When snakes attack, Pikesville doctor gets the call

Physician has reputation for battling deadly venom

August 05, 2002|By Michael Stroh | Michael Stroh,SUN STAFF

On a blazing Tuesday afternoon in late June, painter Charles Lennox was working on a house nestled in the woods above Frederick when his putty knife tumbled into a shrub. As he reached in to retrieve it, he felt something crunch down hard onto his hand.

He jerked his arm away and a jolt of fear shot through him when he saw what was attached: Crotalus horridus horridus, the highly toxic timber rattlesnake, dangling by a single fang from the flesh of his forefinger.

"Oh, my lord," he thought.

Lennox flung the 39-inch snake into the air. A co-worker dialed 911. Recalling something he had seen in movies, Lennox frantically pressed his lips to the puncture and sucked. But by the time paramedics arrived, the venom was already taking effect.

"I started to get the shakes. Every muscle I had felt like it was jittering. My eyes started to blink," the 38-year-old said. "Within minutes, my hand swelled up to my wrist." In the ambulance, paramedics sawed off his wedding band. "By the time I got to the hospital emergency room, my fingers were like kielbasa sausages - I couldn't spread them apart."

As emergency room doctors huddled over Lennox, the pager of Dr. Barry Gold sounded in Pikesville.

Gold is a 54-year-old practitioner in internal medicine with an unusual sideline: He is one of a handful of physicians in the United States who specialize in snake venom. This is his busy season, the time when man and beast are most likely to meet.

For nearly two decades Gold has been the one to whom doctors in Maryland and beyond have turned to when confronted by severe snakebites. He estimates he has worked on more than 250 over the years - including some by the world's deadliest snakes and on victims as far away as South America and Siberia.

"There's no cookbook formula, no protocol like there is for heart attacks," Gold likes to say. "Every bite is different."

And every one, he says, has the potential to take an unexpected turn-which proved true in the case of the Frederick painter.

Dangerous but unlikely

The widespread fear most people feel toward snakes is disproportionate to the danger they pose. Of the twenty-seven species of indigenous snakes in Maryland, just two are venomous: the timber rattler, which dens mostly in Western Maryland; and the northern copperhead, found throughout much of the state. Copperhead bites are no picnic, but the venom is rarely life-threatening. Rattlesnakes are different. Left untreated, a victim could die.

It's hard to know how many people are bitten by venomous snakes. Attacks often go unreported. Based on a 1990 study he did with Dr. Robert Barish of the University of Maryland School of Medicine, Gold estimates about a dozen venomous snake bites occur in the state each year, compared with 7,000 to 8,000 nationwide.

Accidental bites like the one in Frederick are rare. "A lot of people bitten by snakes actually deserve it," Barish says. They poke wild snakes with sticks, or take in venomous exotics as pets. One unpublished study of snakebite victims is particularly revealing. Nearly all were white men. Many had tattoos. Many rode motorcycles. And a significant number were drunk. "Do you get the picture?" Barish says.

In last week's New England Journal of Medicine, Gold and Barish highlight another surprise surrounding snakebites: Much of what we think we know about treating them is just plain wrong. Remedies such as ice or a tourniquet can lead to complications such as amputation, they say.

Perhaps the most famous treatment - so-called "cutting and sucking," first proposed by the Indian physician Sushruta in 600 B.C. and long a Boy Scout mantra - has never been rigorously studied, they say. The best first aid? Keeping the wound below the heart and having a set of car keys handy.

But snakes rarely kill. Less than a half-dozen Americans die from one each year. Three Marylanders in the past century have succumbed to a snakebite.

The most recent case occurred in 1992, when a 25-year-old amateur herpetologist in Emmitsburg went into cardiac arrest after he was bitten in the toe by his pet Indian king cobra. In 1958 a 3-year-old girl in central Maryland died after being bitten twice while playing in a corncrib. Her killer was suspected to be a copperhead.

But by far the most bizarre death occurred in 1955 at Billie's Night Club, a former Fells Point cabaret. The victim: a Baltimore stripper named Princess Naja.

Naja - in real life, Frieda Hoxter - was a blonde who worked The Block and other nightclubs in town. To make her name, she began incorporating snakes into her act.

One night, while gyrating with the cobra coiled over her shoulders, something went wrong. Audience members saw Naja smack the snake. Moments later they noticed her lips and ears swell. She danced for eight more minutes, finishing her act, before stumbling offstage. It would be her last performance.

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