For many decades, the concept of the [Big 4] Snakes of Medical Importance has
reflected the view that 4 species are responsible for Indian snakebite mortality-

the Indian cobra (Naja naja),
the common krait (Bungarus caeruleus)
the Russells viper (Daboia russelii) and
the sawscaled viper (Echis carinatus)

However, a recent discovery that another species, the hump-nosed pit
viper (Hypnale hypnale), is capable of causing lethal envenomation, and that this problem was being
concealed by systematic misidentification of this species as the saw-scaled viper, has necessitated a
review of the concept of the [Big 4]

The concept of the [Big 4] snakes is reviewed to demonstrate
its failure to include all currently known snakes of medical significance in India, and its negative
effects related to clinical management of snakebite.


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http://www.allenpress.com/pdf/weme_18_119_2_9.pdf



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