Rajasthan is the largest state in India, where every year, thousands of people are killed by snakebite. An added complication is that there is a lot of ignorance about snakes, and much misinformation spread by dubious individuals with vested interests in the fear of innocent people.
One day I received a call from a knowledgeable villager from a nearby village, who informed me of a snake biting a person in the hand. I concluded that the victim must be a woman, for women do most of the work with their hands in these areas. Had the victim been bitten in the leg, then the probability of the victim being a man is much higher, for they are far more likely to be roaming from one location to another. The man confirmed that the victim was indeed a woman, and that they had brought her to the shrine of a local deity, but that she was still in distress, and that I should do something to help. I responded that she should be taken to a doctor. He then lamented that it would be difficult, as the community would not agree. The local custom is that the people bring snakebite victims to shrines of various deities in the hope of being cured. This is unfortunately a common practice prevalent in all districts of Rajasthan. A few days later, the woman passed away, leaving behind an infant child who was yet to be weaned off her breast milk.

Saw-scaled viper (Echis carinatus): It is locally known as Fursa, Fopsia, or Bandi. Releases toxins that affect the circulatory system. It produces sound by rubbing the scales on the body. (Photo: Dr. Dharmendra Khandal)

There are scores of folk deities associated with the cure of venomous snakebites in Rajasthan such as Gogaji, Delwarji, Harbuji, Ramdevji, Tejaji and Karishdevji etc. and local people have unwavering faith in these deities. Faith in these deities, also gives people the necessary mental fortitude in the event of a snakebite. If we pause to take a look at the history of these deities, many were warriors, who attained martyrdom fighting wars of ‘local’ relevance. Even the music played at their shrines, along with its instrumentation, is reminiscent of military processions and war songs. When snakebite victims find themselves in such a stimulating environment, they find relief to some extent as a result of a placebo effect. Here, the placebo effect means to have the mental fortitude to withstand pain without any medication and treatment, or to simply be able to ignore it. The unique atmosphere of a shrine where several people simultaneously act in solidarity with the victim’s suffering, all the while singing and dancing to emotionally stirring music enables such a placebo effect. The victim thus tragically gets false hope of survival by being taken to such places. However, let there be no mistake, snakebite victims simply must get proper treatment.

Indian cobra (Naja naja): This snake is portrayed as the most venomous creature of Indian myths, which has been given the exalted status of adorning the neck of the gods. This highly venomous but equally shy reptile often tries to keep its enemy away by spreading the skin around its head into a hood and hissing. Its venom has both hemo and neurotoxic properties.(Photo: Dr. Dharmendra Khandal)

In fact, medical treatment for snakebites began only half a century ago. The creation and use of antivenom does not have a very long history, which is why traditional remedies are still the norm rather than the exception in India’s rural and illiterate populations. For thousands of years, victims of snake bites have been taken to the shrines of local deities where all they have gotten is mental fortitude.

Russell’s viper (Daboia russelii): A very beautiful yet extremely aggressive snake, known as Chitti, is the cause of the highest number of deaths in India. Its venomous fangs are very long and strong, which release venom to a great depth and the amount is also high due to the large size of it’s head. (Photo: Dr. Dharmendra Khandal)

There are many reasons for snakebite victims often surviving at the shrines of local deities, none of which have to do with the shrine itself- sometimes a venomous snake releases a small amount of venom, sometimes a venomous snake does not release venom at all and such an event is called a ‘dry bite’, sometimes the victim has not been bitten at all, but went into a panic after the snake hissed, sometimes the victims have actually been bitten by non-venomous snakes, after all, 35 out of the 40 snake species found in Rajasthan are non-venomous. Thus, in such cases where the victim does fortunately survive, it further perpetuates the belief that shrines to local deities are the solution to snakebites. The result is that people remain engaged in practices that do not save the hapless snakebite victim, and the caretakers of local shrines continue to mislead people, all the while ensuring that the victims do not receive the treatment they need.
Let us assume that if a venomous snake has bitten someone, there is no other cure besides antivenom. You will find many examples where a snakebite victim has been taken to a local shrine, only to die there soon after, and then have the presiding priest blame the victims and their families for ‘carelessness’,all the while taking absolutely no responsibility for this folly.

Common krait (Bungarus caeruleus) : A completely nocturnal snake, but is extremely venomous. Its bite does not cause pain on account of its small fangs, but that only adds to the danger for its neurotoxic venom commonly becomes the cause of death of a sleeping person. Another snake of a species similar to this snake is found in the desert areas of Rajasthan, which is also known as Pivana. Due to the effect on the nervous system, the venom of this snake plunges a sleeping victim into a deeper state of unconsciousness. (Photo: Dr. Dharmendra Khandal)

Interestingly, the idea behind the ‘correct’ treatment of snakebites took birth in the Indian subcontinent. In the year 1870, Surgeon-Major Edward Nicholson published an article in the Madras Medical Journal where he wrote about how a Burmese snake catcher protected himself from future snakebites by having his snake bite him momentarily, thus inoculating himself. Similar stories are also to be found in India. These early observations formed the basis of research that led to the creation of the first antivenom for monocled cobra bites by the French scientist Albert Camette. He created this antivenom after many people trapped in the flood-prone areas of Vietnam were killed by a snakebite.
This treatment, which was developed over a century ago, did not initially receive much attention until 1950, when it was generally accepted, and its availability has increased in the last few decades. However, there is still an acute shortage of antivenom in the country.

In many snake fairs held in the country, snakes are displayed illegally and instead of promoting scientific thinking towards snakes, superstition is perpetuated.(Photo: Dr. Dharmendra Khandal)

How many people are affected by snakebites in Rajasthan?
According to the World Health Organization (W.H.O), 81,000-130,000 people die from snakebites worldwide every year and three times as many people become permanently disabled in the limbs.
The Million Death Study (MDS) was a study conducted by the Government of India, in which data was collected regarding causes of death at a young age. This unique study was conducted between the years 1998-2014. According to the same study, in the 14 years between 2001 and 2014, approximately 808,000 people died of snakebite in India. That is 58000 people a year. Of which 94% were in rural areas and 77% of them never made it to a hospital.
Going by the number of snakebite fatalities, Rajasthan ranks fifth from the top as compared to other states of India, which is a matter of grave concern. According to this study, 52,100 people died in Rajasthan in 14 years, with an average of 3722 deaths per year.

Snakes are harassed in various ways in these fairs, and some dubious people misrepresent their snake-catching skills as a form of divine power.(Photo: Dharmendra Khandal)

According to an article published by Surawera et al. (2020) titled  ”Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study ” – (https://elifesciences.org/articles/54076), 43% of snakebites were caused by Russell’s viper (Daboia russelii), 18% were caused by krait (Bungarus species), 12% were caused by cobra (Naja species) and 21% by other snakes, multiple species caused the death of 6% of the population.

Chiranji Lal’s son remembers his dead father while holding up a portrait of him and reveals how his father was killed by snakebite, while he also used to treat snakebites.It is a strange twist of fate that the one who used to cure snakebite, lost his life to a snake bite. (Photo: Dr. Dharmendra Khandal)

Rescue & First Aid:
There is much confusion regarding first aid that must be administered in the event of a snakebite. You might remember people casually proposing measures such as making X-shaped incisions on the site followed by blood-letting. You might even find such measures proposed in first aid booklets. However, such actions can be fatal, for the victim can lose their life due to excessive blood loss. In many Bollywood films, you might have watched the protagonist save a snakebite victim’s life by making an incision on the bite with a knife and personally sucking the venom out by the mouth! This too is an incorrect method.

Bitten by Russell’s viper, the family took him to the shrine of a deity, but after the first shrine refused, they took him to a second shrine, and wasted valuable time. Due to the delay made by them, it took a few months for his wounds to heal.(Photo: Dr. Dharmendra Khandal)

Firstly, no incisions are ever to be made on the bite site- there are two types of snake venom, neurotoxic and hemotoxic. Both viper species have hemotoxic venom and when bitten, the victim’s circulatory system or vasculature is badly affected and as a result there is bleeding in the nose, mouth, urethra and the bite site itself. In the event of a viper bite, any kind of incision or attempt to drain blood will only exaggerate blood loss, and will be near impossible to stop without a medical intervention. To put it bluntly, the victim will die of excessive blood loss even before the venom does it’s work. So remember once again, never make an incision.

Local people getting a woman suffering from snakebite to run at a high speed around the place of deity, it increases the blood pressure, which is harmful. (Photo: Dr. Dharmendra Khandal)

People keep shouting, sometimes thumping and shaking to wake the victim woman from unconsciousness. (Photo: Dr. Dharmendra Khandal)

Another popular first aid method is to tie a tourniquet above the bite site. This too may be found in old first aid manuals and booklets, but can prove fatal to the victim. Because the venom accumulates in only one part of the body, and it can be very dangerous for that specific part. Complete cessation of blood flow can damage that part of the body anyway.

After a saw-scaled viper bit the child while he was sleeping, he was taken to the shrine of a deity. After being in tremendous pain for several days, although the child gradually got better, no one knows which parts of his body will suffer the long-term effects of the venom.(Phot: Dr. Dharmendra Khandal)

According to current data, both of these popular first aid methods are extremely counterproductive and harmful. So what should be done instead?
Experts recommend two strategies–prevention and proper treatment.
  1. The most important step is to be able to avoid snakebites entirely. Maintaining hygiene in and around your home will minimize snakes frequenting it. Snakes are often attracted to human dwellings by prey animals like rats. Keeping your home and its immediate environs clean, and tidy will go a long way in prevention.
  2. If planning to move about at night, make provisions to ensure you have a source of light. Owning a good flashlight is a solution here.
  3.  Learn to recognize snake species so that you can understand their behavior.
  4. Always maintain a safe distance from snakes and take precautions, many times due to negligence, even trained snake catchers become victims of snakebite.
First Aid & Treatment:
  1.  As stated earlier, do not make any incisions, nor tie any tourniquets above the bite. Wrap a clean cloth around the bite site. This is to be bound with very little pressure and never with force.
  2.  Keep the victim calm, and maintain constant encouragement through the first aid and treatment process.
  3. Use a vehicle to transport the victim to a hospital, they should not be made to run. If a vehicle is not available, use a scooter or motorcycle, and make the victim sit between two people.
  4. If you know anyone working at the hospital, inform them before your arrival so that they can arrange life-saving resources without wasting any time.
  5. People living in areas abundant with snakes should familiarize themselves with the closest hospitals.
  6. An antivenom can only be administered by a trained doctor, so do not store it unnecessarily and never administer it yourself.
  7. The antivenom used for snakebites in India is polyvalent, which is effective against the venom of the 4 major venomous snakes of India. Nevertheless, if the species can be identified, then treatment is far easier.
  8. Many times doctors also do not have the experience to treat a snakebite. By consulting a nearby snake expert, you can get access to an experienced doctor.
  9. While private hospitals do treat snakebites, treatment is completely free of charge in the main government hospital of a  district. Since antivenom is categorized as a life-saving drug, it is mandatory for the hospital to maintain a stock of it.

Priests and Managers collecting offerings to the snake god’s temple (Photo: Dr. Dharmendra Khandal)

Thus, in the vast tracts of Rajasthan, where most of the population lives in rural areas, the risk of snakebite is high. There is a need to avail of proper treatment in the event of a snakebite. However, snakes are also an important part of our ecosystem and it is necessary to conserve them. With just a little care,  you can avoid snakebites altogether. Remember, the snake is not your enemy, the rat is! Nevertheless, carelessness can be fatal. By steering clear of superstition, making decisions based on scientific information, you can save not only your life and the lives of your friends, but also save the lives of snakes.