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Throughout history, envenoming by animal toxins
has fascinated humans. Rarely has a medical
phenomenon had so much religious association,
symbolism, anecdotal communication, and provoked
so much violent professional disagreement. Animal
toxins have made a significant contribution to
enhancing knowledge in human physiology and
pharmacology. Information on the nature and mechanism
of action of these toxins has enabled a more
scientific approach to the treatment of their intoxications.
Early and specific therapy is frequently
required after envenoming and often includes life
support and maintenance of vital functions by
mechanical ventilation, i.v. fluid and drug therapy.
The total number of snake bites throughout the
world has been estimated at 500000 per year, with
approximately 40000 deaths [5,60,81]. The majority
of these incidents occur in Asia, South America
and Africa. Snake bite is the fifth most common
cause of all deaths in Burma [6], and in Sri Lanka,
two people die each day of snake bite [21]. In the
USA, 45000 snake bites occur each year of which
7000-8000 are venomous and there are between 10
and 15 deaths [13]. In the UK several incidents of
bites inflicted by foreign venomous snakes have been
recorded [67] and although there have been 11
deaths caused by adder bites from 1876 to 1941, in
recent years there have been no deaths from snake
bites. The British Military Hospital, Dharan, Nepal,
managed 58 cases of snake bite in 1989 [35]. Eighteen
deaths attributed to snake bite were reported in
Australia from 1981 to 1991 [79]. In Sweden, 44
deaths were reported from snake bite from 1911 to
1978, while in Finland and Sweden there are 200
bites annually. Bee and wasp stings caused 61 deaths
in the UK during a 13-yr period ending in 1972,
while in the USA, hymenoptera stings cause 40-50
deaths annually [74]. At present, an average of five
deaths occur from bee and wasp stings in the UK
annually [61]. Scorpion stings are responsible for
1000-2000 deaths each year in Mexico, and high
mortalities are also encountered in Brazil, Israel,
Trinidad, Algeria, India [85] and Jordan [37]. A total
of 38068 cases of envenoming by scorpion stings
during 1981-1986 were treated in the city of Leon,
(Br. J. Anaesth. 1995; 74: 319-327)
Mexico [20]. Spider bites are associated with a
mortality of 1-17% in Chile, Brazil [50], the
Mediterranean region [85], Israel, North Africa and
in some regions in the former Soviet Union [45].
Black widow spiders caused 63 deaths in the USA
from 1950 to 1959 while the funnel-web spider is
responsible for some morbidity in Australia. Tick
bites cause poisoning and sometimes death in
Australia and western North America. Puffer fish
poisoning is responsible for 250 cases of poisoning a
year in Japan with a 50-60% mortality rate.
Ciguatera is the most commonly reported foodborne
intoxication of marine origin in the United
States, accounting for 7.4% of all food-borne
outbreaks from 1978 to 1982 [73]. It is a public
health hazard in the Pacific and Caribbean islands.
In 1968 an outbreak of paralytic shell fish poisoning
occurred in the north east coast of England affecting
78 people [55]. Scuba diving and similar recreational
activity has been associated with poisoning caused
by marine animals, particularly in the Indian and
Pacific oceans.
Figure 1 shows the principal sites of action of the
animal toxins discussed.
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