Traditional treatments for snake bite in a rural African community.

Snake bite is a signi® cant cause of morbidity and mortality in many parts of the world (Warrell, 1996). The annual incidence of snake bite in KwaZulu-Natal, South Africa, estimated at 81/100 000 (Wilkinson, 1994), is relatively high because the population is mostly rural and the number of snakes resident in the area is large (Branch, 1990). An important determinant of the morbidity and mortality resulting from snake bite is the treatment-seeking behaviour of those bitten. As shown below for KwaZulu-Natal, the use of traditional snake-bite remedies may be an important feature of such behaviour. As part of a prospective study to determine the clinical spectrum of snake bite and to identify the biting snake serologically, data on treatment given prior to admission were collected on all cases of snake bite presenting to Hlabisa hospital. This institution is a 450-bed district hospital serving a largely Zulu-speaking population of around 210 000 people in northern KwaZulu-Natal, South Africa. The local climate is sub-tropical with wet and hot summers between October and March, when most snake bites occur (Wilkinson, 1994). Information relating to traditional treatment was recorded using a standard questionnaire. Overall, 147 patients bitten by snakes were seen between November 1995 and October 1996 and information was collected on all of them (see Table). Of these 147, 132 (90%) had used some form of traditional remedy prior to admission, 118 (89%) had each used two or more traditional remedies and 65 (49%) had each used at least three. One patient had used six different remedies. The commonest forms of treatment employed had been use of a tourniquet (109; 83%) and isibiba taken orally (103; 81%). Isibiba is a local medicine prepared by traditional healers from various parts of cremated snakes; most preparations include the snake’s gallbladder. The burnt snake is ground into a powder and taken in the form of a lick or a drink; it may also be applied to the bite. Other common oral treatments had been drinking urine (mostly the patient’s own) and taking an elixir of crushed aloe leaves to induce vomiting. Other common topical remedies had included scari® cation around the bite site, and the rubbing of herbal mixtures on the site of the bite. Scari® cation had most frequently been done with a razor blade but in three cases a sharpened cow horn had been used. A wide range of substances had been rubbed into the bite site, including isibiba, household detergent, potassium permanganate, paraf® n, breast milk and snuff. Some more bizarre treatments included amputation of the bitten ® nger, the