How WW2 raid was a milestone in history of cancer treatment
On the night of December 2, 1943, the German Luftwaffe launched a surprise attack on the port of Bari in southern Italy. The harbour was crammed with allied shipping and the city crowded with military personnel and civilians. Eighteen ships were destroyed in the raid, a further eight seriously damaged – and over 1,000 people were killed.
For the allies, massing troops and materiel for the assault on the Axis-controlled Europe via the Italian peninsula, this was the worst shipping disaster since Pearl Harbor. For countless Italian civilians, it was a human catastrophe. But, bizarrely enough, the bombing of Bari was also a milestone in the history of cancer treatment.
The allies were tragically complacent, thinking they were beyond the reach of German bombers. There wasn’t even a functioning radar system to give the alarm. There were gigantic explosions as one defenceless ship after another was hit. Multi-coloured flames leapt 1000 feet into the sky and the sea filled with fuel oil, flames blazing in a 40-foot wave of fire above the water. Clouds of suffocating black smoke settled on the harbour and on the town.
One of the American ships to be destroyed was the John Harvey, a merchant vessel that had been waiting in the harbour for days to unload its secret cargo of deadly mustard gas, a poison used to horrific effect in the trenches of the First World War. Responding to intelligence that the Axis forces were preparing for chemical warfare, President Franklin Delano Roosevelt had ordered his troops to be supplied with 100 tons of the gas, to be used in retaliation to Axis chemical attacks or to seal off territory from the enemy.
Merchant ship carrying secret cargo
Captain Knowles of the John Harvey, together with a handful of officers and crew, were aware of what they were carrying. But he was under strict orders not to tell a soul, even the harbourmaster who might have expedited the unloading of the clandestine load. It would have been a diplomatic disaster had the world learnt that the allies were shipping chemical weapons to the European theatre. So when the ship exploded, taking Knowles and his crew with it, there was nobody left alive in Bari who knew about the ship’s deadly cargo.
Equally, nobody was aware that the clouds of smoke blanketing were full of poison gas, or that the fuel oil in the harbour had also combined with the gas to create a deadly soup. Twelve to thirty-six hours after the attack, more than 800 servicemen and countless civilians who had inhaled the gas or even been in the contaminated water, began to present with mysterious blisters and burns all over their bodies. Many died agonising and inexplicable deaths, as none of the overstretched medical personnel knew what they were dealing with. Medics made matters worse by keeping the patients swaddled in blankets, the correct treatment for shock but precisely wrong for those dunked in the mustard-in-oil mixture.
Toxic agent suspected
In time, doctors came to suspect that some toxic agent was at work, thinking that the Germans had used chemical as well as high explosive bombs in their raid. Lieutenant Colonel Stewart Francis Alexander, a chemical weapons medical officer attached to the US general staff, was sent to investigate. He was working blind, without input from those US authorities who knew the Jean Harvey’s secret, but he quickly came to the conclusion that mustard gas was the culprit. He worked from first principles, examining the victims and the evidence of the raid. More than 600 patients were tested. Blood and liver changes were highly suggestive of mustard. He soon established that bomb casing from the bottom of the harbour contained traces of the gas as well, and that these bombs belonged to the allies rather than the Luftwaffe.
A surprising cancer connection
Alexander’s official medical report, circulated in May 1944, made clear that the mustard case had done especial damage to the victims’ lymphatic system and bone marrow. Thus the cancer connection: scientists at Yale University and elsewhere had long suspected that mustard-based chemicals would be effective in controlling certain cancers, particularly lymphoma and leukaemia which are caused by disorders of the tissues that form white blood cells. Alexander’s evidence was akin to an unorthodox drugs trial, proving as a result of tragic circumstances that mustard-based compounds could be effective in attacking these cancers.
This research remained intensely secret, as the allies wanted to keep under wraps the fact they had shipped the gas to Europe. Prime Minister Winston Churchill went so far as to ban any mention of mustard from British reports of the Bari disaster. Yet doctors made progress and in November 1947, Dr S. Farber of the Children’s Cancer Research Foundation gave a nitrogen mustard compound to a group of 16 children who were seriously ill with acute leukaemia. In ten out of 16 cases, the children saw a dramatic improvement, with tumours and lymph nodes shrinking and their bone marrow returning to normal. Doctors at Yale treated a man with an aggressive tumour in his neck caused by Non-Hodgkins Lymphoma: the drug had an immediate and positive impact.
At this stage in the development of chemotherapy, the drugs were exceedingly poisonous and mortality rates high. The focus of research in post-war US shifted to surgery and radiotherapy. But in East Germany, the former German Democratic Republic, research into mustard-based chemotherapy continued apace. In 1963, scientists succeeded in producing Bendamustine, a drug made from nitrogen mustard, used to this day to treat lymphomas and other blood cancers.
Bendamustine has the distinction of being the only major cancer drug to have emerged from behind the Iron Curtain. For decades, it was available in East Germany and nowhere else. After the wall came down in 1989, it was soon made available in Western Europe. The US, more suspicious and unwilling to remember the lessons of Bari, approved the drug only in 2008.