Objective: To obtain and analyse data relating to snake bite fatalities in Australia.
Design: Retrospective analysis of case reports and collation of studies carried out at the Commonwealth Serum Laboratories (CSL).
Results: 18 deaths attributed to snake bite were reported to CSL over a 10-year period. Eleven of the victims were males and four of these were bitten after either picking up the snake or playing with it. In most cases, no pathological findings of significance were found at autopsy. Venom was detected in post-mortem samples from nine cases. Brown snakes (genus Pseudonaja) were responsible for 11 deaths; tiger snake (Notechus scutatus) for four, taipan (Oxyuranus scutellatus) two and death adder (Acanthophis australis) one. Death after a brown snake bite was often sudden and unexpected. In three patients bitten by tiger snakes and in one bitten by a brown snake, the presence of cerebral haemorrhage was confirmed at autopsy.
Conclusions: Not all snake bite deaths in Australia are adequately investigated or reported. Under some circumstances death from snake bite is almost inevitable; two infants who received unwitnessed massive envenomations are tragic examples. Had venom absorption from the bitten area been delayed by correct first aid, some of the patients might have survived. The brown snakes (genus Pseudonaja) must now be considered Australia's most dangerous group of snakes because their venom may cause sudden unexpected collapse and death. The increased incidence of intracranial haemorrhage may in some cases be related to the intravenous use of adrenaline. In at least one case, the prompt administration of a clearly needed antivenom might have altered the outcome.