Attempted suicide by snake bite: A case study

Introduction

Snake bite is an important public health issue, especially in rural areas of tropical and subtropical countries including India. In India the common cobra (Naja naja), common Indian krait (Bungarus caeruleus), Russel’s viper (Daboia russelli), saw-scaled viper (Echis carinatus) and humped nosed pit viper (Hypnale hypnale) are regarded as medically important. ¹

Most snake bites are accidental in manner. Suicide or attempted suicide by snake bite is extremely rare. We encountered a case where a snake charmer tried to commit suicide by inflicting a snake bite. Snake charming used to run in families as a source of earning livelihood in India. However, the snake charmers of India are now experiencing a difficult social and economic situation, as their traditional family business of snake charming is banned by the Indian Wild Life (Protection) Act, 1972.

Case report

The victim was a 50-year-old married male who was admitted to Capital Hospital, Bhubaneswar, Odisha, India with an alleged history of accidental snake bite. At admission the subject was conscious and his vitals were stable; his right arm was tightly tied with a jute rope (Figure 1) and two fang marks were clearly visible at the dorsum of the right forearm (Figure 2(a)). On the basis of the history, fang marks and an abnormal 20 minutes whole blood clot retraction test, polyvalent anti-snake venom (ASV) administration was started. The tourniquet was removed under observation after administration of an initial dose of 10 vials of ASV. The relatives of the patient had also brought the captive snake to the hospital, where it was positively identified by the first author to be a monocled cobra, Naja kaouthia LESSON 1831 (Figure 2(b)). In total 20 vials of ASV were administered during the course of treatment and the patient was discharged on the fifth day. OPEN IN VIEWER

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Figure 2.

(a) Prominent fang marks and (b) monocled cobra, Naja kaouthia LESSON 1831 (Photograph by Subhendu Mallik).

On a visit to the victim’s village and interaction with the eye witnesses, it was revealed that on the day of the snakebite incident the victim was under the influence of alcohol and had quarreled with his wife. Then, to attempt suicide, the victim had caught hold of the head of the captive cobra and inflicted a bite on the dorsum of his right forearm, an account which was contrary to the initial deposed history of accidental bite.

The victim was again interviewed by the other authors regarding the incident. He admitted that due to restrictions on snake charming he had been deprived of his source of income. He was going through a severe financial crisis because of increased family needs. In addition, he had four daughters of marriageable age. Because of these social and financial burdens he had started consuming alcohol on a regular basis. On the fateful day he was drunk and had quarreled with his wife. In rage and frustration, he took action to commit suicide. He had rescued the cobra which had become entangled in a fish net laid by him to catch fish, and because of his old habits he kept it captive.

Discussion

In today’s world, due to day-to-day frustration, stressful life and competition, suicide is on the rise. Injection of snake venom or infliction of snake bite as a method of suicide, though rare, is not new to mankind. Historically there was a belief that Cleopatra, the queen of Egypt, committed suicide by inflicting the bite of an Egyptian cobra (Naja haje), but recent research has nullified this hypothesis and alleged her death to be a murder at the hands of Octavian and his men for political purposes. ²

There have been reports of people committing suicide by snake bite ³ and by injecting snake venom.^4-6 Attempted suicides by injecting ⁷ snake venom and snake bite ⁸ have also been reported.

This attempted suicide was revealed by the authors’ interaction with eye witnesses and the subsequent confession by the victim. However, the victim’s relatives had fabricated the story of accidental bite in sheer shame, and to avoid legal complications for two crimes: ‘Attempt of suicide’ under Article 309 of the Indian Penal Code and ‘Prohibition of hunting’ under Section 9 of WL (P) A. Illegal snake charming is still practiced secretly in many places in India. Regarding attempted suicide, India is in the process of abolishing punishment for this. The Mental Health Care Bill 2013 in this regard, though already introduced in the upper house of parliament, is still pending approval.

When the authors interviewed the victim, he revealed his financial crisis and stress. Family problems, professional problems and poverty are the main causative factors for suicidal behavior; ⁹ this case study had all these risk elements together. Alcohol induces suicidal ideation and is a known risk factor influencing suicidal behavior. ¹⁰ This subject was also addicted to alcohol, and at the time of incident was under influence of it.

The practice of applying a tight tourniquet is highly condemned and is contraindicated for use in India because of increased risk of necrosis, ischemia and loss of limb, risk of massive neurotoxic blockade on sudden release and increased risk of embolism. ¹¹ However, application of a tourniquet is still very common in India; better public awareness is urgently needed to stop this practice and avoid complications.

Incidence and methods of suicide vary from region to region globally, and are influenced by many factors. Often it is the occupation which decides the suicide method, ¹² and snake charmers and handlers are no exception. It is noteworthy that people who frequently handle snakes are at risk of committing suicide by this atypical and rare method, as in this case. Therefore we emphasize that whenever a case of snake bite involving a person who deals with snakes, such as snake charmers, herpetologists, researchers, snake traders and snake rescuers etc., is brought to notice, the suicide angle must not be ignored and the subject and the circumstances should be thoroughly inquired upon. If any suicidal ideation at all is revealed, the patient should be properly counseled and treated to avoid untoward incidents in the future.