[Poisonous-snake bites. Therapy and preventive measures].

It is estimated that every year about 500 000 people around the world are bitten by poisonous snakes. Between 30 000 to 50 000 persons die due to snake-bites; the highest frequency is reported from Southern Asia. Clinically three types of snake-bites can be distinguished: 1. Bites with local damage (extreme pain, edema, necrosis), 2. Bites followed by generalized hemorrhagic symptoms and 3. bites with neurotoxic effects of the poison (no local pain, paralysis of cerebral nerves, coma). For tropical snake-bites snake-venom is live-saving. As in many cases the biting animal cannot be identified it is advisable to use polyvalent sera. These are heterologous sera which contain antitoxins against several poisonous snakes of a certain area. Often there is some delay until the snake-venom becomes available. Therefore local and symptomatic treatment is valuable: cleaning of the wound, superficial incision to remove poison, venous congestion, oral and intravenous fluid-therapy, antihistaminic drugs, steroids and prophylaxis of shock. Tourists are only rarely endangered by poisonous snakes, they do not need to carry anti-snake venom; this is recommended for scientific excursions in areas with dense vegetation and for persons living in warm countries.