Medical A.Pects of an Orbiting Research Laboratory

Medical A.pects of an Orbiting Research Laboratory

SPACE MEDICINE ADVISORY GROUP STUDY JANUARY TO AUGUST, 1964

S. P. VINOGRAD

Scientafic and Tecbnicd Information Division 1966 NATIONAL AERONAUTICS AND SPACE ADMINISTRATION Washington, D.C. .

For Sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D. C. 20402 - Price $1 THE PRESENT VOLUME DESCRIBES how the to develop a research and development program that scientific comur.ity within the United States car- could point the way toward man's ultimate conquest ried out the first systematic investigation of the of the space environment. medical aspects of an orbiting research laboratory in The Mce of Space Medicine within NASA, and space. indeed the entire scientific community concerned with It wa?i a challenging project. Under Dr. Sher- the medical behavioral sciences, is indebted to Dr. man P. Vinograd's guidance, the Nationai Aero- Vinograd and to iiir group of wieiitists who gave 3 nautics and Space Administration brought together willingly of their time and effort toward furthering a group of leading medical scientists of the nation. the national goal of space exploration. These leaders applied their varied specialized competence toward solving the potential problems that han JACK BOLLERUD would face as he left his earth bound environment Brigadier General, USAF, MC and moved into space, bringing their interdiscipli- Acting Director, Space Medicine nary and their interdepartmental viewpoints together Manned Space Flight THE SPACE MEDICINE ADVISORY GROUP (SPAMAG) is a group of consultants representing varied disciplines in the life sciences who met eight times to be briefed on the current status of the space program and to consider the various aspects of a proposed biomedical program of an orbiting research laboratory. This group was asked to consider the support recommendations under three broad categories: (1 ) life support, those environmental factors which are to be controlled or considered to be constant; (rj experiments in which environmental factors might be varied in a significant way in order to test the response in the space environment; and (3) research laboratory decision items which are related to the requirements for its design. The initial challenge to the Group is part of this report and lists the variety of environmental factors md ORL decisions which were discussed. In each of these areas, the Group was furnished a format as guidance in life support or experiment decisions. Additionally, the Space Medicine Advisory Group was divided into task groups so that they might address themselves to the spec& areas in which they had competence. These task groups are listed in the separate sections of the report. Priority assignment, in the context of this report, is an evaluation by the group for administrative purposes. The priority assessment is given on the basis of the degree to which consideration of the experiment was necessary in design of the research laboratory and the degree to which the experiment required preliminary ground-based experimentation. Leadtime in terms of experiment design as well as the personnel involved is also a factor. In this respect it will be clear that the Group felt that all of the experiments were in a high priority category; that is, the experiments were necessary for consideration in design requirements as well as experimental planning at this time. A priority related to importance of the problem must be made at a later date. The report is given in three phases. Phase I on life support recommendations covers six categories: (1) hazards, (2) atmosphere, (3) living conditions, (4) metabolic factors, (5) group integrity, and (6) medical considerations. Under each of these categories the groups made recommendations concerning the spacecraft, research and development necessary for design of the spacecraft, ground-based experiments which were necessary for the design requirements, and, in some cases, experiments which should be accomplished in space flight preceding the orbiting research laboratory. The hazards section considers the toxicological and general housekeeping problems in the spacecraft. The atmosphere section prescribes the ideal atmosphere for a research laboratory and indicates the necessity for being able to change the atmosphere for experimental purposes. The living conditions section deals with general body functions and hygiene, decor, illumination and work schedules as well as volume requirements in the spacecraft. The metabolic requirements section sets forth the present day estimate of the food, water, and waste requirements. The group integrity section discusses those factors which are involved in efficient and harmonious group functioning; however, it does not consider in detail the previously well-studied topic of individual performance. The section on medical considerations addresses itself to recommendations concerning flight crew medical selection and considerations of illness and injury among the crew as well as recommendations for medical safety monitoring.

PRECEDING PAGE BLANK NOT FILMED. vi MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

These 6 sections represent a grouping of the some 15 items which were presented ' for discussion and considered individually. Phase I1 is concerned with the experiments. These experiments fall into three major categories; the first of which are those related to general medical and physiological measurements. Although a number of specific experiments are designed to test the characteristics of physiological and psychological systems, certain observations are recommended on a continuous daily basis to provide data which may be used in a number of data acquisition and reduction procedures. These also will serve for the general medical monitoring in the spacecraft. Physiological tests cover experiments which are designed to test the characteristics of the cardiovascular system and the respiratory system. Additional experiments are designed to test and give indications of functions of overall metabolism, metabolism of bone and muscle and metabolism as related to hematology. A group of experiments which assess the neurologic function and miscellaneous experiments on the cellular level are also included. Although several stress factors were listed by the group for consideration, the experiments given are directed toward weightlessness and total combined flight stress. This does not negate the importance of the interaction of these factors, but it emphasizes the unique factor of weightlessness. Psychological experiments are devised to test the emotions, performance, reaction to frustration, and spontaneous activities. For Phase I11 on the design and operational recommendations, the ORL requirements were gathered from a free discussion by the Group and relate to specific spacecraft requirements, requirements for personnel in the spacecraft, and requirements for specific equipment in laboratory facilities on the spacecraft. The factors presented under the three phases of this report represent the present best opinion of the group with respect to the decisions and areas of emphasis for orbiting research laboratory considerations and give a general presentation which should be continuously reevaluated and revised.

Space Medicine Advisory Group Chairman Vinograd, S. P., M.D. Director, Medical Science and Technology Space Medicine Division, Office of Manned Space Flight NASA Headquarters, Washington, D.C. Co-chairman Karstens, Andres I., M.D. Assistant for Bioastronautics (MOL) Col., USAF, MC Aerospace Medical Division Los Angeles, Calif. Baldwin, Maitland, M.D. Clinical Director, NINDB, National Institutes of Health Bethesda, Md. Buesseler, John A., M.D. Chief of Ophthalmology University of Missouri School of Medicine Columbia, Mo. PREFACE vii

Carlson, Loren D., Ph.D. Chairman, Dept. of Physiology and Biophysics University of Kentucky Medical Center Lexington, Ky.

Deichmann, William B., Ph.D. Chairman, Dept. of Pharmacology University of Miami School of Medicine Coral Gables, Fla. Forster, Robert E., M.D. Professor, Physiology University of Pennsylvania Philadelphia, Pa.

Gordon, Edgar S., M.D. Professor of Medicine University Hospital Madison, Wisc.

Grahn, Douglas, Ph.D. Associate Division Director Division of Biological and Medical Research Argonne National Laboratory Argonne, Iil.

Graybiel, Ashton, M.D. Director of Research Capt., USN, MC Naval School of Aviation Medicine Pensacola, Fla.

Knoblock, Edward C. Director, Division of Biochemistry Lt. Col., USA, MSC Walter Reed Army Institute Washington, D.C.

Kubis, Joseph F., Ph.D. Professor of Psychology Fordham University Graduate School New York City, N.Y.

McFarland, Ross A., Ph.D. Guggenheim Professor of Aerospace Health and Safety Harvard School of Public Health Boston, Mass. Natelson, Samuel, Ph.D. Head, Dept. Biochemistry Roosevelt Hospital New York City, N.Y.

Pollack, Herbert, M.D. Clinical Professor of Medicine George Washington University Institute for Defense Analyses Arlington, Va.

Reitan, Ralph M., Ph.D. Director, Neuropsychology Section Indiana University Medical Center Indianapolis, Ind. c ... VI11 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY + Schmitt, Otto H., PhD. Professor of Zoology and Biophysics University of Minnesota Minneapolis, Minn.

Swisher, Scott H., M.D. Professor of Medicine University of Rochester, Rochester, N.Y.

Townsend, John C., Ph.D. Professor, Department of Psychology Catholic University Washington, D.C.

Warren, James V., M.D. Chairman, Department of Medicine Ohio State University College of Medicine Columbus, Ohio

Whedon, G. Donald, M.D. Director, National Institute of Arthritis and Metabolic Diseases National Institutes of Health Bethesda, Md.

Wood, Earl H., M.D. Professor, Physiology Mayo Clinic Rochester, Minn. PAGE

1 3 PHASE I: LIFE SUPPORT RECOMMENDATIONS SPAMAG Panels ______--_------12 Atmosphere Recommendations ______------12 Life Support Factors ______--__------_------12 Atmosphere ______------12 Space Suits ______---_-__-_------14 Ground-Based Experiments Prior to Launching the ORL ______-_-----14 Pulmonary Atelectasis Problem ______----____----_- 14 Oxidative Hemolysis ______----____-__-___------14 Effect of Atmosphere Composition on Hazards of Dysbarism ______15 Research and Development Prior to Launching the ORL ______-____-15 Flammability in Various Atmospheres ______------15 References ______-__-___---15 Metabolic Factors Recommendations ______16 Food, Water, and Waste ______--____-_--_- 16 Research and Development Prior to Launching the ORL ______18 Ground-Based Experiments and Flight Crew Training Prior to Launching the ORL ______-______--__-______--_-_-_------18 Space Flight Experiments Prior to Launching the ORL ______-____-______19 References ______- ______- ______- ______19 Living Conditions Recommendations ______19 Life Support Factors ______-______-__-____----_19 Body Functions and Hygiene ______-___-_-_--__-19 .. Decor and Illumination ______.. 19 General Conveniences and Diversions ...... 19 Schedules (Work-Rest-Sleep Cycles) ______20 Volume (Space) Requirements ______20 Research and Development Prior to Launching the ORL ______21 Ground-Based Experiments Prior to Launching the ORL ______21 Space Flight Experiments Prior to Launching the ORL ______21 ORL Experiments ______-______21 References ______----______--_____- 21 .. Illumination ______-______21 Work-Rest-Sleep Cycles ______22 Group Integrity Recommendations ______22 Life Support Factors ______- 22 Selection _ - _ _ _ _ - - _ _ _ _ - _ - - _ _ _ _ _ - - _ _ _ - _ - _ _ _ _ _ - - ______- _ _ _ - _ _ _ _ 23 Recommendations - _ - _ _ - _ __ _ - ______- - ______- - _ _ .. ______23 Training ______-_-_-_____- 24 Recommendations - _ _ __ - _ - - _ _ - _ _ _ - _ _ - ______- _ - _ _ 24

ix X MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

PAGE Research and Development Prior to Launching the ORL ______25 Ground-Based Experiments Prior to Launching the ORL ______- 26 Space Flight Experiments Prior to Launching the ORL ______- 26 References ______-____-_-_-_----27 Hazard Recommendations ______-___-______--- 28 Life Support Factors ______--___-_------28 Radiation (Electromagnetic Spectrum) ______------28 Eye ______-__-______-__--______-_----- 28 Skin ______-______-___--__----- 29 Bone Marrow ______-______---- 29 Testes ______-______-______--- 30 Gastrointestinal Tract ______--______-- 30 Ears ______-___-______--- 30 Atmospheric Contaminants ______--- 30 .. Particulate Contamination ...... 30 .. Gaseous Contamination ______-_- 30 .. .. Nutritional Contamination ______-____-- 31 Water ...... 31 Food ______- ______- 31 Prevention and Control of Fire ______-___-______--_31 Micrometeoroids ______- ______- _ _ - ______- ______- - - - 31 Fire ______-______--___-______-31 Decompression ______-__-____-______- 31 Safety Contour Design of Capsule Interior and Exterior ______- 32 Extravehicular Hazards ...... 32 Research and Development Prior to Launching the ORL ______32 References ______-_-______32 Clinical Medical Support ______-_____-- 33 Life Support Factors ______--- 33 Flight Crew Medical Selection ...... 33 Illness and Injury Among Crew Members ...... 33 .. Medical Safety Monitoring ______34 Monitoring of the Environment ______34 .. Monitoring Fitness of Astronauts ______-__-___ 34 Supporting Personnel ______-______-__-- 35 Animals ______35 Research and Development Prior to Launching the ORL _ _ - ______35 Ground-Based Experiments Prior to Launching the ORL ______35 Space Flight Experiments Prior to Launching the ORL ______35 References _ _ - ______- ______35 Appendix to Phase I ______-______-__ 36 .. Medical Safety Monitoring ______36 The Astronaut at Different Stages of Flight ______36 Launch ______- ______- _ _ _ _ _ 36 Preparatory - ______- ______- _ _ _ _ - ______- 36 Countdown _ _ - ______- ______36 Power Phase ...... 36 Orbit ______-_ 36 __~

CONTENTS xi

PAGE

Transitional ______------36 Intermediate ______------36 Predescent ______-______-_------37 Reentry ______------37 Classes of Phenomena ______-__------37 Environmental Factors ______~___~____~_~~~~~~~~~-~37 The Astronaut ______-_------38 .. Tolerance Lmits ______-___-___-______-______-____--38 summary ______--__--____------38 PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS FOR ORL SPAMAG Panels ______-______52 Neurological and Physiological Functions ...... 53 Experiments 1. EEG Changes During Arousal and Drowsing ...... 53 2. The Effects of Rotating Environment on Man in Space Flight ______54 3. The Effects of Weightlessness and Subgravity States on the Function of the Otolith Apparatus and the Semicircular Canals ______67 4. Intraocular Arterial Systolic and Diastolic Blood Pressure Under Condi- tions of Prolonged Whole Body Weightlessness ______70 5. Harmonic and Other Analyses of Voice Characteristics for Possible Iindi- cations of Anxiety, Depression, Hostility, and Other Emotional Re- actions ______-______--______--- 72 6. Emotional Changes During Prolonged Space Flight ______72 7. Evaluation of Spontaneous Activity (Initiative), GSR, and EEG as Indicators of Vigilance on a Prolonged Space Flight Mission ______75 8. Effect of Frustrating Situations on Subsequent Psychological Perform- ance During Prolonged Space Flights ______76 9. Behavior and Performance Levels During Periods of Mental Stress and Relative Relaxation ______77 10. Effects of Spatial Confinement Variables on Group Performance in Weightlessness - ______78 11. Human Performance as a Function of the Work-Rest-Sleep Cycle _____ 79 Circulatory and Respiratory Functions ______81 Preamble ______--____ 81 Rationale of the Experimental Program ______82 Physiological Variables to be Measured ______83 Experiments 1. Changes in Blood Volume and Central Venous Pressure During the Weightless State ______-- 83 la. Body Volume ______- 85 Ib. Assessment of Body Mass ______86 2. Assessment of Body Mass in Real Time ______86 3. Changes in Peripheral Venous Compliance and Pressure During the Weightless State ______88 4. Evaluation of Significance of Ballistocardiogram and/or Kinetocardio- gtam (Seismo or Rosa Accelerometer) for Estimation of Cardiac- dynamics in the Weightless State ______90 xii MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

PAGE P 5. Changes in Peripheral Arteriolar Reactivity During the Weightless State 91 6. Changes in the Efficacy of Arterial Pressure Control Systems During Space Flights by Shifts of Blood Distribution ______- ---- 92 7. Predictive Test to Assess Ability of Vaso-Motor System to Readjust to Reentry Stress and Reaccommodation to Terrestrial Gravity ______94 8. Changes in Circulatory Responses to Exercise with Duration of Exposure to the Weightless State ______-__------_------94 9. Study of Possible Effects of the Weightless Environments on the Sensi- tivity of the Carotid Sinus Arterial Pressure Control Loop _-____--_- 96 10. Study of Possible Effects of the Weightless Environment on the Suscepti- bility of the Cardiovascular System to a Hydrostatically Simulated .. Upright Position ______-_____-______---- 99 11. Determination of the Effect of Weightlessness on Pulmonary Mechanics 102 12. Determination of the Effect of Weightlessness on Control of Respiration 103 13. Determination of Changes in Blood Gas Exchange with Duration of Exposure to the Weightless State ...... 105 14. Determine Changes in the Self-cleansing Action of the Lung with Duration of Exposure to the Weightless State ______105 15. Devise and Evaluate Analytical Techniques for the Assay of Blood (Urine, Sweat, and Saliva, for Components of Significance in the Maintenance of Homeostatisis in Circulation and Respiration on the Ground and During Short Orbital Flights ______107 Metabolic, Digestive, Skeletal, Neuromuscular, Fluid and Electrolyte, Renal, Thermoregulatory, Reproductive, and Endocrine Functions ______111 Experiments 1. Effects of Prolonged Space Flight on Various Metabolic Functions _____ 111 2. Effects of Prolonged Space Flight on Mineral Metabolism and Bone Densitometry ______- ______- _ - ______- ______115 3. Determination of Bone Demineralization During Prolonged Space Flight 118 4. Effects of Prolonged Space Flight on Fluid and Electrolyte Metabolism 120 5. Effects of Prolonged Space Flight on Physiologic Temperature Regulation 121 6. Effects of Prolonged Space Flight on Neuro-Endocrine Function ______124 Hematological, Immunological, and Cellular Functions ...... 129 Experiments 1. Observations Related to Assessment of the Dynamics of Hemic Cell Proliferation, Distribution, and Destruction ...... 129 2. Cytogenetic Studies of Human Hemic Cells ______131 3. Survey of Immunoglobulins, Complement, and Antibodies in the Sera of Selected Astronauts ______133 4. Studies of Selected Parameters of Leukocyte Function in the Space Environment ______134 5. Studies of Selected Parameters of Blood Coagulation and Hemostatic ... . CONTENTS xlll

* PAGE PHASE 111: DESIGN AND OPERATIONAL RECOMMENDATIONS Need for OlU Flight of Duration Longer Than 30 Days for Biomedical Investigation ______- ______- ______- ______- _ __ - ___ - 141 Preferred Method of Approach ______141 Type of Vehicle ______------141 Duration of Flight for an ORL ______-___-___-_------141 Type of Reentry Vehicle ______-----142 Cost Effectiveness Parameters ______- 142

Orbit ~ 142 Need for Artificial G: Rotation of Spacecraft, Onboard Centrifuge, or Both-_- 142 Volume (Space) Requirements ______-_-____-----__--_142 Weight and Power Requirements ______143 Size of Flight Crew ______-______143 Types of Personnel Comprising the Flight Crew ...... 143 Utilization of Animals Onboard ______143 Cycling of Personnel and Animals Utilizing Rendezvous Techniques ______143 Onboard Laboratory and Bioinstrumentation Requirements ______143 Ground Support Personnel and Equipment ______144 Necessity for Total Ground Simulation Prior to Flight ...... 144 Postlanding Medical Examinations ______144 Use of Double-Ended Trampoline Onboard the ORL ______144 4

EARLY IN THE YEAR 1963, NASA began serious from the outset of its activity was regarded impor- consideration of the potential of an Orbiting Research tant for obvious reasons. ‘While the goals and end Laboratory. investigations into both scientific and products were set forth with some degree of rigid- design requirements were launched by various cog- ity, the methodology was only offered. However, nizant groups throughout NASA. Studies of the med- it too was accepted with small modification after ical aspects of the Orbiting Research Laboratory con- minimal discussion. cept were initiated within NASA, and were supple- (4) The establishment of a program of orientation mented a short time later by contracted industrial par- to space flight and its technology to take piace ticipation. As the feasibility of an Orbiting Research throughout the series of meetings. This was deemed Laboratory grew apparent, so grew the opportunity to necessary if recommendations were to be made on tap one of our richest national resources, the scientific a realistic and current basis. CGIXImUnitY. These representatives of American medi- (5) Provision for frequent updating of the orig- cine were invited to participate not only to provide inal report in the light of new research and tech- maximal expertise in the structuring of a specific na- nology, and even of “second thoughts” or future tional space effort of the future, but also because it SPAMAG meetings. This principle of a dynam- was recognized that in doing so they would at the ically oriented effort was served, at least in part, same time be contributing strongly to the direction of by the initial presentation of this report in loose space medical investigation as a whole. leaf form. This participation was realized with the formation IN DECEMBER, 1963, after the first meeting had of the Space Medicine Advisory Group, a group of already been scheduled for January 1964, the Manned 20 distinguished consultants representing some 16 Orbiting Laboratory (MOL) study program was as- specialties and subspecialties in medical and medically signed to the US. Air Force. Consistent with the related fields. The group was organized and its meth- NASA/DOD policy of close coordination, the Air odology established in accordance with certain objec- Force, through General Benjamin A. Strickland, was tives, predetermined in order to enhance the effective- then invited to participate with NASA in this en ness of its work. Foremost among these objectives deavor. In response, the Air Force assigned a CO- were :. chairman, Colonel Andres I. Karstens, and two (1) The establishment of SPAMAG as a working observers to the SPAMAG meetings. group rather than a reviewing committee to enable The Group met on two consecutive days each month recommendations to be made on the basis of “shirt- for a total of eight meetings. The first morning of sleeve” familiarity with the conditions of manned each two-day session was devoted to briefings on vari- space flight and with the several disciplines both ous developmental and operational aspects of space within and without the broad field of medicine flight given chiefly by NASA personnel. Additional which are necessarily involved in these recom- indoctrination was provided by convening two of mendations. these meetings at operational centers, Cape Kennedy (2) The composition of a group of a majority of and the Manned Spacecraft Center at Houston. Both members who had not been previously active in the of these were three-day sessions, the third day of space program together with a strong minority of which was devoted to a tour and discussions of fad- those who had. This made it possible to obtain a ities at each of these two sites. The remaining meet- fresh evaluation while preserving the continuity of ings were held in Washington, D.C. The Group was familiarity with manned space flight, all by highly in every sense of the word a working groip; through competent scientific authority. diligent effort and by means of strict adherence to a (3) The clear statement of methods, goals, and very tight schedule, it managed to complete the very anticipated end products of the work of SPAMAG large task undertaken within the given time schedule. 2 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Prior to the first meeting in January, 1964, a 14-page may be recognized that these are, in reality, check lists 0 general format was devised, which the Group agreed of information required. to adopt with minor revisions at the time of the first It was thought logical that only after thorough con- meeting. The full format, included in this report as sideration had been given the first two phases could Tables I through XII, specifies the aims and meth- reasonable recommendations be made concerning the ods of the work of SPAMAG. third phase, that of general ORL recommendations. The total study of the ORL concept from the med- The questions to which these recommendations were ical standpoint was seen as consisting of three major addressed are shown under column 111, “ORL Recom- phases or tasks. These are shown in Table I. mendations” (Table I), more particularly those listed The first task was to make recommendations con- under point 5. It can be seen that this phase is, in cerning specifications for the environmental factors effect, an operational and engineering translation of which are to be supplied the flight crew. Although the first two phases, and, as such, can provide the most the format shows this section (Phase I, “Life Sup- direct guidance to designers and engineers. Phase 111 port”) as consisting of nine subtask areas, evaluations was discussed and recommendations were made by the and recommendations were made by five panels, one Group meeting in general session. of which submitted two reports, namely “Living Con- Finally, the anticipated end products of this entire ditions and Standards”, and “‘Medical Safety Mon- effort, as shown in Table XII, have, in fact, been itoring.” Consequently, Phase I consists of six panel accomplished. Among these products, the areas of reports. prerequisite space flight experiments, prerequisite ground-based experiments, and prerequisite research The second task or phase was to define the medical and development warrant particular mention since experiments and measurements to be performed aboard these comprise the skeletal structure of an overall in- the ORL. These were devised on the basis of need tegrated program of space flight medical investigation. rather than available space, and needs were determined Since publication of this report follows its comple- by means of carefully examining the interfaces be- tion by more than 18 months, a few of the concepts tween single and combined environmental factors on presented may now be considered dated in light of the one hand, and bodily functions on the other. In more recent findings. Yet these instances are sur- order to accomplish this, the Group as a whole first prisingly few. This report is presented primarily generated a list of potential single and multiple stress for those who have a scientific interest in the field. factors (Tables I1 and 111) , then reviewed and revised At the same time, those who are interested in pro- a comprehensive outline of body functions (Table grammed research, or in the historical or adminis- IV). They then separated into three panels which trative aspects of the field may also find it of some examined the interfaces relevant to their assigned areas value. of body function, and devised experiments and meas- The Space Medicine Advisory Group met this heavy urements in accordance with the method and outlines challenge with diligence, enthusiasm and skill. Their shown in Tables V and VI. The reporting of generous and able participation is most sincerely appre- SPAMAG experiments, measurements, and recom- ciated not only by those of us whose privilege it was mendations was done according to the outlines shown to work with them but by all who are concerned with in Tables VIII, IX, and X. Upon closer scrutiny, it national progress in space medicine.

S. P. Vinograd, M.D. Director Medical Science and Technology, Space Medicine Division Office of Manned Space Flight INTRODUCTION 3

Y Table I.-ORL Snpport Recommendations*

Life Support Experiments* * ORL Recommendations I I1 111

(Controlled environmental factors) (Uncontrolled environmental factors) 1. ORL experiments (Constants) (Variables) 2. Prerequisite ground experiments 3. Prerequisite space flight experiments * * * 1. Atmosphere (Gas pressure, tem- List of experiments and experimental 4. R&D areas to be explored perature, humidity, total quan- requirements to be formulated accord- 5. General ORL decisions to be made tity required, circulation, atmos- ing to the following schema: a. Best and cheapest overall pheric trlrlr?s) approach 2. Suits Environmental Effects on ( 1 ) Method a. Intravehicular factors .--) bodily functions (2) Vehicle b. Extravehicular (3) Duration (1) Maneuvering unit (4) Type of reentry vehicle (2) Communications ( 5) Suggested cost effectiveness ( Portable life support 3) parameters system 1 Experiments + b. Orbit (4) Hazard protection (see measurements c. Onboard centrifuge specs.? below) d. Rotation for artificial G? 3. Food and electrolytes e. Size requirements 4. Water f. Weight reqts. (total for medical 5. Waste experiments) 6. Living conditions and standards g. Power reqts. (total for medical a. Body functions and hygiene experiments ) b. Laundry h. Number of personnel c. Exercise i. Types of personnel d. Decor (1 ) Selection reqts. General conveniences e. (2) Training reqts. f. Schedules (3) M.D. included? g. Diversions j. Animals? h. Volume (1) Number i. Noise (2) Types j. Vibration ( 3 ) Special provisions 7. Group integrity (selection and k. Cycling of personnel and training) animals a. Social compatibility 1. Onboard laboratory b. Mutual confidence requirements c. Individual emotional m. Storage reqts. (volume and stability type) d. Individual physical ability ( 1) For medical lab. supplies e. Individual mental ability (2) For food, Ha,waste f. Individual professionai (3) For laboratory specimens ability n. Supporting logistics 8. Hazard protection 0. Bioinstrumentation requirements a. Toxic substances p. Communications (methods and b. Particulate contamination equip. ) of atmosphere (1) Telemetry c. Fire (2) Onboard recording d. Ionizing radiation (3) Reqts. for extravehicular (1) Selection of orbit activities (2) Dosimetry (4) Voice communication (3) Protection of subjects schedule bY q. Ground support (a) Shielding ( 1) Personnel (b) Prophylaxis (drugs) (2) Equipment and (c) Therapy communication e. Radio frequencies (3) Distribution and schedules 4 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY Table I.-Continued . Life Support Experiments* * ORL Recommendations I I1 111

f. Micrometeoroids (4) Recovery plan g. Loss of pressure r. Necesiity for total ground simu- h. Illness lation prior to flight i. Behavior of drugs in space s. Requirements for postlanding j. Accidental injury medical examinations k. Extravehicular hazards t. Double-ended trampoline 9. Safety monitoring (medical) onboard ORL a. Bioinstrumentation u. Criteria for abort b. Communications c. Ground support

*Each item in I and I1 to be examined from standpoint of prerequlsite ground and space flight experiments, indicated R&D, (for techniques, instrumentation and engineering), and ORL Experiment (with priority evaluation for each investigation). **Any of the items listed under “Life Support” may be changed to an experimental variable if deemed indicated. ***Atmosphere decision of primary importance.

Table 11.-Environmental Factors (Stress) of Space Flight

~~ ~ Single Environmental Factors Combined Stresses Combined Stresses (Stresses) (Prolonged) (Double) (Triple)

1. Weightlessness 1. Weightlessness + radiation 1. Weightlessness + social restriction + confinement 2. Radiation 2. Weightlessness + confinement 2. Weightlessness + threat of danger + particulate matter 3. Confinement 3. Weightlessness + social 3. Weightlessness + artificial restriction atmosphere + particulate matter 4. Social restriction 4. Weightlessness + monotony 4. Weightlessness f toxic substances + particulate matter 5. Monotony 5. Weightlessness + threat of danger 5. Weightlessness + microorganisms + particulate matter 6. Threat of danger 6. Weightlessness + artificial 6. Weightlessness + thermal stress atmosphere + particulate matter 7. Artificial atmosphere 7. Weightlessness + toxic substances 8. Toxic substances 8. Weightlessness + particulate matter 9. Particulate matter 9. Weightlessness + microorganisms 10. Microorganisms 10. Weightlessness + circadian rhythm changes 11 Change in circadian rhythms 11. Weightlessness + UV exposure 12. Ultraviolet exposure 12. Weightlessness + IR exposure 13. Infrared exposure 13. Weightlessness + noise 14. Noise 14. Weightlessness -t thermal stress 15. Thermal stress . INTRODUCTION 6 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Table 1V.-Body Functions

1. Neurological function 3. Circulation a. Central nervous system a. Pump (1) States of consciousness b. Blood volume control (a) Sleep c. Vasomotor control (b) Alertness 4. Respiration (2) Speech functions a. Lung (3) Adaptability b. Blood (4) Emotional reactivity c. Tissue b. Special senses 5. Digestion (1) Vision (2) Auditory 6. Metabolism (3) Smell 7. Endocrine balance (4) Taste 8. Thermoregulatory and integumentary (5) Vestibular c. Peripheral nervous system 9. Neuromuscular (1) Somatic 10. Skeletal (2) Autonomic 11. Fluid and electrolyte balance, renal and urinary tract 2. Psychological performance functions a. Sensation 12. Reproduction b. Psychomotor 13. Hematological response c. Perception d. Higher mental processes 14. Immunological response

Table V.-Sample Evaluation of Environmental FartorJ Format

Weightlessness and Radiation

Body functions list

Evaluate each as potential problem area, assign priority, and devise experiments and/or measurements in experimental design format. INTRODUCTION

Table Vl.-Guideliner

1. Experiments and measures are to be designed to: 6. Consider all stresses, functions, measurements, proce- a. Establish effects both qualitatively and quantitatively dures, life suppport requirements, equipment function, with time relationship storage, animal housing, etc. in terms of behavior in b. Determine mechanisms wcightlcssness. c. Establish predictive means both qualitatively and quantitatively 7. Consider the basic question to be the means by which d. Determine most effective countermeasures prolonged manned interplanetary and orbital missions can be achieved in terms of the well-being of maa. 2. Consider &e& of orbital environmental factors Therefore, in general, MOL environmental conditions (stresses) bcth iztziisica!!y atid in tciiiis d ixst&itzl myh set up paralieiing those anticipated onboard an environmental requirements. (See Table VII) interplanetary or orbital vehicle rather than Earth. 3. Assign priorities to all ORL experiments and measures, 8. Adopted the general philosophy that man is to be sup- all prerequisite experiments, and recommended RW. ported in the best manner possible by life support sys- 4. Attempt to build flexibility into ORL experimental pm- tems. “Best manner” means preservation of psychophysi- tocol and equipment. Provide redundancy where pos- ological integrity. sible. 9. Keep in mind throughout this exercise the possible uses 5. In terms of personnel, time, equipment size, weight and of space for studying and perhaps treating various path- power, etc., ORL experiments are to require the least to ological states. provide valid and reliable results. Suggested altema- 10. Bear in mind MOL (two-man) constraints. tive experiments or additional measurements beyond minimal should be categorized as “minimal,” *‘desirable- 1,” “desirable-2,” etc.

Table VU.-Environmental Factors (Stresses) of Medical Importance for ORL Planning

(Ref.-Table VI, Item 2)

1. Orbital (4) Need for alertness a. Variables (5) Need for precise coordination b. Constants (6) Need for short reaction times 2. Postorbital b. Terrestrial (constant) a. Reentry (Constant) (1 ) Acceleration, impact, possible oscillation and (1) Constant 1 G vibration (2) Change to normal atmosphere (2) Change of atmosphere provided by ECS (3) Organic and functional integrity to resume all (3) Danger normal earth activities 8 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Table VI1I.-Format for Life Support Recommendations

1. Recommendations (specify allowable limits-quantitative and qualitative) 2. Rationale 3. References, briefly annotated Consider interactions of systems with other systems, with spaceflight stresses, and with followup postorbital environmental factors to formulate the following: 4. Prerequisite ground experiments

5. Prerequisite spaceflight experiments 6. Recommendations for research anp/development 7. ORL medical experiments

8. Special comments

Table 1X.-Experimental Design Format (For ORL experiments, ORL measurements, and for prerequisite spaceflight experiments)

1. Name of Experiment 11. Summary of Onboard Laboratory Determinations (type, frequency, time consumed for each) 2. Estimated Priority (priority 1, 2, or 3) 12. Summary of Laboratory Specimens to be Flown to Earth 3. Purpose for Laboratory Examination (type, number, and timing 4. Justification of specimens, how stored aboard, and types of determination) 5. Experiment (experimental design in detail) 13. Proposed Rendezvous Schedule for Rotation of Crew 6. Experimental Controls 14. Telemetry versus Onboard Recording Requirements 7. Summary of Number and Types of Space Station Per- sonnel (level of training required, i.e., physician, lab 15. Prerequisite Ground Based Experiments tech, trained astronaut, etc.) 16. Prerequisite Space Flight Experiments 8. Summary of Onboard Experimental Equipment Re- 17. Prerequisite Research and Development quired (latest state-of-the-art equipment, size, weight, and power requirements, as nearly as known) 18. Onboard Gaseous Atmosphere Desired a. Fixed equipment 19. Requirement for Rotation for Artificial G (if any) b. Consumable equipment 20. Comments re Form of Data and Interpretation of Data 9 Summary of Animals, if needed (number, type, and al- 21. Special Comments ternative types in order of preference) 22. Postflight Evaluation of the Crew 10. Summary of Other Living Forms, if needed (number, type, and alternative types in order of preference) 23. References (briefly annotated) INTRODUCTION 9

Table X.-Format for “Prerequisite Ground Experirnenfs” and “Recommended Reread and Developmenr‘

1. Title and basic format reference (A, B, or C and No., if any)

2. Priority

3. Purpose and description 4. Bibliographical reference (if any), bridy annotated I. Special comments and recommendations

Table XI.--General Agenda

1. Review entire format for overall approach and com- 8. Define “priority.” pleteness-comment and mend. 9. Expose each stress (including combinations) to list of 2. Review list of single stresses. body functions, utilizing guidelines, determine ORL ex- 3. Create list of combined stresses (double, triple, etc.) periments, additional measurements, and prerequisite a. Star those to be included as experimental variables ground-based and spadight experiments, and R&D. for addition to list of ORL experimental stresses Write up in appropriate formats placing byproducts b. Note with circle those requiring prerequisite (philosophies, general ORL decision recommendations, ground-based or spaceflight experiments but not etc.) in appropriate categories according to list of “an- ORL experiments (start lists of these for specific ticipated end products of SPAMAG effort.” recommendations for each in format later on), 10. Review items in 36. Make recommendations in format. 4. Review list of body functions--comment and amend. Again categorize byproduct recommendations. 5. Review list of guidelines--tomment and amend. 11. Study “life support’’ items. Make recommendations in 6. Review formats for experiments (2)-cornment and format. Categorize byproduct recommendations. amend. 12. Review total, make recommendations listed in Phase 111, 7. Review List of anticipated results of SPAMAG effort and “general ORL decisions,” and complete “anticipated end comment. products.’‘

Table XU.-Anticipated End Products of Spare Medicine Conrultant Advisory Group Effora

1. Group of ORL medical experiments in format. 7. General philosophy and recommendations for ORL experimental approach. 2. Group of additional ORL medical measurements in 8. Recommendations for general ORL decisions. format. 9. Tentative flight plan. 3. Group of life support recommendations in format. 10. Reviews of work of four study contracts and ORL Bio- 4. Group of prerequisite ground-based exprrimmts. medical Experiments Working Group. 11. Summary of possible uses of space environment for 5. Group of prerequisite spaceflight experiments. study and therapy of pathological states. 6. Group of recommendations for research and development. 12. Recommendations for future study effort. . .

phase I

LIFE SUPPORT RECOMMENDATIONS spamag panels

Atmosphere and Suits Dr. Carlson Dr. Forster Dr. Wood Dr. Swisher

Food, Water, and Waste L/Col. Knoblock Dr. Gordon Dr. Pollack Dr. Whedon

Group Integrity Dr. Kubis Dr. Reitan Dr. Townsend

Living Conditions and Standards and Safety Monitoring Dr. Graybiel Dr. McFarland Dr. Warren

Hazard Protection Dr. Baldwin Dr. Buesseler Dr. Grahn Dr. Natelson . . PHASE1

THESE RECOMMENDATIONS are based upon the concept that the unique property of the near-Earth orbital flight environment which cannot be duplicated on Earth is weightlessness. The physiological and behavioral effects of this variable should then be studied under conditions that simulate Earth as closely as possible. Where interactions h-een w~ight!~~s~~essd C'k,ei ~~ii&h-e siispted to exist, tbese variables &odd be controlled in the experimental sense, if possible; if the interacting variable is not controllable, it should be monitored precisely to provide a full description of the experimental conditions. Engineering exigencies should not dictate the envimnment-the environment must be supplied to provide the best medium for the experimental effort.

ATMOSPHERE RECOMMENDATIONS

Life Support Factors sure, assumed to be 31/2 psi (additional ground-based experiments are required to determine the actual risk) ; (2) fire Atmosphere hazard (additional experiments are mandatory to be certain of the acceptability of the fire hazard risk associated with this 1. Ideally the atmosphere should be identical in pres- atmosphere); (3) hazard of pulmonary atelectasis (addi- sure and composition to Earth's atmosphere between tional experiments are mandatory to define the degree of this risk) ; and (4) the risk of hematological disorders, e.g., pos- sea level and not greater than 5000 ft altitude. sible hemolytic anemia (this risk also requires further inves- The altitude of 5000 ft is arbitrarily chosen. The consensus tigation). is that short- or long-term residence at this altitude does not constitute a practical significant physiological stress. At- The total pressure should be between 360 mm of Hg mospheric pressure and composition may ultimately be con- (7.0 psi) and the ideal 760 mm Hg (14.7 psi). This sidered as experimental variables. requires that the partial pressure of Nz be approx- If this ideal cannot be met, the atmosphere should be imately 180 mm Hg (3.5 psi) to 610 mm Hg (11.8 a mixture of 6,N,, and rare gases; the rare gases psi) if the ideal (Earth) atmosphere is selected. should be present in the same molecular ratios relative 2. The maximum partial pressure of carbon dioxide to Nzfound in the atmosphere of Earth at sea level. (CO,) should be 8 mm Hg with less than this value Until experiments prove otherwise, it must be assumed that desirable. the remaining gaseous constituents of the atmosphere are necessary. A chemically inert gas is not necessarily physio- This recommendation is based on the work of Schaefer (ref. logically unimportant. 21) in which older work is summarized which indicates that If the ideal atmosphere cannot be provided, the re- above 3% COS them is a deterioration in performance. quirements for preflight ground-based experiments Above CCh there may be difficulty with small adaptive will be greatly increased and the entire program may processes. The permissible level of 0.5% to 0.870 CO, suggested is the general equivalent of 8 mm Hg. be slowed. 3. Carbon monoxide (CO) concentration should The oxygen partial pressure should be within the be This concentration of CO is that range of 150 mm of Hg (2.9 psi) to about 185 mm below 0.001%. of Hg (3.6psi). which would be in equilibrium with the normal carboxy hemoglobin content of the blood of a nonsmoker. The minimum value of 7 psi is the nearest approach to normal which may carry an acceptable degree of risk against There is evidence of change in visual threshold at (I) occurrence of bends on rapid decompression to suit pres- blood concentrations of 3 to 5% carboxy hemoglobin,

13 14 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY which is equivalent to CO concentrations of about mated that lung collapse would occur in approximately 0.0126 to 0.021 mm Hg in inspired air. 70 seconds if a man with a normal metabolic rate 4. Rigorous control of all gaseous and particulate con- breathing oxygen at a total atmospheric pressure of 3 taminants of the system must be established. Partic- psi were to hold his breath for 90 seconds. If his ular attention must be directed to removal of ozone metabolic rate were greatly increased by strenuous and prevention of atmospheric contamination by or- effort, such a phenomenon could occur inadvertently ganic compounds which may be in the environment. if the individual closed his glottis during a period of The chronic toxicology of such compounds must be maximal muscular effort lasting less than 30 seconds. investigated. Furthermore, evidence from centrifuge studies indi- The standards for maximum accumulated concentration of cates that atelectasis occurs during exposure to levels substances in the atmosphere should be expressed in absolute of acceleration encountered in the launch and reentry terms. Preliminary working standards should be obtained phases of space flight. Theoretically, it would be ex- from the current toxicology literature. pected that susceptibility to atelectasis would be in- 5. Relative humidity should be in accordance with the creased when oxygen was breathed simultaneously, ASHVE standards for comfort at 1 atmosphere. particularly under reduced pressure. It is a matter of These values should be confirmed by simulation of the at- record that atelectasis has been demonstrated roent- mospheric conditions, including ventilation, composition, and genographically after exposures to acceleration while pressure which are finally selected. breathing 0, both in aircraft and in the centrifuge 6. Temperature should be adjusted to the thermal (refs. 11, 23). The incidence and degree of atelec- comfort zone determined by studies with simulation tasis detected after such exposure was increased when of the chosen atmosphere. Some range of adjustment antiblackout suits were used. (ref. 11) of temperature should be under the control of the crew. Proposal 7. Air processing rate must be adequate to maintain Experiments designed to elucidate the mechanism the specified atmospheric composition. The distribu- of this occurrence of atelectasis and the associated tion of air flow throughout the environment must be pulmonary arterial venous shunts (ref. 23) during such as to assure bodily comfort. exposure to acceleration should be carried out and the relationship of the susceptibility to these pulmonary Space Suits derangements to the pressure and composition of the 1. From the point of view of the primary function gas mixture being breathed should be delineated. of the ORL, suits should be considered only as emergency devices. A “shirtsleeve” environment is con- Oxidative Hemolysis sidered essential for the performance of the primary Certain data suggest that shortened red cell life span mission. may be induced by chronic exposure of man to oxygen 2. Suit requirements which are laid down by other tensions above normal. To date, there have been no operational aspects of the ORL program, e.g., reentry experiments directed specifically toward elucidation of or extravehicular maneuvering, should be made com- this phenomenon. What is known suggests that the patible, if possible, with the secondary use of the suit hemolytic process is mild, self-limited and achieves a to meet emergency conditions. steady state within 7-14 days. Strong analogies exist with G6PD deficient red cell hemolysis in these and Ground-Based Experiments Prior to other respects. Launching the ORL It is recommended that this phenomenon be investigated in ground-based experiments to (1) determine Pulmonary Atelectasis Problem the time-concentration relationships which may effect It has been demonstrated by Rahn and others that red cell life span shortening, (2) insofar as possible, the susceptibility to pulmonary atelectasis is increased determine individual differences in susceptibility, and when pure or practically pure oxygen is breathed. (3) develop an in vitro predictive test of this sus- Apparently this susceptibility increases in inverse pro- ceptibility . portion to the atmospheric pressure and in direct pro- These studies should be carefully controlled for portion to the metabolic rate. For instance, it is esti- blood loss, blood sampling, and change in red cell (. PHASE I: LIFE SUPPORT RECOMMENDATIONS 15

- mass, blood volume, and red cell life span. Studies fire, the critical tests will necessarily require valida- of pigment metabolism, erythropoietic response and tion in the weightless state. iron metabolism are of secondary, but substantial, These are engineering tests rather than biomedical, interest. If possible, experiments should be run but they are essential for certain decisions concern- long enough to involve a complete turnover of the ing atmosphere. Further studies of materials with red cell pass. primary interest in vapors and flammability are It is probable that the hemolytic state which may important. accompany high oxygen tensions is not a serious environmental hazard. Nevertheless, elucidation of this References phenomenon is deemed important in order to be sure 1. Ader, H. F.: Dysbarism. USAF school of of its magnitude as a hazard and as a basis for inter- Aviation Med., unpub. rept., 1950. pretation of other experiments on board an ORL which 2. Bake, B.: Bioastronautics Progress Report No. might b;: af3ected by the occurrence of hemolysis. 1. USAF School of Aviation Med., Randolph AFB, Texas, 1959. Effect of Atmosphere Composition 3. Burkhardt, W. L.; Adler, H. F.; Thomety, A. F.; on Hazards of Dysbarism Atkinson, A. J.; and Ivy, A. C.: Decompres- Essential to the establishment of firm life support sion Sickness. JAMA, vol. 133, 1947, p. 373. criteria for atmosphere selection are further ground- 4. Clamann, H. G.: Hazards in Oxygen Environ- based studies to clarify the potential incidence of ment. Lectures in Aerospace Medicine, USAF dysbarism following either premeditated operational School of Aero. Med., Brooks AFB, Texas, 1964. or emergency decompressions to the 3.5 psi (absolute) 5. Damato, Morris J.; Highly, Francis H.; Hendler, pressure suit atmosphere. Most critically needed are Edwin; and Michel, E. L.: Rapid Decompres- experiments on men decompressed to the 3.5-psi sion ,Hazards after Prolonged Exposure to 50% atmosphere following varying periods of equilibra- Oxygen 50% Nitrogen Atmosphere. Aero. tion to approximately a 7S-psi atmosphere, MOOJO 0% Med., vol. 34, no. 11, pp. 1037-1040. and 60% N2. The goal is to develop the relation of 6. Ferris, E. B.; Webb, J. P.; Ryder, H. W.; Engle, incidence of dysbarism vs time of equilibration at G. L.; Romano, J.; and Blankenhorn, M. A.: operationally important atmospheres and to determine The Protective Value of Preflight Oxygen Inha- what equilibration time is needed to reduce essen- lation at Rest Against Decompression Sickness, tially to zero the probability of a dysbaric event. US. NRC C.A.M. Rept. No. 132, April 1, 1943. Secondly, when dysbarism occurs under these experis 7. Fraser, A. M.: A Preliminary Study of the Ef- mental circumstances, the efficacy of simple recompres- fect of the Altitude of Residence on the Inci- sion to the original intravehicular atmosphere should dence of Decompression Sickness. Rept. to be evaluated as a countermeasure. Canada, NRC, Associate Committee on Avia- In addition, once the detailed atmosphere pressure tion Medical Research from NO. 2 Clinical In- and composition history of any mission is determined, vestigation Unit (RCAF)No. 2, ITS Regina, consideration should be given to experiments tailored Sa&, 1943. to the specific mission in order to establish firmly the 8. Fraser, A. M.; Stewart, C. B.; and Manning, dysbarism hazard for that mission. G. W.: Review of Canadian Investigations on Decompression Sickness. Canada, NRCC, AS- Research and Development Prior to sociate Committee on Aviation Medical Research, Launching the ORL Rept. from No. 2 Clinical Investigation Unit, Regina, and FPMS Section No. 1, Halifax, 1943. Flammability in Various Atmospheres 9. Fulton, J. F., ed.: Decompression Sickness. Atmospheres which support life may introduce a Saunders and Company, Philadelphia, 1951. fire hazard. Research is necessary to determine the 10. Gray, John S.: Constitutional Factors Affecting extent of risk with various combinations of inert gas Susceptibility to Decompression Sickness. Ch. with oxygen in the pressure range of 3.5 psi to 14.7 VII, in Decompression Sickness, John F. Fulton, psi. Since gravity dependent factors are involved in ed., Saunders and Co., Philadelphia, 1951. 16 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

11. Green, I. D.; and Burgess, B. F.: Report by ters of Human Adaptation to Altitude in Inter- . Personnel Research Committee. British Air Min- national Symposium on the Physics and Medi- istry, Jan. 1962. cine, 0. 0. Benson and H. Strughold, ed. 12. Haldane, J. S.; and Priestley, J. G.: Respiration. Wiley, New York, 1960. Yale University Press, New Haven, 1935. 19. Marbarger, J. P.; Kadetz, W.; Palatarokas, J.; 13. Halperin, et al. : The Time Course of the Effects Vanakalis, D.; Hansen, J.; and Dickinson, J.: of Carbon Monoxide on Visual Threshold. J. Gaseous Nitrogen Elimination at Ground Level Physiol., vol. 146, No. 3, June 1959, pp. 583- and Simulated Altitude and the Occurrence of 593. Decompression. USAF SAM Rept. No. 55-73, 14. Hendler, E. L.: USN Aircrew Equipment Lab- 1956. oratory Informal Report to Gaseous Environment 20. Marotta, S. F.; et al.: Incidence of Bends Fol- Group. NAS, 1962. lowing Partial Denitrogenation at Simulated Al- 15. Henry, F. M.: Aviators’ “Bends” Pain as In- titude. Aero. Med., vol. 32, 1961, p. 289. fluenced by Altitude and Inflight Denitrogena- 21. Roth, E. M.: Space Cabin Atmospheres, Part I, tion. WADC TR 53-227, 1953. Oxygen Toxicity. NASA SP-47, 1964. 16. Henry, F. M.: The Aeroembolism Problem for 22. Schaefer: A Concept of Triple Tolerance Lim- Long Range Mission. WADC TR 52-84, 1952. its Based on Chronic Carbon Dioxide Toxicity 17. Henry, F. M.; and Ivy, A. C.: Preselection Test. Studies. Aero. Med., vol. 32, 1961, p. 197. Ch. X in Decompression Sickness, John F. Ful- 23. Wood, E. H.; Nolan, A. C.; Donald, D. E., ton, ed. Saunders and Co., Philadelphia. and Cronin, L.: Influence of Acceleration on 18. Hurtado and Clark: Physics and Medicine of Pulmonary Physiology. Federation Proceedings, the Atmosphere and Space. Ch. 20 in Parame- vol. 22, July 1963, pp. 1024-1034.

METABOLIC FACTORS RECOMMENDATIONS

Food. Water. and Waste 3. In a shirtsleeve environment for a 150-pound 1. The diet should be as simple as possible with man, the following caloric requirements are emphasis on maximum use of natural foods thought reasonable: which will provide balanced nutritional compo- Sleeping ...... 70 cal/hr or 280 Btu/hr nents, and which is either in a liquid formula Eating ...... 1.5 X basal or 420 Btu/hr form or one which can be readily reconstituted Exercise ...... 2.5 X basal or 700 Btu/hr into a semiliquid or a liquid form to be con- Rest and Relaxation. 1.5 X basal or 420 Btu/hr sumed in space. Work Program : Flight Control .... 2 X basal or 560 Btu/hr A formula diet is required for accurate estimation of intake and to provide adequate measurements for any Reconnaisance ...... 2-2.5 X basal or balance studies. Natural foods will assure balance of 560-700 Btu/hr amino acid components and micronutrients. Scientific Observation. ... 1.5-2.5 X basal or 2. For purposes of planning a schedule of activity 420-700 Btu/hr for a 24-hour day is suggested as follows: Repair ...... 2.04.0 X basal or Activity hours 560-1120 Btu/hr Sleep 8 In a suited environment add increased factors Eating 2 as follows: Exercise 2 Actiihy % Rest and Relaxation 4 Sleep 10 Work Program 8 Eating 50 Exercise 50 This is an estimated schedule to evaluate activity for purposes of calculation of energy requirements and to R&R 50 maintain physical fitness. Work 50 e PHASE I: LIFE SUPPORT RECOMMENDATIONS 17

For extravehicular work, a mean rate of 2000 in view of the possibility of adrenal stress, Btu/hr may be required. This level of expen- the potential use of 10-15 grams of sodium diture is possible for only limited period of chloride per day be considered; a corre- time. These figures presented for panel refer- sponding reduction of potassium to ap- ence are the best available. proximately 1 gram/day might serve as a 4. The dietary component should consist of natu- protective device for the adrenal glands. ral foods of low fiber and low laxative nature. Accordingly, the water intake may need to No adjustment of bacterial flora should be be increased to 4 liters or more per day. attempted. This would also be useful for maintenance Tf?k ranmend2tinn is zi!3e:d at X32iziaizir.g of heat b2x,ce. bowel activity aad to avoid alterations in micro- Vitamin D-1000 units/day nutrient production by normal bacterial flora. Other vitamins-In flights of under 2 weeks 5. The administration of diet should be by liquid there should be no vitamin problem, but or liquid reconstitution with coded cubes which for extended flights the use of a standard are preweighed to facilitate adequate recording minimum daily requirement type of poly- of food intake for purposes of balance studies. vitamin preparation in no greater quantity 6. An oral exercise medium such as a gum or other than the minimum daily requirement as rec- suitable device should be provided for oral hy- ommended by the NAS-NRC (Nat. &ad. giene purposes. This is especially necessary if of Science-Nat. Research Council) is ad- liquid formula diets are to be used. vocated. The one exception to the above 7. Composition of the diet should be as follows: is ascorbic acid with consideration for use k of as much as 150 mg/day to compensate High quality protein 12.5 for the stress of flight. Carbohydrate 52.5 to 57.5 Minerals-Trace mineral supplements are Fat 35 strongly advocated if food used is proc- This ratio will be used to provide 27053200 essed by chelation. This is one of the cal/day (10,800-12,800 Btu/day) with an RQ strong reasons for the recommendation for at 0.8 to maintain a CO, 0, ratio which the maximum use of natural foods. would spare the CO, scrubbing requirements of Water-2.5 liters/day (1 cc/calorie of food). the environmental control system. Water intake should be sufiicient to main- 8. The ratio of polyunsaturated to saturated fat in tain the urine at a specific gravity of 1.015 the diet will be dependent upon the conditions or less or a volume of at least 1 to 1.5 of preservation of diet during the flight pro- liters/day to avoid the development of uri- gram and the method chosen for reconstitution nary gravel. Water should be consumed in of the diet for feeding in space. definite quantities on a programmed sched- Because of their lower melting point, poly- ule. Daily measurements of body mass unsaturated fats lend themselves to easy recon- should be used to adjust water intake. stitution for use in space. These estimates are based upon the best available in- 9. Recommendations concerning mineral and vita- formation regarding nutritional requirements. min requirements are as follows: 10. Because of power, weight, and volume require- Calcium-O.8 gram/day ments, recycling of water is not considered prac- Phosphate-1.2 to 1.5 grams/day tical for flights of less than 30-day duration, but Sodium as NaCl for individuals who are ac- it should be considered for flights in excess of climatized to the environment-4.f to 5 that period of time. Water sources for reclaim- grams/day ing include metabolic water and that produced For those not acclimatized, add 1 gram of by the fuel cells. The recycling of urine is con- sodium as NaCl for each liter of water considered to be costly in both energy and volume- sumed per day over 4 liters. This figure is weight requirements. Ion-exchange or milli- tentative, and the suggestion is made that pore filters appear to be simple devices for re- 18 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

claiming metabolic and fuel cell water and con- caloric density foods, preliminary data are required to . verting them to a potable supply. Metabolic assess the potential use of such food sources. water can be reclaimed easily for hygienic use. 2. Continued work in the field of food packaging This recommendation is based upon presently available to enable the accurate measurement of intake of engineering estimates. food constituents is important. 11. On each voiding, the total volume of urine must Any metabolic experiment depends on accurate meas- be accurately recorded and an aliquot separated urement of food components consumed in the daily diet. for study. Aliquots according to aeromedical 3. Continued development of improved urine and requirements can probably be stored in the walls fecal collection devices to improve both meta- of the cabin to provide additional radiation bolic balance studies as well as improving sani- shielding until they are returned for analysis. tation for the pilot is necessary. Cryogenic preservation is recommended. 4. Further research and development on the recy- Any meaningful study of metabolic activity is depend- cling of water, with purification to acceptable ent on accurate measurements of urine components. standards of potability for human use, should be Adequate preservation is required to prevent loss of made. labile chemical constituents. For extended space flight the conservation of any water 12. To reduce the quantity of fecal material, a low supply may be essential. residue diet is recommended. Samples should be collected, adequately identified, and stored in Ground-Based Experiments and sealed containers for analysis (as with the urine). Flight Crew Training Desiccation and cryogenic storage, utilizing the Prior to Launching the ORL conditions of space, might well be employed to facilitate this program. It should be borne in 1. The study of calcium metabolism at various mind with reference to the storage of feces that phases of training under various conditions dur- drying without either freezing or sterilization ing preflight to establish baseline levels for each may well introduce the danger of bacterial con- potential astronaut is recommended. Each man tamination of the atmosphere. must serve as his own control in addition to 13. From the standpoint of metabolic considerations, furnishing data for statistical evaluation of space medical selection for the ORL program should flight. attempt to rule out those who have a tendency 2. Extensive training in the handling of special toward nephrolithiasis. It is also important to foods, containers and reconstitution techniques record any food intolerances and idiosyncrasies during the flight training program as well as of flight crew candidates. familiarization with the taste and digestive problems associated with special foods should be To minimize medical problems of space Bight, all factors which would predispose a medical problem should provided. be screened carefully. Preflight orientation will minimize inflight problems. 3. A study of the effects of centrifuge simulation of Research and Development Prior to the flight launch profile on the antidiuretic hor- Lazlnching the ORL mone activity and other urinary secretion control factors to provide parameters for compari- 1. A study of nutritional acceptability and palata- son with both 1 G and zero G observation bility for extended periods of such potential should be made. foods as algae, reconstituted liquid or semi- Adequate ground based experiments are required to liquid diets of natural products should be made. assess the effects of gravity on urinary secretion mecha- It is recommended that an investigation be made nisms. as to the possibility of exteflding a natural diet 4. The preconditioning of the ORL crew members by means of a concentrated, high-density, syn- to a low caloric intake is recommended, and thetic diet which can be consumed periodically body fat stores should be normalized prior to during the flight program. flight. Metabolic studies to determine the caloric As it may be necessary in extended flights to use high cost of activity should also be done. PHASE I: LIFE SUPPORT RECOMMENDATIONS 19

+ In the event there is a space and weight limitation on manned space flights by means of urinary assays. the food available, conditioning programs are necessary. This determination relates not only to fluid requirements, per se, under weightless conditions, Space Flight Experiments Prior to but also to blood volume and cardiovascular ef- Launcbing the ORL fects of weightless flight. 1. To fly an animal metabolic cage to determine the effect of weightlessness on metabolism (by References means of oxygen consumption and carbon diox- 1. American Medical Association: Handbook of ide output determination), on H20 balance, and Nutrition. Blakiston Company, Philadelphia, calcium balance. The effects of weightlessness 1951. on peristalsis and muscle deterioration are also 2. Recommended Dietary Allowances, 6th Revised in need of exploration by means of animal Edition, 1964. Report of Food and Nutrition flights. Board NAS-NRC. Publication 1146, Govern- This is an endorsement of the Biostat program to en- ment Printing Office. courage updating as soon as possible. 3. Spector, W. S.: Preliminary Handbook of Bio- 2. The determination of ADH activity during logical Data, p. 196.

LIVING CONDITIONS RECOMMENDATIONS

The following recommendations are given on the provide visual orientation as well. In the case of a basis of clinical judgment and experience. rotating spacecraft (for artificial G) this should include indication of the direction of the centripetal Life Support Factors force and direction of rotation of the spacecraft. Body Functions and Hygiene 2. Recommendations for the illumination of wall surfaces, colors, and design of lighting are offered in 1. A high standard of personal appearance, dress, references Morgan, C. T., 1963, Meaker, P., 1955, and tidiness of the cabin must be maintained. and General Electric Company, 1960. 2. A means of nonaqueous body hygiene should be 3. Recommendations for the illumination of displays available. The use of an oil for cleansing the skin are offered in Morgan, C. T., 1963, pages 78 to 122. may be desirable. Droplet contamination of the at- Here it must be borne in mind that the contrast be- mosphere by the cleansing material is to be carefully tween display light and background light is impor- avoided. tant. Special cases meriting consideration are the 3. The control of body is imperative. odors following: (1 ) the light required for a visual warn- 4. Shaving should be by mechanical razor (spring- ing, (2) moving types of displays, and (3) visual wound or turbo-driven). An electric razor should displays requiring dark adaptation, i.e., radar dis- be used if the atmosphere provided does not impose plays, etc. the danger of spark-induced fire. 5. Haircutting and nail paring should be done by General Conveniences and Diversions methods which avoid particulate contamination of 1. Ground-based radio and TV should provide the the atmosphere. crew with periodic (daily) broadcasts of news and 6. A laundry facility or substitute, such as an ade- special events as well as personal messages. quate supply of disposable clothing, must be pro- 2. Facilities for diversion should be available. These vided. This area is in need of investigation. might include a small microfilm library, a TV or radio for use when orbital position permits, and a Decor and Illumination source of music such as a tape recorder. Personal 1. The decor and illumination should be chosen not earphones will permit the use of these without dis- only for its present effect but should be such as to turbance of other crew members. 20 MEDiCAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

3. Each crew member might be given a certain 4. Thought should be given to the type of duty * weight and volume allowance for recreational mate- scheduled during the wakefulness period regardless rials such as playing cards and other games. Game of the W-R-S cycle used. equipment will have to be designed for the gravity- Kleitman (1962) has reported that efficiency of perform- free state. Early ground experience with flight crews ance during a normal 24-hour cycle varies rhythmically working together would lead to joint selection of throughout the course of the day. Efficiency was low upon these materials. arising, showed an initial ascent phase, a plateau in the middle of the day, and a terminal descent phase. Viaud Schedules (Work-Rest-Sleep Cycles) ( 1945, 1947) has noted that performance immediately upon getting up from a period of sleep was often poorer than 1. A work-rest-skep (W-R-S) cycle of 24-hour du- it was just before retiring. Kleitman, in tests with very ration is the most suitable schedule. An 8-hour on small numbers of subjects on a 4-hour on, 4-hour off schedule, reported a “very low” capacity for work during the and 16-hour off schedule is recommended. If the 4-hour interval separating the two sleep periods. Husband crew is large enough, the possibility of setting up (1935) has reported similar findings using a 3-hour sleep, two teams operating twelve hours out of cycle may 3-hour awake cycle. provide a regular individual schedule yet round-the- 5. If an atypical schedule is to be used, it is recom- clock hours for crew duties and maximum utilization mended that preflight presynchronization periods be of the facilities. employed to provide for crew adaptation. Man is fairly well accustomed to a sleep-wakefulness cycle of 24-hour duration. He has diurnal variations in both 6. Preflight presynchronitation should be accom- performance and physiological functioning which are adapted plished in accordance with the ability of each indi- to this rhythm. When an atypical cycle is imposed, his vidual member of the crew to adapt (those who physiological rhythms may be expected to show some adap- adapt least well should be kept close to their typical tation to the non-24-hour periodicity, but the adaptation is schedule). not likely to be complete nor to be equal for all individuals. 2. Should limitations on crew size and operational 7. Where synchronization is found to be difficult, constraints require the imposition of a non-24-hour sedative and stimulant drugs may be used as an aid. Since this method is generally considered undesirable, work-rest-sleep cycle, the consistent day-to-day ad- it should be used only if the rapid adaptation of a herence to a stable W-R-S cycle is recommended. particular individual is highly important and very The maintenance of a stable W-R-S cycle (as indicated by a superimposable body temperature curve peaking during difficult. wakefulness, and dropping during sleep) serves a dual pur- 8. Local adaptation to an atypical cycle can be accom- pose: (1) it makes for alertness and efficiency during work- plished by new crew members as they arrive aboard ing hours and (2) it insures an easy onset of sleep. the ORL if they are not required to go on duty im- 3. A review of existing literature seems to indicate mediately upon arrival. that where “watches” are required, individuals adjust more favorably in groups where a 4-hour on and Volume (Space) Requirements 4-hour off schedule is used than those where other schedules are used. 1. As a minimal requirement for a +month mission Work-rest-sleep cycle total durations based on 12-hour there should be sufficient space for arms outstretched (Mills, 1950; Mills and Stanbury, 1951), 8-hour (Stein- plus 1 foot, and the “ceiling” should be 1 foot kamp, et al, 1959), and 6-hour (Adams, et al, 1961) time higher than the astronaut’s head. periods have all been studied extensively. These studies 2. Insofar as space is available, areas for on-duty ac- favor the above statement. tivities and relaxation should be separate.. An area The most common division of standing watch, used in the United States submarine fleet, is the 4-hour on and 8-hour of privacy away from the others must be provided in- off schedule, which is in operation on an artificial 12-hour dividual crew members. cycle. Reports in the literature indicate that while the du- 3. As space available is increased, assuming a step- ties of a submariner may be satisfactorily carried out on wise approach to progressively larger orbiting labora- such a schedule, efforts to establish a 12-hour physiological tories, more normal room proportions should be rhythm in man have been uniformly unsuccessful on subjective, biochemical, and hematological bases. (refs. 9, achieved and space provided for exercise and group 10, 5) activities such as a “ward room.” I PHASE I: LIFE SUPPORT RECOMMENDATIONS 21

Research and Development Prior to Thresholds for Chorioretinal Burns. AMRL Launching the ORL TDR 63-71, 38 pp., July 1963, USAF, Wright- 1. The development of techniques and materials for Patterson AFB, Ohio. the accomplishment of body cleansing in space. 2. Buchanan, A. R.; Heim, H. C.; and Stilson, 2. The devdapment of tediniqiie and equipment for 0.W.: Biomedical Effects of Exposure to Elec- shaving, haircutting, and nail paring in space. tromagnetic Radiation; Part I, Ultraviolet. 3. The development of techniques and equipment for WADD TR 60-376, 181 pp., May 1960. the laundering of clothes in space. USAF, Wright-Patterson AFB, Ohio. 4. The investigation of optimal clothing f&rics for 3. General Electric Company. Light and Interior space existence considering weight, skin tolerance, r'inishes. LS-140, January 1960, Large Lamp ease of laundering, ease of storing, and/or disposal Department, Cleveland, Ohio. (in lieu of laundering). 4. Horne, E. P.; and Whitcomb, M. A., ed.: Vi- 5. Investigation of the effects of angular acceleration sion Research Reports. Pub. 835, 182 pp., on visual acuity. 1360. NAS-NRC, Washington, D.C. 5. Jacobson, J. H.; Cooper, B.; and Najac, H. W.: Effects of Thermal Energy on Retinal Function. I Ground-Based Experiments Prior to Launching the ORL AMRL-TDR 62-96, 70 pp., August 1962. USAF, Wright-Patterson AFB, Ohio. 1. Trial and long-term occupation of fixed-based I 6. Ludvigh, E.; and Kinsey, V. E.: Effect of Long simulators employing variations in lighting and color. Ultraviolet Radiation on the Human Eye. Sci- Note effects on crew well-being and performance and ence, Sept. 13, 1946, vol. 104, pp. 246-247. interactions with other variables. 7. Meaker, P.; and Oetting, R. L.: Visual Com- 2. Preflight trial of displays in simulator. fort Index. Data and Tables. IS-108. Oct. 3. Simulation of rendezvous maneuver. 1955. Large Lamp Department. General Elec- 4. Attempts at recognition of lunar and land- Earth tric Company, Cleveland, Ohio. marks by the use of charts and photographs. 8. Miller, J. W.: Visual Problems of Space Travel. 55 pp., April 1962. Armed Forces NRC Com- Space Flight Experiments Prior to mittee on Vision. NAS-NRC, Washington, Launching the ORL D.C. 1. Experimental extravehicular recognition. 9. Morgan, C. T.;Cook, J. S.; Chapanis, A.; and 2. Practice rendezvous and docking. Lund, M. W. (eds.): Human Engineering 3. Measurement of flux of light energy at various Guide to Equipment Design in Visual Detec- wave lengths. tion, Identification, and Estimation. McGraw- 4. Measurement of atttenuation of light achieved by Hill, 1963, pp. 5670. the use of shielding materials. 10. Pig, L. D.; and Kama, W. N.: The Effect of 5. The determination of the interaction between vi- Transient Weightlessness on Visual Acuity. sion and weightlessness. WADD TR 61-184, 19 pp., March 1961. 6. Experimentation with various combinations of USAF, Wright-Patterson AFB, Ohio. non-24-hour W-R-S cycles in the weightless environ- 11. Roman, J. A.; Warren, B. H.; Niven, J. I.; and ment. Graybiel, A.: Some Observations on the Be- havior of a Visual Target and a Visual After- 1 ORL Experiments Image During Parabolic Flight Maneuvers. 1. Recognition of extravehicular objects. SAM-TDR 62-66, 8 pp., June 1962. USAF, 2. Interaction between visual characteristics and School of Aerospace Medicine, Brooks AFB, weightlessness. Texas. References 12. Severin, S. L.; Adler, A. V.; Newton, N. L.; and Culver, J. F.: Photostress and Flash Blind- Illumination ness in Aerospace Operations. SAM-TDR 63- 1. Bredemeyer, H. G.; Wiegmann, D. A.; Brede- 67, 7 pp., Sept. 1963. USAF, School of Aero- meyer, A.; and Blackwell, H. R.: Radiation space Medicine, Brooks AFB, Texas. 22 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

13. Whiteside, T. C. D.: Vision at High Altitude. 7. Kleitman, Nathaniel: Sleep and Wakefulness, FPRC Report 910, 5 pp., Nov. 1954. RAF, Chapter 18: Modifiability of the 24-Hour Pe- Inst. Aviation Medicine, Farnborough, Hants, riodicities. Univ. of Chicago Press, rev. and England. enlarged ed., 1963. 14. Wulfeck, J. W., et al: Vision in Military Avia- 8. Lindhard, J.: Investigations into the Conditions tion. WADC TR 58-399, 378 pp., November Governing Temperature of the Body. Denmark 1958. USAF, Wright-Patterson AFB, Ohio. Expedition to the North Shore of Greenland. pp. 75-175, 1910. Work-Rest-Sleep Cycles 9. Mills, J. N.: Diurnal Rhythm in Urine Flow. J. Physiol. (London), vol. 113, 1951, pp. 528- 1. Adams, 0. S.; and Chiles, W. D.: Human Performance as a Function of the Work-Rest 536. 10. Mills, J. N.; and Stanbury, S. W.: Persistent Cycle. WADC TR 60-248, 18 pp., March 24-Hour Renal Excretory Rhythm on a 12-Hour 1960. Contr. AF 33(616)-6050. Proj. 7184, Cycle of Activity. J. Physiol. (London), vol. Task 71 582. USAF, Wright-Patterson AFB, 117, 1952, 22-37. Ohio. pp. 2. Bartter, Delea, C. S.; Halberg, Frits: A Map of 11. Polimanti, 0.: Sopra la Possibilita di Rena In- Blood and Urinary Changes Related to Circa- versione della Temperatura. Z. Allg. Physiol., dian Variations in Adrenal Cortical Functions in vol. 16, 1914, pp. 506-512. (Quoted in Kleit- Normal Subjects. NY Acad. of Sci. Annals, man, 1962.) (conf. ed.: Wm. Wolf.) vol. 98, art. 4, Oct. 12. Rowe, E. C.: The Hygiene of Sleep. Psychol. 30, 1962, pp. 969-983. Rev., vol. 18, 1911, pp. 425-32. 3. Frank, G. S.; Lange, H.; and Pavy, R.: Cir- 13. Steinkamp, G. R., et al: Human Experimenta- cadian Cycles and Correlations Among EEG tion in Space Cabin Simulator. USAF SAM Output, Discrimination Tests, Body Tempera- Rep. 59-1D1. Aug. 1959. ture, and Other Physiologic Functions in Nor- 14. Strughold, H. : The Physiological Day-Night mal Men. Neurology, 1963, vol. 13, no. 4, Cycle in Global Flights. Spec. Rept. 9 pp., p. 359. Abstract. April 1963. October 1952. USAF, School of Aviation Med- 4. Freeman, G. L.; and Hovland, C. I.: Diurnal icine, Randolph Field, Texas. Variation in Performance and Related Physio- 15. Utterback, R. A,; and Ludwig, R. A.: A Com- logical Processes. Psychol. Bull., vol. 31, 1934, parative Study of Schedules for Standing pp. 777-799. Watches Aboard Submarines Based on Body 5. Halberg; F. : Physiologic 24-Hour Periodicity. Temperature Cycles. Nav. Med. Res. Inst., Z. Vitam. Horrnorn-Ferrnetforsch, vol. 10, Bethesda, Maryland. Rept. No. 1, Proj. NM 1959, pp. 225-296. (Quoted in Kleitman, 004003, March 1949. 1962.) 16. Viaud, G.: C. R. SOC.Biol., vol. 139, 1945, pp. 6. Husband, R. W.: The Comparative Value of 553-555; and J. Psychol. Norm. Path., vol. 40, Continuous Versus Interrupted Sleep. J. Exp. 1947, pp. 195-231. (Quoted in Kleitman, Psychology, vol. 18, 1935, pp. 792-796. 1962.)

GROUP INTEGRITY RECOMMENDATIONS

Life Support Factors Although group integrity presupposes individual in- G~~~~integrity implies efficient and harmonious tegrity, especially in those activities involving all group functioning. In the context of space explo- members of the group, competent and well-moti- ration it implies two or more astronauts working vated individuals do not always form a cohesive, together, living together, and depending on each harmonious, and efficient group. Further, initially other for the efficient execution of the space mission. well-organized groups can deteriorate with time, as s PHASE I: LIFE SUPPORT RECOMMENDATIONS 23

continued stresses lower the anxiety and frustration evaluate candidate potential for positive group inter- tolerance levels of the weakest members. This reaction. Areas of interest and need include: port, then, will consider the problems and methods a. group efficiency measured both in terms of involved in obtaining and maintaining group integ- group output and each individual’s contribution to rity. It will ahconcern itself with the factors re- the team effort, lated to individual integrity and efiiciency insofar as b. adaptation of the individual to group stresses, these are related to harmonious group functioning. c. flexibility of adjustment of an individual to However, it must be borne in mind that many con- different groups, siderations of individual functional integrity remain. d. adaptation of the group, as a group. to the These prablems have been well-studied in the past stresses of confinement, environmental and social and are documented in available sources. These monotony, and basic anxiety and frustration over considerations are not dealt with in detail in the an extended time period, text, but references are appended. e. deterioration of morale and group efficiency With the forthcoming multicrea-men program, over time under the continued stresses of extended new problems emerge which were not present or space flight, and planned for in the one-man missions. Group inter- f. leadership potential and decision making ability. actions, involving added adjustments and integration The additional dimension of group interaction over extended of effort, create new situations needing evaluation as time periods under confining and frustrating conditions in- to their effect upon the success of the mission. An troduces additional complexities which may contribute di- additional vector, one which may well compound the rectly to mission success. As a specific instance, locomo- problems involved in group interaction, is the ex- tion and control of intracapsule objects under conditions of weightlessness will involve a learning experience which can- tended time required for the completion of the mis- not be simulated or practiced to any extended degree before sion. These factors, extended time and group inter- the mission and thus may engender a degree of annoyance action, pose questions quite different in character and hostility, especially in the early mission phases. from those encountered in the one-man, short-dura- 2. Introduce into the selection battery a series of tion flight. The effects of these two new variables psychological measures which have been demon- upon the selection, training, and in-flight aspects of strated to be sensitive to temporary or long-stand- the program must be considered. ing impairment of cerebral functions. During the last 20 years a considerable number of tests have Selection shown excellent validity for this purpose. Spe- Any negative effects of group interaction prob- cifically, the Category Test and Tactual Performance ably will not play a significant role in the currently Test (Halstead), (refs. 2, 3, 5, 8, 10, 15, 16, 17, planned two-week duration missions, In the first 22), various tests of rhythm and sound discrimina- place, considerable attention has been paid to the tion and the Wisconsin Card Sorting Test (Milner), emotional stability and adjustment capability of the (refs. 11-14), the Continuous Performance Test candidates in the current selection process. Sec- (Rowold), (ref. 23), the Psychomet apparatus ondly, the excellent motivation and morale of the (Birren), (ref. I), and the Trail-Making Test and astronauts would minimize any tendencies toward the Picture Arrangement, Block Design, and Digit group disintegration on a short mission. Finally, the Symbol tests of the Wechsler Scale (Reitan), (refs. mission will include relatively intense activity sched- 1, 4, 6, 7, 9, 18, 19, 20, 21), should be studied ules wherein the crewmen will be involved primarily with regard to their contributions to a core-battery. in task-oriented, rather than interpersonal-oriented The inclusion of the evaluation of “those abilities yhich behavior. This report, therefore, is directed toward are specifically related to ceiebial functions which are par- extended mission requirements such as are pertinent ticularly susceptible to variations” will provide for the sys- to the ORL or lunar-based missions. tematic collection of data which may prove highly significant in (a) the assignment of crewmen to future missions and Recommendations (b) the selection of future astronauts. The selection data collection plan should include consideration of the ability 1. Expand the present psychological selection test to conduct in-flight evaluations which will yield data di- battery to include tests and techniques which will rectly comparable with preflight information. The purpose 24 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY of this recommendation is to complete a systematically de- should include a number of basic psychophysiolog- ’ signed matrix of information on cerebral functions. ical activities which would sample sensory, percep- Findings to date suggest that the higher mental functions tual, sensory-motor, learning, and thought and deci- (excluding primary sensory and motor functions) group themselves into the areas of: (1) concept formation or ab- sion processes which underlie ordinary human straction abilities, (2) visuo-spatial and temporal patterns behavior. These data would provide essential base- of organization, and (3) language and related symbolic rep- lines for the evaluation of in-flight performance and resentations for communications purposes. The corre- for the analysis of possible change due to extended sponding regional areas of the cerebral hemispheres, in flight experience. which intactness of function appears necessary for maintenance of the above abilities are, respectively: (a) one or Recommendations both frontal lobes, (b) the right temporo-parieto-occipital area, and (c) the left temporo-parieto-occipital area (and 1. a. During the training procedures, special atten- probably including the posterior-inferior left frontal area). tion should be directed to identify those individuals Other aspects of higher mental functions (4) perceptual whose behavior and performance reduce group effi- awareness and (5) the ability to sustain high levels of vigilance over fairly extended time periods appear to be related ciency. Specific interactions between two or more morphologically to (d) overall, general cerebral function- members bringing about deterioration of group per- ing rather than to specific areas of the brain. Classification formance should also provide criteria for proper as- of the tests into the above psychological functions (1 signment of crew members. The above recommen- through 5) and the corresponding regional or general areas dations could be more easily implemented if “good” of cerebral functions (a through d) would best be stated in a preliminary fashion as follows: Function 1-Halstead and “poor” crews, representing the extremes of effi- Category Test, Trail-Making Test, and Wisconsin Card ciency, were subjected to careful psychological analy- Sorting Test; Function 2-Milner’s tests of rhythm and sis. sound discrimination as perceived through the left ear, the b. The crews in training should be systematically re- Picture Arrangement and Block Design subtests from the constituted in order to (1 ) test hypotheses regard- Wechsler Scale, the Tactual Performance Test score with the left hand, and comparatively poor performance on Part ing crew efficiency, (2) promote flexibility and A as compared with Part B of the Trail-Making Test; Func- adaptability in group interactions, and (3) meet the tion 3-Milner’s tests of rhythm and sound discrimination possible contingency of a last-minute replacement of as perceived through the right ear, comparatively poor per- a crew member for an actual flight. formance on Part B as compared with Part A of the Trail- Making Test, and possible analysis of the inflight verbal With the anticipation of multiman crews numbering four communications of the astronauts for indications of deterio- or more members, it will be virtually impossible to “scrub” ration of language functions; and Functions 4 and 5-Ros- an entire crew in the event that one member is unable to vold’s Continuous Performance Test, the Psychomet appa- participate in the flight mission. It therefore becomes im- ratus, and the Digit Symbol Test of the Wechsler Scale. portant to determine the effect of crewman substitution on Although real-time data are not currently envisioned as the morale and efficiency of the basic crew. This recom- necessary, provision for telemetering of data should be in- mendation is applicable to prerequisite R&D work and cluded to avoid loss of inflight data points in the event of ground-based experimentation (discussed under those sec- landing malfunction. tions) and also to the systematic manipulation of astronaut crew members into different groups during their training Training experiences. 2. Ideally an actual mission should be preceded by As a general principle, the training of astronauts should provide an opportunity for extending and a simulated flight of intense realism and of equal duration with astronauts as crew members. supplementing the selection procedure. This is an endorsement of the current concept that the training This procedure would serve as an analogue of the “shake- program is actually a “selection-in-depth” process. down” cruise and would provide a realistic basis for developing appropriate countermeasures for possible failures in In particular, when group interactions within the equipment or crew integrity. It is recognized that the prac- crews during the latter phases of the training become ticality of this recommendation is problematical, also the well enough established, the data could be very use- predictive values of simulated missions are yet to be estab- ful in the final selection of compatible and efficient lished. Meanwhile, this recommendation will serve to (I ) crews for a particular mission. provide the most adequate substitute for the in-flight situation, and (2) provide the basis for validating the simulation In addition to the training required to prepare for by means of the in-flight mission itself. If the ideal situa- and complete a successful mission, training tasks tion is impossible, it is recommended that the simulation ~ . PHASE I: LIFE SUPPORT RECOMMENDATIONS 25 be completed with as many mission similarities as are performing ground-based experiments. With the practical. exception of the effects of weightlessness and the The use of astronauts in the simulated mission would make actual psychological stress of space flight, both as possible direct inferences to the astronaut population. he- ficial but less valuable results would be obtained from “astro- single and as interacting variables, all of the known naut-like” crew members. The value and pertinence of data perttioent variables of inmediate concern can be in- from simulations with non-astronaut-like crew members, vestigated as to their effects on the astronaut. Par- e.g., college students, etc., are highly questionable. The ticularly, it would appear that most of the variables same of thinking applies to simulation itself. The type of interest in the selection process associated with more realistic the simulation, the greater is the applicability of the data to the space flight situation. preserving group integrity under a variety of expo- sues to both physical and psychological space fac- At intervals during the training period, 3. selected tors are amenable to ground-based experimentation sensory and perceptual functions, sensory-motor and and identification. Once these variables have been learning activities, and higher thought and decision identified, then appropriate tests can be either se- processes should be tested to provide individual base- lected or developed to identify the desirable and lines of performance for each astronaut. undesirable factors in the astronauts and selection More specifically there should be tests of visual and audi- made accordingly. tory acuity, near and far depth perception, motor coordina- 1. Expand psychological test battery to include tests tion, speed and dexterity (gross and fine), visual form and and techniques which will evaluate candidate poten- motion discrimination, temporal orientation and dixrimi- nation, kinesthesis and appreciation of body/limb position- tial for positive group interaction. Develop pnxe- ing and interaction. vigilance, span of attention, continuous dures (tests, ratings, etc.) to evaluate: digit span, speech production and perception, pdlem solv- a. group efficiency, ing (numerical and verbal), and logical analysis. In large b. adaptation to group stresses, part, the functions measured by these tests are related to the c. flexibility to adjustment within different groups, problems of maneuvering in a weightless environment and to d. deterioration of morale and group efficiency the problems of “docking” and so have a decidedly practical orientation. Many of the tests involve standard test equip- over time, and ment (of the Republic and North American Aviation re- e. leadership potential and decision making ability. ports, 24-25); others need no special equipment, in the as No tests or valid measures of the variables of interest here of evaluating speed of “suiting,” quality of writing, case have been standardized. Test construction and validation is and intelligibility of speech. The apparatus tests should be time consuming and must be started without delay. With- packaged into a Behavior Reaction Panel to conserve space out such tests, no measurement in the areas of interest will and permit automatic recording. be available, and then not only the selection process but the Since these functions will be utilized in space, both within comparison methods of training will be handicapped. the capsule environment and outside the capsule, they need 2. to be evaluated periodically throughout an extended space Introduce into the selection battery psychological mission. Theoretical and practical considerations demand measures which have been demonstrated to be sensi- such a program. From a theoretical viewpoint it would be tive to temporary or long-standing impairment of extremely important to know whether weightlessness has an cerebral functioning. Develop instruments and/or effect on any of these functions. (Simulation would con- test procedures to make in-flight measurements of trol for confinement, monotony, and group interaction ef- cerebral deficit or deterioration which are directly fects on those functions). Practical considerations require that these functions be under continuous surveillance to as- comparable to ground-based measurements. sure integrity during the course of the mission. Post-testing Category Test and Tactual Performance Test, Wisconsin on these same functions would provide an overall estimate Card Sorting Test, Continuous Performance Test, Psycho- of the changes induced by the entire mission. Retesting at met apparatus, Trail-Makmg Test, and Picture Arrangement, intervals during the training period not only provides a more Block Design and Digit Symbol subtests of @e Wechsler stable baseline but yields an estimate of expected variability scale, miniaturized EEG and Critical Flicker Frequency within each function. (CFF) equipment are recommended for initial consideration. 3. During training procedures, special attention Research and Development Prior to should be directed to identify those individuals Launching the ORL whose behavior and performance reduce group e&- Much information concerning the influence of ciency. Develop a program to identify which spe- variables encountered in space can be determined by cific crew characteristics serve as criteria for “good” 26 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY and “poor” crews (the extremes of efficiency in to make in-flight measurements directly comparable * performance). to measurements secured during ground-based exper- 4. At selected intervals during the training period, iments. sensory and perceptual functions, sensory-motor and Through such measurements, it will be possible to compare learning activities, and higher thought and decision the astronaut in flight with his baseline as secured on earth. processes should be tested to provide individual base- Further, experiments performed on earth will have the po- lines of performance for each astronaut. Many of tential of transposability and generalization of results to the in-flight situation. the tests for the various sensory, perceptual, and 2. Conduct simulations of specified missions manned higher thought processes are described in the North with astronauts or astronaut-like crew members for American and the Republic Aviation reports. These durations equal to mission time. Measurements re- should be evaluated for reliability and repeatability lated to human reliability regarding flight control and, where necessary, revised for adequacy and feasi- and allied mission tasks should be made. Also of bility. prime importance are measurements regarding the Many psychomotor tests and most tests of higher mental nature of group dynamics and the effects which may ability which are presently available are not designed for repeated valid administration. The need for repetition of be generated as a result of these interactions. In the tests over an extended time period will be necessary in addition, the tests of the sensory, perceptual, and the in-flight evaluation of astronaut performance. In ad- high mental processes should be conducted as they dition, preflight and postflight performances will need evalu- would on an extended space mission. ation. This problem (repeated measurement) requires re- Such simulated missions will provide full rather than part search for the development of appropriate tests, multiform task training. The confinement variable plus the problems if necessary. associated with group interaction can only be discovered prior to actual flight in such real, time-full task simulation. Ground-Based Experiments Prior to 3. Perform a habitability experiment which will an- Launching the ORL swer the qeustions: 1. Selected tests to measure cerebral functioning. a. What are the psychological effects of prolonged a. Conduct an evaluation program on tests or tech- spatial confinement with its concomitant social niques which will detect even a slight trend to- restriction ? ward cerebral impairment as a result of psychological b. What are the psychological effects of restricted concomitants of confinement as well as physiological exercise ? changes, which is designed to: c. What are the psychological effects of crowding? (1) establish sensitivity of tests to space capsule All of the variables can be investigated in an experiment conditions, and where exercise, spatial confinement, and number of individu- (2) collect normative data under these conditions. als confined in a given-sized volume are the independent variables and performance on a battery of psychomotor tasks With the systematic variation of such conditions as (1) (as measured by a performance panel), critical flicker fu- confinement and monotony, (2) time, (3) atmosphere com- sion, a form of the Categories Test, performance of opera- position, (4) atmospheric pressure, (5) contaminant level, tional procedures, and measures of group and individual and (6) other variables representing a threat to crew and interaction are measured as dependent variables. individual integrity, these objectives can be met. As space flights continue, the time spent in such flights will Such tests will aid in the selection of crews with high tol- increase. Because of engineering limitations, the space trav- erance for changes in environmental space variables and will, elers will be faced with confinement to small spaces, re- under repeated administration, permit in-flight evaluation stricted socially, crowded by other crew members, faced with of changes in the astronauts’ physiological and psychological a monotonous existence for long periods of time, and have integrity. reduced possibility for normal exercise. The effects of these The test developed in response to the above recommenda- variables on astronaut performance need to be understood. tions must be capable of repeated valid administration. Fur- ther, the data yielded by the tests must + capable of immediate evaluation so that their usefulness in early detection Space Flight Experiments Prior to will permit immediate remedial measures to be initiated. Launching the ORL b. Utilize any space and time facilities in other ear- 1. The currently scheduled Gemini and Apollo mis- lier manned experiments. sions provide the opportunity to study (in retro- c. Develop flight-type instrumentation with which spect) the group interactions which may occur dur- PHASE I: LIFE SUPPORT RECOMMENDATIONS 27 ing space flight. It is recommended that an appro- 132, 1961, pp. 227-233. priate debriefing form be constructed to elicit this in- 7. Fitzhugh, K. B.; Fitzhugh, L. C.; and Reitan, formation once the astronauts have completed their R. M.: Hects of “Chronic” and “Current” missions. The purpose of such a study would be to Lateralized and Non-Lateralized Cerebral Le- note : sions upon Trail Making Test Performances. a. any atypical interpersonal behavior and to eval- J. Nerv. and Ment. Disease, vol. 137, 1963, pp. uate its effects on group efficiency (positive or 82-87. negative) 8. Fitzhugh, K. B.; Fitzhugh, L. C.; and Reitan, b. any deviations in group efficiency and to deter- R. M.: Psychological Deficits in Relation to mine if ~~pica!kt~~~i~~iid !xh~v..;i~tSC- Aciteiiess ~f Brain Dysfunctim. J. Ccnsu!t. companied such changes. Psychol., vol. 25, 1961, pp. 61-66. A distinct advantage of this procedure is that data from an 9. Fitzhugh, K. B.; Fitzhugh, L. C.; and Reitan, actual flight mission will be available for evaluation. R. M. : Wechsler-Bellevue Comparisons in 2. Every opportunity should be exploited to utilize Groups with “Chronic” and “Current” Lateral- as many behavioral procedures as feasible during the ized and Diffuse Brain Lesions. J. Consult. Apollo flights. These need not be complex; for ex- Psychol., vol. 26, 1962, pp. 306-310. ample, simple motor dexterity (e.g., tapping) need 10. Halstead, W. C.: Brain and Intelligence. Univ. take little time and can be correlated with other si- of Chicago Press, Chicago, 1947. multaneously monitored physiological indices (e.g., 11. Klove, H.; and Reitan, R. M.: The Effects of breathing, pulse rate, etc.) to study mobilization of Dysphasia and Spatial Distortion on Wechsler- effort under conditions of weightlessness. Bellevue Results. A.M.A. Arch. Neurol. Psy- chiat., vol. 80, 1958, pp. 708-713. References 12. Matthews, Charles; and Reitan, R. M.: Com- 1. Biomedical and Human Factors Requirements parison of Abstraction Ability in Retardates and for a Manned Earth Orbiting Station, North in Patients with Cerebral Lesions. Perceptual American Aviation, Inc., (NASA Contract, Motor Skills, vol. 13, 1961, pp. 327-333. NASw-775, S and I.D.), Downey, Calif., 1963. 13. Milner, B.: Effects of Different Brain Lesions 2. Biomedical and Human Factors Requirements on Card Sorting. Arch. Neurol., vol. 9, 1963, for a Manned Earth Orbiting Station, Republic pp. 100-110. Aviation Corp., .(NASA Contract NASw-776), 14. Milner, B.: Intellectual Functions of the Tem- New York, 1963. poral Lobe. Psychol. Bull., vol. 51, 1954, pp. 3. Birren, J. E.; Riegel, K. F.; and Morrison, D. F.: 42-62. Age Differences in Response Speed as a Func- 15. Milner, B.: Laterality Effects in Audition. In tion of Controlled Variations of Stimulus Con- Interhemispheric Relations and Cerebral Domi- ditions: Evidence of a General Speed Factor. nance, V. B. Mountcastle, ed. Johns Hopkins Gerontologica, vol. 6, 1962, pp. 1-18. Press, Baltimore, 1962. 4. Doehring, D. G.; and Reitan, R. M.: Behav- 16. Milner, B. : Psychological Defects Produced by ioral Consequences of Brain Damage Associated Temporal Lobe Excision. Ch. 8 in The Brain and with Homonymous Visual Field Defects. J. Human Behavior, pp. 244-257, Solomon, H. C.; Comp. Physiol. Psych., vol. 54, 1961, pp. 489- Cobb, S.; and Penfield, W., eds. The Williams 492. and Wilkins Co., Baltimore, 1956, 564 p. 5. Doehring, D. G.; and Reitan, R. M.: Concept 17. Reitan, R. M.: An Investigation of the Validity Attainment of Human Adults with Lateralized of Halstead’s Measures of Biological Intelli- Cerebral Lesions. Perceptual Motor Skills, vol. gence. A.M.A. Arch. Neuro!. Psychiat., vol. 73, 14, 1962, pp. 27-33. 1955, pp. 28-35. 6. Doehring, D. G.; Reitan, R. M.; and Klove, H.: 18. Reitman, R. M.: Certain Differential Effects of Changes in Patterns of Intelligence Test Per- Left and Right Cerebral Lesions in Human formance Associated with Homonymous Visual Adults. J. Comp. Physiol. Psychol., vol. 48, Field Defects. J. Nerv. and Ment. Disease, vol. 1955, pp. 474477. 28 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

19. Reitan, R. M.: Effects of Brain Damage on a 271-276. Psychomotor Problem-Solving Task. Perceptual 23. Reitan, R. M.; and Tarshes, E. L.: Differential Motor Skills, vol. 9, 1959, pp. 211-215. Effects of Lateralized Brain Lesions on the Trail 20. Reitan, R. M.: Impairment of Abstraction Abil- Making Test. J. Nerv. Ment. Disease, vol. 129, ity in Brain Damage: Quantitative Versus 1959, pp. 257-262. Qualitative Changes. J. Psychol., vol. 48, 1959, 24. Ross, A. T.; and Reitan, R. M.: Intellectual and pp. 97-102. Affective Functions in Multiple Sclerosis: A 21. Reitan, R. M.: The Relation of the Trail Mak- Quantitative Study. A.M.A. Arch. Neurol. ing Test to Organic Brain Damage. J. Consult. Psychiat., vol. 73, 1955, pp. 663-677. Psychol., vol. 19, 1955, pp. 393-394. 25. Rosvold, H. E.; Mirsky, A. F.; Sarason, I.; 22. Reitan, R. M.: The Validity of the Trail Mak- Bransome, E. D.; and Bech, L. H.: A Continu- ing Test as an Indicator of Organic Brain Dam- ous Performance Test of Brain Damage. J. age. Perceptual Motor Skills, vol. 8, 1958, pp. Consult. Psychol., vol. 20, 1956, pp. 343-350.

HAZARD RECOMMENDATIONS

Life Support Factors It is additionally assumed that no effective means Radiation (Electromagnetic Spectrum) of prophylaxis and/or treatment of ionizing radiation injury will be available to the flight crew. In order to consider exposure limits to ionizing Two exposure limits are given: radiation, several assumptions must be made regard- (1) an allowable upper limit for prompt or brief ing the flight profile. It is assumed for the present exposures selected to avoid injury manifesta- that the Orbiting Research Laboratory will be at an tions altitude of about 200 to 300 nautical miles at a 30’ (2) an allowable accumulated dose for a 1-year inclination from the equator. This flight trajectory flight mission assuming a nearly constant, will be protected from solar flare events since it is low, daily dose rate. within the confines of the earth’s geomagnetic force It is extremely unlikely that the suggested exposure field and avoids exposure at the polar region. The limits will be reached since the flight profile does primary radiation hazard, therefore, will be princi- not cause potentially hazardous ionizing radiation pally the electrons of nuclear fission origin that are parameters to be presented. Should they be reached, encouraged at these flight altitudes. Traverse of the however, recovery of the crew can probably be ac- South Atlantic geomagnetic anomaly will cause sev- complished within 24 hours. The expected time to eral small radiation pulses to occur each day. A sec- recovery must be considered due to the varying la- ondary radiation hazard will be the primary cosmic tent periods for the diverse clinical manifestations of radiations. Though dose rates from the latter will radiation injury. When time to recovery may be probably not exceed 0.5 rad/week, this cannot be days to weeks, then the allowable exposure limits easily modified. and will contain a significant por- should be lowered. tion of extremely high LET radiations. Since the biological effectiveness of these radiations is not thoroughly understood, continual surveillance for 1. Zonizing radiation: Upper limit dosage of 200 early damage to the eye and brain, for example, rad for a single exposure; 300 to 350 rad for accu- should be maintained. mulated exposure in a 1-year mission. Extremely eccentric orbits that might cause brief These doses are based on present clinical experience and traverse of high-energy proton fluxes probably will Group judgment relative to lens opacities. These are mini- not occur. It has been indicated that an associated mum cataractogenic doses (refs. 5, 11, 17). drop in perigee altitude would induce atmospheric 2. 1Tltraviolet radiation spertrunz (14 to 400 mili- drag to foreshorten the useful life time of the micron) : All wave lengths below 400 millimicrons mission. should be screened out. (1 X 105 ergs/cm2/24 hr . PHASE I: LIFE SUPPORT RECOMMENDATIONS 29

. or 0.0024 cal/an2/24 hr maximum tolerable for g. orientation or position of an individual influ- wavelengths of 220 to 320 miuirhicrons). encing resonant conditions and standing waves These doses are based on present clinical and animal re- h. differences in sensitivity of organs and tissues search experience and Group judgment relative to harmful i. effect of reflections (ref. 9) photobiologic effects to the eye (refs. 6, 11, 19). An exposure of 10 milliwatts/an* may produce dangerous 3. i’iJibie radiation specrnrm (400 to 780 mdlimi- tbnrnal effects under certain conditions (ref. 23). There is some evidence that microwave radiation is capable of in- cron): The range of 0.2 to 2.0 cal/cm*/sec should ducing nonthermal effects as well (refs. 4, 15, 20). be considered the maximum. Retinal damage is unrelated, either quantitatively or quali- Skin tatively, to any particular portion of the visible light wave- 1. hizizg r~diztien: As a gmcid ccixideiztion, length band, but it depends merely on the concentration of set the 1-year accumulated dose to the skin below energy incident in this region of the eye. The 0.2 to 2.0 cal/an*/sec limitation as the maximum allowable concentra- 1000 rad at energies less than 100 keV. tion of visible spectrum radiation on the retina is also based This dosage is selected on the basis of clinical experience on present clinical and research experience and Group judg- for a single dose in radiation therapy (refs. 7, 25) : ment. Erythema (hst-degree bum) 200 rad at energies less than 100 keV 4. Infrared radidtim spectrum (0.78 to 6 micron): 400 rad at energies greater than 200 keV The maximum allowable concentration should be Blistering (second-degree bum) 0.2 to 2.0 cal/cm2/sec. 500 rad at energies less than 100 keV Limit for higher energies automatically set by bone At 0.8 micron, 78% of incident energy reaches the retina. marrow exposure limits. At 1.5 micron, 20% of incident energy reaches the lens and 2. 3% reaches the retina. At 3 micron and above, essentially Ultraviolet radiation: Wavelengths below 365 all of the incident energy is absorbed by the cornea. How- millimicrons (refs. 11, 24) should be screened out. ever, the band of greatest biological damage is from 0.8 to Erythemal effect is produced by the wave band from 180 to 1.2 microns. Because tissue damage is dependent on the 315 millimicrons with peak action in the region of 240 and concentration of energy absorbed by the portions of the eye 297 millimicrons. Tanning effect is produced by the wave upon which the infrared radiation is incident, criteria for band from 315 to 400 millimicrons. Antibacterial effect is maximum tolerable exposure of the retina should be essen- produced by the wave band from 180 to 280 millimicrons tially the same as that determined for the visible spectrum. with peak action at approximately 265 millimicrons. Anti- In the absence of determinations for tolerable maximums rachitic effect is produced by the wave band from 180 to 315 of absorbed infrared radiation for the cornea, lens, and vit- millimicrons by the production of Vitamin D in the skin; reous, it is recommended on the basis of Group judgment however, the minimum daily requirement is approximately that the same limitation be used for these tissues as defined one-tent!! the erythemal threshold. for the visible spectrum incident on the retina, 0.2 to 2.0 3. Visible radiation spectrum: cal/an*/sec (refs. 11, 16). Essentially unexplored except in cases of photo-allergy ; other 5. Radiofrequency radiation: The maximum allow- effects are not known. Therefore, in the opinion of the Group, no limitation criteria can be given. able exposure should be determined according to the 4. Infrared radiation: The range from 0.2 to 2.0 following conditions which will modify significantly cal/cm2/sec should be the limit. the effects of microwave radiation: The band from 0.8 to 1.5 microns can penetrate to a depth a. the frequency or wavelength of the generating of 3 cm if sufficient energy is involved. Penetration of n- equipment diation with a wavelength above 6 microns is virtually nil. b. the period of time of exposure in hours, min- In the absence of determinations for tolerable maximums of absorbed infrared radiation for the skin, it is recommended utes, or seconds on Group judgment that the same limitations be used for c. the irradiation cyde rate, referring to the indi- this tissue as defined for the cornea, 0.2 to 2.0 cal/anf/sec vidual ON-OFF periods during a unit time (refs. 11, 24). interval (1 min), when total time of irradia- 5. Radiofrequency radiation: Observe the same rec- tion per minute is kept constant ommendations as those given for the eye. d. air currents e. environmental temperature Bone Mawow f. body weight, type, or mass and covering in re- The ionizing radiation limits should be 150 rad lation to the exposed area as single exposure maximum and 300 rad as accu- 30 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY mulated exposure maximum in a 1-year time period. 3. Quality: In the clinical judgment of the Group, This dosage is selected on the basis of present human expe- the particles should be physiologically inert. rience (refs. 7, 25, 27). The possibility of an "inert" particle absorbing or adsorbing a gas or vapor in concentrations sufficient to induce a toxic Testes reaction should be evaluated. The maximum tolerable limits for ionizing radia- 4. General recommendations: Lint-free fabrics, non- tion are automatically set by those listed for skin and flaking interior surface of capsule, scuff-proof shoe bone marrow. soles, and particle-retaining floor material should be used. Gastrointestinal Tract If the proper precautions are taken before the flight, it prob- The upper-limit for a single dose of ionizing radi- ably would not be necessary to monitor continuously the ation at the midline should be no greater than 100 number and size of particles in the atmosphere. rad. Gaseous Contamination Any dose above 400 rad to the midline of the body is associated with a high probability of inducing nausea, vom- Maximum acceptable or time-weighted mean con- iting, and diarrhea with onset occurring within 4 hours of centrations of exogenous toxic elements and com- exposure. pounds in the air for continuous (24 hours per day) It is extremely difficult to establish a fixed limit below exposure are not available for most toxic agents. which the probability of gastrointestinal symptomatology will be nil since these manifestations of radiation injury are Therefore, an effort should be made to establish susceptible to individual variation, psychogenic factors, such concentrations of the toxic agents most likely combined stresses, and radiation dose and dose rate. to be encountered in the atmosphere of the space- The exposure is set on the basis of present human craft. experience (refs. 7, 25, 27). Threshold limit values of some elements and compounds most likely to be present and to be possible sources of diffi- Ears culty within the spacecraft environment are: antimony, 0.5 mg/cu m; arsenic, 0.5 mg/cu m; beryllium, 0.002 mg/cu m; The maximum noise level at the auricle should cadmium (as oxide fume), 0.1 mg/cu m; chromium (as not exceed 85 decibels total average for all three CrQ), 0.1 mg/cu m; copper (as fume), 0.1 mg/cu m; bands of 300 to 600, 600 to 1200, and 1200 to 2400 copper (as dust or mist), 1.0 mg/cu m; lead, 0.2 mg/cu m; cycles per second. Above this decibel level, ear mercury (inorganic), 0.1 mg/cu m ; mercury (organic), 0.01 mg/cu m; phosphorus (yellow), 0.1 mg/cu m; phosphorus noise guards should be worn (ref. 3). (compounds), 1 to 3 mg/cu m ; zinc (oxide fume), 5 mg/cu In the judgment of the Group, maximum prolonged noise m; carbon monoxide, 100 ppm; chlorine, 1 ppm; cyanide, level at the auricle within the spacecraft should not exceed 5 ppm; fluorine, 0.1 ppm; ozone, 0.1 ppm. Limits for other 55 decibels because of associated hindrance to speed commu- toxic agents which might be present in the atmosphere of the nication. spacecraft also should be considered. Special consideration should be given to the fact that exposures will be to mixtures Atmospheric Contaminants of several substances. Freon contamination should be com- Particulate Contamination pletely avoided (refs. 10, 14, 21, 26). In the opinion of the Group, all materials used in the 1. Size: It is recommended that no spicules larger capsule should be tested under simulated flight conditions than 50 microns in their longest diameter be allowed for the presence of and the kinds of trapped gases and vola- to remain in capsular atmosphere. tile materials as well as volatile deterioration products which This opinion is based on the clinical experience and judg- may be physiologically active. Abnormal atmospheric con- ment of the Group members. ditions should be created with the compounds detected and tested for physiological effect. Additive or possibly syner- 2. Quantity: In the absence of determination for tol- gistic activity of mixtures of compounds should be tested. erance maximums, it is the opinion of the Panel that Testing time for these contaminants should extend over a the number of particulates per cubic meter should time period at least equal to that of the flight duration. not exceed that which will induce ocular surface dis- 2. Aerosols and vapors: Based on its professional comfort or pulmonary ciliary overload. An effort judgment, the Group recommends that, wherever should be made to establish tolerance maximums for practicable, no highly volatile chemical reagents or particles reasonably expected to become airborne in materials should be carried which could contaminate the spacecraft. the atmosphere, e.g. : ammonia, HCI, alcohol, etc. . PHASE I: LIFE SUPPORT RECOMMENDATIONS 31

3. Flatus: A diet should be selected that will pm- ing the drinking water. Carboxylic acid soaps duce little or no gas. should be used for hygiene purposes to facilitate The volume of flatus reportedly varies from 500 ( k 5070) removal in the recycling process. Sulfonated deter- to 5000 (rt 50%) milliliters per 24 hours. The lower vol- gents should be avoided. ume is associated with a milk diet and the higher volume associated with a legume diet. The composition varies and Food generally consists of: Gas % Food to be used in the capsule should not con- co2 8 to 34 tain insecticides, other toxic elements, or microor- Methane 0 to 56 (combustibles other than hydrogen) ganisms in excess of levels which are considered Hydrogen safe by the Food and Drug Administration (refs. iu'iirogru io io 64 The higher percentage of combustible gases is associated 12, 18). Certain contaminants such as antimony, with a legume diet (refs. 1, 2, 8, 13, 22). arsenic, beryllium, cadmium, cyanide, fluoride, lead, 4. General recommendations: The diet should be mercury, and thallium should be mentioned as po- such that a minimum volume of flatus is produced tentially harmful in the spacecraft. A few milligrams from its ingestion. The atmospheric bitration sys- of some of these agents ingested in a single dose or tem should be such that atmospheric contaminants ingested repeatedly could cause toxic effects. It is are prevented from accumulating in the capsular extremely difficult to establish a safe maximum daily atmosphere. intake (expressed as mg/24 hrs) for these elements because the toxicity of each can vary many fold de- Nutritional Contaminants pending on the salt or compound ingested. Water Prevention and Control of Fire 1. Insoluble contaminants: In the opinion of the Group, all abrasive contaminant materiafs such as 1. Nonexplosive atmosphere. particles (e.g. fiberglass) from the storage contain- 2. All clothing should be flash- and fire-resistant. ers or container wall degradation should be avoided. 3. No smoking and no open flame should be al- 2. Soluble contaminants: Based on its professional lowed in the capsule. judgment, the Group recommends that ammonium, 4. No readily combustible materials (e.g., matches) sodium chloride, potassium, and calcium salt con- should be allowed onboard. centration combined should not exceed 100 parts per 5. Explosion-proof circuitry throughout the capsule million. and wire insulation should be fire resistant. 3. Heavy metals, etc.: The maximum permissible 6. Contact surfaces of the capsule interior, clothing, concentration of various elements for potable water and shoes should be conductive so as to avoid static should be taken from U.S. Code, Title 42-Public charge accumulation. Health, if listed therein (ref. 28). 7. Capsule should be compartmentalized so that areas Examples of maximum recommended concentrations of ma- can be walled off by a fire-resistant curtain. terials which might contaminate potable water in the space- 8. Astronaut shouid carry self-contained breathing craft are: arsenic, 0.05 mg/l.; cadmium, 0.01 mg/l.; lead, apparatus with fire-resistant hood for emergency use 0.05 mg/l.; and ffuoride, 1 mg/l. The limits for soluble in case of extensive fire so that the entire capsular salts of other metals such as antimony, beryllium, bismuth, atmosphere can be saturated with nitrogen and mercury, and thallium should be in the order of I mg/l. (expressed as metal). Maximum values for other chemicals flushed overboard prior to replacement. potentially present should be established. 4. Odoriferous contaminants: The concentration of Micrometeoroids such odoriferous materials as H,S or SO, should Fire not exceed 10 ppm (ref. lo). See Prevention and Control of Fire. 5. General recommendations: Supply anion-cation ion-exchange filter and activated charcoal filter for Decompression emergency use in case the water supply becomes The Group recommends developmental research contaminated so that condensate water may be used. and investigation to devise a sealant for capsule A conductivity meter should be available for meter- perforation. 32 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Capsular Fragments (“Shrapnel”) from Impact trum of Keratitis Produced by Ultraviolet Radi- See Clinical Medical Support Panel report. ation. Archives of Ophthalomology, vol. 35, - 1946, pp. 670-677. Safety Contour Design of Capsule Interior and 6. Cronkite, E. P.; Bond, V. P.; and Dunham, Exterior C. L. (ed.): Some Effects of Ionizing Radia- It is recommended by the Group that all sharp pro- tion on Human Beings. U.S. Atomic Energy jections be avoided in the design of the capsular Commission Document TID-5358, 1956. interior and that no unanchored supplies or equip- 7. Davenport, H. W.: Physiology of the Diges- ment be allowed to free-float in the interior of the tive Tract. Year Book Publishers, 1961, p. 206. capsule. 8. Deichmann, W. B.; Stephens, F. H.: Microwave Radiation of 10 mw/cm2 and Factors that Influ- Extravehicular Hazards ence Biological Effects at Various Power Densi- See Atmosphere and Suit Panel report. ties. Industrial Medicine and Surgery, vol. 30, no. 6, 1961, pp. 211-228. Research and Development Prior to 9. Dreisbach, R. H.: Handbook of Poisoning, Di- Launching the ORL agnosis, and Treatment. Third ed., Lange Med- 1. Development of a self-contained emergency ical Publication, Los Altos, Calif., 1961. breathing apparatus for use inside the capsule as 10. Duke-Elder, Sir Stewart: Textbook of Ophthal- protection against atmospheric contaminants. mology. The C. V. Mosby Co., St. Louis, Mo., (See recommendation 8 under Prevention and vol. VI, 1954, pp. 6443-6579. Control of Fire.) 11. Food Additive Regulations and Pesticide Regu- 2. Development of a miniaturized hand-operated, lations, (Summaries of Acceptable Levels and ejection fire extinguisher (e.g., liquid CO,, NP, Tolerances). Food and Drug Administration, or fabric mesh-covered pellet which, when pro- U.S. Department of Health, Education, and pelled against a burning surface, would adhere Welfare, Washington, D.C. and release fire extinguishing gaseous material.) 12. Frees, J. A.: Stomach and Intestinal Gases with 3. Space-based study of fire and its propagation at Description of an Apparatus for their Collec- zero gravity. tion. Am. J. of Phpsiol., vol. 16, 1906, p. 486. 4. Development of a sealant for capsule perforation. 13. Gleason, M. N.; Gosselin, R. E.; and Hodge, 5. Development of a closed-circuiting mechanical H. C.: Clinical Toxicology of Commercial device which would fit tightly against the skin Products. Williams and Wilkins, Baltimore, and could be moved over it in order to cleanse 1963. the surface of the body with a cleansing solution 14. Gunn, A,; Gould, T. C.; and Anderson, self-contained within the washing device. W. A. D.: The Effect of Microwave Radiation on Morphology and Function of Rat Testis. References Laboratory Investigation, vol. 10, no. 2, 1961, I. Alvarez, W. C.: Introduction to Gastroenterol- pp. 301-314. ogy. Hoeber, Inc., New York, 1940. 15. Langley, R. K.; Mortimer, C. B.; and McCul- 2. Baldwin, M.: The Effects of Radiofrequency lich, C.: The Experimental Production of Cat- Energy on Primate Cerebral Activity. J. Neurol., aracts by Exposure to Heat and Light. Archives vol. 10, Feb., 1960, pp. 178-187. of Ophthalmology, vol. 63, 1960, pp. 473-488. 3. Basch, S.: The Stomach and Intestinal Gases. 16. Merriam, G. R.; and Focht, E. F.: A Clinical N.Y.Med. J., vol. 8, 1908, pp. 684-738. Study of Radiation Cataracts and the Relation- 4. Cogan, David G.: Symposium on Ocular Ef- ship to Dose. Am. J. of Roentgenology and fects of Ionizing Radiation and Radiotherapy; Radiation Therapy, vol. 77, 1957, pp. 759-785. 0 Transaction of the American Academy of Oph- 17. Official FDA Tolerances, Nat. Agric. Chem. thalmology and Otolaryngology, vol. 63, July- Assoc. News and Pesticide Rev., vol. 20, no. 3, August 1959, pp. 429-432. Feb. 1962. 5. Cogan, D. G.; and Kinsey. V. E.: Action Spec- 18. Ogilvie, J. C.: IJltraviolet Radiation and PHASE I: LIFE SUPPORT RECOMMENDATIONS 33

Vision. Archives of Ophthalmology, vol. 50, logical Hazards of Microwave Radiation, 1957. 1953, pp. 748-763. Rome Air Dev. Center, 1960. 19. Paff, G. H.; Boucek, R. J.; Neiman, R. E.; and 23. Rees, Ress B.: Dermatoses to Environmental Deichmann, W. B.: The Embryonic Heart Sub- and Physical Factors. C. C. Thomas, Spring- jected to Radar. The Anatomical Record, vol. field, Ill., 1962. 147, no. 3, 196, pp. 379-386. 24. Saenger, E. L., ed.: Medical Aspects of Radia- 20. Patty, F. A., ed.: Industrial Hygiene and Toxi- tion Accidents. U.S. Atomic Energy Commis- cology, Second ed., Interscience Publishers, New sion, U.S. Government Printing Office, Wash- York, vol. 11, 1963. ington, D.C., 1963. 21. Pogrund, R. S.; and Steggrudas, F. R.: Idu- 25. Threshold Limit Values for 1963. J. Occup. ence of Gaseous Transfer between the Colon Med., vol: 5, 1963, p. 491. and Blood Streams on the Percentage Gas Com- 26. U.S. Atomic Energy Commission, Proceedings position of Intestinal Flatus of Man. Am. J. of the Symposium on Protection Against Radia- Physiol., vol. 153, 1948, p. 475. tion Hazards in Space, Books 1 and 2, AEC 22. Proceedings of Tri-Service Conference on Bio- TID-7652, 1963.

CLINICAL MEDICAL SUPPORT

Life Support Factors varied depending upon his medical background, the responsible crew member should be briefed Flight Crew Medical Selection regarding this prior to a mission. The following recommendations are made for 3. A medical chest with drugs and supplies should flight crew selection: be available for symptomatic treatment or spe- 1. Since the avoidance of illness is best achieved by cific therapy of diseases likely to be encountered prevention, a rigorous program of selection such as: should be set up. a. respiratory illness 2. In the selection process, every attempt should be b. urinary infections and stones made to bring to light a predisposition to both c. gastrointestinal disturbances such as mucous functional and organic illness which may inter- colitis, gastritis, peptic ulcer, or diarrhea of fere with in-flight performance. Among these infectious or other origin are susceptibility to motion sickness, seizures, ab- d. cardiac arrhythmias normal behavior, functional bowel disturbance, e. disturbed emotional state allergies, migraine, Meniere’s disease, gall blad- f. aspiration of foreign body der colic, and kidney stones. g. minor trauma h. burns 3. Excellent history taking is extremely important i. foreign body in the eye in this regard. The use of galvanic skin reflex 4. Drugs used aloft should, if possible, have been apparatus in this activity is suggested in an at- tested in situations with similar atmospheric tempt to validate the responses. conditions. 5. A microfilm reader describing diagnosis and Illness and Injury Among Crew Members treatment of such disease would be especially 1. A physician is desirable as a crew member and important to include in the absence of a physi- essential in conducting physiological or medical cian for compiling data for transmission to a experiments. In the absence of a physician aloft, medical monitor on the ground. one crew member should have medical experience 6. The following suggestions are made with re- in handling emergencies. gard to the return of ill crew members to earth: 2. Illness of a short term or minor sort may be a. minor or short term illness should remain I treated aloft. Appropriate to the facilities and aloft 34 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

b. serious illness should be returned to earth: 7. Radiation: (1 ) if something can be accomplished a. Environment: Methods and location to be there decided. (2) if the patient can withstand re- b. Hazard: Solar flare warning system to be entry. The hazard of reentry should decided. Onboard as well as ground-based be balanced against the benefits to (refs. 1, 2, 9) detection facilities are re- accrue. quired inasmuch as ground-to-spacecraft com- c. every attempt should be made to diagnose munication will be intermittent. early and return to earth before a state develops that would prevent the trip. Suit 7. In the design of the capsular interior, all sharp The following recommendations are made for suit projections must be avoided and no unanchored monitoring: supplies or equipment should be allowed to free- 1. Inlet temperature, circulation, partial pressure float in the interior of the capsule. oxygen, and carbon dioxide: Should be moni- 8. The danger of a shrapnel effect from microme- tored and, within limits of feasibility, teleme- teoroid penetration should be investigated prior tered during launch and reentry. Decisions here to flight. If the danger does exist, adequate pre- are still to be made. ventive measures must be developed. 2. Relative humidity: Should be monitored but 9. If death occurs, the body should be returned need not be telemetered. immediately to earth or preserved for autopsy at 3. Extravehicular circumstances: Methods to be a later date. decided. Monitoring Fitness of Astronauts Medical Safety Monitoring The need for monitoring the nzedital and pro- For detailed discussion of medical safety moni- fessional fitness of the astronaut during different toring, see the Appendix at the end of Phase I. stages of flight is discussed in the detailed report attached. On the principle that group safety takes Monitoririg of the Environmeizt* precedence over individual safety, it is concluded Cabin that a launch abort cannot be justified on the basis If the cabin is compartmentalized, these recom- of medical unfitness restricted to one astronaut; mendations apply to all compartments. hence, monitoring physiological parameters during 1. Pressure (CD# and GT**): A fall in pres- launch must be justified mainly on other grounds. sure below normal range should activate auditory It is further concluded that in orbital flight the big and visual signals. problem centers around the professional and medi- 2. Wall temperature (CD and GT): Fire warning cal fitness of the astronaut for reentry. The impor- system to be decided. tance of taking advantage of “naturally occurring 3. Atmosphere: (Partial pressure oxygen and car- opportunities” aloft, including the use of the astro- bon dioxide, temperature, and relative humid- naut as a “biological sensor,” is emphasized. It is ity.) CD and GT launch and reentry. A “sig- assumed and advocated that one crew member will nificant” deviation from the normal range should be a physician. activate a visual signal to astronaut on watch. For launch and reentry periods, see the detailed 4. Atmospheric contaminants (CD) recommendations. The question of “representa- 5. Circdation of air (CD): Failure should activate tive” monitoring of physiological parameters on one a visual signal to astronaut on watch. or two astronauts is still to be answered. 6. Force environment (GT) For the orbital period, there should be: (1 ) Daily evaluation and reporting of astronaut’s ‘Onboard intercommunication (voice and video) and maximal in- fitness. (See suggested form in detailed report.) tercommunication spacecraft and ground station are assured. Emphasis is placed on the value of serial measure- #CD: continuous onboard display. **GT: spacecraft to ground telemetry. ments as indicators of early trends (ref. 3). - - ~~ . PHASE I: LIFE SUPPORT RECOMMENDATIONS 35

. (2) Weekly evaluation (see form). A provocative 2. As space flight experience accumulates, a care- test for physical fitness is emphasized. ful check should be maintained of our experi- (3) Bimonthly evaluation (see form). A medical ence with illness and drugs in space. examination and provocative test of professional fit- 3. Continued surveillance should be made of meth- ness is emphasized. ods used for flight crew medical selection so that they can be constantly evaluated and improved. Supporting Personnel 4. Evaluate methods of medical safety monitoring It is suggested that one or more “assistants” be during parabolic flight to determine feasibility charged solely with the assignment for medical of their use in a weightless environment. .. safety mon!tnrr_n,o. n-is wndd icYn!ve settin.*a ’an-r 5. Simdatiiin siiidies are recijmmnded. a plan and assigning values to stresses and proba- a. They are required to devise and validate test bility values to risks. This plan would undergo con- batteries for medical and professional fitness. stant revision in terms of the great amount of new Here the emphasis should be on prolonged information becoming available and the changing confinement (ref. 7) rather than simulation requirements in terms of how safety monitoring in- of weightlessness. terdigitates with plans dealing with other aspects of b. They are required to obtain background in- the mission. formation on prospective crew members under the most realistic simulated conditions Anirnds possible. The possible use of animal subjects as biological c. Weightlessness simulation studies are re- indicators deserves consideration. quired to identify the most important physiological parameters indicating loss of fitness Research and Development Prior to (refs. 4, 6, lo). Launching the ORL 1. Constant surveillance for more sensitive and more Space Flight Experiments Prior to predictive methods to be incorporated into crew Launching the ORL. selection procedures. 1. The items noted in the clinical test battery for 2. Investigation of the effect of transfusion of surveillance of astronaut and environmental fit- plasma or blood on man under zero G conditions. ness should be tested in actual space flight Susceptibility may change with loss of circula- aboard Apollo or MOL vehicles during their tory reflexes. manned missions. This would be of great value 3. Research and development concerning in-flight toward establishing their validity and ease of detection of atmospheric contaminants. accomplishment. 4. The development of methods enabling the prompt detection of solar flares and means of References transmitting this information from ground-based 1. Bailey, D. K.: Abnormal Ionization in the stations to spacecraft. Lower Ionosphere Associated with Cdsmic-Ray 5. The development of a prompt fire warning Flux Enhancements. Proc. I.R.E., vol. 47, 1959, system. pp. 255-266. 2. Bailey, D. K.: Time Variations of the Energy Ground-Based Experiments Prior to Spectrum of Solar Cosmic Rays in Relation to the Launching the ORL Radiation Hazard in Space. J. Geophys. Res., 1. The Occurrence of untoward reactions to all of vol. 67, 1962, pp. 391-396. the medications included in the medical chest 3. Birkhead, Tu’. C.; et ai.: Cardiodynamic and should be predetermined for all crew members Metabolic Effects of Prolonged Bed Rest. AMRL and notations made and alternate medications in- TDR 63-37. Wright-Patterson AFB, Ohio, cluded. Any special effect of the ORL atmos- 6570th Aero. Med. Res. Lab., 1963. phere on drugs contained in the medical chest 4. Burns, N. M.; and Bursack, W. W.: Bioastro- should also be predetermined. nautics Program Plan. SD 2 11, Minneapolis, 36 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Minn., Honeywell, Aeronautical Division, 1964. Feb. 11-14, 1964. Lofters, J. P.; and Hammer, L. R.: Weightless- 8. Schaefer, H. J.: Time Profile of Tissue Ioniza- ness and Performance. A Review of the Litera- tion Dosages for Bailey’s Synthetic Spectrum of ture. ASD TR 61-166. Wright-Patterson AFB, a Typical Solar Flare Event. BuMed Project Ohio, Aeronautical Systems Division, 1961. MR005.13-1002 Subtask 1, Rept. No. 22, U.S. Manned Environmental Systems Assessment Naval School of Aviation Medicine, Pensacola, (MESA). NASA-Sponsored Project, Seattle, Fla., 1962. Washington, Boeing Company, 2 March-1 April 9. The Manned Orbiting Laboratory Team: A Pro- 1964. gram for the Study of the Effects of Prolonged Manned Orbiting Laboratory Meeting. Air Weightlessness on Man. NASA, Ames Research Force Systems Command, Los Angeles, Calif ., Center, Moffett Field, Calif., July 1963.

Appendix to Phase I MEDICAL SAFETY MONITORING Preparatory: During this period, vital serial base- Medical safety monitoring is defined as the provi- line measurements on the astronauts are obtained sion of information throughout a mission to ensure, for future comparison under resting, provocative within an acceptable risk, the return of the astro- testing, and simulated flight conditions. nauts in good health. In tackling the problem in Countdown: Monitoring physiological parame- advance of the final “deadlines” when all flight ters when it is still possible to delay takeoff and re- parameters are known and the latest flight experi- move the astronauts without risk requires different ence is available, it is important to reach agreement “tolerance limits” or standards than at later stages of on the general concepts underlying safety monitor- flight. ing in order to “update” tentative recommendations Power Phase (when frescape” or “abort” entails a with the necessary facility. Accordingly, a limited risk): At time of launch, the astronauts are demon- analysis of the problem is outlined from which may strably at peak fitness, and it is almost inconceivable be drawn certain generalities. that any diagnosis based on medical information ob- Three important guidelines have been followed : tained on an astronaut during this phase would jus- (1) parameters of the flight insofar as they have tify an abort with its conseqeunt risk to the entire been defined, including six months’ exposure to group. weightlessness; (2) group safety takes precedence Orbit over safety of an individual; and (3) the safety information coverage is for one flight with little or no In orbit, three periods might be defined: regard for subsequent flights in the program. Transitional: Experience suggests that the transi- The analysis is considered from two related stand- tional period will be well tolerated and that it will points: (1) the astronaut at different stages of not last long. The astronauts should remain suited flight and (2) the classes of phenomena to be mon- during the transitional period and until the Life itored and their relative significance. The astro- Control Systems have been checked out. There- naut is at once a person with safety tolerance limits, after, whether the astronaut on watch should remain an essential element in flight systems and operations, suited to cope with an emergency is a matter to be and an active or passive biological indicator. The decided on a “probability-of-occurrence” basis. The three important stages of flight center around launch, need for continuom monitoring of the astronaut on orbit, and reentry. watch, whether in or out of the suit, is hardly justified on his use as an indicator of hazard or danger. The Astronaut at Different Stages of Flight Intermediate: Safety monitoring during the inter- Launch mediate period has daily, weekly, and bimonthly Launch is further subdivided into three periods: requirements which may vary depending on needs. ~

PHASE I: LIFE SUPPORT RECOMMENDATIONS 37

It may be assumed that the risk will increase as a Enlilronmental Fartors function of time in orbit even if no significant ef- Environmental factors have been subdivided into fects appear ascribable to weightlessness. We can “hazards” and “known stresses.” A hazard is de- only speculate on which organs and systems may be fined as a stress which has only a probability of significantly dected by zero G. At any given time, occurrence while, inevitably, known stresses will fitness far reentry is more critical than fitness to have to be borne. Six principal hazards have been carry out the tasks aloft; hence, safety monitoring in considered : orbit has as its main objective safe return to earth. 1. Malfunction or failure of Life Control Sys- Whether the astronauts should be fit at all times for tems. Continuous monitoring of environmental reentry or whether special conditioning in the pre- parameters nf rpacwraft 2nd suit, whcx worn, descent period should be relied upon will be decided, provides not only the early warning signal to in- in part, by reliability of LCS and, in part, by stitute countermeasures but also is tantamount to experience. “diagnosis” in predicting effects on the astronaut. Predesrent: The predescent period, unless short- This is the most important area in safety moni- ened by emergency, should provide ample time to toring. Using the astronaut as an “indicator” is conduct refresher training, which will also serve as a secondary, but poor, line of defense and useful a performance test, and to evaluate general fitness. only in instances of minor malfunctions. A critical decision may arise as to whether to use 2. Monitoring the force environment during “unusual” procedures to temporarily increase astro- launch and reentry is not regarded as part of naut fitness and whether special provisions (such as safety monitoring; however, the probability of reducing elapsed time to pickup) should be made hazards incidental to a tower escape or launch on the ground for the return of a sick or injured abort or an impact during the reentry period and astronaut. survival is related to astronaut fitness. It is assumed that one astronaut in the ferry vehi- 3. The identification of possible contaminants cle may ride as “passenger.” in atmosphere, water, food, et cetera, represents a difficult and partly unsolved problem which Reentry overlaps the considerations of the Panel on Haz- ards. Because of the difficulties in recognition, A comparison of the situation at launch and a second defense line is needed, namely, diag- reentry points up dramatic differences, Takeoff may nosis of their effects on the astronaut. Medical be delayed indefinitely until all systems and all toxicology, which is never easy, is doubly difficult astronauts are “go,” whereas reentry is obligatory under conditions aloft. within a specified time period. Prior to launch the 4. If there is a need for early recognition of astronauts are superbly fit when subjected to “full geomagnetic storms and relativistic flares, the lat- simulation” tests, whereas at reentry they are not ter, at least, should be monitored aloft. only less fit but “full simulation” tests may not be 5. Meteorites deserve special attention in terms feasible. There is opportunity for abort during of varying probabilities of hits under special astro- launch but minimal opportunity during reentry. nomical conditions and the need for one astronaut Finally, launch ends in the comfortable lap of to be suited at all times to cope with emergencies. weightlessness while reentry ends in impact with 6. Survival hazards after impact cannot be survival hazards in prospect. monitored per se, but the most likely stresses should be considered in terms of astronaut fitness. Classes of Phenomena The known environmental stresses fall into two In discussing “classes of phenomena to be moni- categories, namely, those whose effects on the astro- tored,” two main categories will be considered: naut are: (1) known or (2) unknown. (1) environmental factors and (2) the astronaut. 1. With regard to “known effects,” it is irnpor- It is assumed that communications between space- tant to correlate the stress profile with the effects craft and ground control will provide a full ex- to determine if there is an unusual response. change of information at monitoring stations. 2. Weightlessness is a “known” stress with 38 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

“unknown” effects. Prolonged exposure to the results of simulation studies using bed rest and ’ weightlessness should be monitored in terms of water immersion, suggest that, in the absence of inertial forces generated by the astronaut, re- countermeasures at least, special attention should be straints which counter the effects of weightless- given to fluid electrolyte balance, reduced blood vol- ness, and, possibly, librational forces, inasmuch as ume, nitrogen loss, loss of endovascular control, dis- their long-term effects may be important. Inso- turbances in vision, sleep, and psychomotor re- far as measurements on the astronaut are con- sponses, muscular asthenia and fatigue, and possibly cerned, high reliability and good validity take personality changes. precedence over feasibility, since it is better to The effects of prolonged weightlessness, possibly forego a test than interpret an erroneous value. involving cellular and subcellular systems, might not In addition to telemetered items, medical fitness give rise to familiar syndromes or illnesses, hence forms which should be filled out daily are pro- might be misdiagnosed, at least with respect to eti- posed for use aloft. The three forms are similar ology and the time course of the effects in terms of except for the inclusion of additional items at adaptation or progressive deterioration. This points one-weekly and four-weekly intervals. up the need for “undirected” monitoring. It is considered that monitoring the long-term effects of The AJtronaut weightlessness is not critical over short periods of Monitoring the astronaut falls into two main cate- time and therefore need not be continuous. gories: (1 ) detection of physiopathological effects, Monitoring astronaut fitness for space flight ac- and (2) evaluation of fitness. Fitness may be con- tivities deserves the most careful and detailed considered under two headings, spontaneous illness and sideration. It has important relationships with the weightlessness. monitoring of environmental factors and astronaut Spontaneous occurrence of serious diseases, while health. Monitoring astronaut fitness in orbit has unlikely in young persons over relatively short pe- limitations in terms of comparability with ground- riods, cannot be neglected. The possibility of cer- based data, test equipment, and the condition of the tain injuries, infections, and functional disorders astronaut at time of testing. This suggests that would seem to be slightly greater in weightlessness every element in fitness testing aloft be considered than under ordinary conditions. Accurate diagnosis from the standpoint of prior ground-based testing is the basis for proper therapy, and early diagnosis which would serve a useful purpose. As pointed may be important for safety if the astronaut could out earlier, since fitness for activities in orbit is not be treated aloft. less demanding than for reentry, this should serve Weightlessness is the great independent variable as the reference criterion for validating fitness tests. around which the first ORL flight will be centered. Fitness for reentry falls into two categories: (1) It is essential to be on the watch for beneficial as fitness to withstand the environmental stresses and well as harmful effects. American and Russian ex- perform the work incidental to survival after impact perience points to an initial period of adaptation and (2) fitness to carry out the professional astro- with respect to major bodily systems. nautical tasks while undergoing the stresses. Fit- The Russian experience suggests the possibilities ness testing may be specific or nonspecific (per- of vestibular sickness, first stage heart block, and formance or nonperformance). Every effort should prolongation of mechanical systole; nearly every- be made to take maximal advantage of the astro- thing else is speculation, including the possibility of naut’s activities aloft with regard to their value in disturbances in vision and sleep. The American ex- estimating fitness for recovery. Simulation of the perience must be interpreted in the light of physical astronaut’s professional tasks on reentry and haid restraints and multiple stresses. Restraint would physical work should be feasible. The fact that have greatly lessened the tendency to vestibular simulation of the force environment on reentry and symptoms, and it is possible to account for the transition from weightlessness to one G may not be symptoms experienced or manifested on factors other feasible points up a critical deficiency. than weightlessness. The findings from Project If an astronaut should become unfit for reentry in Mercury, nevertheless, when considered along with the conventional manner, such a decision would PHASE I: LIFE SUPPORT RECOMMENDATIONS 39 necessitate his return as a “passenger” with the aid cumstances and especially in terms of any important of unconventional procedures. action to be taken.

Tolerance Limits S-rY Arbitrary “tolerance limits” may be misleading The foregoing remarks may be briefly summarized unless qualified. With regard to environmental as follows: Safety monitoring fails into two main parameters, “tolerance” may be exceeded with the categories, environmental factors and astronaut pa- appearance of a contaminant which may have little rameters. With regard to the former, monitoring or great effect on the astronaut over the same pe- malfunction or failure of LCS, which begins prior riod of time. Trends may appear before “tolerance to takeoff and ends after impact, represents the most limits” are approached. With regard to the astro- critical need. With regard to the astronaut, the naut, tolerance limits may refer to “comfort,” “in- problems incidental to launch and orbit are not as efficient,” or “disability” zones, and time is an im- cirtical as those of reentry. Evaluation of astronaut portant dimension. For example, in a healthy per- fitness for reentry at periodic intervals is essential son over a six-month period there is no upper tol- and, in addition, early recognition of symptoms or erance limit with respect to blood pressure per se; manifestations which might eventuate in “unfitness” however, there may be if it is used as an “indicator,” will provide invaluable lead time. and here the circumstances become important. The The following forms were developed as prelim- point to be made is that tolerance limits as usually inary guidelines for developing appraisals of on- presented may require interpretation in terms of cir- board physical evaluation techniques. 40 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

C -.e E

d PHASE I: LIFE SUPPORT RECOMMENDATIONS 41

DAYS 7 AND 21 OF EACH MONTH

Body weight centrifugal or best substitutes

Times V. C.

Flack

Submaximal exercise with chest lead Vq.

ECG alterations

Max. heart rate

Recovery time (min) heart rate

Symptoms: Pain ; Palpitation 9

Dyspnea ; Fatigue

DAYS 14 AND 28 OF EACH MONTH

Medical Examination:

Laboratory

Blood. Morph. Eosinophile Ct.

Hematocrit: B1. vol. or best substitute

Urine: Glucose Proteins

Bilirubin Ketones

Stool: Gross abn. Occult. bl.

Estimation of Fitness for Reentry:

Prof. qualif. : simulation test.

Hard work substitute capacity test for submaximal exercise test.

High -G load: simulation or best substitutes.

1-G Load: simulation or best substitutes. 42 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY MONITORING EVALUATION

Tolerance limits Comments

Gravitational Inertial force Known "Profile should be available"

Astronaut Tele- Ground- In-flight Item Tolerance limits meter* based experience Comments effort required required 1 Suit: Much reliance should be General Inlet temp. 7 75"(60-100 range)for short periods C Inlet humidity 10 mm Hg -r 3 G C

02 >160 mm Hg min. C COa 10 rnm Hg: higher for short periods C Circulation On- off signal C Physiological: S - C intercom Voice ground Launch and reentry C Orbit P I m., T I I Not essential Resp. C Essential count down ECG Acute cardiac incident c Essential count down BP Shock levels P Essential count down 1 Great advantage with con- Body temp. I Unexplained rise >5" F (1.5" C) tinuous rect. iemp. during 1 lcI count down I I I I * C: continuous; P: periodic. PHASE I: LIFE SUPPORT RECOMMENDATIONS

ONBOARD EXPERIMENTAL DECISION GUIDELINES

(Daily) Name or initials Date Hour

Experiments required

Tolerance limits*+ Recommendations or Item* comments*

A=<4 A=dec >1inc >2

Physical

Est. of performanc A = <4 A = dec >1 OBAI Prof. tasks

4ny drugs other All drugs in chest should than vitamins Yes be tried on each astronaut for (1) idiosyncracy and (2 influence on tasks

byindication of Illness Matter of judgment

Disorder

OBAI

Sleep A=<4 24 hr total b. = progressive dec >2 or inc >2

A inc or dec > 3 if unexplai.net

Discrepancy with tolerance limits

*OW onboard action items; GBO: ground-based observer. **A: tolerance limits; A: change or trend. ***Based on 10-point score: 5 =usual; 10 = best score. #Based on load/time/accuracy: 10 = best; 5 = usual; 1 = worst score. ##Same for all days except every 7th and 14th of each month. ###lo = fit; 1 =unfit. 44 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY (Dailv cont. Experirr s required Ground- Space- Recommendations or Tolerance limits** based flight comments* exper. exper.

Sleep, cont. Insufficient Discrepancy with tolerance May be OBAI limits

Mental Bored .------_- - - - -

Irritable OBAI ?

.------

Concerned (anxious) OBAI

Physical restlessness OBAI ?

Headache OBAI

Ocular abn. OBAI

Visual disturbance OBAI

Abnormal sensc of smell OBAI

Abnormal OBAI

Tinnitis OBAI

Vertigo OBAI

1 GI Food Ate all- %-ratio] PHASE I: LIFE SUPPORT RECOhiMENDATIONS 45 (Daily cont.) Experir 5 required Item* Tolerance limits** Grourd- Space- based flight Recommendations or exper. exper. comments*

GI Appetite, cont.

Fair Good to fair mained 23 ----_-__-_____ ----__days-- __-______-_ -___ -

Poor Fair to pr>2 days Good to poor >lday - _------___

Indigestion >1 - 2 days depending on severity OBAI Trend progressive 3 days even if slight ------_--____-______

Baseline

OBAI

. .

c-v Dyspnea 46 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY (Daily cont. ) Experimenl required Ground- Space - Item* Tolerance limits** based exper.

G-U cont. Pain - _ ------Burning

OBAI

Skin Possible OBAI Abn . Sweat Inc day Possible OBAI Abn . Inc night OBAI

Fatigue*** Unexplained Possible OBAI

Other comments

I OBAI Oral temp. Inc 1.O"F

Dec any day 30% OBAI Inc 10 under controlled cir. rOBAI PHASE I: LIFE SUPPORT RECOMMENDATIONS 47

(Daily cont.) Experimt I required Item* Tolerance limits** Ground- Space- flight Recommendations or based comments* exDer. exper.

RR 1 inc 25%unexplained OBAI , I I I General appearance

Color

Performance Scores: prof. Dec trendZO% 48 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY SUPPLEMENT TO DAILY FORM FOR DAYS I AND 21 OF EACH MONTH

Experiment aquired Ground- Space- Recommendations or Item* Tolerance limits** based flight comments* exDer. exper.

Body wt. (centri- A+ 15% Yes Yes OBAI fugal or best substitute)

Respiratory Timed vital Yes capacity Status of volume velocity loop ------Calibrated Yes Valsalva maneuver (Flack test)

Heart 1- Submaximal ex Yes Yes Equivalent to 3-min ercise with modified Harvard chest lead V4 until heart Step test rate stabilize,

ECG alterations Zoronary disturbance evidence :oronary heart disease, bundlc ranch block I------I Max. heart rate [nc 10 - 15% Yes Recovery time (rnin) heart rate ------Symptoms Pain I Undue dyspnea ~

PHASE I: LIFE SUPPORT RECOMMENDATIONS 49 SUPPLEMENT TO DAILY FORM FQR DAYS 14 AND 28 OF EACH MONTH

Experil . required Item* Tolerance limits** Ground- Space- Recommendations or based flight comments* =Per. exper. General physical medical evaluation

~ Laboratory Blood Morph.

Eosinophile count

Hematocrit

Blood vol. or best substitute€

Stool Gross abn.

Occult bl.

Tst. of fitness for reentry

Prof. qual. Yes Yes Simulation test

- --___-______Substitute capacity tes for sub-max. exercist test ------_-______Simulation or best substitutes _-_-__-___-_---___ 1-G load Simulation or best substitutes .

phase ZZ

INFLIGHT MEDICAL EXPERIMENTS FOR ORL spamag panels

Neurological and Psychological Functions Dr. Baldwin Dr. Buesseler Dr. Graybiel Dr. Kubis Dr. McFarland Dr. Reitan Dr. Townsend

Circulation and Respiration Dr. Carlson Dr. Forster Dr. Natelson Dr. Schmitt Dr. Warren Dr. Wood

Digestive, Metabolic, Endocrine, Thermoregulatory, Neuromuscular, Skeletal, Fluid and Electrolyte, Renal, Reprodudive, Hematological, Immunological, and Cellular Functions Dr. Gordon Dr. Knoblock Dr. Pollack Dr. Swisher Dr. Whedon

Consultants to All Three Panels Dr. Deichmann Dr. Grahn PHASE 11

NEUROLOGICAL AND PHYSIOLOGICAL FUNCTIONS EXPERIMENT1

1. EE6 Changes During Arousal and Drowsing Records: A record should be made for a 2. Estimated Priority minimum of 15 minutes on each man during Priority 2. each phase of his W-R-S cycle. 3. Purpose 6. Experimental Controls To observe EEG changes during the phases of Men will serve as their own controls. Repre- the work-rest-sleep (W-RS) cycle. sentative records could be taken on the ground 4. Justification before flight and presumably a comparable se- From prior ground-based experiments, it seems ries after recovery. clear that there is a continuum of EEG pat- 7. Summary of Number and Types of Space Sta- terns which relate to levels of alertness and tion Personnel drowsing. Under the unusual conditions of the Number will be determined by total in-flight manned space flight system, peculiar work-rest- personnel status rather than by experimental sleep (W-R-5) cydes may be imposed. There- requirements. fore, it is extremely important to monitor levels 8. Summary of Onboard Experimental Equipment of alertness and concomitants of drowsing in Required order to increase understanding of these cycles As noted in 5b, helmet application of scalp aloft. The problem of adjustment from a 24- electrodes in standard symmetrical 8-lead pat- hour pattern to the cycles aloft has not yet been terns, with transistorized or other packaged re- solved. cording equipment, preferably with telemetering 5. Experiment capability. Hypothesis: Each member of the flight crew 9. Summary of Animals will have patterns of EEG activity typical of None. alertness or drowsing, and, if these are analyzed 10. Summary of Other Living Forms in sequence of real time, a continuum can be None. established. Such observations should be corre- 11. Summary of Onboard Luboratory Determinations lated with relevant psychological and other A 15-minute sample from each man during each physiological experiments which are outlined phase of his W-R-S cycle. elsewhere in this phase. 12. Summary of Laboratory Specimens to be Flown Materials: 8-channel EEG system with “hel- to Earth for Laboratory Exmination met” scalp electrode holders for ready applica- None. tion. Telemetering capability is desirable. A 13. Proposed Rendezvous Scbedule for Rotation of considerable instrumentation development is also Crew required in order to package satisfactorily for Not related to present experiment. %ight. 14. Telemetry versus Onboard Recording Require- Subjects: The idight personnel. ments

53 54 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Telemetry is desirable although not essential. 19. Repirement for Rotation for Artificial G 15. Prerequisite Ground-Based Experiments None. Analysis of EEG patterns according to the 20. Comments re Form of Data and Interpretation of Lindsley schedule on all subjects. The preflight Data data should include records to gravitational Data should be in such form as to provide for stresses and isolation and, if possible, in-flight visual, wave form, and frequency analyses. simulation conditions. 2 I. Special Comments 16. Prerequisite Space Flight Experiments None. None. 22. Postflight Evaluation of the Crew 17. Prerequisite Research and Development Postflight evaluation will consist of EEG rec- Development of helmet, EEG lead, electrode ords taken under preflight conditions. holder and cabling system, as well as packaged 23. References EEG equipment with telemetering capabilities. Lindsley, D. B. : Psychological Phenomenon and 18. Onboard Gaseous Atmosphere Desired the Electroencephalogram. Electroencaphalog. and Sea level equivalent. Clin. Neurophysiol., vol. 4, 1952, pp. 443-456.

EXPERIMENT 2

1. The Effects of a Rotating Environment on Man 5. Experiment in Space Flight Assumptions: In the following experimental 2. Estimated Priority design, it is assumed that the rotating ORL will be capable of generating a centripetal force Priority 1. of approximately one G unit in magnitude and that 3. Purpose a counter-rotating facility will permit experi- To determine the level of “artificial gravity” mentation in weightlessness. At stations be- needed to maintain astronaut fitness, on the one tween the “core” and periphery (or at varying hand, and minimize or prevent the side effects velocities of the spacecraft), subgravity condi- of a rotating environment (difficulty in walking, tions would prevail. If this range is not avail- illusions, and canal sickness), on the other. In- able, the experiments can be tailored accord- sofar as feasible, advantage should be taken of ingly. Although a single “set” of environ- the unique opportunity to study man’s intrinsic mental conditions may subserve three cardinal and extrinsic behavior as a function of subgrav- purposes, namely, (1) to determine the one ity levels of gravitoinertial force. ideal force environment to preserve fitness, (2) 4. Justification to validate ground-based experiments, and (3) Design engineers will require human perform- to determine the “tolerance envelope,” the main ance data to determine the configuration of a emphasis will be placed on the last inasmuch as rotating spacecraft and some of its operational it may prove to be the limiting factor in space- characteristics. If the rotating ORL under con- craft design for the near future. sideration is the first of its type, these “data” Subjects: The astronauts or “space crew” for must be obtained from ground-based experi- the rotating ORL should be selected on the ments. Investigations aloft are needed to “per- basis of (1) previous experience in space flight, fect” the design of “second generation” rotating (2) low initial susceptibility to stress in rotat- spacecraft. A very important phase of this uni ing environments, (3) ability to adapt or habit- dertaking is to determine the validity of ground- uate as manifested in training procedures, and based experiments in order to minimize the (4) general suitability as subjects or experi- need for investigations of an applied nature menters. The assessments covering medical, aloft. New information of considerable value physiological, and psychological factors should should be obtained. be intensive and extensive, during the course of PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 55 which the subject should demonstrate a good Procedures: These fall into four categories: understanding of the underlying mechanisms, the a. Measure the time course of adaptation to technical procedures, and his responsibilities as the force environment in the main portion of a subject or experimenter in flight. At the end the spacecraft and compare with the findings of this experiment NAVSCOLAVNMED 6500/ obtained from subjects at other stations. It is 24 is the Preflight Vestibular Evaluation form expected that the astronauts, having been care- from the Navy school of Aviation Medicine. fully prepared, will not be affeaed to a si@- The Force Envkonments: The force uwiron- cant degree. Nevertheless, the force environments as represented by the vector sums of the ment will be different from anything they have forces generated by vehicie and subject wiii have rxyrririiced picvioudy, and f;rC?cis d.ki &ian been carefully estimated prior to going aloft on the force environment may influence the the basis of measurements made in the labora- symptomatology. tory. Nevertheless, it would be essential to re- b. Exploration studies utilizing the independ- peat, insofar as feasible, the measurements in ently rotating center portion of the space- actual flight and determine the dynamic effects craft and a litter-chair which should be capa- in terms of stimulation of vestibular organs. ble of rotating, when desired, either clock- The beneficial forces would be represented wise or counter-clockwise up to 60 rpm with mainly by centripetal force and possibly Coriolis controllable levels of acceleration. force, while the disturbing forces would be rep- (1) Definition of the “symptom or toler- resented by the multiplanar angular accelerations ance envelope” covering angular velocities affecting the semicircular canals, the Coriolis greater than that of the ORL. With some forces, and the changing gradients of gastro- reservations, involving Coriolis accelera- intestinal forces as the subject moves about the tions, the data obtained would be valid to spacecraft. rotating environments with greater radii. Apparatus: It is assumed that the ORL will The apparatus described in Experiment 1, be equipped to carry out all of the necessary entitled EEG Changes During Arousal and procedures except those items related to the as- Drowsing, would s&ce. sessment of vestibular functions and the effects (2) Explore the best procedure for tran- (or lack of interaction) between vestibular and sition from a stationary to a rotating envi- other sense modalities. The apparatus needed ronment. to measure canal and otolith function has been (3) Define the best procedure of precon- briefly described in Experiment 3, entitled The ditioning a subject for transition to a sta- Effects of Weightlessness and Subgravity States tionary environment. This involves not on the Function of the Otolith Apparatus and only the symptomatology incidental to a the Semicircular Camis (including Their Inter- change in force environments but also the relationships and Their Relation with Other possible loss of fitness due to the small Sense Modalities), although some newer pmce- magnitude of the inertial forces. There dures under development may prove more sat- are several possibilities here which need ex- isfactory. As presently determined, the major ploration under terrestrial conditions. items of equipment would include: (1) litter- c. Explore alternative procedures for the chair, (2) nystogmograph, (3) camera and an- maintenance of fitness by “artificial gravity.” cillary equipment to measure ocular counter One involves, solely, the generation of iner- rolling, (4) helmet with self-contained device to tial forces by rotating the spacecraft, except measure egocentric visual iocaiization of up- for the initial period, at constant velocity. down area, (5) device to measure nonvisual Another possibility is to supplement the con- estimates of up-down which is under develop- ditioning provided by the constant velocity of ment. The litter-chair will operate in three the spacecraft through the periodic use of an modes: (1) oscillation, (2) rotating chair, and onboard centrifuge which might consist of an (3) rotating litter. independently rotating central portion of the 56 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

vehicle. Evaluation of medical and profes- 14. Telemetry Versus Onboard Recording Require- - sional fitness and especially physical fitness is ments the main requirement. It is essential to dis- 15. Prerequisite Ground-Based Experiments tinguish between fitness for tasks aloft, dur- As .indicated above, this constitutes a large pro- ing reentry, and postimpact. The procedures gram. These efforts fall into two interrelated described under “Safety Monitoring” are ap- categories, operational and experimental. The plicable and probably sufficient. former includes studies which have fairly di- d. Investigate sensory perceptions, particu- rect application to the selection, assessment, larly interactions of visual, vestibular, and and training of astronauts in preparation for somatosensory cues. space flights in rotating spacecraft. The latter 6. Experimental Controls is an analytic and synthetic approach designed Astronauts will serve as their own controls, but to provide experimental facts and. theoretical comparisons, insofar as possible, may be made understanding of the role of the semicircular with the experience of other astronauts under canals and otolith organs in man under all similar conditions and healthy subjects under conditions. simulated conditions. Analytic studies deal with: (1) the analysis of 7. Summary of Number and Types of Space Sta- gravitoinertial force environments; (2) the tion Personnel mechanics of the semicircular canals and otolith A physician is highly desirable and almost es- organs as transducer mechanisms; (3) the ef- sential for clinical aspects of the experimental fects of different force environments on sensing program. One astronaut well-trained as a tech- elements in the canals and otoliths; (4) the nician is essential. The greater the sophistica- central nervous system mechanisms concerned tion of the subjects the better. with the integration, modulation, and adapta- 8. Summary of Onboard Experimental Equipment tion to sensory inputs from the canals and oto- Required liths; (5) the responses evoked by usual and Described under 5. unusual patterns of stimulation to canals and 9. Summary of Animals otoliths; (6) the individual roles of canals and Effects of exposure of primates to rotating en- otolith organs and their interrelationship; and vironments is desirable. (7) the prevention of illusory phenomena and 10. Summary of Other Living F,orms functional disturbances. Not needed. The synthetic approach deals with (1) an un- 11, Summary of Onboard Laboratory Determinations derstanding of the mechanisms underlying the The requirements for measuring the time-course useful contributions of the canals and otoliths to of adaptation have been given. The “explora- the human economy in health and under ordi- iory” investigations would require the use of nary living conditions, (2) an understanding of one subject for prolonged periods which are the disturbances in homeostatic mechanisms, re- often measured in days rather than hours, but sulting from disease, functional disorder, or in- during this time he could be doing some type jury of the canals and otoliths and their restora- of useful work which did not require his pres- tion and (3) the level of inertial force which ence elsewhere. A total of one experimenter’s should be generated in a rotating spacecraft to time would be needed while the investigation is prevent loss of fitness. in progress; this work load could and should be 16, Prerequisite Spare Flight Experiments distributed. Not essential. 12. Summary of Laboratory Specimens to be Flown 17. Prerequisite Research and Development to Earth for Laboratory Examination Compared with the organ of Corti, our knowl- Not applicable. edge of the semicircular canals and especially 13. Proposed Rendezvous Schedule for Rotation of the otolith apparatus is far in arrears. (See 15.) Crew 18. Onboard Gaseous Atmosphere Desired Not applicable. Not an important factor. PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 57

19. Requirement for Rotation for Artificial G tion. J. Aero. Med., vol. 36, no. 12, Dee. Essential. 1965, pp. 1173-1181. 20. Comments re- Form of Data and Interpretation 6. Graybiel, A.; and Fregly, A. R.: A New of Data Quantitative Ataxia Test Battery. NSAM- Usual procedures. 919, NASA TR-93, Naval School of Avi- 21. Special Comments ation Medicine, Pensacoh, Fla., 19 March, These experiments should provide data which 1965. (Also available from NASA CR- would enable the engineer to design the “per- 63803.) fect” spacecraft for ensuring the maintenance of 7. Graybiel, A.; Guedry, F. E.; Johnson, astronaut fitness insofar as this can be accom- W. H., and Kennedy, R. S.: Adaptation to plished by generating artificial gravity, on the Bizarre Stimulation of the Semicircular one hand, and preventing unwanted side effects, Canals as Indicated by the Oculogyral 11- on the other. lusion. Aero. Med., vol. 32, 1961, pp. 321- At the end of this experiment are forms used 327. by the Naval School of Aviation Medicine: 8. Graybiel, A.; and Hupp, D. I.: The Ocule- NAVSCOLAVNMED 6500/24A, Experiment- Gyral Illusion. A Form of Apparent Mo- er’s Evaluation of Subject’s Fitness for Experi- tion which may be Observed Following ment; NAVSCOLAVNMED 6500/24B, Exper- Stimulation of the Semicircular Canals. J. imenter’s Evaluation of Responses to Procedure; Aviat. Med., vol. 17, 1946, pp. 3-27. NAVSCOLAVNMED 6500/24C, Subject’s Eval- 9. Graybiel, A.; Kennedy, R. S.; Knoblodc, uation of Responses to Procedure; and a Diag- E. C.; Guedry, F. E., Jr.; Me&, W.; nostic Categorization Work Sheet. McLeod, M. E.; Colehour, J. K.; Miller, 22. PostPight Evaluation of the Crew E. F., 11; and Fregly, A. R.: The Effects None. of Exposure to a Rotating Environment (10 23. References RPM) on Four Aviators for a Period of 1. Clark, B.; and Graybiel, A.: Perception of Twelve Days. NSm-923, NASA TR-93, the Pastural Vertical in Normals and Sub- Naval School of Aviation Medicine, Pensa- cola, Fla., 30 Mar. 1965. (Also available jects with Labyrinthine Defects. J. Exp. Psychol., vol. 65, 1963, pp. 490-494. from NASA as CR-67553.) 2. Gazenko, 0.: Medical Studies on the Cos- 10. Guedry, F. E.: Orientation of the Rota- mic Spacecrafts “Vostok’ and “Voskhod.” tion-Axis Relative to Gravity: Its Influence NASA IT F-9207, National Aeronautics on Nystagmus and the Sensation of Rota- and Space Administration, Washington, tion. BuMed Project MR005.13-6001 Sub- D.C., 1964. task 1, Rept. No. 96, NASA TR-93, Naval 3. Gazenko, 0. G.; Parin, V. V.; Chemigov- School of Aviation Medicine, Pensacoh, skiy, V. N.; and Yazdovskiy, V. 1.: Space Fla., 1964. Physiology, Some Results and Prospects of 11. Guedry, F. E.; and Graybiel, A.: Compen- Experimental Investigations. NASA TI’ satory Nystagmus Conditioned during F-305, National Aeronautics and Space Adaptation to Living in a Rotating Room. Administration, Washington, D.C., 1965. J. Appl. Physiol., vol. 17, 1962, pp. 398- 4. Graybiel, A.: Vestibular Sickness and 404. Some of its Implications for Space Flight 12. Loret, B. J.: Optimization of Manned Orbi- in Neurological Aspects of Auditory and tal Satellite Vehicle Design with Respect to Vestibular Disorders, Fields, W. S.; and Artificial Gravity. ASD TR-61-688. Alford, B. R., ed., Charles C. Thomas, Wright-Patterson AFB, Ohio, Aeronautical Springfield, Ill., 1964. Systems Division, December 1961. 5. Graybiel, A.; and Clark, B.: Oculographic 13. Miller, E. F., 11; Graybiel, A.; and Kel- Illusion as an Indicator of Otolith Func- logg, R.S.: Otolith Organ Activitp. within 58 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Earth Standard, One-Half Standard, and Environment. In Symposium on the Role - Zero Gravity Environments. NSAM-119, of the Vestibular Organs in the Exploration NASA TR-93, Naval School of Aviation of Space. NASA SP-77, 1965. Medicine, Pensacola, Fla., Aug. 4, 1965. 16. Thompson, A. B.; and Graybiel, A.: Effects of Long Term Weightlessness and Require- 14. Simons, J. C.: Walking under Zero Grav- ments for Artificial Gravity in Manned ity Conditions. WADC TN 59-327, Space Systems. Presented at the 20th Wright-Patterson Air Force Base, Ohio, Aero. Space Med. Panel Meeting, AGARD, Wright Air Development Center, 1959. NATO, (Athens, Greece), July 5-12, 1963. 15. Stone, R. W., Jr.; and Letko, W.: Some 17. Whiteside, T. C. D.; Graybiel, A.; and Observations on the Stimulation of the Niven, J. I.: Visual Illusions of Movement. Vestibular System of Man in a Rotating Brain, vol. 88, 1965, pp. 193-210. PHASE XI: IN-FLIGHT MEDICAL EXPERIMENTS 59 .

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EXPERIMENTER'S EVALUATION OF SUBJECT'S FITNESS FOR EXPERIMENT Experiment Experimenter Subiect Date

1. Have you been ill in the past week? Yes No- . If yes, specify: a. severity, b. time course, c. where localized, etc.

2. Iam am not in my usual state of fitness.

3. Drugs: a. How much alcohol have you consumed during the past 24 hours? drinks

b. How many cigarettes in past 3 hours? -cigars pipefuls

c. Have you taken any drugs or medications of any kind in the past 24 hours? Yes No If yes. were they:

1. Sedative or tranquilizer 2. Analgesic (aspirin) - 3. Anti-motion sickness remedy (anti-histamine) 4. Other, (Specify)

4. How many hours sleep did you have last night?- Was this sufficient? Insufficient?

5. How concerned are you regarding your performance on this test? None Minimal Moderate Great Very great

6. Do you expect to perform better less well- same , as average person? 7. Food: a. How many hours since your last meal?-

b. Approximately how many cups of fluid have you had in the past 2 hours?

Examiner's Estimate of Subject's Fitness for Test:

1. Fit: Will use results in study.

2. Fit: Will use results only for pilot study.

3. Unfit:

4. Other (Specify):

Purpose of Exposure of Subject: 1. Designated experiment.

2. Pilot run.

3. Clinical evaluation.

4. Other (Specify): 64 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

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DIAGNOSTIC CATEGORIZATION WORK SHEET

lpath0-l Major Signs and Symptoms 11 Minor Signs and Symptoms

1. IIIIIIIIIIIII

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2 PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 67

No. IO,1,2,3 10,1,2,3,41 -1,0,+1 1 *I I I I Vestibular Sickness (VS): . 3. Vomiting or 4. two major symptoms or 5. one major and two minor symptoms. ~ I I I 1 Malaise m: One major or two minor symptoms or one minor and two other symptoms. Malaise I: Any subjective symptom or any sign usually associated with any subjective symptom. Malaise II: All others.

~ Note: In addition, an occasional diagnosis of "Anxiety Reaction" may be made when signs and symptoms warrant.

EXPERIMENT 3

1, The Effects of Weightlessness and Subgravity manifested in weightlessness. Second order ef- States on the Function of the Otolith Appara- fects may have contributed to fatigue and a tus and the Semicircular Canals {including broad spectrum of mild functional disturbances. Their Interrelationships and Their Relation with While it is expected that adaptation will occur Other Sense Modalities) within a short period of time, long-term effects 2. Estimated Priority might result either from alterations in end or- Priority 1. gans or changes in CNS "sensitivity" to der- 3. Purpose ent impulses or both. To measure changes with time under the force 5. Experiment conditions aloft in the function of the otolith The astronauts serve as their own controls, and organs and semicircular canals and determine comparative measurements are made before, dur- their role in lowering the efficiency of astro- ing, and after flight. The principal measure- nauts in flight and post impact. ments, in the light of present knowledge, would 4. Justification fall in four categories: Deafferentation of the otolith apparatus and Otolith function: other gravireceptors has precipitated the most a. Compensatory eye movement response to clear-cut first order symptoms experienced or linear oscillations. Different orientations of 68 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

head (body) to the rectilinear accelerations indicators (refs. 5, 6). (T, illusions, 3 min; , desirable. Litter-chair device could be driven nystagmus, 5 min) . with clock mechanism. Subjective sensations, Illusory effects: A special recording form can electrooculography and cine photography be devised to chart the changes in illusory phe- would be used. Threshold and supra threshold nomena. (T, 2 min.) responses would be obtained at periodic in- Functional disturbances: Only when com- tervals to determine changes with length of parisons are made between subjects with and exposure. Introduction of active rotary move- those without vestibular organs can one gain a ments of head to observe superimposed nystag- firm appreciation of the role of canals and mus might yield worthwhile information on otoliths in causing a great variety of functional combined canal and otolith function. If litter disturbances over a wide range of severity mode is available, compensatory eye move- (ref. 7). Too much reliance has been placed ments might be obtained at constant rotation on nausea as an indicator whereas many persons with selective prepositioning of subject. Time have a variety of complaints before the nausea (T) inflight 45 to 90 minutes. stage is reached. Moreover, the adaptation to b. Egocentric visual localization of the hori- nausea occurs more quickly, in some force envi- zontal (EVLH) (ref. 1). Otolith and, to ronments at least, than to other symptoms. a lesser degree, nonotolith gravireceptors af- It would be difficult to attribute nonspecific fect the response. There is a “shred” of evi- symptoms to the vestibular organs if the sub- dence that these two influences act differently ject acts as his own control, but in a random using the A- and E-phenomena as indicators group of astronauts carefully “calibrated” for (ref. 2). At all events, with otoliths de- susceptiblility to symptoms precipitated by se- afferented the single influence of different lective stimulation of otoliths, significant dif- contact (pressure) cues could be explored. ferences in symptomatology might show up; Moreover, progressive differences under free subsequent adaptation would suggest that they floating and contact condition would point to are of vestibular origin. A brief questionnaire relative roles of otolith and nonotolith influ- can be prepared for this purpose (ref. 8). ences. Not only a wide variety of contact (T, 3 min). cues but also visual cues could be introduced 6. Experimental Controls to measure changes in the interaction of dif- Subjects serve as their own control, but some ferent sense modalities. These tests are suffi- measurements on groups of normal subjects un- ciently interesting that they might come under der terrestrial conditions needed for baseline the heading of “diversion.” (T, 2-10 min, normative data. depending on variety of measures). 7. Summary of Number and Types of Space Sta- c. Before and after measurements, using tilt tion Personnel device (EVLH) and, if warranted, horizon- Any astronaut thoroughly trained in the proce- tal and vertical oscillations and human cen- dure might serve as experimenter but someone trifuge (refs. 1, 3). with training in physiology preferable. If he Canal function: also serves as one of the subjects, a second astro- a. Before and after comparative measure- naut should receive technical instruction. ments. Threshold and suprathreshold re- 8. Summary of Onboard Experimental Equipment sponse to thermal stimulation, using preci- Required sion technique and nystagmographic record- Centrifuge: To be decided. ings (ref. 4). (T--one ear, 13-20 min.) Litter-chair in lieu of centrifuge: TO be Might be tried aloft to determine if response decided. due to endolymph flow in response to heat or Horizontal oscillator: To be decided. cold. Restraint devices: The one item which might b. Response to angular and Coriolis accelera- not accompany any rotating device is restraint tions, using illusions and ocular nystagmus as for head. Dental bite piece and thin partial PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 69

plastic helmet should suffice. A second. experiment which may be accom- Nystagmograph: Any two-channel unit for plished long in advance of ORL concerns the amplifying recording and, if possible, display- important question of whether deafferentation ing changes in surface potentials with a capa- alters the resting discharge of gravireceptors in bility of high gain and low frequency (0 to 50 parabolic flight. This might be accomplished cps) response. with very small nonmammalian “forms,” but Thermal stimulation unit: Present irrigation primates are desirable. method probably unsatisfactory. Work in 11. Summary of Onboard Laboratory Determjnatjons progress on more suitable devices. The experiments utilizing nystagmography are EI’LH decice: neme ucder d~.~!opmmt tiu?;e CGzrmiizg but might sc CGiiiiiined Fit3 for Gemini experiment (ref. 1) or a modifica- other investigative procedures involving the use tion of it is satisfactory. of centrifuge or recorder. The approximate Frenzel ienses: Weight of present model time for an experienced observer and subject might be reduced by using plastic lenses. has been indicated. The minimal total time for Power: Except for rotating devices, small the subject on a complete series adds up to ap- battery(s) for EVLH and small requirements proximately 90 minutes; the preparation would for physiological recorder. require, in some instances, a longer time unless Consumable material: Tape for recorder un- integrated with another experiment; number of less telemetered on “paper” for display. times would depend on the time-course of 9. Summary of Animals changes. Weightlessness is an elegant method to pro- 12. Summary of Laboratory Specimens to be Flown duce physiological deafferentation of the otolith to Eartb for Laboratory Examination apparatus. The effect of this deafferentation on Not applicable. the spontaneous discharge of receptor cells of 13. Proposed Rendezvous Schedule for Rotation of macula and crista should be determined. Also Crew the changes in the resting discharge with time Not applicable. and changes in response to stimulation of oto- 14. Telemetry versus Onboard Recording Require- liths and canals with time would be important ments to measure. This experiment would require a Either satisfactory; onboard preferred. physiologist trained in these techniques unless 15. Prerequisite Ground-Based Experiments the “preparations” were carried aloft which Baseline measurements would be required both would limit the duration of the experiment. for human and animal subjects. Prerequisite Major requirements are to be decided. studies would involve mainly miniaturiting or Whether complete defierentation of otoliths modifying present equipment to generate angu- leads to functional and pathological changes in lar and rectilinear acceleration, to measure nerve peripheral receptors and cell stations in CNS potential and eye movements, and to systema- could be determined in squirrel monkeys, pref- tize procedures. erably, or on lower animals. Comparison with animal freely moving would establish value of 16. Prerequisite Space Flight Experiments head movements in preventing alterations if Desirable but not essential. they were manifested. Much additional infor- 17. Prerequisite Research and Development mation also could be obtained. Two small Human: Mainly to ensure test-retest relia- “units” each weighing about 50 lbs, occupying bility of new equipment; should include trials in about 1 cubic foot, and requiring 2.5 to 5.0 parabolic flight. watts during experimental periods would be the Animal: Stimulation experiments required on major requirements. If biosatellite experiments the ground and in weightlessness. Biosatellite are conducted, improvement in present day re- experiments may suffice unless equipment sig- quirement can be expected. nificantly different. 10. Summary of Other Living Forms 18. Onboard Gaseous Atmosphere Desired 70 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Not directly related to purpose of the experi- posal to Conduct an Experiment in Gemini ment. and Apollo Space Flights. U.S. Naval School ’ 19. Requirement for Rotation for Artificial G of Aviation Medicine, Pensacola, Fla., 1964. Barany chair and linear oscillator; small centri- 4. Guedry, F. E.; Graybiel, A.; and Collins, fuge or rotation of vehicle with counterrotating W. E.: . Reduction of Nystagmus and Dis- central compartment to be decided. orientation in Human Subjects. Aero. Med., 20. Comments re Form of Data and Interpretation vol. 33, 1962, pp. 1356-1360. of Data 5. McLeod, M. E.; and Meek, J. C.: A Thresh- See References. old Caloric Test for the Horizontal Semi- 2 1. Special Comments circular Canal. BuMed Project hf.RO05.13- Integration with the total program is impor- 6001 Subtask 1, Rept. No. 72, NASA TR- tant. It could result in saving time and multi- 47, U.S. Naval School of Aviation Medi- plying uses of equipment. cine, Pensacola, Fla., July 1962. 22. Postflight Evaluation of the Crew 6. Miller, E. F., 11; and Graybiel, A.: The None. Effect of Magnitude of Resultant Gravito- 23. References inertial Force upon Egocentric Visual Locali- 1: Graybiel, A,: Vestibular Sickness and Some zation. BuMed Project MRO05.13-6001 of Its Implications for Space Flight. In Subtask 1, Rept. No. 98, NASA TR-83, U.S. Neurological Aspects of Auditory and Ves- Naval School of Aviation Medicine, Pensa- tibular Disorders, Field, W. S.; and Alford, cola, Fla., July 1964. B. R., ed., Charles C. Thomas, Springfield, 7. Woellner, R. C.; and Graybiel, A.: Counter- Ill., 1964. Rolling of the Eyes and Its Dependence on 2. Graybiel, A.; Guedry, F. E.; Johnson, W. H.; the Magnitude of Gravitational or Inertial and Kennedy, R. S.: Adaptation to Bizarre Force Acting Laterally on the Body. J. Appl. Stimulation of the Semicircular Canals as Physiol., vol. 14, 1959, pp. 632-634. Indicated by the Oculogyral Illusion. Aero. 8. U.S. Naval School of Aviation Medicine Med., vol. 32, 1961, pp. 321-327. forms for motion sickness symptamotology, 3. Graybiel, A.; and Miller, E. F., 11: A Pro- pp. 59-67.

EXPERIMENT 4 1. Intraocular Arterial Systolic and Diastolic Blood 30 mm Hg positive pressure to the eyeballs Pressure under Conditions of Prolonged Whole lowers by 1G the positive centrifugal force Body Weightlessness necessary to produce visual blackout in the hu- 2. Estimated Priority man subject. When systolic blood pressure at Priority 1. head level is reduced below 50 mm Hg by 3. Purpose positive centrifugal force, disturbances in vision To study the possible effects of weightlessness occur although the human subject retains con- on the intraocular systolic and diastolic blood sciousness. pressure. Thus a loss in reactivity of the cardiovascular 4. Justification system under conditions of prolonged weight- One of the possible major effects of weightless- lessness may well result in untoward variations ness on the human subject may be a decrement in intraocular blood pressure which may threaten in cardiovascular reactivity. the limits of visual tolerance of the eye. The effective arterial blood pressure in the eye 5. Experiment is less than that in the brain because circula- Utilizing a plethysmographic goggle type of tion in the retina is opposed by a normal intra- opthalmodynamometer the astronaut can conduct ocular pressure of approximately 18 mm Hg. the experiment unassisted. It is also known that the application of 20 to Procedure: At regularly prescribed intervals PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 71

(e.g.: within the first hour of weightlessness; In addition, prefiight testing will enable the after 2, 3, and 4 hours of weightlessness; after subject and the equipment to be checked out in 1, 2, 4, 8, and 12 days of weightlessness; after regard to standardization of response, familiar- 3, 6, and 12 weeks of weightlessness; and just ity, and reliability. prior to leaving orbit in preparation for reentry 7. Summary of Number and Types of Space Station into the effective gravitational force of the Personnel earth) the astronaut should place the plethysmo- Two trained astronauts. graphic goggles over his eyes. By means of a 8. Summary of Onboard Experimental Equipment hand-operated bulb syringe, he can increase the Required positive atmospheric pressure force exerted on a. Plethysmographic goggle (two pair) one eye to any level up to 200 mm Hg while b. Visual target (modified visual field or perime- the other eye remains at normal cabin atmos- ter) pheric pressure. c. Automatic pressure recording and marking Measurements: While gradually increasing the device atmospheric pressure on one eye during each 9. Summary of Animals test procedure, the astronaut is to fixate his eye None. undergoing the test on a visual target situated 10. Summary of Other Living Forms directly in front of him and at a distance of None. one to three meters. This visual target is 11. Summary of Onboard Laboratory Determinations essentially a visual field device containing a cen- None. tral fixation point and points of illumination 12. Summary of Laboratory Specimens to be Flown 15’, 25’, and 50’ from the central fixation to Earth for Laboratory Examination point. None. As the pressure in the goggle increases, the 13. Proposed Rendezvous Schedule for Rotation of astronaut will observe the gradual onset of Crew “grayout” in the involved eye. When this None. point is reached, the astronaut will observe that 14. Telemetry ver.rus Onboard Recording Require- his peripheral vision is reduced to a point ments where he has just lost awareness of the 15O Telemetry desired if no physician is onboard. (and beyond) points of illumination on the 15, Prerequisite Ground-Based Experiments visual target area although he can still see the a. Verification by means of ophthalmoscopy that central fixation point. Since “grayout” approxi- “grayout” and “blackout” pressure levels co- mates the diastolic pressure level of compres- incide accurately with diastolic and systolic in- sion of the intraocular arterials, the astronaut traocular arterial pressure in the subject astronauts. can manually note this fact by a trigger mark- b. Adaptation of position of peripheral visual ing device. When the plethysmographic gog- points (15O isopter) on visual target to coincide gle pressure reaches that of systolic intraocular with diastolic pressure level and grayout of sub- arterial pressure, “blackout” or complete tem- ject astronauts. porary loss of vision occurs in the involved eye. c. Establish preflight baseline standards for sub- The astronaut at this point is aware that the ject astronauts. central fixation point in the visual target area has also vanished. He then trigger-marks the 16. Prerequisite Space Flight Experiments pressure record at that point and reduces the None. plethysmographic gaggle pressuie back to nor- 17. Prerequisite Research and Development mal cabin atmospheric pressure. Optimization of design of plethysmographic gog- 6. Experimental Controls gles, visual targets, and recording devices. A series of similar preflight tests should be car- 18. Onboard Gaseous Atmosphere Desired ried out on the astronaut so that he can act as Earth atmosphere in range from 0 to 5000 feet above sea level and shirtsleeve environment. 72 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

19. Requirement for Rotation for Artificial G 22. Postflight Evaluation of the Crew None. None. 2 3. References 20. Comments re Form of Data and lnterpretation of Data 1. Lambert, E. H.; and Wood, E. H.: The Problem of Blackout and Unconsciousness in Continuous analogue form during each experi- Aviators. Medical Clinics of North Amer- ment with adequate number of calibrations to ica, vol. 30, 1946, pp. 833-844. insure reliability of references. Interpretation 2. Levis, D. H.; and Duane, T. D.: Electro- should be by a physician or ophthalmologist retinogram in Man During Blackout. J. Appl. trained to interpret the telemetry reports and Physiol., vol. 9, no. 1, 1956, pp. 105-110. who had participated in the preflight phase of 3. Smedal, H. A.; Rogers, T. A.; Duane, T. D.; this experiment on the subject astronauts. Holden, G. R.; and Smith, J. R.: The Physi- 2 1. Special Comments ological Limitations of Performance During Interpretation of the data obtained during flight Acceleration. Aero. Med., vol. 34, no. 1, might prove to be of considerable aid in deter- January 1963, pp. 48-55. mining the visual function margin of safety 4. Weeks, S. D.; Jaeger, E. A,; and Duane, present in regard to the relative difference be- T. D.: Plethysmographic Goggles: A New tween intraocular arterial blood pressure and the Type of Ophthalmodynamometer. Neurol- hydrostatic intraocular pressure of the eye. ogy, vol. 14, no. 3, March 1964, pp. 240-243.

EXPERIMENT 5

1. Harmonic and Other Analyses of Voice Charac- in the larynx should have a definite influence teristics for Possible Indications of Anxiety, De- on a number of characteristics of the voice. It pression, Hostility, and Other Emotional Reactions is felt that an analysis of the voice pattern (i.e. 2. Estimated Priority when saying the same word) would reveal criti- Priority 1. cal changes under different emotional conditions. 3. Purpose Since voice communication will be involved To develop a number of indices based on the in all orbital flights, no extra equipment would analysis of voice for possible use in distinguish- be needed aboard the capsule to conduct this ing between various emotional states; to evalu- experiment. And if the above hypothesis is ate the stability of such patterns over time. correct, we would have a readily available 4. Justification and Rationale method to objectively evaluate the emotional Voice communication between the astronauts in condition of the astronaut at every stage of his the capsule and the ground crews is a necessary orbital flight. medium for the transmission of essential mes- 5-22. Not applicable. sages. Since emotional changes are reflected in 23. References a neuro-muscular discharge, it is reasonable to Awaiting appropriate references to determine assume that the muscles of the larynx would the feasibility of such analyses with the pres- be affected by the emotional condition of a sub- ent quality of voice recordings obtained from ject. Changes in the tension of selected muscles astronauts while in flight.

EXPERIMENT 6

1. Emotional Changes During Prolonged Space 3. Purpose Flight To determine what emotional changes occur in 2. Estimated Priority a space crew during a prolonged space flight Priority 1. and to correlate these changes with whatever ~

PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS . performance data are available at the time the enced by the astronaut. An analysis of the emotional changes are reported. discrepancy between self-ratings and ratings 4. Ius tifiration and Rationale of self by others might provide indices of A number of investigations suggest that the group cohesion. confining and environmentally monotonous as- b. Physiological: Respiratory, cardiovascular pects of extended space flight will tend to in- (blood pressure, heart rate), eledromyo- duce undesirable emotional and behavioral reac- graphic, and galvanic skin responses should tions (ref. 1). These in turn may lead to de- be monitored. terioration of social and personal integrity. It c. Biochemicd: Determination of catechol has been conjectured that prolonged periods of amines, ACTH, and adrenal steroids. weightlessness might generate anxiety and ap- Subjects: Assuming a complement of 5 to 6 prehension (ref. 2). Prolonged confinement is men in an orbiting laboratory, the subjects of also considered to produce irritability, hostility, the experiment would consist of 3 to 4 men. depression, and other negative attitudes (ref. 3) The other members of the laboratory crew that could be disturbing and disruptive of group would be individuals who could be rotated after morale. Similar results are available from the varying periods of time depending upon the psychometric studies on the long cruises of the training and experimental needs of the overall atomic submarines (ref. 4). program. To control for weightlessness and the Deterioration of efficiency, morale, and motiva- “hazard” effects that are unique in being aloft tion may well accompany the undesirable emo- in an orbiting laboratory, a contrast group tional reactions mentioned above and such ef- should be used in a ground-based simulator fects could jeopardize the successful completion which would attempt to replicate the physical of any extended space mission. As a specific characteristics of the orbiting laboratory and the example, deteriorating attitudes and inadequate activity program of its members. performance may bring about a lowering of Procedure: Part of this experiment could be standards in the execution of the reconditioning embedded within a much larger experiment and retraining programs (for reentry) that will dealing with simulation of extended space flights. have to be periodically instituted aloft. The data obtained could well serve as feed- Aside from such practical considerations, it is back for restructuring the experiment in the of inherent theoretical interest to study the na- orbiting laborato ry. ture of the changes in the emotional life of an Baseline data for all the measurements would individual exposed to the unique, intense, and be obtained at various time points in the train- focalized pattern of stresses experienced by an ing of the crews for an orbital laboratory as- astronaut during a space mission. The long signment. From 4-8 time points should be in- continued impact of this stressful experience corporated into the training procedure and at should reveal changes that would not be observa- least the same number should be utilized in the ble in a short flight. Experimental evidence, experiment proper. The number of time points obtained from an orbiting laboratory, may pro- will be determined by the time characteristics of vide leads for developing countermeasures the extended space mission. against any possible negative effects. The minimal experimental mission should last 5. Experiment 30 days, followed by extensions to 60 days, 90 Materials: Three types of measurements are days, 180 days, and 360 days. If no detrimen- needed to analyze the complex characteristics of tal effects are in evidence at the lower time pe- what is called emotional behavior: psychologi- riod, the experiment could be escalated to the cal, physiological, and biochemical. next higher level. Should evidence of question- a. Psychological: Rating scales (e.g., Nowlis able deterioration appear, the experiment should Mood Scale) and sociometric devices. These be repeated with the presumed influences for procedures will help identify the psychological the deterioration eliminated or counteracted. onset and the nature of the emotion experi- Such an escalated program should provide “de- 74 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

velopmental” data that would indicate critical to Earth for Laboratory Examination phases in the developmental aspects of man’s Initially, it is anticipated that the biochemical adjustment to conditions which an astronaut specimens will have to be flown to Earth for would experience on an extended space mission. analysis. These flights should be integrated with 6. Experimental Controls other experimental programs which might also T6e simulation (ground-based) group can serve require specimens to be returned to Earth. as a partial control group for the effects of 13. Proposed Rendezvous Schedule for Rotation of weightlessness and the unique stress conditions Crew of orbital flight. The baseline data would serve Rotation is necessary only for the “adjunct” crew as Earth-based standards against which the ex- of two members. The rate of rotation should perimental data can be evaluated. Such base- be determined by the training and experimental lihe data should have reached an asymptotic or requirements of the overall laboratory program. “homeostatic” level in order to serve as a valid 14. Telemetry versus Onboard Recording Require- comparative standard. ments 7. Summary of Number and Types of Space Station Test information can be stored in tapes pend- Personnel ing the relaying of this data to Earth. As fa- In a group of five to six, three to four persons cilities and the state of the art develops, more will comprise the experimental group. The and more of such data should be telemetered two nonexperimenters should consist of a physi- soon after it is obtained. cian and a trained astronaut who could be ro- 15. Prerequisite Ground-Based Experiments tated for various other duties or experimental The simulation portion of this experiment can tasks. also serve as a prerequisite ground-based experi- 8. Summary of Onboard Experimental Equipment ment. Required 16. Prerequisite Space Flight Experiments Amplifiers and multichannel recorders to indi- None. cate respiratory, cardiovascular (blood pressure, 17. Prerequisite Research and Development heart rate), electromyographic, and galvanic skin Rating and sociometric devices. Miniaturization changes. of the systems for the physiological recordings. Multiple purpose behavior panel which, in addi- 18. Onboard Gaseous Atmosphere Desired tion to serving as a test instrument for various As similar to Earth atmosphere as possible. psychological processes, should provide a capa- 19. Requirement for Rotation for Artificial G bility for recording ratings (self and others) If provision for artificial G becomes necessary, and sociometric data. this could provide a method for controlling the 9. Summary of Animals weightlessness variable. None. 20. Comments re Form ,of Data and Interpretation 10. Summary of Other Living Forms of Data None. Digital wherever possible. 11. Summary of Onboard Laboratory Determinations 21. Special Comments Three determinations of each of the physiologi- None. cal indices at each time point. The number of 22. Postflight Evaluation of the Crew time points for obtaining the whole set of psy- None. chological, physiological, and biochemical de- 23. References terminations will depend on the length of the 1. Burns, N. M.; and Kimura, D.: Isolation extended space mission. For the shortest ex- and Sensory Deprivation. In Burns, N. M.; tended mission (30 days), it is recommended Chambers, R. M.; and Hendler, E.: Unusual that the testing take place at least once a week Environments and Human Behavior, Free and at such times that will assure coordination Press of Glencoe, Collier-Macmillan, London, with other psychological measures. 1963, pp. 167-192. 12. Summary of Laboratory Specimens to be Flown 2. Schock, G. J. D.: Some Observations on PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 75

I Orientation and Illusions when Exposed to Collier-Maunillan, London, 1963, pp. 127- Sub- and Zero-Gravity. Dissert. Abst., vol. 166.

I 18, no. 5, 1958, pp. 1832-1833. 4. Weybrew, .B. B. : Psychological Problems of 3. Simons, D. G.; Flinn, D. E.; and Hartman, Prolonged Marine Submergence. In Bums, B.: Psychophysiology of High-Altitude Expe- N. M.; Chambers, R. M.; and Hendler, E.: rience. In Burns, N. M.; Chambers, R. M.; Unusual Environments and Human Behavior, and Hendler, E.: Unusual Environments and Free Press of Glencoe, Collier-Maunillan, Human Behavior, Free Press of Glencoe, London, 1963, pp. 87-126.

EXPERIMENT 7

1. Evaluation of Spontaneous Activity (Initiative), Emotional Changes During Prolonged Space GSR, and EEG as Indicators of Vigilance on a Flight. Prolonged Space Flight MiJsion Procedure: Physiological measurements and 2. Estimated Priority ratings should be taken every second day for a Priori9 1. 30-day space flight. Dictation (an indicator of 3. Purpose initiative) should be recommended (though not Inherent in the title of the experiment. demanded) at the same rate during the astro- 4. Justification and Rationale naut’s recreation period. Submarine research indicates that alertness, con- 6-22. Same as in experiment entitled Emotional centration, and excitation levels tend to de- Changes During Prolonged Space Flight. crease as a prolonged mission progresses (refs. 2 3. References 2, 4). Initiative also tends to diminish in an 1. Riehl, J. L.: An Analog Analysis of EEG environmentally restricted, high-altitude balloon Activity. Aero. Med., vol. 32, 1961, pp. flight (ref. 3). Degredation of vigilance and 1101-1108. initiative could have serious consequences on a 2. Ritch, T. G.: Report on the Effects of Pro- prolonged space flight where the succcss of the longed Snorkelling on the Health of the mission may depend on the continued vigilance Officers and Men and on the General Habita- of one or two members at any one particular bility of *e Guppy-Snorkel Submarine USS period of time. The role of vigilance on a Trumpetfish (s%25), U.S.N. Med. Res. prolonged space flight needs to be analyzed and Lab., Rept. No. 132, New London, April evaluated. 1948,9 pp. 5. Experiment 3. Simons, D. G.; Flinn, D. E.; and Hartman, Muter&: Rating scales for vigilance (alert- B. : Psychophysiology of High-Altitude Ex- ness, concentration, excitation level). A minia- perience. In Burns, N. M.; Chambers, R. M.; ture tape recorder into which the subject would and Hendler, E. : Unusual Environments and dictate any interesting or exciting experiences of Human Behavior, Free Press of Glencoe, the day (or any other time period). The “time Collier-Macmillan, London, 1963. spent dictating to this recorder . . . {would 4. Weybrew, B. B.: Psychological and Psycho- represent} . . . a form of initiative or sponta- physiological Effects of Long Periods of Sub- neous activity” (ref. 3) as would the GSR and mergence. I. Analysis of Data Collected EEG, using the method of RiehI to develop in- during a 265-Hour, Completely Submerged, dices of vigilance. The basal resistance level Habitability Cruise made by the USS Nauti- and extinction rate can also be used as indices lus (SSN571). USN Med. Res. Lab. Rep., of excitation level for the GSR. New London, February 1957, 16 (3, Whole Subjects: Same as in experiment entitled No. 281), iv, 43 pp. 76 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

EXPERIMENT 8

1. Effect of Frustrating Situations on Subsequent on the astronaut is available. Psychological Performance During Prolonged Since it is anticipated that such troubleshooting Space Flights and emergency training will be continued aloft 2. Estimated Priority in order to keep the astronaut at peak perform- Priority 1. ance in emergency situations, equivalent frustrat- 3. Purpose ing tasks should be incorporated in both ground- To evaluate the degree of behavioral disrup- based and orbital training sessions. Since the tion and disorganization following a frustrating number of possible emergency situations is ex- situation in order (1) to determine the overall tensive, it should not be too difficult to construct effects of the stress associated with prolonged many relatively equivalent task situations. flight missions and (2) to assess the need for It is anticipated that the frustrating tasks will additional conditioning or training to overcome arouse sufficient emotional reaction in astro- possible adverse reactions. nauts who presumably have high ego regard and 4. Justification and Rationale self-confidence. Before reentry and after the Experiment 6, entitled Emotional Changes Dur- completion of the in-flight series of trouble- ing Prolonged Space Flight, may not indicate shooting tests, the astronauts should be de- any dramatic alterations in emotional status from briefed concerning the insoluble task so as to one measurement period to another since changes minimize any anxiety the frustrating experience in stress tolerance may proceed by small incre- of failure may have provoked. ments. Furthermore, ordinary behavior controls 5. Experiment may mask significant inner changes. Neither Materials: The same psychological, physiolog- will that experiment show directly how emo- ical, and biochemical measures as those in the tional changes can affect subsequent perform- experiment entitled Emotional Changes During ance. Prolonged Space Flight. An intense but controlled stress input, inte- Subjects: Those in the experiment entitled grated into the usual program of astronaut ac- Emotional Changes . During Prolonged Space tivities, could provide a situation sufficiently Flight. frustrating to permit an evalaution of (1) emo- Procedure; Basically similar to that in the tional overreaction and (2) degradation of sub- experiment entitled Emotional Changes During sequent psychological performance. The degree Prolonged Space Flight. In the present experi- to which both of these effects exceed the base- ment, four troubleshooting tasks would comprise line preflight data could be attributed in large one training session. The astronauts are in- part to the stresses of space flight. If the deg- structed that they might not be able to com- radation of subsequent psychological perform- plete the tasks in time allotted. Of these tasks, ance is “excessive,” remedial action would seem one or more would be “failed” by the astro- to be indicated. nauts; the fourth would be a standard type for It is recommended that the controlled stress in- which preformance data is available. Immedi- put be incorporated into the astronaut condi- ately following the fourth task, performance on tioning schedule related to troubleshooting and the psychological tasks of the behavioral panel emergency training. If, for example, the sched- should be evaluated. The psychological rating ule on a particular day demands that the astro- scales should follow the psychological tests in naut undergo four different troubleshooting half of the experimental sessions; they should maneuvers, the third of these should be one in precede the psychological tests in the other half. which he fails (either to find the trouble spot 6-22. As in Experiment 6, entitled Emotional or to fix it in a specified period of time). The Changes During Prolonged Space Flight. fourth troubleshooting task should be a routine 23. References one for which some previous performance data None. PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 77

EXPERIMENT 9

1. Behavior and Performance Levels During Pe- b. The environmental atmosphere. riods of Mental Stress and Relative Relaxation c. The personnel strength. 2. Estimated Priority d. The test cycle. Priority 2. Dependent Variables: 3. Pnrpose a. Psychological performance as measured by To determine psychophysiological effects of verbal foreign language test, full scale per- concentrated mental stress in relative isofation formance test, Minnesota Memory Test, md cGmpaie +hac--*La &Acv ..,,,,wy,.,,.w!"~,,a!----h--h--:- ---- pa- continuous performance test, and other tests rameters taken during relative relaxation. to be designed and introduced as the pro- 4. Justifiration tocol develops. As manned space flights develop, various men- b. Physiological measurements. tal stresses will come to bear on the responsible (1) Polygraphic recording, including GSR in-flight personnel. Such personnel will be re- and peripheral temperatures. quired to perform at relatively high, or even (2) EEG. extremely high, levels during the stresses and (3) Biochemical profile with particular em- yet must have periods of relative relaxation. The phasis on excretion of urinary steroids. problem of periodicity or cycling of duty and 6. Experimental Controls the relationship of performance levels to it re- Eight experimental controls will be included as mains largely unsolved. Therefore, this experi- noted under 5. It seems clear that this number ment is of considerable importance in that it is will be a function of the number of experimen- designed to provide further information on the tal personnel. relationship of concentrated mental stress, rela- 7. Summury of Number and Types of Space Station tive relaxation, and periods of drowsing to Personnel average mean performance levels. None. 5. Experiment 8. Summary of Onbomd Experimental Equipment The basic postulate is that intense concentrated Reqivired language instruction constitutes a mental stress None. which can be evaluated in tern of full scale Summary of Animals and verbal performance, as well as memory, and 9. both physiological and biochemical parameters. None. This is a ground-based experiment in which 8 10. Summary of Other Living Forms experimental and 8 control subjects will partici- None. pate. The experimental subjects will be in- 11. Summary of Onbomd Laboratory Determinations structed in a language foreign to them by a None. technique known as total immersion for 3 days, 12. Summary of Ldboratory Specimens to be Flown then permitted a relative rest period of 2 days, to Earth for Laboratory Examination followed by another intensive language iostruc- None. tion period. The control group will be iso- 13. Proposed Rendezvous Schedule for Rotation Of lated and relatively restrained in a manner iden- Crew tical to the experimental group, but will not None. meet the language instruction requirements. On 14. Telemetry versus Onboard Recording Require- the contrary, the control group will have rela- ments tively nonstressful tasks assigned, but will be None. subject to the same test procedures as the ex- 1 5. Prerequisite Ground-Based Experiments perimental personnel. None. Irzdependent Variables: 16. Prerequisite Space Flight Experiments a. The physical parameters of the test area. None. 78 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

17. Prerequisite Research and Development If successful, this test should provide data sig- None. nificant for itself and significant for correlation 18. Onboard Gaseous Atmosphere Desired with the proposed experiments on the W-R-S None. cycle, the EEG continuum, and various psycho- 19. Requirement for Rotation for Artificial G logical assessments of emotional and isolation None. states. 20. Comments re Form of Data and interpretation 22. Postjight Evaluation of Crew of Data None. None. 23. References 2 1. Special Comments None.

EXPERIMENT 10

1. Effects of Spatial Confinement Variables on (1) the space configuration of the Apollo, Group Performance in Weightlessness (2) the next larger configuration, and 2. Estimated Priority (3) a normal outside environment. Priority 1. b. Crowding: 3. Purpose Varied from 4 to 5 to 6 in terms of num- To help answer questions concerning the effects bers of subjects confined. of certain psychological variables (confinement, c. Exercise: social restriction, monotony, and crowding), Varied under the conditions of which are seemingly inherent in space flight, on (1) programmed considerable exercise, the individual and group performance of astro- (2) programmed minimum exercise, and nauts. (3) lack of any programmed exercise. 4. Justification Dependent Variables: As space flights continue, the time spent in such a. Performance as measured by: flights will increase. Because of engineering (1) a performance panel consisting of limitations, the space travelers will be faced psychomotor and cognitive tasks, with confinement to small spaces, restricted SO- (2) critical flicker fusion, cially, crowded by other crew members, face a (3) the Categories Test, and monotonous existence for long periods of time, (4) operational procedures. and have reduced possibility for normal exer- (5) Physiological variables associated with cise. The effects of these variables on group weightlessness and/or lack of exer- performance need to be understood both as sin- cise. gle and as interacting variables with weightless- b. The experiment is a modified 3 X 3 X 3 ness. factorial design with subjects assigned to 5. Experiment the space confinement variable as follows: The hypothesis tested is that the spatial con- replication of Apollo volume size using 4 finement, social restrictions, monotony, crowd- and then 5 occupants; replication of next ing, and exercise concomitants of space environ- larger size using 5 and then 6 occupants; ment for the Apollo and next larger. space cap- and using 6 occupants only for the normal sules will operate as both single and interacting outside volume. variables to affect the performance of individuals 6. Experimental Controls exposed to them. To determine the effects of weightlessness as a Independent Variables: main effect and as it interacts with the other a. Spatial confinement (includes social restric- independent variables, the study must be either tion and monotony variables) : replicated on the ground or in an artificial grav- Varied between ity environment aboard the space craft. PHASE n: IN-FLIGHT MEDICAL EXPERIMENTS 79

7. Summary of Number and Types of Space Sta- period will vary from two weeks in the Apollo- tion Personnel like space volume to three months in the nor- (level of training required, i.e., physician, lab mal outside volume condition. tech, trained astronaut, etc.) All subjects must 14. Telemetry versus Onboard Recording Require- be either astronauts or of astronaut-iike physical ments and p$chological characteristics. Not counting Some onboard recording delayed transmission the control replication for the weightlessness and readout capability, but for the most part variable, seventy-eight subjects would be re- direct telemetered data liwith ground slation. quired. Subjects could be run in a series of 15. Prerequisite Ground-Bared Experiments groups as small as four to six members at a time. The control run for weightlessness should be 8. Summary of Onboard Experimental Equipment conducted as a ground-based experiment. Be- Requii.ed side yielding control data, it will permit an (latest state-of-the-art equipment, size, weight, evaluation of methods and techniques before the and power requirements, as nearly as known) weightless phase in space is conducted. a. Fixed equipment 16. Prerequisite Spare Flight Experiments b. Consumable equipment: Performance None. panel, critical flicker fusion apparatus, Cate- 17. Prerequisite Research and Development gories Test, exercise equipment. All equipment None. is nonconsumable, will weigh approximately 100 18. Onboard Gaseous Atmosphere Desired pounds, and occupy approximately 20 cubic Whichever atmosphere appears to be chosen for feet, exclusive of laboratory equipment required future spacecraft operations. for physiological measurements. 19. Requirement for Rotation for Artificial G 9. Summary of Animals Not required if weightlessness control group is None. run as a ground-based experiment. 10. Summary of Other Living Forms 20. Comments re Form of Data and Interpretation None. of Data 11. Summary of Onboard Laboratory Determinations Data should be recorded automatically where (type, frequency, time consumed for each) possible and in a form convenient for com- Physiological determinations decided upon at the puter reduction and analysis. time as most relevant to measurement of ef- 2 1. Special Comments fects of weightlessness and/or lack of exercise. This experiment should be coordinated with re- 12. Summary of Laboratory Specimens to be Flown searchers presently engaged in the “exercise to Earth for Laboratory Examination area” of space flight. None. 22. Postflight Evaluation of the Crew 13. Proposed Rendezvous Schedule for Rotation of Complete medical and psychological debriefing Crew examination and interview. Subjects should not be rotated until after data 23. References have been completely collected on them. This None.

EXPERIMENT 11

1. Human Performance as a Function of the psychological performance of the individual Work-Rest-Sleep Cycle crew members. 2. Estimated Priority 4. ]ustifiration Priority 2. As space flights continue, the time spent on such 3. Purpose missions will increase. Because of engineering To help answer questions concerning the effects limitations, the space travelers will be faced with of prolonged space flight on the well-being and confinement to small spaces, social restrictions, 80 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

crowding by other crew members, monotonous (3) Inert gases existence for long periods of time and work- c. Crew size rest-sleep cycles adjusted to duties and not to d. Duration of cycle periods the 24-hour patterns to which they have been (1 ) The work-rest cycle: dw/dr adapted in the past. The effects of these varia- (2) The duration of the work periods; dw bles on the physiological status and psychologi- (3) The sleep-wakefulness cycle; ds/daw cal functions of astronauts need to be evaluated. (4) The duration of the sleep period: ds 5. Experimetit (5) The total daily periodicity: DT Hypothesis: The physical parameters of the Dependent Variables: space cabin (size) in combination with its en- a. Physiological measurements vironment (atmosphere) and a work-rest-sleep (1 ) Temperature cycle adjusted to duties (instead of self-selected) (2) Urinary excretion of steroids will operate as single and interacting variables (3) Heart rate to affect the performance of the crew members. (4) Blood pressure Experimental design: Determined by the (5) EEG number of astronauts in flight (for example, 4 b. Psychological performance as measured by or 8) and whether the specific duties would (1) Psychomotor and cognitive tasks allow for the matching of various hours on and (2) Critical flicker fusion off duty with paired subjects carrying out a (3) The categories test different routine or a similar program. In this (4) Operational procedures way it might be possible to obtain optimum 6. Experimental Controls well-being and performance in flight. The men would be their own controls as they The first step would be to work out a pro- participate in the same tasks and tests during posed schedule on the ground previous to flight the simulation and training runs prior to the based upon the findings from present studies actual flights. and expected operating procedures. The sec- 7. Summary of Number and Types of Space Station ond step would be to repeat the program in Personnel flight. The third step would be to readjust the Number will not be determined by experiments schedule as determined by the requirements of in this phase of testing. Any type crew mem- flight operating procedures. The fourth step ber chosen will satisfy the requirement for test would involve the collection of data from the subjects in this phase. various matched subjects in which the basic 8. Summary of Onboard Experimental Equipmetit work-rest-sleep cycles were varied in some and Required not in others. For example it would be inter- Unless steroid excretion rates are measured and esting to determine whether the data from the EEG's are taken there will be no need for more normal scheduling, as on Earth, would equipment in excess of that already proposed give more efficient performance records com- for other phases of the experimental program. pared with 4 hours on duty, 4 hours off, and 4 9. Summary of Animals hours sleep. The various patterns of schedul- None. ing for experimental purposes would be set up 10. Summary of Other Living Forms once the overall operational procedures had been None. established. 11. Summary of Onboard Laboratory Determinations lndependent Variables: 1. Temperature a. Physical parameters of the space cabin 2. Heart rate (1) Volume 3. Blood pressure (2) Shape 4. EEG b. Environment (atmosphere) 5. Urinary steroid levels (1 ) Partial pressure 6. Psychological tests (2) Oxygen content 12. Summary of Laboratory Specimens to be Flown PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 81

. to Earth for Laboia~oryExattiination 17. Prerequisite Research and Development 1. Urinary steroid samples None. 2. companion blood samples 18. Onboard Gaseous Atmosphere desired 13. Proposed Rendezvous Schedule for Rotation of Sea level equivalent. Crew 19. Requirement for Rotation for Artificial G To be determined by factors other than the pres- None. ent experiment. 20. Comments re Form of Data and Interpretation 14. Telemetry versus Onboard Recording Require- of Dafa ments Data may be recorded by hand in crew members There are no teiemetry requirements in excess daily logbook or, in the case of the EEG, be of those already available within the space cabin recorded onboard for later analysis at ground- as now proposed. based station. 15. Prerequisite Ground-Based Experiments 21. The experimental program as outlined in final Special conmentr draft will include requirements for obtaining See previous sections of report on work-rest- complete baseline data on all subjects during sleep cycle for more complete discussion of this ground-based training and simulation maneu- field of study and for recommendations. vers prior to actual flight in order to evaluate 22. Portflzght Evaluation of the Crew the effects of altered light-dark cycles, altered There will be requirements for thorough post- gravitational stresses, and interaction of these flight crew evaluation in a manner similar to and other parameters. that in which the crew is evaluated preflight. 16. Prereqnisite Space Flight Experiments 2 3. References Similar types of experiments in other orbital See bibliography at end of report on this sub- flights of long duration. ject in Phase I.

CIRCULATORY AND RESPIRATORY FUNCTIONS PREAMBLE

The experiments proposed for the ORL are pre- which are unique. Prominent among these environ- sented on the basis of a critical review of the physi- mental features are: (a) low acceleration relative ological mechanisms which may be affected adversely to the surrounding vehicle, (b) absence from the during space flight. terrestrial diurnal cycle, (c) presence of a stress pat- These proposed experiments are based, partly, on tern not readily simulated on Earth, and (d) im- the currently available results of space flight. In- mersion in a radiation flux not simulable at ground flight experiments and observations in the Gemini- level. Apollo, Biosatellite, and MOL are considered to be These critical experiments are also related to (2) sources of information that will be available during the research and development required to assess the design of the experiments. man’s capability of long-term (one-year) space flight The group has interpreted an experiment to be a with indication of the support he may require. series of measurements and observations designed to Conceptually, a class of experiments that seems test a hypothesis. Certain systematic observations of most promising is that revolving about examination physiological changes during flight are necessary for of the gain (p), feedback constant (p), and loop monitoring and for more detailed analysis as indi- transfer function characteristics for the important cated below. However, the justification of a space homeostatic feedback and feedahead loops of famil- station depends on its requirement for the perform- iar physiological regulatory system. In addition to ance of critical experiments. These critical experi- experiments utilizing the normal physiological sys- ments are related to (1) additions to knowledge tem, design here would surely seem to include open- made possible by features of the space environment ing the said loops or of exposing their internal 82 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY characteristics by pushing the system into the p p+1 over manned orbital laboratory for research. Pref- region where “overload” begins to show. erably, new experiments are most desirable if they Although a number of specific experiments are require no new data acquisition techniques. Where designed to “test” the characteristics of the physio- new techniques are required they should be care- logical systems, certain observations are recommended fully designed so as to optimize their utilization and on a daily (continuous) basis to provide data which minimize their interference and burden on the ve- may be used in a number of data acquisition and hicular resources. reduction procedures. Prominent among these are Acquisition of this class of data is especially suited heart rate, blood pressure, and ballistocardiograms by a bioengineering system which incorporates a related to cardiac function, and minute volume, res- small, but fast, central control and processing com- piratory frequency, oxygen consumption, and arte- puter capable of stored program control operation. rial oxygen saturation related to pulmonary function. A compatible slow memory of larger extent (e.g., There are additional measurements which will be an incremental multichannel magnetic tape recorder) made on a periodic basis in the proposed experiments. is also a near requisite. Among these measurements are body mass, blood With a good onboard data reduction system of volume, hematocrit, body water, and routine urine analysis. adaptive type, it becomes feasible to store in a few Experiments that require minimal increases in pounds of tape a detailed running record of hun- burden of the experimental subjects with transducers dreds of experiments along with essentially continu- or additional duties or of the vehicle with added ous records of routine monitored how-goes-it in- weight, complexity, or hazards are highly desirable format ion.

RATIONALE OF THE EXPERIMENTAL PROGRAM

One of the possible effects of long-duration ex- sinus-transducer system in sensing shifts in arte- posure to the weightless environment is a deteriora- rial pressure away from the normal homeostatic level tion in cardiovascular reactivity due to absence of the and transducing these shifts to the appropriate vari- usual hydrostatic stresses imposed during existence ations in frequency of affector nerve impulses in the in the 1 G environment of Earth. carotid sinus nerve. If such deterioration does occur, it would be ex- Similarly, it would be ideal to investigate the efi- pected to be manifest as a malfunction of one or ciency of the various effector mechanisms responsible more of the control loops responsible for homeo- for the maintenance of arterial pressure such as arte- static regulation of the cardiovascular system. Those riolar and venous tone or compliance and the static loops, susceptible to hydrostatic effects such as the and dynamic capabilities of the arteriolar and venous systems for regulation of systemic and venous blood systems to respond in an appropriate manner to pressure and blood volume, will presumably be sub- effector stimuli for alteration of their caliber. jected to minimum stress during exposure to zero G Since the major concern is with the capability of and hence would be most likely to deteriorate dur- man to maintain his normal function in the zero G ing sustained existence in this environment. environment and to withstand the stresses of reentry Analysis of the mechanism of such deterioration into and subsequent (ideally) immediate adaptation could logically be divided into investigation of pos- to the Earth environment, studies carried out on sible alterations in the affector, the error-sensing, and man himself will probably be most productive of the the effector arms of the control loop under study. practical information required. This is particularly For example, one of the major control systems of true since man’s adaptation to the erect posture in arterial blood pressure is the baroreceptor (carotid the 1 G environment is not closely simulated in sinus) system. experimental animals. Ideally, tests should be carried out on the static Investigation of cardiovascular reactivity in man and dynamic sensitivity characteristics of the carotid in the zero G environment restricts applicable exper- PHASE II: IN-FLIGHT MEDICAL EXPERlMENTS 83 . imental procedures to those which carry a minimally tem. This type of experimental rationale does, how- acceptable risk of causing Other than aCCuraklY for- ever, provide a logical basis for desigll and seeable, temporary restriction of the subject's full nation of experiments. An attempt has been made, mental and physical capabilities. These restrictioiis therefore, to design experiments with this rationale preclude most academically ideal experiments involving opening of control loops and study of the in mind, realizing that full separation of the indi- static and dynamic characteristics of the affector, vidual components of a control loop cannot be error-sensing, and effector components of the 9s- achieved in conscious human subjects.

PHYSIOLOGICAL VARIABLES TO BE MEASURED

The following list summarizes the variables which PCo2 total hemoglobin) may be measured during prolonged space flight. 16. Metabolic rate and heat exchange Their priority is listed in the experiments them- 17. Respiratory rate and minute volume (spirom- selves. The purpose of this listing is to present some idea as to the extent of the equipment and 18. Respiratory gas analysis (0,and CO,) techniques required for carrying out the proposed 19. Venous pressure (central and peripheral) experiments and the day-to-day measurements dis- 20. Venous tone cussed in the preamble. Some of the variables to 21. Chemical analysis of blood (Hemoglobin, he- be measured require research and development on the matocrit, catecholamines, cortiosteroids, anti- ground. The variables are listed in alphabetical order. diuretic hormone, pH, protein, COP content, 1. Arterial pressure (direct and indirect) oxygen content, electrolytes (Na, K, C1, Ca, 2. Ballistocardiogram Mg, P), glucose, urea, uric acid, cholesterol, 3. Blood volume (intra- and extracellular fluid prothrombin time, thromboplastin genera- volume hematocrit) tion, transaminase, lactic dehydrogenase, toxi- 4. Body mass and volume (density) cological tests in case of an overdose or expo- 5. Body temperature and skin temperature sure (e.g., salicylate, barbiturate, heavy met- 6. Cardiac output als, demerol), 02 + C02 in gas) 7. Circulation time 22. Microscopic examination of blood (Exami- 8. Electrical activity of the heart (EKG) nation of red and white cells as to number, 9. Heart size morphology and reticulocyte count) 10. Heart rhythm and rate 23. Routine urine examination (pH, glucose, pro- 11. Index of airway resistance tein, sp. gr., sediment examination, 24-hr 12. Intraocular pressure (tonometer) specimens from time to time for electrolytes 13. Left ventricular ejection time (phonocardiog- (including Ca and P) and nitrogen balance) raphy and carotid pulse) 24. Other specialized measurements described in 14. Measurement of lung compliance (esophogeaI the individual experiments, such as urinary pressure) hormone analysis (ADH, catecholamines, and 15. Oxygen saturation of arterial blood (PO2, steroids)

EXPERIMENT 1

1. Changes in Blood Volume and Central Venous 3. Purpose Pressure During the WejghtIess State TO determine the time course of changes in blood volume and venous pressure during 2. Estimated Priority weightlessness and the recovery following Priority 1. weightlessness (return to 1 G). 84 hl IDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

4. Itrstificatioiz and Rationale 6. Experimental Controls Since space flights as well as experiments in the A preliminary study should be ground-based. hypodynamic state and following bed rest have Six subjects followed for 45 days are desirable. indicated that there is a postflight or postexperi- 7. Summary of Number and Types of Space Station ment period of abnormal circulatory responses Personnel to tilt (refs. 1, 2, 3), heat (ref. I), and G Preferably, the experimental team should in- forces (ref. 1). The mechanisms that may be clude: postulated include (1) reduction in blood vol- 1. A physician who has participated actively ume, (2) abnormal blood pooling, and (3) ab- in the control ground-based experiments normal regulatory responses. Each of these on the astronauts just prior to their flight. mechanisms is subject to experimental test and 2. A trained laboratory technician. will serve to indicate a rational countermeasure. 3. Two trained astronauts who would alter- Russian reports and hypodynamic experiments nate in acting as subjects and as the third suggest that a readjustment in fluid volumes member of the experimental team. occurs in one day. 4. Other personnel would be measured if 5. Experiment possible. No method of determining blood volume is a. Summary of Onboard Experimental Equipment clearly superior. For the purposes of this dis- Required cussion, a dilution technique will be presented Fixed equipment: with the general characteristics of the solute and (1) Apparatus for determining mass and diluent. Proper experimental design will allow volume of body determination of a number of other parameters (2) Apparatus for determination of deu- of physiological interest. A solute which is terium (Alternative samples may be retained in the circulatory system may be in- returned to Earth) jected in a deuterium oxide medium and blood (3) Laboratory equipment for urinalysis volume and total body water determined. The (4) Pressure gages and recording equip- determination of hematocrit is a necessary part ment of the experiment. Determination of the body Consumable equipment: Chemicals for all mass will give additional data for calculation of determinations. percent body water and lean body mass. Urine 9. Summary of Animals volume and sodium analysis and. water intake None. determination will allow determination of fluid 10. Summary of Other Living Forms balance. None. Determinations should be made daily at the 11. Summary of Onboard Laboratory Determinations same time for a period of 30 days and, if pos- 1. Determination of blood volume (once each sible, a second determination made to deter- day for at least 5 days, then on 15th and mine any circadian responses. (Alternative, 30th). every fifth day could be used following the first 2. Measurement of venous pressure daily. 5 days.) Postflight determinations after 30 12. Summary of Laboratory Specimens to be Flown minutes in the supine position should continue to Earth for Laboratory Examination for 15 days. It may be convenient to return urine and blood Specific Techniques and Accuracies samples for analysis. Blood volume (red cell and 13. Proposed Rendezvolis Schedule for Rotation of plasma) indicator =k 500ml Crew Deuterium determination 100 ml Rendezvous may be necessary for transfer of Mass 1+ 10gm samples. Sodium + 3 meq/l. 14. Telemetry versus Onboard Recording Require- Urine volume + 10ml ments Central venous pressure -t. 1mmHg Onboard recording with telemetry facility for . PHASE II: IN-FLIGHT -MEDICAL EXPERIMENTS 85

sending data to Earth laboratory. 32, 1961, pp. 726-736. 15. Prerequisite Gromd-Based Experiments 3. McCally, M.: and Lawton, R. W.: The Complete standardization of techniques and con- Pathophysiology of Disease and the Problem troI levels on all subjects. of Prolonged Weightlessness. A Review 16. Prei-equisite Space Flight Experhents AMRL TDR 63, 3 June 1963, Aero. Med. None. Res. Lab., Wright-Patterson AFB, Ohio. 17. Prei.equisite Research and Developnze??t 4. Mercury Project Sutnmay. NASA SPA5, Standardization of blood volume technique. May 15-16,1963. 18. Onboard Gaseous Atmosphere Desired 5. Parin, V. V.; Volynkin, Y. M.; and Vas- 92!pyp! Pnl,;~7?lc=nt :i!yev, ?. \'.: ?.h?ced Space F!igt..t, cos- -1- - 19. Requirement for Rotation for Artificial G PAR, Florence, Italy, May, 1964. None. 20. Comnients re Form of Data and Interpretation Experiment 1 a of Data 1. Body Volume 1. Data should be in continuous analog form It has been suggested in association with the (magnetic analog tape or photokymographic previously discussed method of determining record) during each experiment with requi- weight by an oscillatory method that a method site number of calibrations to insure relia- for determining the volume of these by exclud- bility. Spot checks online by visual moni- ing the volume occupied by air in the lungs toring of stored oscilloscope trace or po- would give a valuable set of additional infor- laroid picture thereof during importmi mation. A suggested method requiring minimal phases of each experiment would be highly apparatus for accomplishing this purpose would desirable. be as follows: a relatively simple, zipper-closed 2. Interpretation should be by a cardiovascular enclosure (preferably translucent and with access physiologist or a physician with special train- to the zipper from the inside so as to provide ing in cardiovascular physiology who has par- minimal claustrophobia for the occupant) would ticipated in the series of these experiments be made of a very flexible and thin, but not carried out preflight on the astronauts being readily stretchable, fabric, This suit, when studied in flight. inflated at a very low positive ambient pressure, 21. Special Comments would take up a fixed volume which could prob Interpretation of the data obtained during flight, ably be held constant to within a few cubic if progressive changes should be observed, may centimeters. Knowing the volume of the con- prove to be one of the best objective bases upon tainer, the volume of the body excluding air which to decide whether or not a flight should would be available if the amount of air in the be continued or rendezvous for rotation of crew chamber were measurable. Two methods for be carried out. measuring this air seem simple and practical. 22. Postflight Euahation of the Crew One would include the introduction of an ac- None. curately known, small incremental volume of air 23. References preferably in a sinusoidally oscillatory fashion. 1. Beckman, E. L.; Colrun, K. R.; Chambers, For example, a small cylinder of air could be R. M.; DeForest, R. E.; Augerson, W. S.; discharged and reclaimed from the chamber by and Benson, V. G.: Physiological Changes essentially a motor-driven hypodermic syringe Observed in Human Subjects During Zero G of fairly large volume. Knowing the volume Simulation by Immersion in Water up to change and the pressure change accompanying it Neck Level. Aero. Med., vol. 32, 1961, from a simple transducer, the volume of air 1031 p. would be measurable so long as the individual 2. Graveline, D. E.; and Barnard; G. W.: Phys- kept his airway open. The air in the lungs iologic Effects of a Hypodynamic Environ- would be part of the air of the chamber and thus ment: Short Term Studies. Aero. Med., vol. it could be measured. Alternatively, a tracer 86 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

method could be used in which a known volume a fiducial mark but would measure the period of a measurable gas is projected into the chamber of oscillation of a system including the experi- and rebreathed a few cycles; a sample is then mental subject with the spring as a restoring extracted to determine by dilution method the force. If one assumes that a compliance is used remaining air. Since the experiment would OC- which is sufficiently high to make a period of cupy only a fraction of a minute or a little more, oscillation long with respect to the natural peri- there would be no necessity for elaborate pro- ods of the body (i.e., long with respect to about vision of additional oxygen or carbon dioxide a quarter second), then an estimate can be made management. of the required period of observation and the accuracy with which a cycle has to be measured. If one chooses a period of approximately 0.6 sec, Experiment 1 b then a measurement period of 1 minute would 1. Assessment of Body Mass include something approaching 100 cycles of This experiment is concerned with the systematic oscillation using a platform simpler, but of the variations in body weight over a period of days same general sort, than that proposed in the and is almost totally concerned with the provi- experiment. The measurement required would sion of a method of a simple, yet precise, meas- be one of stress in the compliant element which urement of body mass. Notice that it is not need not be quantitative beyond rough linearity, important that the method have high absolute and in a 100 cycle process it would require dis- accuracy as its interest is concerned mainly with crimination of approximately the percentage of changes in mass of the order of a few ounces the cycle represented by the fraction of a percent with respect to a baseline. However, the method tolerable error. Thus, determination of oscil- must be intrinsically sensitive and reproducible lation to the nearest tenth of a cycle which is enough to detect changes of this order of mag- very easy would give a tenth of a percent ac- nitude. If, as has been suggested, there is curacy while the previously mentioned 1/40 of interest in mass changes of the order of 20 1% precision would require measurement to a grams, then the precision of the measurement fortieth of a cycle which is about 10 degrees of must be sufficient to permit detection of 20 g in phase-a feasible but not completely easy task. 80 kg or about 1 part in 4000, i.e., 1/40 of 1 %. A factor of two enters into the precision meas- This is not easily achieved with simple scale urement to the square root relationship between reading instruments. The method proposed in mass and period. A special purpose device the experiment calls for an accelerometer meas- attached to a central computer designed to record urement of the person when accelerated by a the time required for 200 zero crossings of this known force or rather a known impulse im- compliant element would seem entirely suitable parted by a coil spring. While it is quite pos- for this measurement and would require minimal sible to calibrate a spring to this precision, it is equipment. Should there be real concern about quite difficult to measure accelerations to a the slight error induced through shaking of the necessary degree of accuracy with any reasonably abdominal structures, this could be detected by practical transducers. providing a pair of compliances and noting the An alternative procedure which seems much two indicated masses which would differ in terms simpler would be one relying on a spring to of the coupling to the movable portions of the provide a known compliance when extehded to body.

EXPERIMENT 2

1. Assessnieiit of Body Mass in Real Time izing these techniques. 2. Estimated Priority 3. Purpose Priority dependent on particular experiment util- To measure fluctuation in body mass as a means PHASE 1I: IN-FLIGHT MEDICAL EXPERIMENTS 87

* of calculating weight gain or loss. the total mass. The meter is attached by hard 4. Justification and Rationale wires to a suitable recording instrument. The One of the major medical problems incurred by acceleration by a fixed impulse will vary with the the astronauts and cosmonauts has been dehydra- mass. By daily recording at a fixed time of tion. By means of ilaijp body niajs estinutions, the 24-hour cycle (on awakening, after voiding, it should be possible to estimate significant and before eating), fluctuations in mass can be changes in total fluid balance. Refinement of determined. techniques may lead to the ability to determine It is calculated that changes in body mass of major shifts within large segments of the body. more than 0.5 Ib daily are due largely to fluid baiance iiuctuations. The metaboiic requirements 5. Experiment for the man are in the order of 25OOKcd daily. The subject places himself on a suitable platform If he eats nothing, he will have a caloric deficit fixed in the erect position. A vertical bar is of this magnitude A pound of body tissue is firmly attached to the central point of the plat- equivalent to 3700 cal. The estimated weight form. At the top of the bar is a cap on a ring loss of maximum caloric deficit will be 25/37 slide. This is fitted snugly down onto the head or 0.66 Ib. Rapid catabolic changes will alter of the subject Below this is a cross bar at the these figures. Necessary N2 excretion data will ends of which on either side are molded shoulder be available from previous flights which will pads. This is slid down and fixed over the enable one to make suitable corrections in the shoulders. At about waist height on this bar calibrations. are preset band bulbs which are grasped firmly by the hands. Thus it is possible to place the 6. Experimental ControIs subject in a reproducible position for each subse- Experimental controls will be governed by those quent measurement. If a problem arises by of the experiment employing these techniques. virtue of the inertia of large internal abdominal 7. Summary of Number and Types of Spare Station organs it may be necessary to use the sitting Personnel position with the thighs drawn up tightly onto Utilization of existing crew. No special training. the abdomen. This position will compress the 8. Summary of Onbomd Experimental Equipment abdominal organs into the upper quadrant of the Required abdominal cavity and insure the whole body Inertial displacement machine as described. One mass moving as a unit. Attached to his shoulder accelerometer. Utilization of existing recorder pads and head cap is a harness which is loose channel for 5 min daily. No additional points. enough to allow his body mass to be displaced Total weight about 10 lb. upward for several inches at which point it serves 9. Summary of Animals as a restraining mechanism and decelerates him. Not applicable. (The ends of the harness are fixed to appropriate 10. Summary of Other Living Forms plates on the floor of the capsules.) The plat- Not applicable. form sits on top of a spring-driven piston of 11. Summary of Onboard Laboratory Determinations exactly the same surface area which is contained Five minutes daily for each man. in a cabinet about 1 foot square and 18 inches 12. Summary of Laboratory Specimens to be Flown higher. The spring is wound to a fixed point to Earth for Ldboratory Examination of tension by a ratchet mechanism. A second Not applicable. member of the crew at a signal of readiness 13. Proposed Rendezrcous Schedule for Rotation of releases the spring tension. The impulse is Crew transmitted by means of the piston to the plat- Not applicable. form on which the man is standing. This ac- 14. Telemetry versus Onboard Recording Reguire- celerates the subject up into the restraining ments harness. An accelerometer which is attached to Daily telemetry to ground monitor. No special the vertical rod to which the man has been at- band. tached is activated by the upward movement of 1 5. Prerequisite Ground-Based Experiments 88 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Ground-based experience to check feasibility and Data improve design. Ground-based calibration to measure mass in 16. Prere yuisite Space I;ligbt Experiments terms of weight. Any change in mass of more Establishment of degree of catabolic response than 0.7 Ib each day or average over any selected which may increase weight loss. time period may be interpreted as water loss from 17. Prere'guisite Research aiid Development body. Build and ground-test prototype. 2 1. Special Comments 18. Onboard Gaseous Atmosphere Desired None. No special requirement. 22. Postbight Evaluation of the Crew 19. Requirement for Rotation for Artificial G None. No special requirement. 23. References 20. Comments re Form of Data and Interpretation of Mercury Reports.

EXPERIMENT 3

1. Changes in Peripheral Venous Compliance and 6. Experimental Controls Pressure During the Weightless State A series of experiments should be carried out on 2. Estimated Priority healthy male subjects (in the same age range Priority 1. as the astronauts) under carefully controlled con- 3. Purpose ditions using the procedure outlined above and To determine if the reduced stress on the circula- variants thereof. tory system (absence of gravity dependent hydro- The objective of these experiments would be: dynamic effect) effects a reduction in venous 1. To standardize in detail the techniques and compliance or reactivity to stretch (filling) or equipment to be used. results in changes in venous pressure. 2. To obtain the baseline data. 4. Justification and Rationale 7. Summary of Number and Types of Space Station Since space flights as well as experiments in the Personnel hypodynamic state and following bed rest have Preferably, the experimental team should include: indicated that there is a postflight or postexperi- 1. A physician who has participated actively ment period of abnormal circulatory response in the control ground-based experiments on to tilt (refs. 1, 2, 3), heat (ref. I), and G the astronauts just prior to their flight. forces (ref. I), the mechanisms that may be 2. A trained laboratory technician. postulated include (I) reduction in blood v01- 3. Two trained astronauts who would alternate ume, (2) abnormal blood pooling, and (3) ab- in acting as subjects and as the third mem- normal regulatory responses. Each of these ber of the experimental team. mechanisms is subject to experimental test and 8. Summary of Onboard Experimental Equipment will serve to indicate a rational counter-measure. Required Russian reports and hypodynamic experiments The type of plethysmography will determine the suggest that a readjustment in fluid volumes oc- equipment list. The influences are given for curs in one day. mercury in rubber strain gage techniques. 5. Experiment 9. Summary of Animals Methods for this determination are equivocal, and None. effort should be made to increase the confidence 10. Summary of Other Living Forms in the techniques. For initial purposes, the fol- None. lowing are proposed: 1 1. Summary of Onboard Laboratory Determinations Venous compliance in flight, e.g., measure leg Experiment should be performed during first 24 circumference with mercury in rubber strain hours of flight, if possible, and repeated at gage (Whitney) and record pulse. Inflate 48-hour intervals for about the first week and cuff proximal to gage in 10 mm Hg pressure each week thereafter. steps and record change in volume (refs. 4-1 3). 12. Summary of Laboratory Specimens to be Flown PHASE 11: IN-FLIGHTMEDICAL EXPERIMENTS 89

- to Earth for Laboratory Examination 23. References None. 1. Bedunan, E. L.; Colrun, K. R.; Chambers, 13. Proposed Rendezvous Schedule for Rotation of R. M.; DeForest, R. E.; Augerson, W. S.; Crew and Benson, V. G.: Physiological Changes Not necessary for these experiments. Observed in Human Subjects During Zero G 14. Telemetry Versus Onboard Recording Require- Simulation by Immefsion in Water up to ments Neck Level. Aero. Med., vol. 32, 1961, If a physician or a highly-trained physiologist or 1031 p. laboratory technician is onboard, onboard record- 2. Butch, G. E.: Digital Plethysmography. ing and visuai display oniine or on piayback Cii~ Str~tt~fi,XZF Yd,1954, 134 3. from tape recorder would be highly desirable. 3. Burger, et al: Physics in Medicine and Biol- Telemetry to Earth online or on playback from ogy, vol. 4, 1959-1960, pp. 168 and 176. onboard tape recorder would also be highly de- 4. Burton, A. C.: The Range and Variability sirable as a backup and to insure that data were of the Blood Flow in the Human Fingers not lost on reentry. and the Vasomotor Regulation of Body Temperature. Am. J. Physiol., vol. 127, 1 5. Prerequisite Ground-Bused Experiments Standardization of method and acquisition of 1939, pp. 437-453. 5. Eagan, C. J.: The Construction of a small baseline data are necessary prior to experiment. Mercury Strain Gauge. TN 60-14, Arctic 16. Prerequisite Space Flight Experiments Aeromedical Laboratory, APO 731, Seattle, Flights to check out performance of equipment Washington, 1960. and technics under weightless conditions would 6. Eagan, C. J.: The Physics of the Mercury be highly desirable. Strain Gauge and of Its Use in Digital 17. Prerequisite Research and Development Plethysmography, TN 60-71, Arctic Aero- Standardization of plethysmographic technique. medical Laboratory, APO 731, Seattle, Wash- 18. Onboard Gareous Atmosphere Desired ington, 1961a. Earth atmosphere in range from 0 to 5,000 feet 7. Eagan, C. J.: Techniques in Mercury Gauge above sea level with shirtsleeve environment. Plethysmography Specific to the Rabbit Ear. 19. Requirement for Rotation for Artificial G TN 60-16, Arctic Aeromedical Laboratory, None. APO 731, Seattle, Washington, 1961b. 20. Comments re Form of Data and Interpretation of 8. Elmer, R. W.; Eagan, C. J.; and Anderson, Data S.: Impedance Matching Circuit for the 1. Data should be in continuous analog form Mercury Strain Gauge. J. Appl. Physiol., (magnetic analog tape or photokymographic vol. 14, 1959, pp. 871-872. record) during each experiment with requisite 9. Goett, R. H.: Effect of Changes in number of calibrations to insure reliability. Posture on Peripheral Circulation, with Special Refer- Spot checks online by visual monitoring of ence to Skin Temperature Readings and the stored .oscilloscope trace or polaroid picture Plethysmogram. Circulation, vol. 1, 1950, thereof during important phases of each experiment would be highly desirable. pp. 56-75. 2. Interpretation should be by a cardiovascular 10. Graveline, E. E.; and Barnard, G. W.: physiologist or a physician with special train- Physiologic Effects of a Hypodynamic En- ing in cardiovascular physiology who had par- vironment: Short Term Studies. Aero. Med., ticipated in the series of these experiments vol. 32, 1961, pp. 726-736. carried out preflight on the astronauts being 11. McCally, M.; and Lawton, R. W.: The studied in flight. Pathophysiology of Disease and the Problem 2 1. Special Comments of Prolonged Weightlessness. A Review None. AMRL TDR 63-3, June 1963, Aero. Med. 22. Postflight Evaluation of the Crew Res. Lab., Wright-Patterson Air Force Base, None. Ohio. 90 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

12. Schweitzer, A.: Rhythmical Fluctuations in 13. Whitney, R. J.: The Measurement of Vol- . Arterial Blood Pressure. J. Physiol., VO~. urne Changes in Human Limbs. J. Physiol., 104, 1945, 25 p. vol. 121, 1953, pp. 1-27.

EXPERIMENT 4 I

1. Evaluation of Significance of Ballistocardiogram 7. Stlmmary of Number and Types of Space Sta- and/or Kinetocardiogram (Seismo or Rosa Ac- tion Personnel celerometer) for Estimation of Cardiac Dynam- Preferably, the experimental team should in- ics in the Weightless State clude : 2. Estimated Priority 1. A physician who has participated actively in the control ground-based experiments Priority 1. on the astronauts just prior to their flight. 3. Purpose 2. Trained laboratory technicians. To determine whether or not ballistocardio- 3. Two trained astronauts who would alter- graphic techniques can be used as a measure of nate as subjects and as a third member of cardiac dynamics and to extend these investiga- the experimental team. tions for the determination of cardiac output 4. All other personnel would be measured if during various activities in weightlessness. possible. 4. Justification 8. Summary of Onboard Experimental Equipment An external indication of changes in stroke v01- Required urne (and heart rate) would serve as a useful Fixed equipment for determining the ballistic measurement in testing effects of weightless- response which would include the appropriate ness and in defining the effectiveness of coun- recording techniques. termeasures. The ballistocardiogram has had a 9. Summary of Animals series of ardent supporters, but lacks general None. acceptance among cardiovascular physiologists. IO. Summary of Other Living Forms In the weightless state certain objections to the None. technique may be removed. Bayevskiy (ref. 1) 11. Summary of Onboard Laboratory Determinations in Russia and Rosa in the U.S. have proposed A determination would be made at every occa- using the principle of an accelerometer over sion in which a cardiac output was measured. the heart to indicate the force and duration of Further interim measurements could be made the stroke. during activities of various sorts and the records held for future evaluation. 5. Experiment 12. Summary of Laboratory Specimens to be Flown Appropriate ballistocardiographic devices can be to Earth for Laboratory Examination mounted on selected astronauts or other space- None. craft personnel and the cardiac dynamics as- 13. Proposed Rendezvous Schedule for Rotation of sessed. This assessment will be particularly Crew valuable if made during the times in which car- Not necessary for these experiments. diac output, as suggested in other experiments, 14. Telemetry versus Onboard Recording Require- are determined. ments 6. Experimental Controls Onboard recording with telemetry facility for While the preliminary study should be ground- sending data to Earth laboratory. based, the primary control will be the determi- 15. Prerequisire Ground-Based Experiments nations made while cardiac outputs are being Complete standardization of the technique and determined in the weightless environment. equipment. PHASE 11. . \ LIGHT MEDICAL EXPERIMENTS 91

. 16. Prerequisite Space Flight Experiments 22. Postjzght Evaluation of the Crew Some equipment checkout could be made on None. preliminary space flights. 23. References 17. Prerequisite Research and Development 1. Bayevskiy, R. M.; and Kazer’yan: Recording Design and piGdudion of the appropriate equip- of Seismocardiograms in Dogs in Problems ment for use in the weightless state. of Space Biology, M. M. Sisalsyan, ed., 18. Onboard Gaseous Etzvironment Desired NASA ‘IT F-174, vol. 1, pp. 461-464. Sea level equivalent. 2. Guyton: Circulatory Physiology Cardiac Out- put and Its Regulation in Ballistocardiog- 19. Requirement for Rotation for Artificial G *ap&y, s-.,ILIUUC~> -2- - aid Co., PhZaddphia, 2963, None. pp. 91-98. 20. Comments re Form of Data and Interpretation 3. Landes, G.: Uber die Estehung der Hertz- of Data tone =in, Wschr, vol. 36, 1941, pp. 902- Data should be in continuous analog form dur- 906, Rosa L. Die Graphische D- stallung ing each experiment with requisite number of Gasunder und Krankhafter He&;- -eit As calibrations to insure reliability. Data should Beschleuigen und Ausschla dar B 3dr.d- be stored on tape and transmitted to Earth sta- sation Cardiologia, vol. 8, 1944. ~ >-112. tions at appropriate times. 4. Parin, V. V.: Development of 3c., ,tocardi- 2 1. Special Comments ography in the USSR-Proc. Third Int. Cod. None. on Medical Eng., IEE, 1961.

EXPERIMENT 5

1. Changes in Peripheral Arteriolar Reactivity Dur- ured following arterial occlusion, exercise, and a ing the Weightless State painful stimulus. 2. Estimated Priority 2. Observation of skin response to pressure and Priority 1. to wheal-inducing stress (injection of histamine 3. Purpose phosphate). To determine if reduced stress on the circula- 6. Experimeiztd Controls tory system (absence of gravity-dependent hy- Preliminary study should be made on each of podynamic state) affects arteriolar tone. the subjects on ground level to provide base- 4. Justification line experiments. Since space flights as well as experiments in the 7. Summary of Number and Types of Space Station hypodynamic state and following bed rest have Personnel indicated that there is a postflight or postexperi- Preferably the experimental team should indude ment period of abnormal circulatory responses a physician who has participated in the ground- to tilt, the mechanism that may be postulated based experiments. The subjects will be the re- includes effects on arteriolar tone. These experi- maining personnel onboard. ments are designed to determine whether arte- 8. Summary of Onboard Experimental Equipment riolar tone changes during the weightless state Required or whether changes can be detected following Adequate plethysmographic and pressure-meas- the weightless state. uring devices and a timing device. 5. Experiment 9. Summary of Animals 1. Venous occlusion plethysmography to deter- None. mine blood flow following ischemia (reactive 10. Summary of Other Living Forms hyperemia), e.g., the Whitney gage (as pro- None. posed in venous compliance experiment) can 11. Summary of Onboard Laboratory Determinations be used. Peripheral blood flow will be meas- These determinations will be made at least once 92 MEDICAL ASPECTS OF ANORBITING RESEARCH LABORATORY

a day for 5 days and repeated at 5- or 10-day 20. C,omments re Form of Data and Interpretation . intervals during the flight. of Data 12. Summary of Laboratory Specimens to be Flown Data will be acquired by continuous analog form to Earth for Laboratory Examination as well as by observation. The analog data None. should be stored in a suitable form for trans- 13. Proposed Rendezvous Schedule for Rotation of mission to Earth laboratory at appropriate times Crew and also should be available to onboard observ- No rendezvous or rotation is necessary in this ers for analysis. experiment. 2 1. Special Comments 14. Telemetry versus Onboard Recording Require- None. ments 22. Postflight Evaluation of the Crew Onboard recording with telemetry facility for None. sending data to Earth laboratory. 23. References 15. Prerequisite Ground-Bared Experiments 1. Lewis, T.: Vascular Disorders of the Limbs. Complete standardization of techniques and Macmillan, 1936. control levels on all subjects. 2. Martin, P.; Lynn, R. B.; Dible, J. H.; Aird, 16. Prerequisite Space Flight Experiments I.: Peripheral Vascular Disorders, E. and S. Many of the techniques can be checked out on Livingston Ltd., Edinburgh, 1956. preliminary shorter-term space flights if possible. 3. Redisch, W.; Tangco, F. F.; and Saunders, 17. Prereqnisite Research and Development Standardization of plethysmographic technique. R. L. de C. H.: Peripheral Circulation in 18. Onboard Gaseous Atmosphere Desired Health and Disease. Grune and Stratton, Sea level equivalent. 1957. 19. Requirement for Rotation for Artificial G 4. Rothman, S. : Physiology and Biochemistry None. of Skin. Univ. of Chicago Press, 1954.

EXPERIMENT 6

1. Changes in the Eficacy of Arterial Pressure based experiments on individuals in the sub- Control Systems During Space Flight by Shifts merged states also indicate similar results. of Blood Distribution 5. Experiment 2. Estimated Priority Procedures will be used to shift the blood vol- Priority 1. ume in the astronauts by means of simple ex- 3. Purpose perimental techniques. Under normal circum- To study the influence of prolonged weightless- stances, such a shift would require a readjust- ness on the integrity of the reflex and humeral ment in vasomotor activity to maintain arterial control mechanisms which integrate and sustain blood pressure and circulatory inadequacy. If the circulation. the normal mechanisms are not operative, under 4. Justification the test conditions blood pressure and circula- This is a necessary piece of knowledge relative tory adequacy will be disrupted. to the safety of prolonged space travel. There The initial test situations will be (I) a calibrated is evidence from American and Russian expe- Valsalva procedure (Flack Test) which pro- rience in weightless states over a long period of duces an increase in intrathoracic pressure and, time that a loss of blood pressure control de- in turn, peripheral pooling of blood; (2) the velops, and there is at least transient postural inflation of blood pressure cuffs about three hypotension. It is interesting to note that this extremities, two legs and one arm to provide one has been noted to occur with a diminished or free arm for measurements (The cuffs will be absent excretion of norepinephrine. Ground- inflated to 60 millimeters of mercury pressure PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 93

. for a period of 10 minutes.); and (3) other 12. Summary of Laboratory Specimens to be Flown , methods including the development of “arti- to Earth for Laboratory Examination ficial gravity” may be used in later stages of None unless norepinephrine assays are avaiiable. this experiment. 13. Proposed Rendezvous Schedule for Rotation of Proposed protocol: A minimum of 4 subjects I Crew will be studied. The first control observation None. will be made prior to orbital conditions. Arte- 14. Telemetry versus Onbourd Recording Reqnire- rial pressure will be measured by the customary ments 43technique and heart rate accurately timed. Control observations will be made after the All onboard. subject has been supine for a minimum of 20 1 5. Prerequisite Ground-Based Experiments minutes. Then, the test procedure will be ap- See Proposed Protocol under 5. plied, pressures and heart rates again measured, 16. Prerequisite Space Flight Experiments and, following this, additional control observa- Experiments of similar nature on shorter flights tions will be obtained. The entire experiment will be of interest, but prolonged weightlessness will be repeated a minimum of 3 times prior to is essential for these observations. I orbital flight. Following the assumption to 17. Prereqrrisite Research and Development orbital flight, the procedure will be repeated 1 None. I time per day during the first week in orbit, 18. Onboard Gaseous Atmosphere Desired then, time per week unless circulatory diffi- 1 Sea level oxygen and nitrogen atmosphere is culties develop. On return to Earth, the ob- highly desirable. I servations will be made as soon as possible and 19. Requirement for Rotution for Artificial G repeated at 2-hour intervals, insofar as possible, during the first 24 hours. Thereafter, they will None unless experiments show serious cardiovascular deterioration which cannot be prevented be made 1 time per day for the first 2 weeks, although this may be modified depending upon by other simpler measures. the test results. 20. Comments re Form of Data and lnterpretation of Data 6. Experimental Controls Ground-based observations will serve as con- None. trol for each subject. 2 1. Special Comments 7. Summary of Nrrmber and Types of Space Station None. Personnel 22. Postflight Evaluation of the Crew One physician with physiologic training and one None. laboratory technician or trained astronaut. 2 3. References 8. Summary of Onboard Experimental Equipment 1. Ebert, R.; and Stead, Eugene A.: Effect of Required the Application of Tourniquet of Henody- One Valsalva device for controlled resistance to namics of the Circulation. J. Clin. Invest., expiration, three blood pressure dsfor placement about the extremities, and one blood pres- vol. 19, 1940, 561 p. sure device for pressure measurements. 2. Fitzhugh, S. W., Jr.; McWhater, R. L., Jr.; 9. Summary of Animals Estes, E. H., Jr.; Warren, James V.; Merdl, None. A. J.: The Effect of Application of Td- 10. Summary of Other Living Forms quets to the Legs on Cardiac Output and None. Renal Function in Normal Human Subjects. 11. Summary of Onboard Laboratory Determina- 3. Graveline, D. E.: Maintenance of Cardio- tionr vascular Adaptability During Prolonged None essential; if available, determinations for Weightlessness. ASD TR 61-707, Wrigb’ catecholamines would be of interest. Patterson AFB, Ohio, 1961. 94 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

EXPERIMENT 7

1. Predictive Tests to Assess Ability of Vasomotor 7. Summary of Number and Types of Space Station System to Readjust to Reentry Stress and Re- Personnel accommodation to Terrestrial Gravity No special training of astronaut. 2. E;timated Priority 8. Summary of Onboard Experimental Equipment Priority 1. Required 3. Purpose Equipment, urine containers, test tablets. To measure the secretion response of catechola- 9. Summary of Animals mines to standardized stress such as hypoxia None. and/or thermal stimuli. 10. Summary of Other Living Forms 4. ]ustificati,on and Rationale None. It has been noted that with increasing time in 11. Summary of Onboard Laboratory Determinations orbit there has been a degradation of the vaso- Daily-1 minute. motor response after return to 1 G. It has been 12. Summary of Laboratory Specimens to be Flown found that in ground-simulated experiments of to Earth for Laboratory Examination prolonged bed rest that there is a disappearance None. of catecholamines and their metabolic end prod- 13. Proposed Rendezvous Schedule for Rotation of ucts from the blood and urine of the subjects. Crew It is known that under conditions of hypoxia None. (about 1.4 psi of 0,) there is a marked increase 14. Telemetry versus Onboard Recording Require- in the circulating catecholamines. It is assumed ments that if there is an adequate catecholamine re- Routine voice report of test results. sponse by an astronaut in orbit to a measured 1 5. Prerequisite Ground-Based Experiments stress that he has sufficient responsiveness to As noted previously under 4 and 6. tolerate reentry stress and return to 1 G. 16. Prerequisite Space Flight Experiments 5. Experiment None. At a given time each day while the astronaut is 17. Prerequisite Research and Development in orbit, he will stress himself by a suitable tech- Develop color-producing reagent tablet. nique chosen from a series to be ground-tested 18. Onboard Gaseous Atmosphere Desired by bed rest simulation. These stresses may be Not applicable. hypoxia, alternating hot and cold exposure in 19. Requirement for Rotation for Artificial G the new pressure suits, etc. After the stress, the Not applicable. astronaut voids into a container. A simple tab- 20. Comments re Form of Data and Interpretation let containing ingredients similar to those for of Data the DOPPA test is put into the urine. A posi- Decreasing concentration of catecholamine meta- tive color reaction indicates an adequate respon- bolic end products indicate failing ability of siveness. A negative color would be an indica- vasomotor system to respond to stress. tion of abort. 21. Special Comments 6. Experimental Controls None. Ground simulation testing to determine validity 22. Postflight Evaluation of the Crew of response. Since the test will be carried out Non F daily, a diminution in excretion can be detected 23. RejL.rences early. None.

EXPERIMENT 8

1. Changes in Circulatory Responses to Exercise 2. Estimated Priority with Duration of Exposure to the Weightless State Priority 1. -~ ~~

PHASE It: IN-FLIGHT MEDICAL EXPERIMENTS 95

3. Purpose 13. Proposed Rendezvous Schedule for Rotation of As a measure of circulatory integrity, the ability Crew of the heart to respond to stressful situations None. under prolonged weightless states is an impor- 14. Telemetry versus Onboard Recording Require- tant component of circulatory reflex integration. ments 4. Justification Mi onbcard. Maintenance of circulatory function in prolonged 1 5. Prerequisite Ground-Bared Experiments weightless states is of great importance in the See experimental protocol. survival of astronauts during prolonged space 16. Prerequisite Space Flight Experiments travel. New aspects become of critical impor- Not presently known. tance in the integration of the circulation on 17. Prerequisite Research and Development return to Earth. None. 18. Onboard Ga~eousAtmosphere Desired 5. Experiment Sea level pressure with oxygen and nitrogen The response of the circulation to a stimulus that preferable. increases cardiac output under usual circum- 19. Requirement for Rotation for Artificial G stances will be studied in the weightless state. The stimulus to increase cardiac output will be None. 20. Comments re Form of Data and Interpretation (1) exercise and (2) reactive hyperemia. The of experimental plan calls for 4 subjects. Data None. Observations will be carried out on Earth and 2 1. Specid Comments repeated daily in orbit for the first week, then None. 1 time per week until return to Earth where 22. Postfight Evaluation of the Crew they will be repeated once a week until the None. values have stabilized. The experimental plan 23. References will indude control Observations of cardiac out- 1. Asmusser, E.; and Nielson: Cardiac Output put at rest, then under the stress of exercise, During Muscular Work at Its Regulation. and will be followed with observations at rest. Physiol. Ref., vol. 33, 1955, 778 p. 6. Experimental Controh 2. Bevergard, S.; Holmgren, A.; and Jonsson, Each subject will serve as his own control. A.: Circulatory Studies in Well-Trained Ath- 7. Summary of Number and Types of Space Sta- letes at Rest and During Heavy Exercise, tion Personnel with Special Reference to Stroke Volume and One physician with physiologic training and one the Influence of Body Position. Reprint technician or trained astronaut. from Stockholm, Sweden, Department of 8. Summary of Onboard Experimental Equipment Clinical Physiology, Karolinska. Required 3. Bishop, J. M.; Cumming, G.; Donald, K. W.; Cardiac output calculator, bicycle ergometer or and Wade, 0. L.: The Effect of Exercise of exerciser, blood pressure dsfor inflating about the Cardiac Output and Circulatory Dynamics extremities. of Normal Subjects. Clin. Sci., vol. 14, 1955, 9. Summary of Animals p. 37. None required. 4. Blount, S. G.; Filley, G. F.; Grover, R. F.; and Reeves, J. T.: Cardiac Output Response 10. Summary of Other Living Forms to Standing and Treadmill Walking. J. None required. Appl. Physiol., vol. 16, 1961, p- 283. 11. Summary of Onboard Laboratory Determinat%ns 5. Brostoss, P.; Freedman, M. E.; Katz, L. N.; Cardiac output by indicator dilution utilizing and Snider, G. L.: Effects of Training on computer techniques. Response of Cardiac Output to Muscular 12. Summary of Laboratory Speciments to be Flown Exercise in Adults. J. Appl. Physiol., vol. 8, to Earth for Laboratory Examination 1955, p. 37. None. 6. Cargill, W.. H.; and Hickam, J. B.: Effects 96 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

of Exercise on Cardiac Output and Pulmon- Physiol., vol. 3, 1951, p. 439. ary Atrial Pressure and Normal Persons and 9. Guyton, A. C.: Circulatory Physiology Car- in Patients with Cardiovascular Disease and diac Output and Its Regulation. Mississippi Pulmonary Enphysema. J. Clin. Inves., vol. Medical Center, Jackson, Miss. 27, 1948, p. 10. 10. Hoover, George; Mathews, Donald K.; Stacy, 7. Chapman, C. B.; Fisher, J. M.; and Sproule, Ralph W.: Physiology of Muscular Activity B. J.: Behavior of Stroke Volume at Rest and Exercise. and During Exercise in Human Beings. J. 11. Marshall, R. J.; Shephard, J. T.; and Wang, Chn. Inves., vol. 39, 1960, p. 1208. Y.: The Effect of Changes in Posture and 8. Dexter, L.: Effects of Exercise on Circulatory of Graded Exercise on Stroke Volume in Dynamics in Normal Individuals. J. Appl. Man. J. Clin. Inves., vol. 39, 1960, p. 1051.

EXPERIMENT 9

1. Study of Possible Effects of the Weightless En- the stretch receptors in the wall of the carotid vironments on the Sensitivity of the Carotid sinus is the usual stimulus which will produce Sinus Arterial Pressure Control Loop an increment in activity of the carotid sinus 2. Estimated Priority mechanism. Priority 1. An increase in transmural pressure in the carotid 3. Purpose sinuses can be produced by applying a known To study the effect of the weightless environ- degree of subambient (negative) pressure to ment on the sensitivity of the carotid sinus arter- the neck. This has been done by Drs. J. Ern- ial blood pressure control loop. sting and D. J. Parry in Farnsborough, England, 4. Justification (Journal of Physiology 137: 45-46, 1957), and It is generally believed that one of the possible confirmed and extended by Drs. John Shephard major effects of a weightless environment will and Sture Bevegard at the Mayo Foundation be a decrement in cardiovascular reactivity asso- using specially fabricated neck casts made of ciated with the absence of the usual gravita- transparent plastic lucite. Subambient pressures tional hydrostatic stresses which this system must surrounding the neck ranging up to 50 to 60 withstand on Earth. cm H,O can be produced at will and are fol- The Baroreceptor carotid sinus mechanism is one lowed promptly by a decrease in heart rate and of the major control loops responsible for the systemic arterial pressure and an increase in regulation of systemic arterial pressure and hence forearm blood flow, the magnitude of which is its sensitivity might possibly be altered by the dependent on the degree of negative pressure. relative disuse of the system during existence in It is proposed to study this reaction in detail in the zero gravity state. An objective and quanti- selected astronauts preflight in the 1 G state and tative test of the sensitivity and reactivity of alter varying periods of weightlessness. If a this system which could be applied both in the decrement in sensitivity of the carotid sinus 1 G and the zero G environment would make mechanism is demonstrable in the weightless possible collection of firm data in this regard. environment, then the effects on this decrement If positive results were obtained during the zero of various possible countermeasures, such as gravity state by means of this procedure, there graded degrees of exercise, application of nega- would be a significant probability that the test tive pressure to the body caudad to the dia- could be used as an objective means of assessing phragm, or large amplitude body oscillation the severity of this hypodynamic state as well as (exercises on a double-ended trampoline) will the efficacyof various types of counter measures. be studied. 5. Experiment Procedure: In preflight, 1 G studies and ob- An increase in transmural pressure which in- servations would be made in the supinehorizon- creases the tension and hence tends to lengthen tal position under controlled ambient conditions PHASE 11: IN-FLKHT hlEDICAL EXPERIMENTS 97

after one-half hour period of recumbency. These I. TO standardize in detail the technics and observations will be repeated at selected intervals equipment to be used. after the launch phase of the flight. The first ex- 2. To determine the reproducibility of the reac- periment should be performed within 24 hours tion to negative neck pressure from subject after launch if possible. These observations should to subject and in the same subject. be repeated abcui ei~rj:48 how5 foi the first 1 or 7. Shrizmdt] uj liatnber and Types of Space Sta- 2 weeks and approximately once a week there- tion Personnel after, depending on the results obtained. Preferably, the experimental team should in- If positive evidence of cardiovascular deteriora- clude: tion is obtained, the experiments should be re- 1. A physician who has participated actively in peated at selected intervals after return to Earth the control ground-based experiments on the to delineate the recovery phase from the hypo- astronauts just prior to their flight. dynamic site. Neck cast with seals around base 2. A trained laboratory technician. of head and neck-shoulder junction regions will 3. Two trained astronauts who would alternate need to be indiridual!~fabricated and fitted for in acting db subjects and ds the [hid mem- each subject. Periods of negative pressure of ber of the experimental team. 60 seconds duration will be used. 8. Summary of Onboard Experimental Equipment Measurements: Required a. Priority I Fixed Egnipnienf (1) Heart rate continuously for 15 sec a. Individually-fitted lucite neck casts for the prior to, during, and 60 sec after period of two astronauts and a suitable source of nega- negative pressure. tive pressure with quick disconnect connec- (2) Respiratory amplitude continuously for tions to the neck cast. same period. b. Apparatus for continuous registration of (3) Arterial pressure by auscultatory or di- heart rate based on the ECG, ear opacity rect method for same period. pulse, or a directly recorded arterial pulse. (4) Intermittent measurements of forearm c. Forearm plethysmograph for measurements blood flow (plethysmograph) for same of forearm blood flow and venous compliance period. of the volume displacement of possible mer- b. Phrity 2 (priority based on judgment of cury-tube strain-gauge type. technical difficulty of measurement and the d. Strain gauge and appropriate cannula and value of the data obtained) Ringer's fluid-flushing system for continuous (1) Cardiac output (just prior to period of registration of arterial pressure. negative pressure to neck and during last e. Appropriate venous cannula for injection 30 sec of period of negative pressure). of indicator and strain-gauge manometer for (2) Venous pressure via the catheter or registration of venous pressure via this can- needle used to inject the circulatory indi- nula. cator. f. Cuvette or ear densitometer for registra- (3) Measurement of compliance of fore- tion of indicator-dilution curve directIy on arm veins (plethysmograph). arterial blood flowing from the arterial can- (4) Repetition of experiment during circu- nula (mentioned under d) or indirectly latory stress associated with exercise. through transillumination of the ear (ref. 3). 6. ExperimerrtaI Corltrols g. Means of continuous or essentially con- A series of experiments should be carried out on tinuous registration of variables such as an healthy male subjects in the same age range as onboard tape recorder with miniature multi- the astronauts under carefully controlled condi- channel oscilloscope display (oscilloscope tions using the procedure outlined under 5 and should have trace storage and erase capability) variants thereof. and possible miniature Polaroid camera for The objective of these experiments would be: photographing particularly pertinent traces. 98 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

The tape recorder should have playback capa- 16. Prerequisite Space Flight Experiments bility for telemetering back to Earth and for Flights to check out performance of equipment onboard monitoring and analysis of data. and technics under weightless conditions would h. Cuvettes and/or earpiece densitometer and be highly desirable. oximeter. 17. Prerequisite Research and Development Consumable Equipment 1. Optimization of design of neck cast, negative a. Sterilized cannula and syringes. pressure source, and quick disconnect fittings. b. Sterile heparinized (20 mg sodium hep- 2. Optimization of design of arterial and venous arin/liter) Ringer's solution. cannula, forearm plethysmograph, pressurized c. Skin antiseptic. Ringer's fluid-flushing system, ear and/or d. Two percent procaine solution. cuvette oximeter and densitometer with asso- e. Indicator dye-indocyanine green (prefer- ciated hydraulic connections and blood with- ably) or Evans blue. drawal reinfusion system, circulatory indicator f. Sterilized towels or special drapes and dispenser and injection syringe, onboard re- sponges. corder with associated miniature multichannel g. Sterile surgical gloves. oscilloscope of storage-beam type for online 9. Summary of Animals monitoring and possible recording (polaroid None. camera), and onboard tape recorder with play- 10. Summary of Other Living Forms back capability for display on oscilloscope and None. telemetering to ground station highly desir- 11. Summary of Onboard Laboratory Determinations able, special drapes, disposable syringes and 1. Experiment should be performed during first cannula (including plastic catheters), skin 24 hours of flight if possible and repeated at antiseptic dispenser, strain gauges for arterial 48-hour intervals for about the first week and venous pressure with appropriate hydraulic thereafter, depending on the results obtained. connections for flushing and calibration, ap- 2. The time consumed for each experiment paratus for registration of respiration (pref- would depend on the number of parameters erably oral pneumotachograph) . recorded. If all parameters mentioned were 18. Onboard Gaseous Atmosphere Desired recorded, approximately 1 to 2 hours would Earth atmosphere in range from 0 to 5,000 feet be required for each experiment. above sea level with shirtsleeve environment. 12. Siinzniavy of Laboratory Specimens to be Flown 19. Requirement for Rotation for Artificial G to Earth for Laboratory Examination None, unless experiments show serious cardio- None. vascular deterioration which cannot be prevented 13. Proposed Rendezvous Schedule for Rotation of by other measures such as application of sub- Crew ambient pressure to the body caudad to diaphragm None, unless experiment reveals serious progres- at intervals during each 24 hours (perhaps dur- sive deterioration of cardiovascular status of ing the sleep cycle), large amplitude body vibra- astronauts. tion (double-ended trampoline) , etc. 14. Telemetry versus Onboavd Recording Require- 20. Comments re Form of Data and Interpretation ments of Data If a physician or a highly trained physiologist 1. Data should be in continuous or essentially or laboratory technician is onboard, recording and continuous form (magnetic tape or photo- visual display online or on playback from tape kymographic record) during each experiment recorder would be highly desirable. with requisite number of calibrations to insure Telemetry to Earth online or on playback from reliability. Spot checks online by visual moni- onboard tape recorder would also be highly de- toring of stored oscilloscope trace or polaroid sirable as a backup and to insure that data were picture thereof during important phases of not lost on reentry. each experiment would be highly desirable. 15. Prerequisite Ground-Based Experinzents 2. Interpretation should be by a cardiovascular Outlined under 6. physiologist or a physician with special train- PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 99

ing in cardiovascular physiology who has basis for judging the efficacy of various types of participated in the series of these experiments countermeasures which could be employed, e.g., carried out preflight on the astronauts being as an unlikely last resort, an onboard centrifuge. studied in flight. 22. PostfZight Evaluation of the Crew 21. Special Comments None. IGterpretation of the data obtained during flight, 2 3. References if progressive changes should be observed, may 1. Ernsting, J.; and Parry, D. J.: Some Obsema- prove to be one of the best objective bases upon tions on the Effects of Stimulating the Stretch which to decide whether or not a flight should Receptors in the Carotid Artery of Man. J. be continued or rendezvous for rotation of crew Phgsioi., vol. 137, 1957, pp. 45-46. be carried out. 2. Reed, J.; and Wood, E. H.: Use of Dichro- If positive evidence of cardiovascular deteriora- matic Earpiece Densitometry for Determina- tion during weightlessness is obtained, these ex- tion of Cardiac Output. The Physiologist- periments may prove to be an excellent objective in press.

EXPERIMENT 10

1. Study of Possible Efects of the Weightless En- countermeasures are required, that this procedure vironment on the Susceptibility of the Cardio- would be an excellent countermeasure to prevent vascular System to a Hydrostatically Simulated deterioration of cardiovascular reactivity due to Upright Position the absence in the weightless state of the normal 2. Estimated Priority hydrostatic stresses associated with existence in Priority 1. the 1 G environment of Earth. 3. Purpose 5. Experiment To study the effect of the weightless environ- An effective decrease in resistance to blood flow ment on the capability of the cardiovascular sys- to dependent portions of the body and increase tem tocompensate for simulatedhydroastatic effects. in the level of venous pressure in dependent 4. Justification veins required to return blood to the heart are It is generally believed that one of the possible the essential effects of being tilted upright at 1 G major effects of a weightless environment will or exposure to positive acceleration which con- be a decrement in cardiovascular reactivity asso- stitute a stress to the cardiovascular system. ciated with the absence of the usual gravita- These effects of the upright tilt as well as weight- tional hydrostatic stresses which this system must bearing by the lower extremities can be simul- withstand on Earth. ated as follows: the lower body is enclosed, in It has been demonstrated by Dr. David Green- the supine position, in a rigid, elongated (rec- field that application of subambient pressure to tangular or cylindrical) container sealed around the body surface caudad to the diaphragm pro- the lower rib margin by a rubber diaphragm duces a stress and consequent reactions of the and with the feet resting on a block of suitable cardiovascular system which are similar to effects thickness to contact the opposite end of the of exposure to positive acceleration or to being container. Subambient pressure of about 40 to tilted upright in the normal (1 G) environment. 60 cm H,O is created in the container by con- If positive results were obtained during the zero necting it to a high volume level vacuum source gravity state by means of this procedure, there such as a vacuum cleaner mechanism. The would be significant probability that the test negative pressure over the entire lower surface could be used as an objective means of detecting of the body created in this fashion accelerates the onset of a decrement in cardiovascular re- arterial inflow to the lower body and hinders activity and as a means of assessing the severity the return of blood from the caudad portions of this hypodynamic state. There is also a sig- of the vascular system to the heart. Dr. David nificant probability, if it is demonstrated that Greenfield has demonstrated that this results in ZOO MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

compensatory cardiovascular reactions similar to tion is obtained the experiment should be re- * those produced by the upright tilt or exposure peated at selected intervals after return to earth to positive acceleration. to delineate. the recovery process. It is proposed to study these reactions in detail Measurements: in selected astronauts preflight in the 1 G state a. Priority 1 and after varying periods of weightlessness. If (1) Heart rate continuously for 15 sec a decrement in cardiovascular reactivity to this prior to, during, and 60 sec after period type of simulated hydrostatic stress is demon- of negative pressure. strable in the weightless environment, then the (2) Respiratory amplitude continuously for effects on this decrement of various possible same period. countermeasures, such as graded degrees of ex- (3) Arterial pressure by auscultatory or ercise, repeated applications of negative pressure direct method for same period. to the lower body, or large amplitude body (4) Intermittent measurement of forearm oscillation (exercise on a double-ended tram- blood flow (plethysmograph) for same poline), will be studied. period. Parenthetically, the negative pressure produces a b. Priority 2 (priority based on judgment of force tending to push the body into the con- technical difficulty of measurement and the tainer. This force amounts to a pound per value of the data obtained) square inch of cross sectional body area at the (1) Cardiac output (just prior to period point of seal per 52 mm Hg of subambient of negative pressure and during last 30 pressure. For instance, an individual whose sec of this), lower thorax was 31.4 inches in circumference (2) Venous pressure via the catheter or would experience a caudad force supported by needle used to inject the circulatory indi- his lower extremities of about 78.9 pounds. cator. This may have some effect on the presumed (3) Measurement of compliance of fore- muscle and skeletal wasting effects of the weight- arm veins (plethysmograph). less environment. (4) In some subjects, esophageal pressure Procedure: Lower body containers of minimum should be recorded in order to assess in- volume and optimum design in relation to directly the effects of application of lower- weight, configuration and ease of obtaining a body negative pressure on intrapleural and seal around the lower thorax will be designed pericardial pressures. and fabricated for interchangeable use between 6. Experimental Controls subjects. A suitable high-volume, low-vacuum A series of experiments should be carried out source with suitable rapid disconnect connec- on healthy male subjects in the same age range tions to the lower-body container will be ob- as the astronauts under carefully controlled contained. In pre-flight 1 G studies, observations ditions using the procedure outlined under 5 would be made in the supine-horizontal position and variants thereof. under controlled ambient conditions after one- The objective of these experiments would be: half hour period of recumbency. 1. To standardize in detail the technics and Periods of negative pressure of 20 or more sec- equipment to be used. onds will be used. These observations will be 2. To determine the reproducibility of the re- repeated at selected intervals after the launch action to negative lower-body pressure from phase of the flight. The initial experiment subject to subject and in the same subject. should be performed during the first 24 hours 7. Summary of Number and Types of Space Sta- after launch if possible. These observations tion Personnel should be repeated about each 48 hours there- Preferably, the experimental team should in- after the first 1 or 2 weeks and approximately clude: weekly thereafter depending on the results 1. A physician who has participated actively in obtained. the control ground-based experiments on the If positive evidence of cardiovascular deteriora- astronauts just prior to their flight. PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 101

2. A trained laboratory technician. d. Two percent procaine solution. 3. Two trained astronauts who would alternate e. Indicator dye-indocyanine green (prefer- in acting as subjects and as the third member ably) or Evans blue. of the experimental team. f. Sterilized towels or special drapes and 8. Summary of Onboard Experimental Equipment sponges. Re puived g. Sterile surgical gloves. Fixed equip ment: 9. Summary of Animals a. A suitable lower-body chamber and sealing None. diaphragm which will fit both astronauts 10. Summary of Other Living Forms and a suitable source of negative pressure None. with quick disconnect connections to the 11. Summary of Onboard Laboratory Determinations lower-body container. 1. The experiment should be performed during b. Apparatus for continuous registration of. the first 24 hours of flight if possible and heart rate based on the ECG, ear opacity repeated at 48-hour intervals for about the pulse, or a directly recorded arterial pulse. first week and each week thereafter. c. Forearm plethysmograph for measurements 2. The time consumed for each. experiment of forearm blood flow and venous compli- would depend on the number of parameters ance of the volume displacement or pos- recorded. If all parameters mentioned were sible mercury-tube strain-gauge type. recorded, approximately 1 to 2 hours would d. Strain gauge and appropriate cannula and be required for each experiment. Ringer’s fluid-flushing system for contin- 12. Siiriimary of Laboratory Specimens to be Flown uous registration of arterial pressure. to Earth fQY Laboratory Examination e. Appropriate venous cannula for injection None. of indicator and strain-gauge manometer 13. Proposed Rendezvous Schedule for Rotation of for registration of venous pressure via this Crew cannula. None, unless experiment reveals serious progres- f. Cuvette or ear densitometer for registra- sive deterioration of cardiovascular status of tion of indicator-dilution curve directly on astronauts. arterial blood flowing from arterial can- 14. Telemetry versus Onboard Recording Require- nula (mentioned under item d) or indi- ments rectly through transillumination of the ear If a physician or a highly-trained physiologist or (ref. 3). laboratory technician is onboard, onboard record- g. Means of continuous or essentially contin- ing and visual display online or on playback uous registration of variables such as an from tape recorder would be highly desirable. onboard tape recorder with miniature multi- Telemetry to Earth online or on playback from channel oscilloscope display (oscilloscope onboard tape recorder would also be highly de- should have trace storage and erase capa- sirable as a backup and to insure that data were bility) and possible miniature polaroid not lost on reentry. camera for photographing particularly 1 5. Prerequisite Ground-Based Experiments pertinent traces. The tape recorder should Outlined under 6. have playback capability for telemetering 16. Prereguisite Space Flight Experiments back to Earth and for onboard monitoring Flights to check out performance of equipment and analysis of data. and technics under weightless conditions would h. Cuvette and/or earpiece densitometer and be highly desirable. oximeter. 17. Prerequisite Research and Development Consumdbk equipment: 1. Optimization of design of lower-body con- a. Sterilized cannula and syringes. tainers, negative pressure source, and quick b. Sterile heparinized (20 mg sodium hep- disconnect fittings. arin/liter) Ringer’s solution. 2. Optimization of design of arterial and venous c. Skin antiseptic. cannula, forearm plethysmograph, pressurized 102 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Ringer’s fluid-flushing system, ear and/or monitoring of stored oscilloscope trace or * cuvette oximeter and densitometer with asso- Polaroid picture thereof during important ciated hydraulic connections and blood with- phases of each experiment would be highly drawals reinfusion system, circulatory indi- desirable. cator dispenser and injection syringe, onboard 2. Interpretation should be by a cardiovascular recorder with associated miniature multi- physiologist or a physician with special train- channel oscilloscope of storage-beam type ing in cardiovascular physiology who had for online monitoring and possible record- participated in the series of these experiments ing (Polaroid camera), onboard tape re- carried out preflight on the astronauts being corder with playback capability for display studied in flight. on oscilloscope and telemetering to ground 21. Special C.0mment.r station highly desirable, special drapes, dis- Interpretation of the data obtained during flight, posable syringes and cannula (including plas- if progressive changes should be observed, may tic catheters), skin antiseptic dispenser, strain prove to be one of the best objective bases gauges for arterial and venous pressure with upon which to decide whether or not a flight appropriate hydraulic connections for flushing should be continued or rendezvous for rotation and calibration, apparatus for registration of of crew be carried out. respiration (preferably oral pneumotacho- If positive evidence of cardiovascular deterio- graph). ration during weightlessness is obtained, these 18. 0nbodr.d Gaseous Atmosphere Desired experiments may prove to be an excellent ob- Earth atmosphere in range from 0 to 5,000 feet jective basis for judging the efficacy of various above sea level with shirtsleeve environment. types of countermeasures which could be em- 19. Requirement for Rotation for Artificial G ployed, e.g., as an unlikely last resort, an on- None, unless experiments show serious cardio- board centrifuge. vascular decrement which cannot be prevented by other measures such as application of subambient 22. Postflight Evaluation of the Crew pressure to the body caudad to diaphragm at None. intervals during each 24 hours (perhaps during 23. References the sleep cycle), large amplitude body vibration 1. Greenfield, A. D. M.; Brown, H.; Goei, J. S.; (double-ended trampoline), etc. and Plassaras, G. C. : Circulatory Responses 20. Co?mieizts re Form of Data and Interpretation to Abrupt Release of Blood Accumulated in of Datu the Legs. The Physiologist, vol. 6, 1963, 1. Data should be in continuous or essentially p. 191. continuous form (magnetic tape or photo- 2. Reed, J.; and Wood, B. H.: Use of Dichro- kymographic record) during each experiment matic Earpiece Densitometry for Determina- with requisite number of calibrations to in- tion of Cardiac Output. The Physiologist- sure reliability. Spot checks online by visual in press.

EXPERIMENT 11

1. Determination of the Effect of Weightlessness weight of the chest and thorax in inspiration. on Pulmonary Mechanics Absence of gravity may lead to shifts in lung 2. Eshiznted Priority volume (particularly to a decrease in FRC, with Priority 1. an accompanying probatory of atelectasis) and 3. Purpose may increase airway resistance, the latter result- To determine whether prolonged weightlessness ing from decreased tissue pull on the conducting produces any alteration in pulmonary mechanics. airways. Possibly, decreased work of the respir- 4. Itistifiration atory muscles may lead to a decrease in muscle Respiratory muscles normally are opposed by the strength. These studies will also be helpful in weight of the viscera in expiration and the medical care of the astronaut. PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 103

5. Experiment Results could be transmitted to Earth for per- Serial measurements of the following will be manent record. performed every day for the first week and less 13. Proposed Rendezvous Schedule for Rotation of frequently thereafter: Crew a. Vital capacity and spirometric volumes No restrictions. b. Index of airway resistance, such as maximal 14. Telemetry versus Onboard Recording Require- expiratory flow rate and total airway re- mentJ sistance Onboard recording and telemetry required. c. Maximum inspiratory and expiratory pres- 15. Prerequisite Ground-Based Experiments sure Presently available equipment could be rede- d. Lung compliance with spirometric volumes signed for this experiment to reduce weight and esophageal pressure and space. 6. Experimental Controls 16. Prerequisite Space Flight Experiments Similar studies performed once a week for 3 Equipment should be tested in flight. AU pul- weeks before launching and similarly on return. monary function tests should be attempted un- Subject would be his own control. der zero G. 7. Summary of Number and Types of Space Sta- 17. Prereqilisite Research and Development tion Personnel Only on the equipment which could be modi- Subject and technical assistance from one other fied from present types. individual, although subject could be taught to 18. Onboard Gaseous Atmosphere Desired perform the test. Physician or technician would Air in the range from sea level to 5000 ft. If not, facilitate measurements. controls must be done under same atmosphere. 8. Summary of Onboard Experimental Equipment 19. Requirement for Rotation for Artificial G Required None. 1. Spirometer of wedge- or bellow-type ar- 20. Comments re Form of Data and Interpretation ranged to record on paper. of Data 2. Pressure transducer arranged to record in Volume-time and pressure-volume records could same manner. be stored on paper or tape. 3. If cathode ray oscillioscope is available, it 21. Special Comments could be used. None. 9. Summary of Animals 22. Postflight Evaluation of the Crew None. None. 10. Summary of Other Living Forms 23. References None. 1. Comroe, J. H., Jr.; et al: The Lung. Year 11. Summary of Onboard Laboratory Determination: Book Publishers, Chicago, 1958. No chemical examinations. 2. Wood, E. H.; et al: Influence of Accelera- 12. Sirmmary of Laboratory Specimens to be Flown tion on Pulmonary Physiology. Fed. Proc., to Edvth for Laboratory Examination vol. 22, 1963, pp. 1024-1041.

EXPERIMENT 12

1. Determination of the Effect of Weightlessness 4. Iustijication on Control of Respiration Respiration is controlled largely by arterial 2. Estimated Priority P,,,, pH, and Poz, but a number of other fac- Priority 1. tors contribute indeterminant amounts, indud- 3. Purpose ing the acid base state of the cerebrospinal To determine whether prolonged weightlessness fluid, body temperature, and reflexes (particu- produces any change in the regulation of respi- larly those from the bones and joints). The ration. effect, particularly long-term, of zero G upon 104 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

this control system is not known. An example Outlined under 8. of a possible derangement is a reduction in 12. Summary of Laboratory Specimens to be Flown respiratory minute volume, particularly while to Earth for Laboratory Examination asleep, owing to a reduction in sensory inflow. None. An alteration in alveolar ventilation can cause 13. Proposed Rendezvous Schedule for Rotation of disability whether it is raised or lowered. Crew 5. Experiment Does not apply. The following measurements would be made 14. Telemetry versus Onboard Recording Require- awake and asleep, at rest and during a fixed ments grade of exercise daily: Telemetry required. a. Respiratory rate and minute volume 15. Prerequisite Ground-Based Experiments b. Expired alveolar PCo2 and PO2, during Only to develop the equipment. The use of it steady state breathing and at the breaking will be checked in the controls. point in breath holding 16. Prerequisite Space Flight Experiments The following would be measured at longer It would be worthwhile, although not completely intervals : essential, to have the techniques checked in pre- a. Arterial pH, bicarbonate, PCO2,02Hb sat- liminary space flight. uration, and Po?, under steady-state condition 17. Prereyuisite Research and Development b. Response to breathing increased C02 (as This will be needed largely for the refinement by rebreathing) consisting of measurement of the methods. Usable techniques are avail- of alveolar P,,., and minute volume. able at present, but will need to be modified. Breath-holding time measured daily. 18. Onboard Gaseous Atmosphere Desired 6. Experimental Controls Air. If not, controls will have to be done with Comparable measurements would be made over same atmosphere. the 3 weeks before launching to establish nor- 19. Requirement for Rotation for Artificial G mal values at 1 G and to familiarize the astro- None. naut with the procedure. 20. Comments re Form of Data md Interpretation 7. Summary of Number and Types of Space Sta- of Data tion Personnel Data can be obtained in numbers and inter- One individual to provide technical assistance preted aloft. although the subject could learn to do the 2 1. Special Comments measurements himself. All the parameters of the respiratory control 8. Summary of Onboard Experimental Equipment system cannot be determined at present, but the Required measurements suggested are directed towards 1. Flow meter for measurement of minute detecting changes in the most important factors. volume. 22. Postflight Evaluation of the Crew 2. Gas analyzer for O2 and COP (could be a None. mass spectrometer, gas chromatograph, or 2 3. References chemical method). No indication has been obtained that the con- 3. Equipment for the determination of blood trol of respiration is altered in zero G, nor is pH, PCO2,Po2, OaHb saturation, and bicar- there any obvious reason to expect a major al- bonate. This and item 2 may be in the gen- teration. The references are general ones re- eral laboratory. garding the control of respiration. 9. Summary of Animals 1. Comroe, J. H., Jr.; et al: The Lung. Year None. Book Publishers, Chicago, 1958. 10. Szlmmary of Other Living Forms 2. Haldane Centenary Symposium: The Con- None. trol of Respiration. Cunninham and Lloyd, 11. Summary of Onboard Laboratory Determinationj eds. Oxford 1Jniv. Press, Oxford, 1962. I PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 105

EXPERIMENT 13

1. Determination of Changes in Blood Gas Ex- sibly PCo2. . About two samples per week. change with Duration of Exposure to the 12. Summary of Laboratory Specimens to be Flown Weightless State to Earth for Laboratory Examination 2. Estimated Przorzty None. Priority 1. 13. Proposed Rendezvaus Schedule for Rotation of 3. Purpose Crew To determine if continued exposure to weight- Not applicable. 14. Telpmptry &r~r&- lessness results in a lowering of the efficacy of versns 0.nhoard “‘6 - Repire- aeration of blood by the lungs. ments 4. Justification No telemetry needed. It is important to learn if any interference with 15. Prerequisite Ground-Based Experiments gas exchange in the lungs results from expo- Exact equipment and procedures should be car- sure to weightlessness. ried out in a mock-up to determine expected 5. Experiment accuracy. These studies could be combined with those on 16. Prerequisite Space Flight Experiments the control of respiration. The actual study Use of analytical methods and zero G should be would consist of measuring expired alveolar and tested, if it is possible. The drawing of an arterial PCo2, O,Hb, and Po, at weekly inter- arterial sample would be essential. vals at rest and during standard exercise. 17. Prerequisite Research and Development 6. Experimental Controls Only as noted under 15. Two control studies exactly the same as listed 18. Onboard Gaseous Atmosphere Desired under 5 should be done during the 3 weeks Air. before and after launching. 19. Requirement for Rotation for Artificial G 7. Summdry of Number and Types of Space Station None. Personnel 20. Comments re Form of Data and Interpretation A physician or technician who could take arte- of Data rial samples is required. Results will be in single numbers, relatively few 8. Summary of Onboard Experimental Equipment in total, and storage should be no problem. Required 2 I. Special Comments Equipment to analyze gas for 0, and C02. None. Laboratory equipment for the analysis of blood 22. Postflight Evaluation of the Crew for 02Hb (spectrophotometric), pH, PcOz, None. P02, and bicarbonate. 2 3. References 9. Summary of Animals This experiment measures the alveolar-arterial None. differences of C02 and 02,and, of course, the 10. Summary of Other Living Forms arterial gas tensions. This is a general ap- None. proach to the study of gas exchange at a basic 11. Summary of Onboard Laboratory Determinations level and any textbook of physiology will pro- Blood 02Hb, pH, bicarbonate, Po,, and pos- vide the necessary background.

EXPERIMENT 14

1. Determine Changes in the Self-cleansing Action 2. Estimded Priority of the Lung with Duration of Exposure to the Priority 2. Weightless State 3. Pwpore 106 hlEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

To discover whether the normal self-cleansing 11. Summary of Onboard Laboratory Determinations - mechanisms in the lung are disturbed in the No general chemical studies specifically needed. weightless state. 12. Summary of Laboratory Specimens to be Flown 4. Justification to Earth for Laboratory Examination The mucus sheet which moves from the bronchi- Unless remarkable changes are seen, there is no oles to the pharynx, propelled by the cilia of -- -. need to return the specimens to Earth with the the epithelium, is the major protection of the exception of a small number of tissue specimens distal parts of the lung against foreign mate- for microscopic section. rials, bacteria, and inanimate airborne particles. 13. Proposed Rendezvous Schedule for Rotation Of A cough cannot increase the velocity of air flow Crew in the finer airways sufficiently to expel1 particu- Not applicable. late matter. If the ciliary action is changed or 14. Telemetry versus Onboard Recording Require- the secretion altered so that this cleansing mech- ments anism is less effective, damage to the lung may No telemetry required. result. Below the respiratory bronchiole, foreign 15. Prerequisite Ground-Based Experiments particulates are carried away by macrophages. The clearance of particulate matter from the While this should be investigated at some point, lung has not been well-studied, and no good intuitively there is less likelihood of an effect of methods are available for man. Experiments zero G. should be initiated to determine the best meth- 5. Experiment ods of studying mucus flow (possibly in man) Measure the clearance of labeled particles from and tried out on various animals. The type of the lungs of animals. A labeled dust of a size animal, the dose of aerosol, the number of ani- that will deposit largely in the airways, rather mals, and the times of sampling will depend on than in the alveoli, will be chosen by experi- the results of these studies. The classical stud- ment and introduced into the lungs of a con- ies on ciliary motion in fresh specimens of venient animal (rat or mouse). The animals tracheae in vitro should be repeated to investi- will be sacrificed and the clearance of the par- gate the effect of orientation in relation to 1 G ticles from the lung followed over a month. on ciliary motion and mucus flow. 6. Experimental Controls 16. Prerequisite Space Flight Experhents A similar study will be done on the ground be- Unless a useful technique for the study of mu- fore launching. cus flow in man is developed, animals must be 7. Summary of Number and Types of Spare Station employed, and these could as easily be carried Personnel out in space flight experiments of long dura- One individual with at least training as a lab- tion without accompanying human beings. oratory technician who can autopsy animals and 17. Prerequisite Research and Development measure the labeling material, presumably radio- Outlined under 15. active. 18. Onboard Gaseous Atmosphere Desired 8. Sunmary of Onboard Experinlental Equipment Air which is thoroughly free of particulate Required matter. Instrumentation to measure the labeling mate- 19. Requirement for Rotation for Avtificial G rial. This would appear to be a radioactive tracer. None. of 20. Comments re Form of Data and Interpretation 9 SummawJ, Animals For the first experiments a small convenient of Data animal could be used, the mouse a likely choice. Data will consist of the remaining concentra- The exact number would have to be determined tion of labelled particulates. by preliminary experimentation, but would prob- 21. Special Comment5 ably run about 16 in all. Samples of tissue may be saved for histological 10. Sunimary of Other Living Forms section. Finer particulate suspensions, less than None. 0.5 micron in diameter, tend to deposit in the PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 107

. alveoli where they are removed by macrophages Acta Physiol. Sand., vol. 49, pp. 242-250, and possibly carried to the mucus sheet. By 1960. altering the size of the labelled particulate, the 2. Dalhamn, Tore: The Electronmicroscopy of efficacy of macrophage activity could be studied the Tracheal Ciliary Mucosa in the Rat. in the same manner as outlined under 5. Zeitschrift fur Zelforshung, vol. 44, 1956, 22. Postflight Evaluation of the Crew pp. 345-1112. None. 3. Laurenzi, G. A.; Guameri, J. J.; Endriga, 23. References R. B.; and Carey, J. P.: Clearance of Bac- 1. Dalhamn, Tore: The Determination in Vivo teria by the Lower Respiratory Tract. Science, cf fhp &tp of ciliap Reqt iz TrAz. I ---- VS!. 142, 1963, pp. ?>72-1>7?.

EXPERIMENT 15

1. To Devise and Evaluate Analytical Techniques changes which may eventually be disastrous to for the Assay of Blood (Urine, Sweat, and crew performance. Thus, techniques should be Saliva) for Components of Significance in the available for these components of blood which Maintenance of Honieostasis in Circulation and are simple and rapid so that they may be avail- Respiration 012 the Ground and During Short able for interpretation by the medical team both Orbital Flights on the ground and in space. 2. Estimated Priority 5. Experiments Generally, these experiments should rate first Obtaining the sample: priority, since without analytical techniques one a. Syringe or vacutainer: For some purposes cannot obtain the data required for mainte- such as obtaining blood volume, extra- nance of the personnel and for other experi- cellular and total body water and arterial ments. pressure, it may be necessary to enter the 3. Purpose vein or artery. At these times, samples of In the condition of weightlessness, certain con- blood may be sampled for analysis. Con- ventional techniques present problems which ventional techniques are probably satisfac- may be avoided by designing analytical proce- tory for this purpose. dures so that the force of gravity is not neces- b. For repetitive analysis: It is recommended sary. Thus, pipetting in the conventional man- that a capillary tube be developed for fin- ner cannot be used. An open container for ger, toe, or ear prick. Specifications for liquids is impractical in the weightless state. these capillaries should be chosen after In preparing for a long-range stay in orbit, the ground-based experiments, and for early weight of the reagents and equipment to be tests in space before the orbital research used must be minimized. Ideally, techniques laboratory program is put into effect. This which require no reagents are to be preferred. tube could have such a design that the Sample size for assay should be at a minimum. tube itself acts as the puncturing device, These limitations must not decrease the accu- collector, measuring device, and cuvette for racy and precision obtainable with conventional analysis. Heat- and fracture-resistant glass techniques. is recommended. Plastic that is wetted by 4. ]rislificdon water is not omitted from consideration. The level of certain blood components needs to it is suggested that a capiilary be dwel- be monitored from time to time and during the oped with a sharpened end similar to that performance of certain experiments while in the of a hypodermic needle but transparent, of weightless state. A significant change which is a light absorbency (in the visible near in- noted and recorded in certain blood components frared and near ultraviolet which is the during the mission may anticipate profound same from tube to tube within +2%), 108 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

and of a constant bore, length, and outer measured amount of blood is recommended as - diameter so that the volume contained is an experiment to be carried out during short constant. The volume contemplated is of orbital flights. It should be pointed out that the order of 20 to 50 microliters. This capillary blood is essentially arterial blood capillary, for certain purposes, may be (93%), and a good estimate of arterial oxygen embedded in a small container of flexible saturation can be obtained from capillary blood. plastic so that it may be emptied by posi- Hematocrit value: tive pressure if necessary. In Figure 1, Development: Develop a small, lightweight when pressure is applied at A (with the hematocrit centrifuge with a stroboscope attach- finger closing the opening at the top), the ment coupled to a linear scale so that the capil- sample will be ejected. The capillary may lary full of blood can be observed during cen- be metal-tipped for a sharper cutting edge trifugation. Removal of the capillary from the without danger of fragmentation. This centrifuge during weightlessness will resuspend system can also be used for sampling the cells. Thus, measurements must be made (quantitatively) urine, sweat, or saliva. during centrifugation. At the same time, the It is suggested, therefore, that samples for length of the upper coat of leucocytes may be analysis be obtained by finger prick and by examined and measured for gross evidence of placing the capillary at the puncture SO abnormality. as to let the blood flow into the capillary. Experiment: Test the instrument under An alternative method is to prick the fin- weightless conditions in preorbital flights for ger with a blade and use an ordinary capil- evidence of its practicability. lary, square on both ends, to sample the Hemoglobin and oxygen saturation: blood. Development: A small lightweight colorimeter, capable of taking measurements at two specific wavelengths, needs to be developed. The capillary full of blood is inserted and a measurement is made at an isobestic point for determining grams of hemoglobin and at another wavelength peak for oxyhemoglobin for its ab- sorbence. From these two values, a table can be constructed for giving the percentage of oxyhemoglobin. If a spectrophotometer is contemplated for other purposes, then an adapter for holding the capillary is all that needs to be developed. Experiment: Test this instrument in the state of weightlessness for practicability in preorbital flights. Other chemical components of blood ,or plasma development: In order to avoid the need for FIGURE1 reagent bottles to be carried into space, a general technique is hereby proposed for develop- Experiment: The development of a suitable ment. capillary system is subject to ground-based de- An ideal method would be one where the cap- velopment; however, the best technique for ob- illary is touched to a piece of filter paper, the taining the specimen can only be decided after filter paper containing the reagents and devel- attempts are made during weightlessness to ob- oping a color which can be quantitatively meas- tain the specimen. Thus, the use of the capil- ured. This cannot be done with serum or blood lary as a means of obtaining and delivering a because they are colored and because the addi- PHASE Ii: IN-FLIGHTMEDICAL EXPERIMENTS 109

tion of a fluid to a piece of paper washes the From plasma, obtained by centrifuging the cap- reagent out of the field, producing chromato- illaries and cutting at the plasma-cell interface, graphic rings and uneven spots. Further, the sodium, calcium, phosphate, potassium, &lo- presence of cells or proteins vitiates the tests in rine, CO,, pH, and other values could be ob- many-cases. For this reason, the following 9s- tained. tem is proposed for development and is illus- If the porous tape is made of thin teflon so as trated in Figure 2. to permit only gas exchange, Go,and Po, could a. Top view be measured from whole blood. If the porous tape is perforated so as to let protein through, rl.ulcll -- iota: pi&& and aibumin could be assayed. For the elements, the bottom tape can be simple filter paper, using the technique of x-ray spectrometry for assay. As an alternative, a thin layer of cellophane or cellulose acetate is placed on a reagent paper. b. Side view A drop of blood from the finger is touched to Confining wax circle the cellophane. After a short time (1 min), Filter paper J the blood can be washed off or lifted off with the cellophane. The stain below will vary in size, but the intensity will be a function of the concentrations of the element sought. The stain can then be evaluated by comparison with a color chart or by reading in the spectrophotom- FIGURE2. eter with a beam of light narrower than the stain as shown in Figure 3. The sampler from the capillary is blown onto a a. Topview piece of filter paper containing a spot confined by a wax circle. This retains the specimen in a definite area. As an alternative, the blood Inertpaper holder Porous membrane on test paper is placed directly onto the cellophane (or cellulose acetate). The paper with the sample is placed on a porous sheet (cellophane) underneath which is a reagent paper. When pressure is applied, the proteins will be retained and an ultrafiltrate Water repellant of plasma passes through to the reagent tape. polyethylene The color produced on the reagent tape is a b. Side view measure of the component being tested. The Porous membrane three tapes are contained in a polyethylene or (extends so it can be polypropylene bag. A press plate for timing lifted and torn away) the period of pressing in order to obtain reproducibility will be necessary. This would be Test pad hand-operated with a timer which releases the pressure after a fixed time. The Eeagent tape Blood being removed could then be torn off and placed in a colorime- 7 ter for evalaution of the spot. For whole blood sugar, urea, uric acid, pH, creatine, and creatinine, this system would be satisfactory. FIGURE3 110 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

In summary, it is suggested that pads be devel- 14. Telemetry versus Onboard Recording Require- oped for the various components. That a ments colorimeter or spectrophotometer be fitted with Both telemetry and onboard recording will be an adapter to read the colored spots developed used. and that a radioisotope x-ray source instrument 15. Prerequisite Ground-Based Experiments be developed for the elements. Experiments discussed under 5 all require de- Experiment: Evaluate the instrumentation velopment on the ground. discussed above during short orbital flights for 16. Prerequisite Space Flight Experiments practicability. Testing of techniques discussed under 5 should Body water and blood volume: all be done during short orbital flights and Development: Evans blue dye, dissolved in should be finalized before ORL. deuterium oxide, may be satisfactory as a tracer 17. Prerequisite Research and Development for these studies. It is recommended that the Discussed under 5 in experiments. deuterium be assayed by either gas chromatog- 18. Onboard Gaseous Atmosphere Desired raphy or by osmotic pressure measurements with Gaseous atmosphere onboard immaterial. instrumentation available. 19. Requirement for Rotation for Artificial G Experiment: Attempt to evaluate these tech- No requirement for artificial gravity anticipated. niques in flights prior to the ORL flight. 20. Comments re Form of Data and Interpretation Corticosteroids and catecholamines: Urine of Data and blood specimens should be stored for assay Interpretation of data to be made by physician on the ground. Develop suitable containers and onboard and on ground by physician and con- techniques for such storage. sultant clinical chemist. 6. Experimental Controls 21. Special Comments Methods will be evaluated on the ground and No special comments. with controls and standards while in flight. 22. Postflight Evaluation of the Crew 7. Summary of Number and Types of Space Station None. Person n el 23. References Astronauts can be trained to do the tests. On the theory and behavior of fluids in 8. Summary of Onboard Experimental Equipment capillaries: Required 1. Mouquin, H.; and Natelson, S.: A Micro- Consumable equipment: Approximately 10 Ib. Method for the Measurement of Surface Fixed equipment: Estimated weight of all equip- Tension, J. Phys. Chem., vol. 35, no. 2, ment needed under ideal conditions varies from 1931, pp. 1931-1934. less than 10 Ib to less than 70 Ib, depending upon 2. Mouquin, H.; and Natelson, S.: Equilib- whether an x-ray spectrometer/spectrophotometer rium Forces Acting on Free Drops in Ir- is to be carried with the equipment. regular Capillaries. Microemie, vol. 12, 9. Summary of Animals no. 3, 1932-1933, pp. 293-302. None. 3. Natelson, S.; and Pearl, A.: A Device for 10. Summary of Other Living Forms the Determination of the Surface Tension None. of Small Amounts of Liquid. J. Am. 11. Summary of Onboard Laboratory Determinations Chem. Soc., vol. 57, Sept. 1935, pp. 1520- Number, frequency, and function of other tests 1526. and experiments planned. On hemoglobin estimation and oxygen satu- 12. Summary of Laboratory Specimens to be Flown ration: to Earth for Laboratory Examination 4. Crehan, E. L.; and Kennedy, R. L. J.; and Urine and blood serum for catecholamines and Wood, E. H.: A Study of the Oxygen Sat- steroid hormones. uration of Arterial Blood of Normal New- 13. Proposed Rendezvous Schedule for Rotation Of born Infants by Means of a Modified Photo- Crew Electric Oximeter. Proc. Staff Meet., Mayo Not pertinent. Clinic, vol. 25, July 1950, pp. 392-397. PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 111

5. Natelson, S.; and Menning, C. M.: Meth- 8. Natelson, S.: The Present Status of X-Ray ods of Analysis for Oxygen Carbon Mon- Spectrometry in the Clinical Laboratory. oxide and Iron on Fingertip Blood. Clini- Proc. N.Y. Acad. Si., vol. 26, No. 1963, cal Chem., vol. 1, no. 1, 1955, p. 165. pp. 3-26. On x-ray ;pectron;etry atid rdicirotope mwce: On the use of tapes for chemical analysis: 6. Cameron, J. F.; Rhodes, J. R.: Nucleonics. 9. Natelson, S.: U.S. Patent 3,036,893 and vol. 19, no. 6, June 1961, pp. 53-57. pending applications. 7. Karttunen, J. 0.;Evans, H. B.; Henderson, D. J.; Markovich, P. J.; and Niemann, On estimation of deuterium: R. L.: A Portable Fluorescent X-Ray In- io. Rraxr, P. E.; and Burch, G.: Drtrmnina- strument Utilizing Radioisotope Sources. tion of Deuterium Oxide in Water by Analytical Chem., vol. 36, no. 7, June 1964, Measurement of Freezing Point. Science, pp. 1277-1281. vol. 128, no. 3321, p. 415.

METABOLIC, DIGESTIVE, SKELETAL, NEUROMUSCULAR, FLUID AND ELECTROLYTE, RENAL, THERMOREGULATORY, REPRODUCTIVE, AND ENDOCRINE FUNCTIONS

The five experiments proposed in this section be examined in these experiments are (1) biochemi- are concerned with testing the reaction to prolonged cal or metabolic processes affecting energy expendi- space flight of several systems of the body which ture; utilization of protein, fat and carbohydrate; are vitally concerned, at the least, with ability to and acid-base metabolism, all very important for maintain effective working capacity and, in some efficient physical and mental function; (2) mineral instances, with ability to maintain life itself. For metabolic processes which, if sufficiently and con- this reason they are among the more important tinuously deranged, could lead to dangerous thin- studies proposed for ORL. ning of the skeleton and possibly to urinary tract Important preliminary information on the reac- stone formation; (3) fluid and electrolyte metabolism tion of these systems to weightlessness and to cer- and kidney function because of the vital necessity tain other stressewonfinement, threat of danger, to maintain normal water balance and electrolyte thermal and circadian rhythm changes, monotony- equilibrium and to preserve kidney function for the will be obtainable from earlier flights and certain effective elimination of body wastes; (4) ability of ground-based studies. However, the resistance of the body's temperature regulatory mechanisms to the body to or its ability to adjust to and compen- maintain normal body temperature without undue sate for these stresses in flights lasting for weeks or loss of fluid or other incapacity; and (5) the ability months can best, if not only, be determined by of the body's endocrine glands to make appropriate lengthy and precise observations in an orbiting lab- hormonal responses to the stresses of space flight and oratory environment. to continue indefinitely to provide effective modula- The vital functions and reactions principally to tion of essential physiologic functions.

EXPERIMENT 1

1. Effects of Prolonged Space Flight on Various effects of various stresses of prolonged space Metabolic Functions flight on energy, protein, carbohydrate, and 2. Estimated Priority acid-base metabolism. Although certain meta- Priority 1. bolic changes can be predicted qualitatively, 3. Purpose there is need to know the quantitative asws To determine the qualitative and quantitative of metabolic derangement with respect to rate, 112 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

pattern, and degree, and, further, to learn effects on muscle metabolism and bone. If hy- whether man’s metabolism after some or con- percapnia is found to develop, discussion and siderable alteration will come into a steady-state investigation should be undertaken with respect physiologically or become medically compatible to the possibility that allowing the carbon diox- with long space flight. Knowing the kinds ide in cabin atmosphere to reach approximately aqd magnitudes of these derangements, the next 0.5% might be a useful ventilatory stimulant. step will be to determine the relative effective- It has been suggested that many of the proc- ness of corrective or preventive measures, if esses of intermediary metabolism may be grav- needed. The stress primarily involved in this ity or weight dependent, normal function de- experiment is weightlessness, but in the initial pending on directional orientation of subcellular stages of flight, at least, and in the first ORL particles. Although this rather fundamental flights there will be combined stress effects of question should be answered by studies with confinement, threat of danger, thermal stress and simpler life forms in earlier space flights, it circadian rhythm changes; less likely to exert would be important to find out if the phenome- effects will be the stresses of monotony, social non held in higher species and might, in part, restriction, toxic substances, and noise. The be responsible for disorders of metabolic func- relative importance of some of these secondary tion. stresses can be determined in either prior or 5 Experiment subsequent ground-based studies. Procedure: The human subjects under study 4. Iustijication would all have to be under well-controlled meta- Prior detailed studies on the ground (Deit- bolic observation for an appropriate control rick, Whedon, Shorr, and others) of the effects phase prior to flight in ORL and for a similar of immobilization or confinement to bed had postcontrol phase following return to Earth. shown significant, and in some respects, strik- These control phases should each extend for a ing alterations in a variety of metabolic func- minimum of 2 weeks during which all of the tions, eg., decline in basal metabolic rate, in- same tests and measurements should be made creased excretion of nitrogen, phosphorus, as would be made during ORL flight; prior to calcium, and potassium (resulting in negative beginning of the actual control phase, some balance depending upon the dietary intake level time would have to be devoted to “shake-down” of the clement), impaired carbohydrate toler- of the various procedures and orientation of ance, and altered creatine metabolism. Con- subjects and of directly-participating staff per- versely, in the Walter Reed rotating room pro- sonnel. Throughout all phases of the study, viding 0.2 to 0.3 + G, increased carbohydrate control of the metabolic intake will be essen- clearance has been reported. The question is tially by keeping dietary intake as constant as whether or not the greatly diminished effect of possible and recording it and fluid intake with gravity and greater physical disuse associated complete accuracy. Collection of all urine (or with weightlessness in comparison to immo- appropriate aliquots thereof) and stool speci- bilization will result in greater disturbance in mens will be required, and some attention must metabolic functions, perhaps in some instances be given to collection of sweat since important to an extent incompatible with effective per- losses of metabolic constituents can occur by formance unless corrective or preventive meas- this route. Serial blood samples at minimal ures are devised and instituted. volumes will also be needed. The procedure With respect to acid-base metabolism, the ques- employed in this experiment should be planned tion is raised as to whether reduced movement so that experiments on endocrine function, on or immobility associated with weightlessness skeletal function (or mineral metabolism), and may result in reduced chest ventilatory move- on fluids and electrolytes can be carried out si- ment leading to hypercapnia. This event, if it multaneously and in direct association. occurred, would lead to a respiratory acidosis Measzri.ements: ’ which would tend to have. significant outward a. Enerpy metabolism: Although it has been PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 113 suggested that the total energy metabolism of phase, and 2 in postcontrol phase. These tests all occupants of the ORL craft could be can be combined with serial sampling of serum measured by determining the rates of utiliza- phosphorus and with continuous expired air tion of oxygen as supplied from the oxygen oxygen and carbon dioxide analyses for R.Q. tanks and of carbon dioxide as picked up by to give significantly more meaningful infor- the onboard carbon dioxide scrubbers and mation on carbohydrate metabolism. In ad- making a correction for the determined leak dition, by the time minutely detailed protocols rate of the craft at the existing pressure dif- are required, methodology for determining ferential, a much more accurate and finite de- metabolism of labeled sugars (carbon-14 in termination of energy mettahnlic rater (for the one ad SLY cdxn psiitionsj r~aybe specific individuals and during specific activi- more advanced and be practicable in ORL ties) can be made by placing onboard elec- cabin studies. With development of onboard tronic continuous stream gas analyzers for O2 experimental technology, glucose intravenous and CO, and making continuous expired air tolerance tests can be performed at weekly collections at desired intervals. Reasonably intervals during flight. Changes in fat me- accurate determinations of 24-hour total en- tabolism should also be investigated pre- and ergy metabolism can be made from short postflight, and in-flight if feasible, by analy- measurements of sample determinations; the ses of blood free fatty acids (FFA). This “sample activities during the day” are ob- index of fat metabolism shouId also be meas- tained by a detailed time-and-motion study ured in association with changes in blood log, which will permit energy metabolism glucose in response to infusions of insulin and observation over a few hours to be an accu- glucose and could be carried out in conjunction rate representation of a 24-hour day. In this with analyses of expired air oxygen and car- method the O2 and COz content of the in- bon dioxide for R.Q. in association with inspired cabin air also has to be made at fre- fusions of insulin and glucose. Measure- quent intervals. From the ratio of oxygen ments of changes in the blood level of growth and CO, utilized, R.Q. can be calculated for hormone in association with these studies will any desired interval, activity, etc., corrected also be practicable by the time these studies for urinary nitrogen excretion, and the “meta- are ready to be flown (see experiment enti- bolic mixture” (quantitative proportions of tled EfJects of Prolonged Space Flight on protein, fat, and carbohydrate being burned) Neuroendocrine Function). for the interval precisely determined. d. Hepatic function: In view of the possi- b. Nitrogen metabolism: In order to assess bility of an impairment of blood supply to the extent of possible muscle wasting related and through the liver from confinement, to inactivity and weightlessness, nitrogen bal- weightlessness, or both, certain relatively eas- ance would be determined by analyses of ily performed tests of hepatic function should urines and stools and knowledge of the pro- be carried out at 1 to 2 week intervals:-BSP tein intake, an effort being extended to keep retention, serum protein profile, and certain the latter relatively constant. Urinary nitro- serum enzymes to be selected at a later time gen would be analyzed on a 24-hour basis for in accordance with what seems pertinent in balance determinations, but in shorter aliquots the light of most recent knowledge. e. Arid-base metabolimz: In view of the pos- in conjunction with energy metabolism deter- sible development of some degree of hyper- minations. capnia, periodic analyses of serum should be c. Cdrbohydrate and fat metabolisnz: Intra- made for pH and pC02 and of urine for tri- venous glucose tolerance tests, 30-minute in- tratable acidity and chloride. fusion of 1 gm glucose per kilogram body f. Mineral metabolism: The importance of weight, blood samples for glucose every 30 measurements in this area of metabolism is minutes for 3 hours. Frequency of test ap- unusual and will be dealt with in a separate proximately weekly, 3 such tests in control experiment. 114 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

g. Body compoJition: Of considerable assist- 8. Summary of Onboard Experimental Equipment , ance to evaluation of energy metabolism ob- Required servations will be measurements of body com- Basic equipment required is that for collection position with respect to lean body mass, total and storage of blood, urine and stool specimens, fat, etc. The key measurements are total body preparation of urine aliquots, accurate recording water, body volume, and body weight (vide and labeling of all specimens, and recording infra) from which the various compartments of fluid intake and all food items consumed. can be calculated by standard formulae. De- Also required are (1) electronic continuous gas termination of lean body mass by whole body analyzers for O2 and CO,, (2) recorders or counting for the natural radioactive element devices for telemetering to ground data from of. potassium does not seem practical with the analyzers, (3) solutions and necessary in- presently available methods, but may later fusion apparatus for intravenous glucose toler- prove feasible. ance tests, (4) body volume determination (a h. Body r‘weight”: This is a critical and difi- box of known volume in which subject is placed cult measurement under the conditions of for brief period while volume of space sur- space flight. Since an object literally does rounding the subject’s body is determined by not have weight in space, the mass of the dilution of a known injected volume of an body equivalent to what it would have under inert gas, usually helium), and (5) apparatus conditions of Earth gravity will have to be for determining body mass. determined with an inertial technique (to be 9. Summary of Animals developed) using the fact that time period None. of oscillation of an object suspended between 10. Summary of Other Living Forms springs is a function of its mass. A varia- None. tion of this method which has been suggested 11. Summary of Onboard Laboratory Determinations would use the time and distance the subject Minimum requirements will be in line with moves, suspended between springs, from a equipment described under 8-specimen (blood, motionless start as set in motion by a Cali- urine, stool) collection, recording of food and brated impulse. In addition to assessment of fluid intake, etc., requiring 1 to 5 minutes sev- mass changes related to metabolism, this meas- eral times a day; continuous expired air gas urement will be very useful for determining analyses (detailed protocol to be developed) but changes in fluid balance. 20 minutes to 4 hours per determination for 6. Experimental Controls certain subjects approximately 1 to 2 times per Control is built into the procedure of the experi- week; i.v. carbohydrate tolerance requiring parts ment by preflight and postflight control phases, of 3 hours at intervals to be determined; body each subject in effect serving as his own con- volume and total body water requiring parts of trol. In addition, however, prior ground-based 2 hours approximately every 2 weeks; and body studies of the effects of immobilization or con- “weight” requiring a few minutes daily. finement serve as control studies for the effects Whether or not additional analyses (nitrogen of weightlessness. or excreta, hepatic function test samples, etc.) 7. Summary of Number and Types of Space Station will be done will depend on the relative fea- Personnel Trained astronauts will serve satisfactorily as sibility of the proposed onboard laboratory an- subjects. Laboratory technicians will be needed alytic function within capacity versus capability to the extent that laboratory analyses can be of transferring specimens to the ground where performed in the weightless state. One tech- the analyses can be done much more simply. nician who is well-trained in operation of the 12. Summury of Laboratory Specimens to be Flown continuous gas analyzers (competence in elec- to Earth for Laboratory Examination tronic maintenance), body volume determina- Until the feasibility of analytic operations on- tor, and other metabolic procedures will defi- board has been demonstrated, one would say nitely be required. “as many as possible.” PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 115

13. Proposed Rendezvous Schedule for Rotation of 20. Comments re Form of Data and Interpretdon Crew of Data Not pertinent. No special comments except that in interpre- 14. Telemetry versus Onboard Recording Require- tation there must be awareness of the interac- ments tion of several stresses. A number of them Telemetry would be preferable for the energy can undoubtedly be minimized or eliminated, metabolism measurements, whereas laboratory with planning, in subsequent ORL flights. analyses may as well be recorded. 2 1. Special Comments 15. Prerequisite Ground-Based Experiments None. As indicated, ground-based control observations 22. PortfIight Evaluation of the Crew pre- and postflight are essential. Despite the None. fact that most of the methods are well estab- 23. References lished, considerable time and effort should be 1. Brozek, J.: Techniques for Measuring Body expended in shakedown, calibration, etc. Composition. National Academy of Sciences, 16. Prerequisite Space Flight Experiments National Research Council, Natick, Mass., To the extent possible, various procedures 1959. should be evaluated on prior flights in which there is sufficient room. In particular, efforts 2. Buskirk, E. R.; Thompson, R. J.; Moore, R.; and Whedon, Human Energy should be made to devise and test means of G. D.: Expen- carrying out various laboratory biochemical anal- diture Studies in the National Institute of yses in the weightless state. Arthritis and Metabolic Diseases Metabolic 8, 17. Prerequisite Research and Development Chamber. Am. J. Clin. Nutr., vol. no. 602, 1962. I. Interaction of Cold Environ- See under 16. A particularly important method to be developed is that to measure mass ment and Specific Dynamic Effect, and 11. (“weight”) in flight. Sleep. 18. Onboard Gaseous Atmosphere Desired 3. Deitrick, J. E.; Whedon, G. D.; and Shorr, It is strongly urged that Earth atmosphere be E.: Effects of Immobilization upon Various provided; otherwise, a new factor or stress is Metabolic and Physiologic Functions of Nor- introduced which may interact with weightless- mal Man. Am. J. Med., vol. 4, Jan. 1948, ness and other stresses in a way not yet cal- pp. 3-36. culable. 4. Lutwak, L.; and Whedon, G. D.: The Effect 19. Requirement for Rotation for Artificial G of Physical Conditioning on Glucose Toler- Not required. erance. Clin. Res., vol. 7, Jan. 1959, p. 143.

EXPERIMENT 2

1. Effects of Prolonged Space Flight on Mineral observations, have shown an increase in urinary Metabolism and Bone Densitometry calcium excretion to more than double the con- 2. Estimated Priority trol level, an increase in fecal calcium excretion, Priority 1. and development of negative calcium balance at 3. Purpose moderate levels of mineral intake. Although To determine the pattern, rate, and degree of demineralization of the skeleton was not de- mineral loss from the skeleton associated with monstrable in the 6 to 7 weeks of immobilization weightlessness and inactivity in prolonged space with the techniques of x-ray visualization of the flight. skeleton then available, studies of the immobiliza- 4. Justification tion associated with paralytic poliomyelitis (ref. Prior detailed studies of the effects of immobiliza- 2) showed definite decrease in bone density in tion in bed (ref. 1) , confirmed in several recent paralyzed lower extremities within 2 months ; 116 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

and confinement studies of normal subjects cur- performed prior to, during, and post-ORL * rently in progress have implied demonstrable flight, but it is not clear at this time that such decrease in bone density of the os calcis within studies would significantly add to the informa- a few weeks. It is extremely important to deter- tion obtained from balance measurements ; mine whether this demineralizing process will such radioisotopic kinetic studies, however, occur at the same or a more rapid rate under should be brought into consideration for pos- conditions of weightlessness, in which the stress sible later ORL flights. Serum calcium, phos- and strain of weight bearing, muscle pull on phorus, and alkaline phosphatase should be periosteum, and likely changes in circulation to measured approximately four times preflight, bone are expected to be maximally oriented approximately weekly during flight, and four toward increased bone resorption (ref. 3). times during the postflight control phase. An associated significant problem is whether the b. Bone densi/onzetry: The technology of factors favoring the development of urinary tract bone densitometry is in rapid flux at the present gravel or calculi will be significantly enhanced time, and it is difficult to define a specific by weightlessness and associated inactivity. Al- protocol for an experiment to take place some though the anticipated increase in urinary cal- years in the future. Minimal recommendation cium and phosphorus have commanded maximal at the present time is that at least 4 determina- attention in relation to the stone problem, other tions of bone density during the ground-based metabolic constituents of the urine are now re- control must be made at each of 4 sites: (1) garded as having equal or more important sig- os calcis, (2) distal end of ulna, (3) lateral nificance with respect to stone matrix formation of vertebral body L-3, and (4) neck of femur, and crystalline deposition, and these must be using a collimated x-ray radiation source, an intensively investigated. aluminum graduated wedge on the film, and 5. Experiment a scanning technique for determination of Procediire: Identical to that described for the density of bone areas and correction of the experiment entitled EfJects of Prolonged Spare latter for superimposed soft tissue density. Flight on Variorrs Metabolic Fmrtions, which Four additional measurements within a period also will be utilized for the experiments entitled of 2 to 3 days should be made at each of the Effects of Prolonged Space Flight on Fluid and sites mentioned immediately following return Electrolyte Metabolism and Effects of Prolonged to Earth. The possibility of taking x-ray films Spare Flight on Neuroendocrine Function. for bone densitometry in flight has been con- Measurements: sidered, but the weight and volume require- a. Mineral t)zetabolisni: In association with ments for this technique preclude this at the the regulation of relative constancy of dietary present time. Under development is a tech- intake and urine and stool collections of the nique utilizing iodine-125 as a radiation experiment entitled Effects of Prolonged Space source, which would have a great advantage Flight on Various Metabolic Functions, calcium with respect to weight to be carried on the and phosphorus intake will be stabilized and space craft and would be practical from this recorded and urinary and stool calcium and point of view ; current disadvantages of this phosphorus measured for determinations of new technique are (1) the several minutes calcium and phosphorus balance. For possible required for the radiatioa source to scan across utilization of bone-seeking isotopes in conjunc- the body part being viewed so that the body tion with balance studies, see the experiment part must be kept immobile for a long period proposed by Dr. Grahn as a method of assess- and (2) the fact that the technique can be ment of rates of mineral loss from the skele- applied only to extremities. It is hoped that ton (Determination of Bone Demineraliza- within 1 year a reliable and reproducible bone tion During Prolonged Space Flights). densitometry technique will be available which Kinetic studies using radioactive calcium- will be suitable for this experiment. 45 or 47 of turnover, pool size, and “bone c. Factors related to urinary tract stone forma- formation rate” or “accretion rate” could be tion: Measurement in urine specimens already - ~~ ~ ~~

PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 117

. planned to be collected prior to, during and 14. Telemetry oersus Onboard Recording Require- after flight of pyrophosphate, magnesium, ments manganese, zinc, and various mucoproteins Not pertinent. and related biocolloids (refs. 5, 6). 1 5. Prerequirite Ground-BaJed Experiments 6. Experimental Controls As indicated, ground-based control observations Control is built into the procedure of the ex- pre- and postflight are essential. Despite the fact periment by preflight and postflight control that most of the methods are well established, phases, each subject in effect serving as his own considerable time and effort should be expended control. In addition, however, prior ground- in shakedown, calibration, etc. ,I n... rL -. r11-1 bawd stidits of &e c5a

of Normal Man. Am. J. Med., vol. 4, Janu- Genesis of Urinary Calculi. J. Urol., vol. 90, ' ary 1948, pp. 3-36. November 1963, pp. 521-526. 4. Heanejj, R. P.: Radiocalcium Metabolism in 6. Whedon, G. D.; and Shorr, E.: Metabolic Disuse Osteoporosis in Man. Am. J. Med., Studies in Paralytic Acute Anterior Polio- vol. 33, 1962, 188 p. myelitis. Part 11, Alterations in Calcium and 5. Thomas, W. G., Jr.; Bird, E. D.; and Phosphorus Metabolism. J. Clin. Inves., vol. Tomita, A,: Some Concepts Concerning the 36, part I1 (supp.), June 1957, pp. 966981.

~~EXPERIMENT 3~~

1. Determination of Bone Demineralization Dur- cium withdrawal would be by representative ing Prolonged Space Flight analyses of excreta samples from an individual 2. Estimated Priority who had previously been given ,tolerable doses Priority 1. of either radioactive calcium or one of the al- 3. Purpose kaline earths which would simulate the meta- To detect the time and quantity of calcium mo- bolic behavior of calcium. Strontium-85 would bilization from the skeleton during prolonged seem to be the most easily used isotope for this flight and to anticipate any physiological com- purpose since it decays with the emission of plications therefrom as they may occur during gamma radiation unaccompanied by any elec- orbital flight or reentry. trons and can, therefore, be given safely in the 4. JuJtification largest doses. The other possibilities would be Calcium is known to be withdrawn from bone calcium-45, calcium-47, barium-140, or ra- during periods of bed rest and during periods dium. However, there are technical and radio- of weightlessness. The results of this may have logical problems associated with each of these serious effects upon the structural strength of alternatives. the skeleton and, therefore, upon the capability A preflight test experiment under conditions of of the skeleton to withstand excessive G loads. normal physical activity using the person to be The extent of bone demineralization that may flown into space as the experimental subject, occur in prolonged flights must be carefully an- should be carried out a few weeks prior to ticipated before such flights are programmed. flight. Using good experimental techniques, this 5. Experiment could be accomplished with a minimum dose of It would appear that the phenomenon of bone strontium-85 (possibly as little as 1 pc). The demineralization is similar to that which occurs second dose of strontium-85 which would be in hospitalized patients. In these cases the de- appreciably larger than this for two reasons: mineralization accompanying disuse may be suf- (1) to override residual activity from the first ficient to allow radiographic diagnosis of de- dose and (2) to compensate for inferior in- mineralization following periods of inactivity in strumental possibilities in flight, would be ad- excess of 6 weeks or so. However, this is ministered at approximately 10 days prior to probably subject to considerable individual vari- flight. The individual should be carefully mon- ation. It is generally felt that radiographic ob- itored during these 10 days to determine the servation of demineralization requires that bone preflight baseline and for comparison with the densities be reduced to 60 to 70% of their ini- first dose. Dose required for the second intra- tial value. One can assume that the skeleton is venous injection could be in the order of per- more or less uniformly demineralized under haps 200 pc. This would deliver a maximum these conditions. This would involve a loss of gamma dose to the individual of 20 to 25 milli- approximately y3 of the 600 grams of calcium rads per day. This would drop steadily accord- contained in a standard man. ing to power function laws. The most sensitive method for determining cal- It has been amply demonstrated that the power PHASE R: IN-FLIGHT MEDICAL EXPERIMENTS 119

- function descriptions of whole body strontium- 14. Telemetry versus Onboard Recording Require- 85 retention can be used to predict the normal ments behavior of strontium in humans as well as The results of the determinations should be tele- experimental animals. These would allow for metered rather than being read onboard. Tele- quantiption of the increased mobilization of metering the count rate, for example, will per- calcium which may occur. A dose in excess of mit immediate analysis of the data with the 200 FC could be safely administered to humans. baseline program stored in the computer. It Using good technique, it is possible to measure may be necessary, however, to accumulate count the strontium-85 whole body burden of such an rates over a number of hours and, therefore, an individual over periods well in excess of a year. onboard tape storage may be required which 6. Experimental Controls can then read out when over appropriate ground In essence, the control is inherent. The indi- StationS. vidual astronaut must be baselined in a pre- 15. Prerequisite Ground-Bared Experiments flight study and the e%ects of weightlessness Each individual astronaut has to be evaluated will be controlled against the normal ground- through preflight ground-based studies in order based calcium metabolism pattern. to define his normal pattern of calcium metab- 7. Summary of Number and Types of Spare Staiion olism. This will also help to determine the Personnel required frequency of determinations during It is anticipated that the study can be done by flight. the trained astronaut. 16. Prerequirite Space Flight Experiments 8. Summary of Onboard Experimental Equipment The procedure should be evaluated during one Required of the Gemini missions. In this case, the ex- A minimum requirement for fixed equipment creta would be saved and returned and the would be one single-channel pulse height ana- counts made in ground-based laboratories. These lyzer, or its equivalent, for the detection of a can then be evaluated against chemical analysis gamma-emitter in excreta. If payload is avail- and full calibration of the procedure will result. able, the experiment can become more elaborate 17. Prerequisite Research and Development and look for phosphorus as well as strontium- The only required R and D would be to bring 85. about some miniaturitation of the counter and 9. Summary of Animals to consider the most dective way of prepiuing a No experimental animals required. sample of the excreta for counting. 10. Summary of Other Living Forms 18. Onboard Gaseous Atmosphere Desired No other living forms required. No unusual gaseous atmosphere required. 11. Summary of Onboard Laboratory Determinations 19. Requirement for Rotation for Artificial G The frequency of determinations will have to The capability for the induction of artificial be determined from preflight studies and will gravity would make the total experiment more have to be kept flexible during flights to allow useful, but it is not a prerequkite. for possible abrupt changes in calcium excretion. 20. Comments re Form of D6ta and Interpretmion It can be recommended that all excreta be sam- of Data pled, at least at the outset. The determination The data can be taken directly in the form of would be simply a matter of evaluating the count rate and should be interpreted by proc- sample for its content of radioactive isotopes. essing through the computer and comparison 12. Summary of Ldboratory Sperimens to be Flown with the baseline metabolic parameters. to Earth for Lrlboratory Examindtion 21. Sperial Comments It is not anticipated that specimens will have to No special comments. be ferried back to Earth during the course of 22. Postflight Evaluation of the Crew prolonged orbital flight. None. 13. Proposed Rendezvous Schedule for Rotation of 23. References Crew 1. Norris, W.; Speckman, T.; and Gustafson, Not applicable. P.: Studies of the Metabolism of Radium in 120 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Man. Am. J. Roentgenology, Radium, Ther- 2. Norris, W.; Tyler, S.; and Brues, A.: Reten- apy and Nuclear Medicine. vol. 73, 1955, tion of Radioactive Bone-Seekers. Science, 785 p. voi. 128, 1958,456 p.

~~EXPERIMENT 4~~

1. Effects of Prolonged Space Flight on Fluid and Procedure: Identical to that described for the Electrolyte Metabolism experiment entitled Effects of Prolonged Space 2. Estimated Pri,ority Flights on various Metabolic Functions. It is Priority 1. anticipated that this experiment will be run in 3. Purpose conjunction with those on Metabolism, Skele- To determine the effects of weightlessness in tal Systems, and Endocrine Balance. prolonged space flight on water balance, elec- Measurements: trolyte metabolism and excretion, and renal func- a. Water balance: The various measurements tion. Although the primary stress under study associated with water balance and its control is weightlessness, in initial stages of flight, at are (1) total fluid intake, (2) urinary vol- least, there may be added stress effects from ume, (3) fecal water content, (4) body mass confinement, threat of danger, thermal stress, (or “weight”), (5) urine and blood osmolol- and circadian rhythm changes. ity, (6) blood osmololity, (7) blood hemo- 4. [ustifitation globin and hematocrit, (8) blood volume, Various prior studies on Earth have indicated (9) total body water, and (10) assay of substantial changes in fluid balance and renal urine for antidiuretic hormone activity. Con- function with changes in body position from siderable attention will have to be devoted vertical to horizontal-mobilization of fluid from to methods for measuring or assessing sweat tissues into the bloodstream, increased renal volume losses; in this conjunction, accurate blood flow, changes in glomerular filtration repeated or continuous temperature and hu- rate, and increased urinary volume. Such func- midity measurements of the cabin air and tions have not been studied extensively in stud- walls must be taken. ies of the effects of long-term bed rest or in- b. Electrolyte metabolism: With careful reg- activity, but are under investigation at the pres- ulation of dietary intake and with the urine ent time (Air Force). Preliminary observations and stool collections associated with other in short space flights have suggested, in a situa- experiments, balance studies can be carried tion having poor control, that marked water loss out for sodium, potassium, magnesium, and takes place possibly due to both sweating re- chloride. The studies planned on acid-base lated to heat stress and to changes in anti- metabolism and described in the experiment diuretic hormonal control of water balance. entitled Effects of Prolonged Space Flights on There is also the possibility that disturbances Various Metabolic Functions should be men- may take place in the mechanisms responsible tioned in this section since the changes in for adequate thirst response to dehydration. fluids and electrolytes related to heat and Since large changes in water balance and pos- orthostasis could be complicated by the possibly associated disturbances in electrolyte me- sible development of hypercapnia which tabolism are incompatible with efficient per- would favor sodium retention and chloride formance of duty, if not life itself, it is expected loss; respiratory rate and cabin atmosphere that pertinent preliminary information will be carbon dioxide will need to be monitored and obtained in earlier flights, but it will be essential telemetered to ground. to obtain detailed data of the problem in ORL c. Renal function: The relatively easily meas- flight to assess its status with respect to pro- ured indices of renal function are creatinine longed space flight. clearance and blood urea nitrogen (urea can 5. Experiment be measured in blood or urine by a paper PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 121

stick method). Much more precise methods, 12. Summary of Laboratory Specimens to be Flown such as insulin clearance (for glomerular fil- to Earth for Laboratory Examination tration rate) and para-arninohippurate clear- Until the feasibility of analytic operations on- ance (for tubular reabsorption) require in- board has been demonstrated, one would say travenous infusions and various timed urine “as many as possible.’’ specimens so that they probably should not 13. Proposed Rendezvous Schedule for Rotation of be induded in initial protocols. Crew d. Factors related to vrinary tract stone for- Not pertinent. mation: Measurement in urine specimens al- 14. Telemetry versus Onboard Recording Require- ready planned to be collected prior to, dur- ments ing, and after flight, of pyrophosphate, mag- Not pertinent. nesium, manganese, zinc, and various muco 1 5. Prerequisite GroundLBused Experiments proteins and related biocolloids. As indicated, ground-based control observations 6. Experimental Controls pre- and postflight are essential. Despite the Control is built into the procedure of the ex- fact that most of the methods are well estab- periment by preflight and postfiight phases, each lished, considerable time and effort should be subject in effect serving as his own control. expended in shakedown, calibration, etc. Im- 7. Summary of Number and Types of Space Station portant studies of renal function as affected by Personnel inactivity appear to be in progress. Trained astronauts will serve satisfactorily as 16. Prerequisite Spdce Flight Experiments subjects. Laboratory technicians will be needed To the extent possible, various procedures to the extent that laboratory analyses can be should be evaluated on prior flights in which performed in the weightless state. there is sufKcient toom. 8. Summary of Onboard Experimental Equipment 17. Prerequisite Research and Development Required A particularly important method to be developed Basic equipment is that for collection and stor- is that to measure mass (“weight”) in flight. age of blood, urine, and stool specimens as 18. Onboard Gdseous Atmosphere Desired prepared for the experiment entitled Efects of It is strongly urged that Earth atmosphere be Prolonged Space Flight of Various Metabolic provided; otherwise, a- new factor or stress is Functions. introduced which may interact with weightless- 9. Summary of Animals ness and other stresses in a way not yet cal- None. culable. 10. Summary of Other Living Forms 19. Requirement for Rotation for Artificial G None. Not required. 11. Summary of Onboard Laboratory Determinations 20. Comments re Form of Data and Znterpretation Blood, urine, and stool collections as described of Data in the experiment entitled Efects of Prolonged No special comments. Space Frights on Various Metabolic Functions. 2 1. Special Comments Measurements related to water balance will need None. to be made with extreme frequency during the 22. Postfight Evaluation of the Crew first week of ORL flight. Tests of renal func- None. tion, as forecast at present, will need to be made 23. References approximately every 1 to 2 weeks. No specific ones available.

~~EXPERIMENT 5~~

~~1. Effects of Prolonged Spare Flight on Physiologic 2. Estimated Priority Temperature Regulation Prioriq 1. 122 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY~~

3. Purpose substantially above normal; subjectively, heat loss To determine the effects of various stress of was considerably increased.) A significant por- prolonged space flight on physiologic mecha- tion of the questions suggested can be approached nisms of temperature regulation. and at least partially solved by ground-based 4. Justification experiments and by space flights prior to ORL. Tliermal comfort of the astronaut is absolutely 5. Experiment essential for both his work efficiency and even Procedure: This experiment logically should maintenance of his life. If the effective tem- be coordinated closely with the experiment en- perature of the vehicle is too low or if other titled Effects of Prolonged Space Flight on Vuri- factors lead to excessive heat loss which is pro- ous Metabolic Functions since the method of longed, his efforts to increase his heat pro- measurement of heat production is identical with duction (by exercise or shivering) or efforts to the measurement of oxygen consumption and is conserve heat by body positioning will, at the carried out with the subject in the basal state. least, take extensive effort away from that re- Measurements of heat production, loss, storage, quired for performance of duties. If the ef- and balance will be made on 2 or more occasions fective temperature is too high, excessive sweat- during a preflight control phase, at least at ing may lead to extensive or even life-threaten- weekly intervals in flight, and again on 2 or ing water loss and elevation in body tempera- more occasions postflight. (See under 15 for ture. While at first glance the problem would Prerequisite Ground-Based Experiments and see seem to be entirely an engineering one with experiment entitled Effects of Prolonged Space respect to temperature regulation of the vehicle Flight on Various Metabolic Functions.) or of the astronaut’s suit, actually nothing is Measurements: known of the effects of stresses other than ther- a. Heat production: Heat production is calcu- mal on the temperature regulating mechanisms lated from oxygen consumption on the basis of of the body. Engineering design to handle the caloric value of oxygen for a particular thermal changes or unusual thermal situations metabolic mixture (relative amounts of protein, can have a much more meaningful direction if fat, and carbohydrate being metabolized) as in- it can be determined whether or not weightless- dicated by the respiratory quotient (RQ). In ness, confinement, changes in circadian rhythm, the resting postabsorptive state, an RQ may be threat of danger, etc. (either alone or in com- assumed; but it is preferable to determine it bination with vehicular atmospheric conditions accurately by measuring the rate of carbon diox- different from Earth in either gas composition ide production as well as that of oxygen con- or pressure) have distinct effects on thermal sumption. Correction is then made for the regulation. amount of nitrogen excreted during the period The limited space flight experience to date has of measurement. The apparatus to be used suggested difficulty in maintaining comfort on would consist of the continuous expired air col- the warm side (because of overheating), and it lection system and continuous stream gas is not clear whether this difficulty was due en- analyzers described in the experiment entitled tirely to the diminished heat loss attendant to Effects of Prolonged Space Flight on Various wearing a space suit coupled with faulty cooling Metabolic Functions. apparatus within the suit. An additional pos- b. Heat loss: There are a variety of ways in sible basis for difficulty in achieving proper rates which the various partitions of heat loss-con- of heat loss may be related to the currently used ductive, convective, radiated, and evaporative atmospheric pressure of 5 psi which would tend may be measured, either alone or in combination. to diminish the effectiveness of the convective The best system will be to set up a number of route of heat loss and may well have other im- these methods which in being partially dupli- portant effects on mechanisms of thermal regula- cative will increase the accuracy of measurement. tion (see under 15). (The reverse situation (1) Nonezlaporative beat loss (total Zess the was noted in experiments simulating submarine evaporative) : Continuous analogue recording exposure in which the atmospheric pressure was of the output of constantan-silver thermo- ~ ~

PHASE XI: IN-FLIGHT MEDICAL EXPERIMENTS 123 couple thermal gradient disks applied to the ume flow of the air stream. surface of the b6dy at a minimum of 9 selected (4) Conductive heat loss: The same basic areas for gradient heat flow from the skin. system described under Convective heat loss The 9 spots can be sequentially scanned by a can be applied to the cooling fluid circuit of a continuous multiple-point recorder in approxi- liquid-cooled space suit. This system would mately 5 minutes. If it becomes important to have to be ground-calibrated for corrections telemeter these data to ground, the analogue which would need to be made for heat con. information could be converted as received to ducted entirely through the suit. digital data and the latter telemetered. c. Heat Storage: Heat storage is determined LL---..l I-^ ---iiic~ uiciulpi gdhtdish ci “bt93~ h~ikges in ifitcid b$ ci “cere” tea- meters” are in general use by a number of peratwe as obtained from a continuously re- physiological research laboratories but provide cording deep rectal thermometer or from a only relative measure of nonevaporative heat recording thermometer placed to obtain deep loss, valuable mainly for indicating compara- ear temperatures. tive changes in the same individual from one d. Heat Balance: This calculation for any period set of circumstances to another. In order to of time is obtained from the equations: (1) obtain data via these disks which would indi- Heat Production equals Total Heat Loss plus cate heat loss quantitatively, a study of the Heat Storage and (2) Total Heat Loss equals precision of calibration of sets of disks for the Separate Heat Losses by Conduction, Con- quantitative heat loss would have to be re- vection, Radiation, and Evaporation. Ady, I quested of the Department of the Navy for since each part of the equation can be measured performance by the staff of the Calorimetric (although nonevaprative heat loss, particularly Research Laboratory of the Naval Medical Re- conductive and radiated, less accurately than the search Institute, National Naval Medical others), these less accurate partitions can be ob- Center, Bethesda, Maryland. This Laboratory tained or checked by difference in the balance operates the most accurate gradient calorimeter equation, e.g., Nonevaporative Heat Loss equals in the world, and it is the only group capable Heat Production minus Evaporative Heat Loss of performing this valuable research, essential minus Heat Storage. for quantitation of this method of measuring 6. Expeviniental Controls nonevaporative heat loss. Ccntroi is essentially built into the procedure by (2) Evaporative beat loss: Measure the tod preflight and postflight tests and analyses, each air flow volume passing over the subject’s subject serving as his own control. total surface (either through a space suit, 7. Stlmrnary of Number and Types of Space Station through a light plastic envelope surrounding Personnel the subject, or through some specific space or Trained astronauts will serve satisfactorily as section of the craft in which the subject is subjects. In conjunction with the experiment located, the latter two arrangements for shirt- entitled Efects of Prolonged Space Flight on sleeve environment) and multiply by average Various MetaboIic Functions, one technician who difference in relative humidity between the is well trained in the maintenance and operation point of entrance of the air stream and the of electronic equipment will definitely be re- point of exit from the suit or specific space. quired. Prior to the experiment the system described 8. Summary of Onboard Experimental Equipment would have to be calibrated with measured Required water loads. Eiectronic continuous gas analyzer, oxygen, car- (3) Convective heat loss: In the system de- bon dioxide, and expired air collection system, scribed under evaporative heat loss (either and recording and possibly telemetering equip- suit or specific space), place highly accurate ment as described in the experiment entitled heat meters (thermometers) in the inlet and Effects of Prolonged Space Flight on Various outlet of the air stream. Multiply the inlet Metabolic Functions. Also needed are thermal and outlet temperature difference by the vol- gradient disks to be attached to the subjects, 124 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

relative humidity and temperature sensing ele- thermal regulation mechanisms. At least 3 pos- ments for the air flow system, and rectal and sible ways in which these mechanisms could be * deep ear thermometers. affected or altered are suggested: (1) diminished 9. Summary of Animals heat loss by reduced convection in a less dense None. atmosphere ; (2) altered evaporative heat loss due 10. Summary of Other Living Forms to changes in rates of sweating or evaporation None. from the skin under conditions of reduced pres- 11. Summary of Onboard Laboratory Determinations sure (increased water loss from the lungs is also This experiment consists primarily of physiologic a possibility) ; and (3) alterations in peripheral measurements which are to be recorded continu- (skin) blood flow due to diminished pressure ously by electrical and electronic equipment. support to skin blood vessels. The most likely 12. Summary of Laboratory Specimens to be Flown possibility is capillary dilation resulting in subjec- to Earth for Laboratory Examination tive warmth but increased heat loss by radiation. None. The number and variety of these possible altera- 13. Proposed Rendez~~ousSchedule for Rotation of tions indicates the necessity for ground-based Crew study of the effects of low atmospheric pressure. Not pertinent. The measurement techniques would be identical 14. Telemetry uersus Onboard Recording Require- to those described for this ORL experiment. ments 16. Prerequisite Space Flight Experiments The bulk of the data is to be recorded on ana- To the extent possible, these thermal balance logue recorders and the data reviewed onboard studies should be inserted in the flight plan of and reported by radio to the ground. Digital earlier flights. telemetry of oxygen consumption data might be 17. Prerequisite Research and Development useful (see experiment 1.) None visualized. 15. Prereyuisite Ground-Based Experiments 18. Onboard Gaseous Atmosphere Desired In the experimental protocol per se, ground- It is strongly urged that Earth atmosphere be pro- based control observations pre- and postflight vided; otherwise, a new factor or stress is intro- are essential. Despite the fact that most of the duced which may interact with weightlessness methods are reasonably well established, con- and other stresses in a way not yet calculable. siderable time and effort would need to be ex- With specific regard to thermal regulation, if pended in shakedown, calibration, etc. In addi- ground-based studies show significant effects of tion, however, specific experimental studies low atmospheric pressure, it may be necessary to should be arranged, if possible, to calibrate the shift to Earth atmosphere. thermal gradient disks for quantitative measure- 19. Requirement for Rotation for Artificial G ment of nonevaporative heat loss as described Not required. under 5, Measurements, b, (1). Calibration 20. Comments re Form of Data and Interpretation studies also need to be carried out for conductive of Data heat loss through a space suit if measurements No special comments. of conductive heat loss are set up using the cool- 21. Special Comments ing fluid circuit of a liquid-cooled space suit None. (see 5, Measurements, b, (4)). 22. Postfight Evaluation of the Crew The most important ground-based experiment, None. however, is a study of the effects of low atmos- 2 3. References pheric pressure (specifically oxygen at 5 psi) on No specific ones available.

~~EXPERIMENT 6~~

~~1. Efects of Prolonged Space Flight on Neuro- 2. Estimated Priority endocrine Function Priority 1. PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 125~~

3. Purpose Response to single stresses can be studied very To determine the qualitative and quantitative largely in ground-based experiments (such as effects of various stresses of prolonged space severe confinement, inactivity, abnormal atmo- flight on pituitary, thyroid, adrenal, gonadal, sphere, or exposure to toxic materials), but there and neurohumoral function. will almost certainly be a compounding eff& of 4. Jusfjficatzon multiple stresses acting concurrently that can be Since the endocrine system through the hormones studied only during space flight. secreted by its various internal glands exerts a Fortunately for the purpose of this study, highly important regulatory control over the endocrinologists have devoted considerable effort idties of b;~&iiiId iedoiis in a!: of the C&S kj CXF!GiZ?iOR Gf m&iGdj: 2nd P-WCdUiej: i0 of the body and thus regulates to a considerable assess not only the level of function of the vari- degree most of the important functions of the ous endocrine glands, but also their response to body, detailed knowledge of the way in which various forms of physical, biochemical, and, to the endocrine glands will react to and stand up some extent, psychological stress. Methodology under severe and prolonged stresses is essential. has advanced prodigiously from the point 20 Fundamentally, the degree of success with which years ago when the only test available for evalu- the space traveler will meet, adjust to, and con- ation of adrenal cortical response to stress was tinue to withstand the various flight stresses de- the circulating blood level of eosinophiles; in pends upon the appropriateness of response of fact, by the time this experiment is actually the endocrine glands and their continuing, effec- flown it will need to be updated for advances tive modulation of essential physiologic func- on techniques expected in the near future. tions. 5. Experiment The principal stress to the human organism Procedure: The various measurements of currently visualized is weightlessness, but in endocrine function all depend upon sampling of addition, during the early and final moments of venous blood at various intervals and upon flight, there will be high gravity stress and, until analyses of urine, usually collected in 24-hour further experience is gained and more adequate samples, all such samples to be returned to Earth space provided in the vehicle, there will be the for analysis at the present state of methodology. added stresses of confinement, threat of danger, The various measurements will need to be made heat, changes in circadian rhythm, monotony, during a preflight control phase and also post- noise, social restriction, and possible toxic sub- flight, as well as during flight to the extent stances. If we consider a “stressor” to be any possible. For these reasons this study can be environmental change that disturbs the “steady reasonably easily integrated with the experiments state” of existence of a living organism, then on Metabolism, Fluid and Electrolytes, and the almost every event taking place in orbital flight Skeletal System. The measurements proposed may be a significant stress to which adaptive consist of those believed to be most useful and changes must be made. The stressor stimulus, revealing within the feasibility limits of urine however, whether specific or nonspecific, is fol- samples and periodic venous blood samples of lowed by a final common pathway of response modest size; tests involving complex procedure, which is largely neuroendocrine in nature. administration of radioisotopes, or large blood Adrenal cortical response is best known, but the samples have been generally excluded. entire homeostatic function of the central ner- Measurements: vous and endocrine systems is almost certainly a. Thyroid futzction: The oldest procedure for involved. The capacity of healthy men to main- testing this function is measurement of the rate tain health through vigorous physiological re- of oxygen consumption in the basal (post- sponse is very great, but the duration of this absorptive and resting) state, the basal metabolic adaptability in the course of continuous severely rate. This index can be obtained automatically adverse environmental conditions is unknown in conjunction with the measurements of energy and can be clarified only by further information metabolism proposed in the experiment entitled obtained from carefully planned experiments. Effects of Prolonged Space Flight an Various 126 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

Metabolic Functions; the instrumentation sug- well be increased above normal during the days gested is continuous stream gas analyzers for just preceding takeoff. It is anticipated that in- oxygen and carbon dioxide to be used with a creased secretion will take place during and hood arrangement for continuous collection of shortly following takeoff, but it will be impor- expired air. These measurements should be ob- tant to examine excretion levels thereafter during tained periodically before, during, and after flight to determine how long this evidence of flight. stress continues to be present, and, if continued, At a minimum pre- and postflight venous blood to look for later suggestion of adrenal cortical samples should be taken for protein-bound exhaustion. iodine (PBI) , circulating total thyroxine, circu- The next most feasible analysis would be of lating free thyroxine, tri-iodothyronine red cell plasma levels of 17-OHCS (or of free cortisol uptake, and thyroxine binding pre-albumin soon to be available). Normal adrenal cortical (TBPA) capacity. To the extent that space for function (on Earth) is indicated by a diurnal storage and facilities for blood collection are variation, higher values being noted in the available in the vehicle, the value of these in- morning, lower values in the afternoon and dices would be considerably enhanced by in-flight evening; absence of this pattern, or flattening, is blood sampling for this purpose. The currently noted in adrenal hyperplasia and might be ex- best available test which indicates rapid response pected from chronic stimulation in association in free thyroxine to stresses such as surgery and with continuing stresses. It would thus be use- severe exertion is TBPA capacity. ful periodically during a long flight to obtain Among the various radioactive iodine proced- blood samples for 17-OHCS. (Four or more ures, it is now possible to do 1131 neck uptake per period, preferably at 12-hour intervals re- scanning with sufficiently low dosage of isotope lated to the flight day if the latter should be (5 to 10 microcuries) that it should be carried altered from 24 hours). Their value would be out pre- and postflight. If the vehicle can carry greatly enhanced, of course, as a guide to the the weight of counting equipment, uptakes state of endocrine response to stress, if method- can be done periodically during flight, but ology could be developed so that these analyses whether or not this test is selected will depend could be performed during flight. on the total radioactivity burden from all sources. When in-flight analytic methodology for plasma If this procedure is used, 1131 neck decay curve 17-OHCS has been developed, it would then as measured daily will be useful to separate be feasible to carry out, periodically, tests of increased from normal thyroid activity. adrenal cortical response to stimulation with Various other radioactive iodine tests are not pituitary adreno corticotrophic hormone recommended. FBI131 requires an dosage (ACTH). The simplest form of this test is to in the neighborhood of 50 microcuries. Al- obtain collections of urine for 17-OHCS before though produces a much smaller radiation and immediately following an 8-hour continuous exposure and is excellent for repeated tests of intravenous “drip” of 25 units of ACTH; obvi- neck uptakes on Earth, it produces a hard gamma ously, in flight the ACTH infusion will have to ray and so requires heavy shielding which would be administered by an infusion pump since present a weight problem in flight; further even gravity will not be available. Although seldom if telluri~m~3~is carried as the source for if ever used now, in this test in Earth studies, its half-life would be too short to be of ACTH gel intramuscularly would avoid the use on flights longer than 2 weeks. in-flight gravity problem of administering an b. Adrenal cortical function: At a minimum, intravenous “drip”. In any case, it is recom- 24-hour urine samples should be collected pre- mended that this test be performed as soon after flight, during, and postflight for 17 hydroxy flight as possible. If response to an 8-hour in- corticords (17-OHCS) . Initial control analyses fusion of ACTH is low or absent (which would should be carried out many days or weeks prior suggest adrenal cortical exhaustion), considera- to takeoff to be certain of obtaining true control tion should be given to testing for the response values; adrenal corticosteroid secretion could to a 48-hour infusion. PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 127

Measurement of possible alteration in adrenal suspected. At present, this hormone can be cortical salt-retaining regulatory function may analyzed in the urine by bio-assay; an immuno- be obtained by analyzing 24-hour urine samples assay for blood levels, which will be much for aldosterone. This measurement is closely more precise and pertinent, is anticipated in allied to the measurements of urinary sodium the near future. Preflight, in-flight and post- proposed in the experiment entitled Effecti of flight 24-honr urine samples (and blood sam- Prolonged Space Flight on Fluid and Electrolyte ples for immuno-assay) will be required. metabolism. If increased urinary aldosterone For further definition of the function of reg- excretion is noted, it would be well to obtain ulation of water retention and excretion, con- venous blood samples for plasma renin. Nor- sideration should be given to the following mal or increased amounts of plasma renin will pre- and podight functionai tests: Urine be present if the increased aldosterone stimula- concentration test-restrict fluids overnight tion is of renal origin, whereas plasma renin and obtain urine specimen in morning for will be undetectable if increased aldosterone urinary specific gravity; if there is apparent inactivity is primary in the adrenal cortex. zbility to concentrate, the test may be repeated c. Pituitary function: with the administration of pituitrin. Carter- (1 ) Circulating ACTH: An immuno-assay Robbins salt-loading test-after a water diure- for blood levels of this pituitary hormone has sis has been established as measured by urine just been reported. This analysis should be volumes in successive 30-minute periods, an carried out pre- and postflight and blood infusion of hypertonic saline is administered specimens should be taken for this analysis following which there is normally a prompt during flight. reduction in urine volume; if this does not (2) Pituitary ACTH reserve: Until in-flight occur, attribution of the disturbance in func- laboratory and physiological testing method- tion to the pituitary rather than to the kidney ology becomes well advanced, this test will be can be determined by administration of pitu- feasible only during observations pre- and itrin when it is clear that salt-loading has had postflight. A synthetic steroid known as SU- no effect. 4885 is capabIe of suppressing Il-beta- d. Gonadal function: Two potential threats to hydroxylation by the adrenal cortex. In the reproductive function of man in space are recog- resulting absence of cortisol production by nized. this gland, the pituitary is normally induced The first of these is ionizing radiation. Fortun- to produce ACTH in increased amounts. The ately, a great deal of factual information is avail- result is production by the adrenal cortex of able from unmanned flights, both relatively close steroids other than cortisol, and the test to the Earth and far out in free space. These measurement currently is analysis of the urine data indicate that the constant flux of radiation for increased amounts of “Compound B”; a in free space probably is not dangerous except three- to .four-fold increase is normal. SU- during solar flares when it may rise to as high 4885 is administered orally every 4 to 6 hours as 80 rads total for very brief periods. Satellites for 2 to 3 days. With availability of the in polar orbit also would be subject to much circulating ACTH immuno-assay, its response higher and even dangerous levels of radiation, to SU-4885 should be measured as well as up to possibly 21 rads daily. So long as the urinary “Compound B”. polar orbits are excluded, therefore, genetic dam- (3) Circulating TSH: An immuno-assay for age of significant degree probably is unlikely, blood levels of this pituitary hormone which and the only remaining danger would occur when regulates thyroid function is anticipated soon a space vehicle, far out in space was “caught” and.should be added to the protocol when in a solar flare with no alternative except to take available. the radiation that occurred. (4) Pituitary antidiuretic hormone (ADH): The second threat is the possibility of a disinte- From the limited space flight experience to gration of cellular function as a consequence of date, a suppression of pituitary ADH has been zero.gravity. It has been reported that mitotic 128 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

activity of cells deteriorates under these condi- integrated into this experiment and those on tions, and, accordingly, the intense rate of cell Metabolism and the Skeletal System. division of germinal tissues would be expected f. Neurohumoral function: Recent additions to to reflect this abnormality. Furthermore, the the considerable number of indices of physiologic male should be more severely affected than the reaction to stress are the neuropressor amines female. Inasmuch as no dependable factual data known as catecholeamines. These may be deter- are available upon which to establish a judg- mined on 24-hour urine specimens by bio- ment, further observations of these functions assay for total catecholeamines or by chemical must be made. analysis for metanephrine or VMA. The closely The most readily available analysis reflective of associated substance, 5-hydroxy indole acetic acid gonadal function is the 24-hour urinary excre- (serotonin) may also be determined and might tion of 17-ketosteroids (17-KS). These steroids be particularly useful in conjunction with tilt in the male are produced principally by the table tests of the circulatory adjustment to the interstitial cells of the testes, but significant upright position. In-flight collection and pres- quantities are produced by the adrenal cortex. ervation of urine for these analyses will present Among the various steroids of this group, certain a special problem in that specimens must be ones are more indicative than others of adrogenic promptly acidified; in contrast, urine specimens function. Whether or not partition specifically for 17-OHCS and 17-KS must not be acidified for urinary adrogens (by column or double- and should be refrigerated. isotope dilution methods) would contribute in- 6. Experimental Controls formation not indicated by total 17-KS is debat- Control is essentially built into the procedure by able at the present time. preflight and postflight tests and analyses, each In disease the pituitary trophic hormones most subject serving as his own control. susceptible to impairment are the gonads-trophic. 7. Summary of Number and Types of Space Sta- Bio-assays are currently available for both fol- tion Personnel licle-stimulatory hormone (FSH) and luteinizing Trained astronauts will serve satisfactorily as hormone (LH), the latter being closely similar subjects. Laboratory technicians will be needed to interstitial cell (of the testes) stimulating to the extent that laboratory analyses can be per- hormone. Immuno-assays for both FSH and LH formed in the weightless state. will ultimately probably be available. For these 8. Summary of Onboard Experimental Equipment assays blood samples and 24-hour urine speci- Required mens pre- and postflight will be required. Basic equipment required is that for collection With specific reference to reproductive function, and storage of blood and urine specimens. On when space flights of longer than approximately board analytic apparatus will depend on develop- 60 days become feasible, it would be important ment of techniques for analysis in the weightless to collect semen specimens pre- and postflight state. to detect any impairment in total sperm count 9. Summary of Animals and motility. It would also be important in at None. least two astronauts to obtain a testicular biopsy 10. Summary of Other Living Forms before and after a long flight. This procedure None. under local anesthesia is associated with only 11. Summary of Onboard Laboratory Determinations minor discomfort and is a distinctly more sensi- Determination of basal metabolic rate will be tive index of spermatogenic function than sperm made by gas analysis equipment described in counts. the experiment entitled Effects of Prolonged e. Other jmmuno-assays: Immuno-assays just Spare Flight on Various Metabolic Functions. becoming available or to be available soon are Of the numerous analytic procedures on blood those for blood levels of pituitary growth hor- and urine described in this experiment, prob- mone, insulin, and parathyroid hormone. When ably the most useful, if an onboard method can the relative case of analysis of these endocrine be devised, would be that of 17-OHCS in urine indices becomes more clear, they will need to be and free control in blood. PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 129

12. Summary of Laboratory Specimens to be Flown be evaluated on prior flights in which there is to Earth for Laboratory Examination dcient room for apparatus and specimen stor- As many as possible, since it would not be neces- age. In particular, efforts should be made to sary to set up onboard determinations for more devise and test means of carrying out various than +hose described under 1 1, and storage space laboratory biochemical analyses in the weight- on the vehicle is expected to be Liiited. im state. 13. Proposed Rendezvous Schedule for Rotation ot 17. Prerequisite Research and Development Crew Laboratory analysis in the weightless state, al- Not pertinent. though not absolutely essential, would particu- 14. Telemetry versus Onboard Recording Require- larly enhance the value of these studies of &e& me& of stress on the neuroendocrine system. Digital telemelry of oxygen consumption data 18. Onboard Gaseous Atmosphere Desired would be useful (see experiment entitled Effects It is strongly urged that Earth atmosphere be of Prolonged Space Flight on Various Metabolic provided; otherwise, a new factor or stress is Functiom). All other data to be recorded. kroduced which may interact with weightless- 15, Prerequisite Ground-Based Experiments ness and other stresses in a way not yet calcul- In order to separate the influence of weightless- able. ness from inactivity, confinement and all the 19. Requirement for Rotation for Artificial G various other possible stresses, it would be use- Not required. ful to set up groGd-based studies of the effects 20. Comments re Form of Data and Interpretation on the various indices described from the several of Data individual stresses, particularly inactivity and No comments. confinement. Earlier studies of the effects of 21. Special Comments immobilization were done prior to the avail- None. ability of the present array of tests of endocrine 22. Postfight Evaluation of the Crew function. See 5c. 16. Prerequisite Space Flight Experiments 23. References To the extent possible, various procedures should No specific ones available.

~~HEMATOLOGICAL, IMMUNOLOGICAL, AND CELLULAR FUNCTIONS~~

~~4 EXPERIMENT 1~~

1. Observations Related to Assessment of the Dy- in the situation of actual space flight which could namics of Hemic Cell Proliferation, Distribution, induce significant hematological changes. Among and Destruction the stresses which may activate these mechan- 2. Estimated Priority isms are weightlessness, radiation, psychological Priority 2. Probably first feasible in extended stresses, artificial atmospheres, toxic substances, Apollo. and microorganisms of the environment. Multi- 3. Purpose ple patterns of interaction of these stresses may These observations are not experimental in type; operate. Furthermore, if these interactions do rather, they are in the nature of screening ob- occur, the nature and extent of the interactions servations to determine the characteristics, trends, which may involve weightlessness are totally and magnitudes of possible changes in the unpredictable and cannot be studied by ground- hematopoietic function and the body distribu- based simulation. For example, if weightless- tion of the formed elements of peripheral blood. ness seriously alters processes of cell division, the 4. Justification rapidly proliferating cells of the hematopoietic A variety of possible mechanisms may operate tissues might be strongly affected. This, in turn, 130 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

might alter such parameters as the dose-response performed by a trained astronaut, utilizing sim- relationship for radiation injury to these cells. plified apparatus for the measurement, dilution, ’ 5. Experiment and storage of capillary blood samples and The observations should consist of periodic ex- preparation of blood smears for return to Earth amination of all available subjects exposed for and later analysis on missions of short duration. periods longer than 24 hours to the space flight In this case, hematocrit determinations will not environment. The examination should include: be feasible. Red blood cells: More sophisticated studies will require a spe- a. Hematocrit by a micro method. cially trained crew member who will have to b. Reticulocyte counts. function at the level of a routine hematology c. Periodic estimates of red cell mass. These technician, again utilizing a variety of special may be available by calculation of the apparatus. data used in determining blood volume. 8. Summary of Onboard Experimental Equipment d. Red cell life span measurements by the Required Cr51 technic. This observation has lower Fixed eqtripment: If hematocrits are to be priority and a higher requirement for skill measured, a centrifuge comparable to a clinical of crew; thus, it probably will require machine will be needed. With appropriate deferral until later flights with larger engineering, this should weigh no more than crews. It is mentioned here for the sake 3 to 5 lbs, have a power requirement of less of completeness. than 250 watts, and require a cube space of less e. Determination of blood hemoglobin content. than ‘/3 cu ft. Such a machine could be multi- White blood cells: purpose in dealing with a variety of samples. a. White blood cell counts. Otherwise, there is need for no fixed equip- b. Differential leukocyte counts. ment. c. Determination of selected parameters of Consumable equipment: Consumable equip- leukocyte function (see related experiment). ment will have to be developed for the automatic Platelets: measurement, dilution, and storage of blood a. Determination of platelet counts. samples for short flights. Pipettes of this gen- b. Measurement of selected parameters of eral nature can be developed from existing auto- platelet function (see related experiment). matic plastic pipettes, preloaded with diluent. Examination of the morphology of the formed The stability of the preserved cells will have to elements of the blood on Wright’s stained be proven in the diluent chosen, and possibly blood smears. modified diluents will have to be developed Frequency of determinations: All of these ob- for these purposes. servations should be made at least every 3 to 5 At the moment, it seems impractical to consider days during missions less than 30 days in dura- microscopy of wet samples of any type under tion, and every 7 to 10 days in longer missions. weightlessness. Cell sedimentation will not occur TO some extent, these determinations can be in counting chambers, for example, and it would coordinated with other schedules of drawing be difficult to construct a completely closed sys- blood samples. Red cell mass calculations can tem to prevent atmospheric contamination. If be coordinated with blood volume determinations. a gravitational field is available, the problem 6. Experimental Controls becomes much simpler, and modified standard Control observations should be determined by microscopy could be employed, permitting on- the same method to be used in flight and by board determinations of blood cell counts. parallel standard methods at similar intervals Alternatively, an electronic particle counter could during both preflight and postflight control study be employed, possibly utilizing an onboard scaler periods of the subjects. of multipurpose type. Many possible designs 7. Summary of Number and Types of Space Sta- for such an instrument exist, of which the tion Personnel Coulter type seems most promising. The basic The simplest level of these observations may be apparatus, exclusive of the scaler, might occupy PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 131

0.1 cu ft, weigh less than 1 pound and require consideration, return of samples every 90 to 120 less than 50 watts with proper engineering days would probably be satisfactory, if adequate miniaturization. specimen preservation can be obtained. Equipment can be designed for staining of blood 13. Proposed Rendezvous Schedule for Rotation of films in a closed system if onboard examination Crew is possible. This might occupy less than 0.1 Does not apply. cu ft, weigh less than 1 pound, and require no 14. Telemetry versus Onboard Recording Require- pOWe2. ments 9. Suninrary of Animals Onboard recording is adequate with voice trans- None. rcissier? of rwdts 2.5 3bk 10. Smmary of Other Living Forms 15. Prerequisite Ground-Based Experiments None. Validation of technics by parallel study with 11. Summary of Onboard Laboratory Determinations standard methods. Determination frequencies are suggested under 16. Prerequisite Space Flight Experiments 5. Each complete determination would require Preliminary checkout of technics on flights of about 10 minutes to collect (technician and sub- short duration. ject) and 5 minutes to process if only sample 17. Prerequisite Research and Development storage is involved. These time allowances are See under 8, 15, and 16. generous and anticipate di5iculties secondary to 18. Onboard Gaseous Atmosphere Derired restricted space and mobility. Not pertinent. ' If onboard processing is possible, each deter- 19. Reguirement for Rotation for Artificial G mination would require about 30 minutes after See under 8. the samples had been obtained. Saving of time 20. Comments re Form of Dakr dnd Interpretation could be accomplished if multiple samples can of Data be processed simultaneously. Standard clinical format of report and prelim- 12. Smimary of Laboratory Specimens to be Flown inary interpretation. to Earth for Laboratory Examination 2 1. Special Comments If samples cannot be processed onboard, they These observations may' be of basic biological will have to be either saved or returned period- importance as well as of significance for opera- ically to Earth. For flights of less than 30 days, tional purposes. It may not be possible, for storage onboard seems best. The same is prob- example, to study certain of these parameters ably true of flights of less than 90 days, unless in animals in a preliminary way. other samples are returned for other reasons. 22. PostfEight Evaluation of the Crew Beyond 90 days, some type of onboard process- See 6. ing seems desirable, particularly if any of the 23. Reference parameters measured are found to have implica- Dacie, I. V.: Practical Haematology. Blackwell, tions for crew safety. If crew safety is not a London, 1957.

~~EXPERIMENT 2~~

1. Cytogenetic Studies of H~~rnanHeniir Cells tion of stresses of the space environment. 2. Estimated Priority 4. \u+ation Priority 2. Pre- and postflight examinations Reported Russian studies suggest that the weight- could be carried out on crew members of any less environment may && the mitotic mechan- flight of more than several days' duration. ism of cells. This might &ect the function of 3. Purpose hematopoiesis in some way. Cytogenetic tech- To determine if chromosomal abnormalities, nics provide a sensitive means of detecting which may be reflected in the rapidly proliferat- certain types of alterations in the processes of ing hemic cells, are induced by some combina- nudear replication and division. More impor- 132 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

tantly, these technics may permit identification 14. Telemetry uersus Onboard Recording Require- of this type of abnormality at levels of altera- ments tion or injury which might not affect the func- None. tion of the entire hemopoietic organ because of 15. Prerequisite Ground-Based Experiments the capacity of unaffected cell clones to increase AS part of 6, repeated preflight observations their activity. should be made at intervals roughly equal to 5. Experiment proposed flight durations to test the stability of Pre- and postflight cytogenetic examinations of the cytogenetic pattern of these subjects on the crew members in a graded series of flights of ground working area environment. increasing duration is all that is deemed possible 16. Prerequisite Space Flight Experiments at present. If this can be done, there will prob- Program can start on any flight longer than ably be a great advantage, since the technics 24 hours. are very demanding and might well be impos- 17. Prerequisite Research and Development sible in the weightless state. Experiments will require development of acyto- Standard cytogenetic methods can be employed, genetic laboratory. Since large numbers of utilizing peripheral blood leukocytes with phyto- karyotypes may have to be examined, thought hemagglutinin stimulation, Since the detection should be given to application of the several of an increase in chromosomal abnormalities is technics of automatic classification of chrom- essentially statistical in nature and since the con- osomes. trol level of these abnormalities and the possible 18. Onboard Gaseous Atmosphere Desired increase are expected to be very small, the statis- Does not apply. tical design of these studies must be carefully 19. Requirement for Rotation for Artificial G considered. It is probable that large numbers Does not apply. of metaphases will have to be examined and 20. Comments re Form of Data and Interpretation complete karyotyping carried out on any anom- of Data alous or suspected anomalous cells. (Details of Standard nomenclature (Denver classification) design will depend upon available methods and upon the findings of preflight control observa- for types and locations of chromosomal anom- alies, with appropriate statistical analysis for tions.) significance. 6. Experimental Controls Preflight observations of selected crew members. 2 1. Special Comments It should be recognized that the possibility of 7. Sutiiniaiy of Number and Types of Space Sta- tion Personnel finding major cytogenetic changes in these experiments is very low. However, a finding Does not apply. of “no change” will be of nearly equal interest and 8. Simmary of Onboard Experimental Equipment Required importance in that it will yield some assurance None. as to safety of crew in terms of possible effects 9. Summary of Animals of the space environment on proliferating cells. None. 22. Postflight Evaluation of the Crew 10. Suniinary of Other Living Forms None. None. 23. References 11. Snmmary of Onboard Laboratory Determinations There are no known publications, beyond those None. of Russian origin on space-flight-induced cyto- 12. S~ninzaryof Labovatory Specinzens to be Floiutz genetic changes. The literature on cytogenetics to Earth for Laboratory Examination is now so vast that specific references are not None. particularly helpful. In general, the literature 13. Proposed Retidezuons Scbedde for Rotation of dealing with radiation-induced cytogenetic Crew changes, both short- and long-term, provides a None. model of the type of study herein outlined. PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 133

EXPERIMENT 3 I 1. Survey of Immunoglobulins, Complement, and individual to serve as his own control in such Antibodies in the Sera of Selected Astronauts immunization experiments. 2. Estimated Priority 6. Experimental Controls Priority 3. Fiights of longer than 30 days with Pre- and postflight samples on each individual. multiple crew members (MOL, ORL). 7. Summary of Number and Types of Spdce Sta- 3. Purpose tion Personnel TO assess changes which may occur in the amount A person capable of drawing, centrifuging, and and type of serum immunoglobulins. comple- separating a h!d- szq!~;this mdc! !x a trziaed ment, preexistent, and newly-formed antibodies astronaut at the least. of subjects exposed for prolonged periods to 8. Summary of Onbocrd Experimental Equipment the space flight environment. Required 4. [ustifiration a. Centrifuge (see experiment entitled Observa- If cellular processes of proliferation, differentia- tions Related to Assessment of the Dynamics tion, and function are affected by the weightless of Hemic Cell Proliferatron, Distribution, space flight environment, it might be expected and Destruction) . that ultimately these changes will be reflected b. A closed system of tubes or small bags which in the immune apparatus. This would be of can be centrifuged, frozen, and stored; basic biological interest. Operational consider- weight less than 0.5 lb for 10 determinations. ations might be involved as well, since resistance No additional power required. Syringes, to disease, i.e., invasion by mutant organisms or needles, and blood drawing equipment. flora of other persons in the environment, may 9. Sumnzary of Animals be influenced by alterations in immune processes. None. 5. Experiment 10. Summary of Other Living Fnms Basically, the experiment involves only periodic None. collection of blood samples with separation of 11. Sttmnrary of Onboard Laboratory Determination c serum and storage in the frozen state at less than None. -2OOC for return to Earth and later analysis. 12. Summary of Laboratory Speciments to be Flown Samples every 14 to 30 days would be adequate to Edrth for Laboratory Examination for survey purposes. Samples of 2 to 3 ml See under 5. volume would be required, although micro tech- 13. Proposed Rendezvous Schedule for Rotation of niques might be used if less than this is avail- Crew able. Determinations should include immunoelec- Does not apply. trophoresis, electrophoresis, on starch gel, meas- 14. Telemetry versus Onboard Recording Require- urement of yn, yla, and ,,M globulin levels, ments measurement of whole hemolytic complement, Does not apply. titration of blood group antibodies, and measure- 15. Prerequisite Ground-Based Experiments ment of preexistent antibacterial antibodies. It Ground and preliminary space flight checkout would also be of interest to test the capacity of of sample handling technics. subjects for anamnestic recall of antibodies and 16. Prerequisite Space Flight Experiments primary immune responses by in-flight immuni- Ground and preliminary space flight checkout zations after varying periods of exposure to of sample handling technics. space flight conditions. However, this would 17. Prerequisite Resecrch and Development be reasonable only on long-term flights, i.e., Equipment only. longer than 90 to 120 days, and it shodd be recog- 18. Onbomd Gaseous Atmosphere Desired nized that with small numbers of individuals None. tested, absolute standards for responses can- 19. Requirement for Rotation for Artificial G not be applied. It is also impossible for the None. 134 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

20. Comments re Form of Data and Interpretation 22. Postflight Evaluation of the Crew of Data None. Standard immunological methods. 23. References 21. Special Comments 1. Gell, P. G. H.; and Coombs, R. R. A.: Clin- Stotage of samples under even optimal condi- ical Aspects of Immunology. Blackwell tions may result in slow deterioration of complement activity and certain antibodies. The Scientific Co., Oxford, 1963. possibility of onboard determinations seems re- 2. Kabat, E. A.; and Mayer, M. M.: Experi- mote; thus, these limitations will have to be mental Immunochemistry. C. C. Thomas, considered in the interpretations of results. Springfield, Ill., 1948.

~~EXPERIMENT 4~~

1. Studies of Selected Parameters of Leukocyte move over the surface of a slide. In the absence Function in the Space Environment of gravity, the force which orients a motile cell 2. Estimated Priority to the surface may be lacking and mobility may Priority 2 or 3. Multiple crew member flights be impaired or in a different mode, i.e., swimming. of longer than 1 week. It is proposed that apparatus be developed to 3. Purpose permit observation of leukocyte mobility under To determine effects of the space environment weightless conditions. This might take the form upon physiological functional capacities of leu- of a prepared microchamber with 2 flat sides kocytes. spaced between .05 and .01 mm apart. This 4. Justification could be loaded with capillary blood directly Space vehicles are characteristically small, closed, by capillary action or with a predetermined ecological systems. As such, a rapid interchange amount of diluent-anticoagulant. Alternatively, of microflora is to be expected in the crew; IOW- a centrifugal separation of leukocytes can be grade pathogens and pathogenic mutants of made, and the WBC-rich plasma loaded in the ordinarily saprophytic organisms will thus be observation chamber. rapidly spread. Infections may result if host The onboard microscope proposed for use in resistance is altered unfavorably. Although connection with surveys of hematological param- many factors are undoubtedly involved in main- eters can be used for these observations. Phase tenance of normal host resistance, many of them contrast capability would be valuable but not unknown and unmeasurable, certain pertinent essential. An attachment to keep the sample at aspects of leukocyte function are amenable to 37°C will be required. This may take the form measurement. These measures, along with meas- of an electrically heated, thermostatically con- urements of immune responsiveness, may pro- trolled stage with a stage hood. vide a first order approximation of host defenses, Determination of the mode of leukocyte motility particularly if they can be correlated with in- can be made by a trained observer, Determina- flight experiences with infectious processes of tion of the rate of movement can probably be several crew members. made as well, utilizing an eye piece disc microm- 5. Experiment eter and distance standard. Three types of observations are proposed: Determination of leukocyte phagocytic capac- Observations of leukocyte mobility under ity: Qualitative observations of phagocytosis weightless Conditions: It is thought that leuko- can be made in the system described under cyte mobility is primarily crawling, i.e., the Observations of leukocyte mobility under weight- cell moves by pseudopodial motion over a sur- less conditions by the addition of particles such face or over other cells. Under ordinary condi- as starch, polystyrene, killed staphylococci, or tions of terrestial observation, cells are seen to opsonized red blood cells. PHASE II: IN-FLIGHT MEDICAL EXPERIMENTS 135

A semiquantitative method is also recommended. ies of all subjects for control periods of at least In such a test, a leukocyte suspension is pre- several weeks. pared, particles are added, and, after a constant 7. Summary of Number and Types of Spare Sta- period of incubation, the leukocytes are recov- tion Personnel ered by gentle centrifugation, smeared, stained, These experiments will require an advanced level and exammed for phagocytosis. The percentage of general training and a period of training in of potential phagocytes which have ingested par- the specific technics involved. The general level tides is determined. Because a great deal is of required competence lies between that of an known about the system, erythrophagoqtosis advanced research technician and a trained pro- would be a very useful method. On the other fessional biomedical investigator. hand, it is technically more demanding in that 8. Summary of Onboard Experimental Equipment opsonized red cells and complement must be Required provided. The exact method chosen should be Equipment and power as needed for general based upon a feasibility study. Specimens need hematology observations plus a small amount not be stained and exammed onboard; only the (less than 1 Ib) of disposable equipment and smears need to be prepared at the time of the supplies. study. These can be preserved for later study. 9. Summary of Animds Studies of leukocyte mobilization: These None. studies are designed to test the capacity of the 10. Summary of Other Living Forms stressed subject to mobilize leukocytes at the None. site of a sterile idammatory lesion which is 11. Summary of Onboard Laboratory Determimtions artificially created. Two general methods have With no knowledge of the nature or magnitude been developed and standardized. These are of changes which might be encountered, only the skin window method of Rebudr and the the most tentative of schedules can be proposed. quantitative leukocyte washoff method of Finch, It seems unlikely that it would be practical to et al. Both methods require the preparation of carry out these studies more frequently than a small abraded area on the volar forearm. In every 5 to 7 days on a single subject. A deter- Rebuck's method, this area is covered with a mination within 1 to 2 days after entry into cover glass which is removed with adherent orbit would be of interest, as would a determina- leukocytes and replaced periodically. The pat- tion shortly after reentry. On longer flights, in- tern of time of appearance and proportions of tervals of 10 to 15 days would seem feasible. the several types of leukocytes in such a lesion It is estimated that each study will require 6 to has been well studied in normal subjects and in 10 hours of the observer's time and '/2 this a variety of abnormal states. amount of the subject. The method of Finch, et al. involves the quali- 12. Si~tnmaryof Laboratory Specimens to be Flown to Earth for Laboratory Examination tative recovery of the leukocytes from the lesion If blood cell counts can be done onboard, these by a system of closed flushing of the area. These can be determined in flight. If not, samples cells can then be counted and differential leuko- can be stored, as for general hematology deter- cyte counts can be made as well. minations, and returned with the crew. The two methods complement each other in that 13. Proposed Rendezvous Schedule for Rotation of better morphological observations can be made Crew by the Rebuck method, but better quantitation Does not apply. can be achieved by the latter method. Both 14. Telemetry versus Otzboard Recording Require- methods can be carried out simultaneously on ments the same subject. The quantitative method is Does not apply. much more time consuming and technically 15. Prerequisite Ground-Based Experiments demanding. As under 6. 6. Experimental Control 16. Prerequisite Space Flight Experiments Comparable periodic preflight and postflight stud- Does not apply. 136 hf EDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY

17. Prereqrtisite Kesearxh and Development in laboratories carrying out comparable studies. I Equipment and method development and adapta- 21. Specjal Comments tion. None. 18. Onboard Gaseotrs Atmosphere Desired 22. Postflight Evaluation of the Crew Does not apply. None. 19. Requirement for Rotation for Artificial G None. 2 3. Reference 20. Comments re Form of Data and Interpretation Perillie, P. E.; and Finch, S. C.: Inflammatory of Data Reaction in Acute Leukemia. J. Clin. Inves., As outlined under 5 and as currently utilized vol. 43, 1964, pp. 425-430.

~~EXPERIMENT 5~~

1. Studies of Selected Parameters of Blood Coag- conized containers should be determined. In ulation and Hemostatic Function addition, it should be possible to see for the 2. Estimated Priority first time if blood will clot spontaneously in the Priority 2 or 3. Probably not feasible until absence of contact with any surface. It should flights where a trained biomedical investigator be possible to place a small volume of freshly is a crew member (ORL). drawn blood in suspension in the center of a 3. Purpose containing flask and observe it periodically for To determine if the space flight environment, coagulation without allowing it to contact the including weightlessness, affects the measurable sides of the flask. Unless the atmosphere pro- parameters of blood coagulation and hemostasis. vides a surface activation effect, the coagulation 4. /ustifiration time of such a sample might be greatly pro- It seems probable that the weightless state will longed. affect a variety of cardiovascular functions, spe- Bleeding time: Methods of Duke and Ivy. cifically vascular tone. As a consequence, pat- Platelet count: Either- by onboard determina- terns of vascular perfusion and venous return tion or preparation of stable fixed samples for can be expected to be affected. If blood is later determination. pooled in the venous circulation, the possibility Observations of clot retraction. of thrombosis must be considered. Although Measurements of platelet adhesiveness: By there is no hemostatic function which is directly the glass bead adherence method. correlated with thrombosis, it nevertheless seems Measurements of fibrinogen concentration. advisable to carry out those observations which Measurements of fibrinolytic activity: By the can be made. Furthermore, the behavior of euglobulin clot lysis technic or by measurement these physiological processes in the space en- of the release of IIs1 from iodinated fibrinogen. vironment has inherent biological interest and Measurements of prothrombin complex activ- justifies a survey in this area even in the absence ities. of a practical consideration. Measurements of antihemophilic globulin 5. Experiment (AHG) and plasma thromboplastin component It is proposed that a wide variety of coagulation (PTC) activities: These observations have the and hemostatic functions be surveyed on selected greatest technical requirements and lowest subjects. Not all of these observations need be priority. carried out on all subjects or on every flight, but Observations of coagulation time of fveshly- it is hoped that data in all these areas might be drawn whole blood through measurements of obtained in the course of a number of flights. platelet adhesiveness should be carried out on- The following observations are recommended: board. The remainder of this study probably Coagulation time of freshly-drawn whole cannot be carried out in flight and will involve blood: Coagulation of blood in glass and sili- obtaining samples for postflight analysis. PHASE 11: IN-FLIGHT MEDICAL EXPERIMENTS 137

6. Experimetztal Controls crews. If other specimens are to be returned, . Pre- and postflight determinations, utilizing the these should probably be included, since many methods to be used during flight and standard of these activities are quite labile. methods in parallel on all subjects. 13. Proposed Rendezvous Schedule for Rotation of 7. Summary of hlunzber and Types of Space Sta- Crew tion Personnel Does not apply, These studies might be carried out by a specially 14. Telemetry versus Onboard Recording Require- trained person operating at the level of an ad- rnentr vanced technician. A trained biomedical in- Does not apply. vestigator would & preferable. 1 5. Prerequi rite C;mrlnd-B~sedE-xperirlment 8. Summary of Onboard Experimental Equipment Does not apply. Required 16. Preregwisite Space Flight Experiments Equipment and power as for genera1 hematology Does not apply. plus approximately 2 lbs of special purpose con- 17. PtereqUi.de Research and Development sumable supplies. Development of onboard methods by adaptation 9. Summary of Animals of existing methods. Development of special None. onboard disposable equipment and methods of 10. Snniniary of Other Living Forms sample preparation and preservation. None. 18. Onboard Gaseous Atmorphere Desired 11. Summary of Onboard Laboratory Determinations Does not apply. Only a tentative schedule can be proposed. 19. Requirement for Rotation for Artificial G Determinations oftener than every 7 to 10 days None. are probably not needed. Observations every 2 20. Comments re Form of Data and Interpretation to 4 weeks on long flights would probably be of Data adequate if definitive trends do not appear Standard current nomenclature and units as used during shorter flights. in leading coagulation laboratories. Each examination can be expected to take 2 hours 2 1. Special Comments of observer’s time and ‘/z hour of subject’s time. None. 12. Smznzary of Laboratory Specimens to be Flown 22. Postflight Evaluation of the Crew to Earth for Laboratory Examination None. If adequate preservation methods can be devel- 2 3. References oped, the specimens can be returned with the None. Phase 111

~~DESIGN AND OPERATIONAL RECOMMENDATIONS~~

~~PRECEDING PACE BLANK NOT FILMED. c~~

~~PHASE I11~~

~~DesZgn and Operatlbnal Recoundths~~

SPAMAG chose to formulate its recommendations des@ B series of dBermt v&ides hi different as discussions of a number of critical topics. These flights. The interior of the vehicle could be rede- contributions developed over the course of eight signed according to the latest technology for what- meetings. The topics are not proposed as being ever duration and purpose of mission is desired. inclusive of all significant ORL related problems. This vehicle or class of vehicles would, in this sense, However, they appear to include all the major prob- serve in the same manner that a ship or class of lems of which we are currently aware. ships does, being capable of undertaking many varie- ties of missions as required. NEED FOR ORL FLIGHT OF DURATION LONGER THAN TYPE OF VEHICLE 30 DAYS FOR BIOMEDICAL In general, the Group thought that the most de- INVESTIGATION sirable form of ORL would be one which is some- what similar to the MORL concept. It should carry The consensus was that it is highly probable that a crew of 6 to 12 persons with the optimum figure important medical questions will remain unresolved set at an &man crew. It should allow 400 to 550 after the 30-day MOL and, in fact, after the %day cu ft of free space per man with an additional 1000 MOL missions which are currently Considered a fu- cu ft volume reserved for a common laboratory area. ture possibility. Important questions will probably Each man has to be allowed his own small area of be revealed by these missions. In order to resolve privacy. (See also Volume (Space) Requirements these questions, there will be a need for space flights recommendations in Phase I). of longer than 30 to 90 days, carrying crews larger than 2 to 3 men, providing more space than the cur- DURATION OF FLIGHT rent configuration, and including among the crew FOR ORL members medical scientists. The Group was unan- AN imous in its opinion that a year-long ORL investiga- The Group was of the opinion that we can safely tional flight is essential if very long, manned flights, proceed from the 30-day experience to a 90-day such as a Mars mission, are planned for the future. experience unless unanticipated prohibitive factors In addition, it was concluded that an ORL is re- develop within 30 days. If no insurmountable d&- quired in the interest of pure science as well as for culties develop within the W-day expexience, then the actual undertaking of prolonged missions by man we are justified in designing for a 1-year or more at some time in the future. ORL. Regarding the ORL as a vehicle and operational configuration which can be characterized as a PREFERRED METHOD forgiving flight, then a 1-year forgiving experience OF APPROACH onboard the ORL should enable us to undertake a I-year (-c 10 to 20%) unforgiving mission. The The Group concluded that the most feasible ap- group considered the physiological end points serv- proach would be to design a single vehicle for very ing as criteria for extending flight durations to be long-duration flights, preferably one which would roughly exponential, specifically, 30 days, 90 days, remain in orbit virtually indefinitely, rather than to and 360 days.

~~141 142 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY~~

TYPE OF REENTRY VEHICLE design for both an onboard centrifuge and vehicular ‘ rotation in parallel until a specific decision can be The Group was unanimous in favoring a high made on the basis of Gemini, Apollo, biosatellite, L/D vehicle as a more desirable form of reentry and MOL findings. vehicle. It did not, however, establish this as a requirement. A reentry vehicle which can operate Several members of the Group agreed that quite over an incremental range of reentry gravitational apart from physiological considerations, intermittent profiles would provide a great safety factor in long- rotation of the vehicle is desirable for simple duration missions. “housekeeping” purposes, it., assisting the performance of various laboratory procedures, cleaning up the laboratory, etc. COST EFFECTIVENESS PARAMETERS The Group was unable to suggest particular cost VOLUME (SPACE) REQUIREMENTS effectiveness criteria from the medical standpoint. It did, however, suggest that a payoff ranking method In addition to the recommendations made with be used, i.e., that potential medical payoffs be first respect to the volume of living space to be provided stated, then placed in order of importance utilizing per crew member (see under Type of Vehicle), the a broad base of informed opinion. Group made several comments with respect to volume allowances for equipment: ORBIT 1. As a general principle, it is important to integrate as many experiments and measurements as The Group advocated an equatorial orbit of ap- possible into the equipment which is to be provided. proximately 30° inclination, circular, with an apogee 2. The laboratory area must be separate from the of 250 to 300 nautical miles. A polar orbit is to living area. be avoided because of the hazard of excessive expo- 3. The laboratory area must measure at least 6% sure to ionizing radiation. If minor adjustments in ft in the “vertical” dimension and 8 ft in one “hori- altitude can be made to provide subharmonics of a zontal” dimension in order to allow the medical 24-hour cycle, Le., on or just off the circadian examiner to assume his full height and the subject rhythm, this may be desirable. to “recline” fully stretched out with hands over his head. If a double-ended trampoline is provided, it NEED FOR ARTIFICIAL G: will require a dimension of at least 12 ft in the ROTATION OF THE SPACECRAFT, direction of movement of the subject. ONBOARD CENTRIFUGE, OR BOTH 4. Some of the required laboratory equipment will The Group first considered whether or not some consist of the following: a general purpose scaler form of artificial G will prove to be required for an with pulse height analyzer, radiation detectors, an ORL in which persons would be exposed for 1 year. incubator for cell cultures, an electronic computer Opinions consisted entirely of educated guesses. and special purpose sensors, electronic gas analyzer, With that understood, a vote was taken: 11 of 18 microscope, miniature oscilloscope, tape recorder, felt that no artificial G will be required; 6 of 18 x-ray unit, and bone density measuring device (us- voted in favor of artificial G; and 1 did not vote. ing isotopes or x-ray unit or other method which The type of artificial G preferred, centrifuge or may be developed), rotation of the vehicle, was also expressed by vote: 5. A specimen storage area should be provided 8 of 18 preferred rotation of the spacecraft, with which is to include a refrigerator, freezer, and lyo- counterrotating core; 10 of 18 preferred an onboard philization apparatus. The storage capacity require- centrifuge. ment is dependent upon frequency of rendezvous A portion of the spacecraft must provide weight- and the experimental program. lessness at all times. A centrifuge may be used as 6. An x-ray laboratoq is recommended as a first a provocative test or for conditioning of crew. priority item on clinical grounds and as a second However, 16 of 18 voted to recommend deferral priority item from the standpoint of medical investi- of a specific decision at present, and, instead, to gation. . PHA5E I11 : DESIGN AND OPERATIONAL KECOMMENDATIONS 143

WEIGHT AND POWER CYCLING OF PERSONNEL AND REQUIREMENTS ANIMALS UTILIZING RENDEZVOUS These are to be determined primarily on the TECHNIQUES basis of total experimental payload and represent In general, the SPAMAG favored an 8-man crew relatively basic engineering considerations. Large with replacement of 2 members at 90 days, 2 mem- power requirements are not anticipated for labora- bers at 240 days, and removal of ail at 360 days. tory Purposes- As an alternative procedure, 2 crew members may be replaced at 60 days, 2 at 120 days, 2 at 240 days,

SIZE OF TiE FLXGHT CREW -*..,"A '...-11 L_"._Y*Pmn..PA -I.04. ,"zq kYS. pue heer p2G&* is considered preferable if rendezvous capabilities The Group was generally agreed that the num- and logistic considerations will allow. Provision of personnel to be carried should range ber between must be made for the removal of the entire crew at 6 and 12 with 8 as optimum number. It was an any time during the orbital stay of the vehicle in also the consensus of the Group a crew size of that case of an emergency. 24 is unnecessary for medical research purposes. Recommendations for cycling of animals were for the same intervals and the same proportionate re- TYPES OF PERSONNEL COMPRISING placement cycling to provide greater scope of infor- THE FLIGHT CREW mation at the same data points used for evaluation The group made the following recommendations: of the crew. This would permit thorough study of 1. A physician-physiologist must be a member of the animals at these same critical points by means the crew. He must have research as well as clinical of intensive physiological and performance exami- experience. It may be additionally advantageous if nations and by means of gross and histologic stud- he were also an engineer and a pilot or had had ies of morphological changes on sacrificed specimens additional experience these two fields. of each animal group. 2. A well-trained medical person (a medical chi- cian) should also be included as a crew member. ONBOARD LABORATORY AND 3. A technician, one who has had training in ex- BIOINSTRUMENTATION perimental physiology and also in electronics and REQUIREMENTS who is able to repair and maintain the sophisticated (See also Volume (Space) Requirements.) hardware involved in the experimental package, must Onboard laboratory and bioinstrumentation re- also be included as a member of the crew. quirements in addition to those mentioned under 4. In general, the crew must resemble flight crews Volume (Space) Requirements will include at least which will later embark upon unforgiving missions the following: computer using central package of beyond ORL. logic, ECG, VCG, impedance pneumograph, temperature measurements, blood pressure, EEG (at UTILIZATION OF ANIMALS least 4 leads), electroretinography, tonometry ONBOARD (spring loaded), ophthalmodynamometry, electro- The panel concluded that provision should be oculography (Em), ballistocardiogram and/or seis- made for a small animal laboratory (mice, rats, and mocardiogram, oximetry, densitometry, strain gauge squirrel monkeys) aboard the ORL. This conclu- or other manometer, electromyography, analog dis- sion was based on the fact that techniques can be play, tape recorder, measurement of sweating rate, performed on animals which cannot be performed body mass measurement, body volume measurement, upon man and that animals can be sacrificed and bicycle ergometer, negative lower-body pressure ap- examined for biochemical changes and microscopic paratus, and additional laboratory methods. as well as gross morphological changes. Further- The following additional laboratory equipment is more, if considered as substitutes for additional per- suggested : measurement of volume of respiratory sonnel, animals provide a much better payoff per gases, measurement of flow of respiratory gases, weight, volume, power, etc. requirements. measurement of blood gases, measurement of acid- 144 MEDICAL ASPECTS OF AN ORBITING RESEARCH LABORATORY base chemistries, radioactive tracers, microscope, easier reentry mode (high L/D), perhaps with a method of making frozen sections, swallowable in- specially trained medical attendant as a crew mem- strumentation for measurement of core temperature ber. and pH of the GI tract, galvanic skin response, a behavioral testing panel, head restraint and camera NECESSITY FOR TOTAL GROUND for measurement of ocular motions, Barany chair SIMULATION PRIOR TO FLIGHT device for semicircular canal studies, swing device The Group recommended that baseline studies for otolith studies, device for measurement of ego- performed on flight simulators should be of 2 &pes. centric visual location of the horizon, pupillometry One type would employ the actual flight crew as and eye tracking devices, visual field device, a lab- subjects for relatively short periods of time so as oratory centrifuge, spectrophotometer or colorimeter, not to endanger their subsequent usefulness in- possibly an x-ray spectrometer, an osmotic pressure as flight experimental subjects. The other would em- apparatus (as a substitute for measurements of spe- ploy astronaut-like subjects exposing them to long- cific gravity of specimens), and provision for stor- term simulations (although very probably less than age, refrigerated storage, frozen storage, and lyo- the full duration of the flight). philized storage of specimens. Simulations for purposes of training and testing The Group also recommended that designers be of equipment, systems, and methodologies will be mindful of the necessity for carrying spare parts for of relatively short duration and will reveal their much of the above equipment. In the opinion of own end points. the Group, virtually all of the laboratory equipment As a general principle, wherever possible, all on- will require redesign from that used in Earth-based board equipment should be spaceflight tested in ad- laboratories for use in the weightless environment. vance of the ORL flight or flights. GROUND SUPPORT PERSONNEL POSTLANDING MEDICAL AND EQUIPMENT EXAMINATIONS The Group made the following recommendations : In the opinion of the Group, confinement and 1. A display system should be worked out to en- intensive observation for at least 1 month will be a able ground-based monitors to have baseline data postflight requirement. During this period of time, quickly available to them at all times. studies will be extensive, very probably even includ- 2. Serious consideration should be given the use ing tissue biopsy. It may also be necessary to have of a selective data sampling system based upon for- ad hoc postflight simulations to obtain baseline in- mal information content analysis in place of a “total formation relative to a particular flight finding or data dump system.” situation. The flight crews will be under general 3. A group comprised of clinical medical con- observation for a long period of time, perhaps many sultants and of chief investigators should be avail- years after the flight. It is even likely that their able for communication at all times for both clinical offspring, both preflight and subsequent, will be un- consultation and consultation with respect to bio- der long-term medical observation. All of this must medical investigations for the ORL, should the need be thoroughly explained and acceptable to the flight arise. The responsibility for experimental protocols crew prior to selection. and procedures and their control should rest with the chief investigators on the ground. Should questions of illness or other clinical problems arise, both USE OF DOUBLE-ENDED the medical consultants and the experimental con- TRAMPOLINE ONBOARD THE ORL sultants should be informed and should advise, since As indicated under Onboard Laboratory and Bio- the welfare of the experimental subjects will mark- instrumentation Requirements, in’ the opinion of the edly influence experimental protocols. Group, the use of the double-ended trampoline, as 4. It would be advisable to investigate the pos- an in-flight technique for exercising the cardio- sibility of a special “ambulance” vehicle with an vascular system, is worthy of investigation.

~~f7u.s. GOVERNMENT PRINTING OFFICE: 1968 -0 214-518~~