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Effects of organochlorine pesticides

dispatched to the Commonwealth Serum Laboratories, Melbourne, where Dr Struan Sutherland examined the piece of skin which was the suspected bite site. The site contained a high concentration of brown snake venom (genus Pseudonaja). The control skin did not. This case recalls the first case in Australia, in 1972, in which a death of a snake-bite could be attributed by means of a radioimmunoassay to a specific snake in this instance, a tiger snake (genus Notechisi.' The victim again was a young child who had been seen playing with a "piece of yellow rope" in the backyard at dusk. There was a vague history of a bite or a sting. The child developed the obvious symptom of drowsiness; she was taken to hospital and observed, returned home and subsequently was found dead. Here again, the envenomation site was difficult to detect. If I had not had the good fortune to see the minimal trauma that was consistent with snake envenomation, these deaths (particularly the more recent case) easilycould have been misdiagnosed as sudden infant death syndrome in a child who was somewhat older than is usual for that condition. Dr Sutherland informs me that the death rate of snake-bites has fallen significantly in Australia over the last 15 years and about two fatalities now occur a year. Most of these cases have received massive envenomation and/or quite inadequate first-aid measures. In the last 10years, all but two of these deaths have involved adults and were unusual in that death generally occurred within several hours of the bite. The majority of these rapid deaths followed bites by brown snakes. Dr Sutherland and Dr James Tibballs currently are investigating the possible mechanisms by which these venoms produce this rapid collapse and death. In the meantime, the case that is reported above demonstrates clearly that an unwitnessed snake-bite in a young child may lead to a rapid, unexpected, and possibly inexplicable death. John M.N. Hilton, FRCPA Forensic Pathology. State Health Laboratory Services Queen Elizabeth II Medical Centre Nedtands, W A 6009 I. Sutherland SK. Australian animal toxins: the creatures, their toxins and care of the poisoned patient. Melbourne: Oxford University Press, 1983. 2. Sutherland SK, Coulter AR, Broad AJ. et al. Human snake bite victims: the successful detection of circulating snake venom by radioimmunoassay. Med J Ausl 1975; 1: 27-29.