It also had a profound psychological impact on soldiers - it terrified them. In September , Lieutenant G L Grant, a medical officer of the London Scottish, had to deal with large numbers of officers and men who thought they had been gassed, but displayed no physical symptoms.
He "cured" each of them with a placebo. Although there had been no reports of a gas attack, panic spread - and within hours, 67 of the men in the unit had been evacuated as gas casualties. Ian Kikuchi, a historian at the Imperial War Museum in London also sees something insidious about gas. It is this particular horror of gas that is captured in Wilfred Owen's poem Dulce et Decorum Est, arguably the most widely read description of the horrors of war in the English language. In all my dreams, before my helpless sight,.
He plunges at me, guttering, choking, drowning. The poem is written in the style of a first-hand account, but there's no evidence in Owen's letters from the front, or in his regiment's war diary, that he experienced such an attack before writing the poem. Owen describes a chlorine attack, referring twice to the gas's characteristic green colour - and victims of a chlorine attack would indeed choke. The gas reacts quickly with water in the airways to form hydrochloric acid, swelling and blocking lung tissue, and causing suffocation.
But by , when Owen went to the front, chlorine was no longer being used alone. Another, more dangerous "irritant", phosgene, was the main killer.
But phosgene is slow to act - victims may not develop any symptoms for hours or even days - so Owen's description may not quite fit with the reality of gas attacks at that moment in time. The standard-issue gas mask in - the "small box respirator" - provided good protection against chlorine and phosgene. But soon all sides had turned to gases which maimed even soldiers wearing a mask - blistering agents, or "vesicants". The most widely used, mustard gas, could kill by blistering the lungs and throat if inhaled in large quantities.
Its effect on masked soldiers, however, was to produce terrible blisters all over the body as it soaked into their woollen uniforms.
Contaminated uniforms had to be stripped off as fast as possible and washed - not exactly easy for men under attack on the front line. A horror of the use of poisonous substances in war goes back far beyond WW1. The first bilateral treaty banning the use of chemical weapons - poisoned bullets in this case - was signed in between France and the Holy Rome Empire, says Dr Joanna Kidd of Kings College London.
The Hague Convention of outlawed shells for the "diffusion of asphyxiating or deleterious gases" even before they had been used on the battlefield. The very first use of gas, in the form of grenades rather than shells, is thought to have been carried out by the French in - the attack was so ineffectual that few even knew it had taken place until the war was over. But even in World War One there were those who argued gas was no worse than other weapons.
The first-named form of death, as a matter of fact, is the most merciful," wrote one Dr J F Elliott to his local paper in Other terrible weapons were developed at the same time. The flamethrower appear on the Western Front in , two months before gas.
Others weapons, like the machine gun, were honed to new levels of murderous perfection. The first large-scale use of lethal poison gas on the battlefield was by the Germans on 22 April during the Battle of Second Ypres. At Ypres, Belgium, the Germans had transported liquid chlorine gas to the front in large metal canisters.
With the wind blowing over the French and Canadian lines on 22 April, they released the gas, which cooled to a liquid and drifted over the battlefield in a lethal, green-yellow cloud. The gas shocked but, while some troops fled in panic, the Canadians held their ground. After several days of chaotic and brutal fighting, the Ypres position remained in Allied hands.
With the introduction of poison gas, many contemporaries feared that the Germans had discovered a war-winning weapon. But the introduction of increasingly effective gas masks and other precautions helped counter the German advantage.
Nobody aboard the SS John Harvey survived and as a consequence the townspeople of Bari did not know they were under mustard gas intoxication. In the days and weeks following this catastrophe, the other military and civilian victims from the accident began to develop the familiar signs of mustard gas exposure.
Lieutenant Colonel Stewart F Alexander, an American physician trained in chemical warfare confirmed the exposure to mustard gas, based on autopsies of the victims that had profound medullar damage, particularly a low white blood cell count [ 4 ].
White blood cells are capable of rapidly dividing which prompted the attention that this chemical agent could be useful in killing rapidly dividing cancer cells as well.
As a consequence, the event at Bari enhanced the suspicion that the effect of mustard gas on blood cells could have medical use. The first clinical trial investigating the use of mustard gas was conducted by Louis Goodman and Alfred Gilman in , just before the events at Bari [ 9 ].
The clinical trial involved a patient identified as JD [ 10 ] diagnosed with advanced lymphosarcoma who received the first therapeutic trial with nitrogen mustard in low doses Ten doses of 0.
To everyone's amazement, the tumor regressed considerably but the effects were not permanent. In , all the results and findings were published and more research was conducted on chemical agents like nitrogen mustard giving rise to the first alkylating agents such as mechloretamine [ 10 ]. This also motivated other cancer research such as the study on folic acid that gave rise to methotrexate [ 11 ].
These events changed the perception of cancer therapy. In the late s, with the introduction of combination of chemotherapy agents like nitrogen mustard, vincristine, methotrexate and prednisone MOMP protocol more and more patients had longer remission from cancer, allowing it to be conceived as a curable disease, particularly for diseases like lymphomas and leukemia [ 11 ]. Since the s, overall death rates from cancer have declined in the USA [ 12 ].
Despite the improvements in cancer treatment, this condition still constitutes an important burden for health systems, particularly in low and middle income countries where the cancer burden is increasing. Every year almost In low and middle income countries the main challenges for cancer control are poorer access to cancer screening and treatment and as a consequence presentation at more advances stages, when they are less amenable to cure.
Even if the mustard gas accidents of Bari were the pivotal events that launched the research for cancer chemotherapy, nowadays more research must be done not only to encourage individuals to adopt healthy behaviors to prevent cancer, but also to develop more effective screening methods to detect cancer at earlier stages and also to orient national health systems to make affordable and effective cancer treatments available to everybody.
New York: Oxford University Press, pages. Goodman, M.
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