed it was the lack of gape that saved me from an envenomated bite. Though I guess it could have just been a warning.

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Tony Phelps
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Posted: 15 Jul 2003
This guys reaction to the bite is unusual and suggests that he may be ultrasensitive, as some are with bee stings. My friend, who is a wildlife cameraman has filmed and studied hornets, wasps, etc all his life, never been stung. Last year a hornet tagged him on the arm, he felt unwell and had to pull in at Corfe castle and ring 999, he was in Poole Hospital for three days.

recently both bosniensis and sachalinensis have been considered as full species (Joger et al. 1997; Ananjeva et al 1998). V.nikolski is genetically almost identical to berus as is bosniensis to V.barani (Joger et al 1997)
All these can still be described as subspecies of berus or as full species - things are never fully resolved,
Now about Bitis..................??????????????

Tony
Jim Foster
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Joined: 24 Jul 2003
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Posted: 24 Jul 2003

One interesting point to be aware of in these sorts of reports of adder bites is whether an adder was really the culprit. I've investigated a number of cases where people claim to have been bitten but have not actually seen the snake, and from distribution records one can rule out adders. I am sure that some cases are actually due to spiders (my invertebrate colleagues tell me there are quite a few British species that are capable of delivering a painful bite) or even thorns etc. A few years ago I looked into a case where a man claimed to have been bitten, and suffered some of the symptoms one would expect from adder envenomation, but we were puzzled because there were no adders in the area. We had a blood sample tested at Liverpool School of Tropical Medicine, and they detected no antibodies to adder venom. It was rather mysterious!

Re the severity of adder bite, I agree that underplaying the dangers of adder bite is unwise. We have just produced a leaflet on reptiles in gardens (available from our Enquiry Service on 01733 455100, or download from website, if you're interested) in which we say that "most reactions to adder bites are mild, but any bite should be regarded as serious and immediate medical advice should be sought." But from experience I know the impact of sensational reporting - there is certainly a risk of real conservation losses via persecution if the message is distorted. I think the comparison with insect sting mortality is useful as it sets the risks in context (many people do genuinely believe there are multple annual deaths from adders), but obviously it is completely wrong to make a direct comparison of toxicity between bees/wasps/hornets and adders. There have been two reported British deaths from insect stings in the last couple of months, tragically. Detailed risk assessment is, I would suggest, far too complex a subject to try to convey accurately in general media opportunities. The message has to be simple and positive: unless you go around catching adders, you are extremely unlikely to be bitten, but if you are bitten, get help quickly!


Jim Foster. Reptile & amphibian specialist, Natural England.
GemmaJF
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Posted: 24 Jul 2003

Welcome to RAUK Jim, the advice sheet may be downloaded at:

 

http://www.english-nature.org.uk/pubs/publication/PDF/Reptilesingarden.pdf

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