August 5, 1986 New York Times
THE DOCTOR'S WORLD; NEW SHOCK THERAPY FOR SNAKEBITES
By LAWRENCE K. ALTMAN, M.D.
A CHAT in a London laboratory between an American missionary physician who practices in the Amazon and two tropical disease experts has led to a new electric shock therapy that saves the lives of snakebite victims but that defies scientific explanation.
The treatment is delivered through modifications of what are popularly known as stun guns. It comes in the form of four or five high-voltage, low-current electric shocks. Each is painful and lasts one to two seconds. The shocks are given about five to ten seconds apart and are applied as close as possible to the site of the bites of snakes and such venomous insects as scorpions and ants.
In 34 cases where there was evidence of venomous bites that had penetrated the skin of limbs, the current was applied within about a half hour. None of the usual serious medical complications developed and none of the patients died, the researchers said in a report on what could become a revolutionary treatment. Also, the pain of the poisonous bites disappeared within 15 minutes, according to the report in the July 26 issue of The Lancet, a leading medical journal published in London.
The missionary physician and the tropical disease experts reported on treatment of the 34 patients in Ecuador. The patients did not receive the usual antivenom therapy for snakebites, one of the authors of the report said in an interview.
Venoms can produce damage very quickly. Seven bite victims who refused the electric shock therapy suffered complications such as swelling, bleeding, shock and kidney failure. Two needed life-saving amputations.
Although the biting snake could not be identified in all 41 cases, the authors believed that most bites were by small pit vipers similar to the water moccasin and copperhead of North America. Bites by such snakes tend to cause destruction of tissue in the area surrounding the bite, leading to the loss of a finger or part of limb. Larger snakes in the Amazon area can be even more dangerous, but more research is needed to determine if the jolts of electricity will work against venoms that damage the central nervous system.
Most astonishing to the authors was that the jolts of electricity were successful even after serious symptoms had already developed. Two additional patients suffered intense pain and swollen limbs from viper bites. Although they were not treated with electric shocks until two hours after the bites, they were relieved of pain within 30 minutes. Their symptoms did not progress, and both recovered with no serious lasting damage.
''We don't understand that and it is very hard to come up with a good scientific hypothesis to account for the change,'' said one of the authors, Dr. Jeffrey F. Williams, an expert in tropical diseases at Michigan State University in East Lansing.
Although other physicians said they would consider the treatment experimental until confirmatory reports were published, doctors in three other countries have used it successfully, according to the Lancet report.
The technique's greatest potential is in snake-infested areas with limited health care facilities. In eastern Amazon jungles of Ecuador, according to an earlier report, 4 percent of deaths are caused by snakebites, and half the men of the Waoroni tribe suffered more than one snake bite.
Because the shock treatment can be applied with electricity generated by such simple devices as outboard motors and power lawn mowers, reports of the therapy have brought inquiries from American military officials and oil company executives who see the potential of including stun guns in first-aid kits for troops and workers in snake-infested jungles and tropical rain forests.
Beyond the natural role of electricity in governing the rhythm of the heart and nervous system activity, doctors have been harnessing electricity to play an increasing role in the practice of medicine. They have long used electrocardiograms and brain wave tests called electroencephalograms and other tests to diagnose ailments.
In treatment, doctors have little difficulty understanding why jolts of electricity can be effective in resuscitation efforts and in converting abnormal heart rhythms to normal ones. Yet doctors have no explanation for the relief that electroshock therapy can bring many depressed and mentally disturbed patients.
More recently, doctors have used lithotripter machines to provide jolts of electricity to break up kidney stones, avoiding major surgery. Orthopedic surgeons apply electric currents to help some broken bones heal.
Electric shock therapy for snakebites had its origins in part in the London discussion between the three authors of the report.
Dr. Williams recalled how surprised he and Dr. Charles D. MacKenzie of the London School of Hygiene and Tropical Medicine were when, during a chat in Dr. MacKenzie's laboratory two years ago, the subject somehow turned to venoms and Dr. Ronald H. Guderian, the missionary physician in Ecuador, described his experiments with the electric shock therapy for snakebites.
Dr. Williams said Dr. Guderian described the notion, widespread in Ecuador, that electricity was a therapy for snakebites. He said snakebite victims try to get to an engine in order to run a wire carrying electricity from its coil into the area of the bite.
This folklore also led him to overcome his skepticism about a newspaper report of an Illinois farmer who applied high voltage, low amperage, direct current shocks to the site of bee stings to prevent the severe reactions he usually experienced.
Though enormous potential exists for clinicians to make valuable contributions to medicine, particularly those who practice in remote geographic areas, most have great difficulty in doing so because they have neither time nor the training to write up their cases in a scientific manner.
In this case, all three doctors knew that injections of antivenoms would prevent death or injury in snakebite cases when the biting snakes could be identified and when the antivenoms were available. ''The problem is that people living in a jungle often get bitten four hours canoe ride from anywhere there might be an antivenom,'' Dr. Williams said. He said he and Dr. MacKenzie encouraged ''Ron to pull together his patient records and to collect evidence that was good enough to build a story around.''
Dr. Guderian did just that. Then Dr. Williams and Dr. MacKenzie paid him a visit in Ecuador at the Hospital Vozandes in Quito and at a clinic in Zapallo Grande in the northwestern Ecuador. When Dr. Williams saw the treatment firsthand, he said he realized ''it was a first-aid measure that worked better than anything else.''
The biggest mystery is why electric shock therapy works against snakebites.
At first, the group thought it might be because the jolts produced severe muscular spasm that restricted blood flow, preventing the spread of the venom in the body. But favorable results among people who had already suffered severe systemic symptoms, including shock, strongly argue against that theory, Dr. Williams said. Also, he said that the amperage is too low to give a cauterizing effect.
Dr. Williams said he had reviewed the entire scientific literature on the chemical makeup of venoms and found they were very complex, some consisting of up to 10 toxic substances. ''It is not a simple toxic effect, and it is hard to understand how something like electricity can have an effect on such a wide range of processes,'' Dr. Williams said. ''It just doesn't make sense right now.''
Now the research must move to laboratories, he said, ''because it is hard to justify too much experimentation on victims in the jungle, particularly when the therapy hurts.''
Dr. Williams said he had milked snakes in Ecuador and carried the venoms back with him for further research. In the next step, he said he and other researchers at Michigan State University plan to find an animal suitable for use in study of the electroshock therapy and venoms. They hope to determine the correct dose of electricity, to learn why the jolts work and to find out what current does when it passes through the body. ''I want a reasonable scientific explanation,'' Dr. Williams said.
Correction: September 4, 1986, Thursday, Late City Final Edition
