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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 155-158

Treatment of snakebite with snakestone – A preliminary observational study


Department of Psychiatry, JSS Medical College, Mysore, Karnataka, India

Date of Submission08-Jun-2019
Date of Acceptance09-Jul-2019
Date of Web Publication05-Aug-2019

Correspondence Address:
Dr. Dushad Ram
Department of Psychiatry, JSS Medical College, Mysore - 570 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_45_19

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  Abstract 


BACKGROUND: Snakestone (blackstone) is known to be useful in the treatment of snakebites in different parts of the world for centuries. So far, no empirical study examined its usefulness in snakebite. This study was conducted to know the efficacy of snakestone in snakebite.
METHODS: This was a clinic based cross-sectional observational study. Fifty-six consecutive individuals with different snakebites who underwent snakestone treatment were recruited and assessed with demographic clinical pro forma and clinical assessment was done for recovery from snakebite.
STATISTICAL ANALYSIS USED: Descriptive and inferential statistics (Kruskal–Wallis test) were used.
RESULTS: The mean score on age was 34 years, 8 h since the bite, and 278 stones were used. Number of stone used for treatment varied significantly based on postbite symptom (P < 0.05), type of snake (P < 0.05), and body part bitten (P < 0.05). All participants recovered from snakebite, and treatment was uneventful.
CONCLUSIONS: Snakestone treatment may be effective in snakebite. Further study is needed to replicate the finding.

Keywords: Snakebite, snakestone, treatment


How to cite this article:
Ram D, Jancy C. Treatment of snakebite with snakestone – A preliminary observational study. Int J Health Allied Sci 2019;8:155-8

How to cite this URL:
Ram D, Jancy C. Treatment of snakebite with snakestone – A preliminary observational study. Int J Health Allied Sci [serial online] 2019 [cited 2019 Nov 19];8:155-8. Available from: http://www.ijhas.in/text.asp?2019/8/3/155/263949




  Introduction Top


India is reported to have the highest number of snakebites (81,000) and deaths (11,000) per year.[1] Still, the snakebite remains an underestimated cause of accidental death.[2] Of the estimated deaths due to venomous snakebite worldwide, half occur in India.[3] All epidemiological surveys from the developing world indicated that the majority of victims of snakebite seeks initially seek traditional medicinal care.[4],[5] Common traditional methods are cutting the bite site; use of a tourniquet; freezing, burning, and shocking; ingestion of plant extracts; and local application of poultices and ingestion of alcohol, etc. Extraction is another method used in some parts of the world such as Asia, Africa, and Latin American countries.[6],[7] The use of snakestone (blackstone) is the most common extraction method. Although it is known to be useful for centuries in snakebite, there is little scientific literature on its use and efficacy. Chippaux et al. attempted to explore the possible benefit of blackstone in the animal model but could not establish clear efficacy.[4],[5] Few studies found some usefulness as prehospital first aid.[8],[9] Madaki et al. could not find a decreased incidence of envenoming using snakestones compared to those receiving no first aid, decreased duration of hospital stay, or differences in morbidity or mortality. However, dose requirement of antivenom was significantly low among those used snakestone, but Michael et al. could not replicate these findings. In these studies, the sample size was not enough to draw a clear conclusion. There is a knowledge gap of use of snakestone in snakebite, and this study was conducted to explore the possible efficacy. We hypothesized that snake stones are effective in the treatment of snakebites.


  Methods Top


This clinic based cross-sectional observational study was conducted at the Shantinilaya Clinic, Hallikerehundi, in Nanjangud district of Karnataka, India, from January 2018 to March 2019. The clinic was established about 40 years back and since then provides free snakestone treatment for all types of snakebites. Stone is made of fallen horns of deer and animal bones that is seasoned with herbal juice such as mint or betel leaf. People availing service are those who cannot afford modern treatment such as tribal and underprivileged people of backward class.

In this study, 56 consecutive individuals with different snakebites who attended the clinic and underwent treatment were consecutively recruited after obtaining informed consent. Inclusion criteria were history of snakebite, any gender, and age. Individuals were excluded if they had a history of any other serious physical illness such as uncontrolled diabetes and history of cerebrovascular disease.

Participants underwent snakestone treatment for snakebite. Stones were applied in the limbs only irrespective of snakebite location. Initially, under aseptic precaution, small superficial skin cut is made so that there is little oozing of blood. Over the cut, a stone of about 1.5 × 1 inch is applied though the size of stone varies with manufacturer [Figure 1]. The same procedure is repeated adjacently in all the limbs, and the number of stones used depends on the symptoms they presented with. If the symptoms are local at the bite site, less number of stones are used, while for those with gastrointestinal or central nervous symptoms, more number of stones are applied. However, in any case, a minimum of 40 stones are used. Duration of application depends on improvement. Usually, improvement takes place within hours to few hours. If the improvement is slow, daily application is used, while in case of faster improvement, alternate day application is done. Usually, the total duration of application ranges from 5 to 15 days and the participant needed to be in complete bed rest. All the participants were assessed with sociodemographic and clinical pro forma designed for this study; clinical assessment was done of symptoms in the beginning and at the time of discharge and outcome measures were clinical improvements of symptoms or death.
Figure 1: Stones are applied in limbs

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  Results Top


The demographic features were characterized by more number participants who were male, educated, married, lower socioeconomic status, and Hindus of rural background. In the majority, snakebite was on the right upper limb; pain and burning were the presenting symptoms; stones were applied on an alternative day; and all improved with the treatment [Table 1]. The mean score on age was 34 years, 8 h since the bite, and 278 stones were used [Table 1]. The number of stones used for the treatment varied significantly based on postbite symptom (P < 0.05), type of snake (P < 0.05), and body part bitten (P < 0.05). All the participants recovered from snakebite, and the treatment was uneventful [Table 2].
Table 1: Sociodemographic and clinical characteristics

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Table 2: Relationships of number of stones used with postbite symptoms, type of snake, and body part bitten (Kruskal-Wallis test)

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  Discussion Top


Although the indigenous practice of treating the participant with snakebite with blackstone is many centuries old, to the best of our knowledge, this is the first clinical study of use of blackstone on human with snakebite.

Demographic characteristics were indicative of local population. Since majority of population was right-handed, commonly used for physical activity making it predisposed to expose for risk of contact with snakes while working in the field, particularly those with middle-aged, with lower socioeconomic status of rural background. The mean 8 hour since the bite was probably due to the difficulties related to transport in rural area, while mean stone number used were 278, indicating that the symptoms were emerged in a significant severity due to long untreated period. Higher number of stone was used in case of bleeding, in Daboia russelii bite, and when the trunk or upper right limb was the site of bite. Bleeding indicates severe envenomation that is commonly seen with Daboia russelii bite. Since the upper limb has been the most active part of the body, dissemination of venom and development of symptoms might result in more number of stones used to control the symptoms.

One of the most surprising findings is overall good outcome. “Snakestones” are a long-advocated indigenous first-aid treatment. Black- or snakestone of Indian origin has been used as first aid in Asia, Africa, and Latin American countries.[6] Despite no evidence supporting their use and scientific studies disproving efficacy, their use remains widespread.[6] Earlier clinical arguments for its use in literature derived mostly from anecdote rather than actual scientific demonstration of blackstones' efficacy.[10]

Mechanism of action is uncertain. The premise is that they will absorb the venom from the bite site due to the porous nature of the material. Attempt has been made to understand efficacy in animal model. Chippaux et al. examined the efficacy of blackstone in animal model by injecting venoms of Bitis arietans, Echis ocellatus, and Naja nigricollis.[4] Local application of stone did not have any efficacy against venom. In another study, Chippaux et al. used murine model; they used stone and its powder.[5] They found that the direct contact between the blackstone powder and the venom did reduce venom toxicity; however, overall evidence did not support to recommend the use of stone to treat envenomation. Thus, animal studies failed to show strong efficacy.

It may be concluded that despite inadequate literature support of the efficacy of snakestone, our study revealed it to be effective in all types of snakebites. Further studies are needed to replicate the finding.

Acknowledgment

The authors would like to thank Yahosha, Shamaya, Hagai, Asther, Yasuas, Marias (Divine Retreat Centre, Chalakudy, Kerala, India), Ashish, Akash, and Mini for their moral support.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008;5:e218.  Back to cited text no. 1
    
2.
Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite mortality in India: A nationally representative mortality survey. PLoS Negl Trop Dis 2011;5:e1018.  Back to cited text no. 2
    
3.
Menon JC, Joseph JK, Whitaker RE. Venomous snake bite in India – Why do 50,000 Indians die every year? J Assoc Physicians India 2017;65:78-81.  Back to cited text no. 3
    
4.
Chippaux JP, Diédhiou I, Stock R. Study of the action of black stone (also known as snakestone or serpent stone) on experimental envenomation. Sante 2007;17:127-31.  Back to cited text no. 4
    
5.
Chippaux JP, Ramos-Cerrillo B, Stock RP. Study of the efficacy of the black stone on envenomation by snake bite in the murine model. Toxicon 2007;49:717-20.  Back to cited text no. 5
    
6.
Baldwin M. The snakestone experiments. An early modern medical debate. Isis 1995;86:394-418.  Back to cited text no. 6
    
7.
Scarpa A. The 'serpent-stone' or the 'black-stone'. Soc Sci Med 1987;25:229-30.  Back to cited text no. 7
    
8.
Madaki JK, Obilom RE, Mandong BM. Pattern of first-aid measures used by snake-bite patients and clinical outcome at Zamko comprehensive health centre, Langtang, Plateau state. Niger Med Pract 2005;48:10-3.  Back to cited text no. 8
    
9.
Michael GC, Thacher TD, Shehu MI. The effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Trans R Soc Trop Med Hyg 2011;105:95-101.  Back to cited text no. 9
    
10.
Rasquinha D. Snake stone for snake envenomization. Am J Emerg Med 1996;14:112-3.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

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