PIG-GEMINI MEDICAL PREDICTIONS VERSUS GEMINI FLIGHT RESULTS

By Charles A. B e r r y , M.D.

Allen D. Catterson, M.D.

(NASA-TM-X-74419) PRE-GEMINI MEDICAL

PREDICTZONS VERSUS G E B I I I FLLGBIT RESULTS
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16.&PRE-GEMINI MEDICAL PREDICTIONS VERSUS GEMINI FLIGHT RESULTS
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By Charles
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A. Berry, M.D., Director o f Medical Research and Operations,

NASA Manned Spacecraft Center, an en D. Catterson

of Medical Research and Operation SA Manned Spacecr

SUMMARY

The Mercury and Gemini space f l i g h t s provided approximately

2000 man-hours of weightless exposure for evaluating predicted e f f e c t s of

space f l i g h t s versus a c t u a l findings. I n general, t h e environmental

hazards and t h e e f f e c t s on man appear t o be of l e s s magnitude than

originally anticipated. The p r i n c i p a l physiologic changes noted were

orthostatism f o r some 50 hours p o s t f l i g h t as measured with a tilt t a b l e ,

reduced red-cell mass ( 5 t o 20 p e r c e n t ) , and reduced X-ray density

(calcium) i n t h e os c a l c i s and t h e s m a l l finger. No abnormal

psychological reactions have been observed, and no v e s t i b u l a r disturbances

have occurred t h a t were r e l a t e d t o f l i g h t . Drugs have been prescribed

for i n f l i g h t use. The r o l e of t h e physician i n supporting normal space

f l i g h t i s complex, requiring t h e p r a c t i c e of c l i n i c a l medicine, research,

and diplomacy, Although much remains t o be learned, it appears t h a t i f

man i s properly supported, h i s l i m i t a t i o n s w i l l not be a b a r r i e r t o t h e

exploration of t h e universe.
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INTRODUCTION

P r i o r t o t h e f i r s t exposure of man t o o r b i t a l space f l i g h t , t h e

biomedical community expressed considerable concern over man's c a p a b i l i t y

not only t o perform i n such an environment, but even t o survive i n it.

Since weightlessness w a s t h e one unknown f a c t o r which could not be exactly

duplicated i n a laboratory on t h e ground, numerous i n v e s t i g a t o r s and

various committees predicted some e f f e c t on almost every body system. It

i s understandable t h a t detrimental e f f e c t s were t h e ones l i s t e d , as t h e s e

could have been l i m i t i n g f a c t o r s i n manned space f l i g h t . In some r e s p e c t s ,

t h e medical community becomes it own worst enemy i n t h e attempt t o protect

man against t h e hazards of new and unknown environments. Frequently, t h e

physician dwells upon t h e possible individual system decrements, and

f o r g e t s t h e tremendous c a p a b i l i t y of t h e body t o maintain a s t a t e of

homeostasis,in many environments. Following t h e f i r s t manned space f l i g h t s ,

some of t h e s e a n x i e t i e s were reduced, although most observers believed t h e

evidence w a s i n s u f f i c i e n t t o r e j e c t any of t h e dire predictions.

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PREDICTED AND OBSERVED ENVIRONMENT AIQD HUMAN RESPONSES

The successful and s a f e l y conducted Mercury and Gemini Programs have

provided t h e f i r s t s i g n i f i c a n t knowledge concerning man's c a p a b i l i t y t o

cope with t h e environment of space. I n t h e s e programs, 19 men have flown

26 man-flights f o r a t o t a l weightless experience of approximately 2000 man-

hours. Three individuals have flown as t h e s i n g l e crewman i n Mercury and
as one of t h e two crewmen i n t h e Gemini spacecraft; four individuals have

flown twice i n t h e Gemini spacecraft. The f l i g h t programs a r e summarized

i n t a b l e s 16-1 and 16-11. This P l i g h t experience only scratches t h e

surface of d e t a i l e d space exploration, but should provide a sound b a s i s

f o r comparing t h e p r e d i c t i o n s concerning man's support and response t o

t h i s environment with t h e r e a l i t y of t h e findings from t h e a c t u a l

experience.

The space-flight environment p r e d i c t i o n s a r e compared w i t h t h e a c t u a l

observations i n t a b l e 16-111.

The human responses t o space f l i g h t which were predict-ed a r e compared I

w i t h t h e observations i n t a b l e 16-IV. There were more predicted system

e f f e c t s than were observed, though t h e r e were a l s o s e v e r a l e f f e c t s noted

which were not predicted.

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GENERAL ASPECTS OF THE FLIGHT PROGRAM

In evaluating the results of flight programs, it i s important to

realize that man is being exposed to multiple stresses and that it is

impossible at the present time to evaluate the stresses singly, either

inflight or postflight. M a n is exposed to multiple stresses which may be

summarized as: full pressure suit, confinement and restraint, 100-percent

oxygen end 5-psia atmosphere , changing cabin pressure (launch and reentry),

varying cabin and suit temperature, acceleration g-force, weightlessness,

vibration, dehydration, flight-plan performance, sleep need, alertness

need, changing illumination, &nd diminished food intake. Some of the
stresses can be simulated in ground-based studies but the actual flight
situation has never been duplicated, and more data from additional flight
programs are necessary before flight observations can be applied to the

ground situation.
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It is necessary t o provide t h e c a p a b i l i t y t o monitor the physiologic

state of man during f l i g h t a c t i v i t i e s . A great deal of consideration

has been given t o t h e d e f i n i t i o n of a set of physiologic indices which

might be e a s i l y obtained i n t h e f l i g h t s i t u a t i o n and which could be

meaningfully monitored. Routine parameters have included measurements of

voice two leads f o r electrocardiogram, r e s p i r a t i o n , body temperature ,

and 'blood pressure ( f i g . 16-1). Other functions were added f o r t h e

experiments program, but w e r e not monitored i n real t i m e . The monitoring

of man's physiologic state i n f l i g h t i s necessary t o provide information

f o r real-time decision making concerning the accomplishment of a d d i t i o n a l

f l i g h t objectives; t o assure t h e s a f e t y of t h e f l i g h t crew; and t o obtain

experimental data f o r p o s t f l i g h t a n a l y s i s f o r predictions concerning t h e

e f f e c t s of long-dura-bion f l i g h t upon man. The sensors and equipment

should not i n t e r f e r e w i t h t h e comfort and t h e function of t h e crew.

Whenever possible, t h e procurement of data should be v i r t u a l l y automatic

requiring l i t t l e o r no a c t i o n on t h e p a r t of t h e crewmen. A great deal

has been learned concerning t h e use of minimal amounts of data obtained

at i n t e r m i t t e n t i n t e r v a l s while a spacecrafi i s over a tracking s t a t i o n .

"he extravehicular crewmen have been monitored by means of one lead each

of electrocardiogram and of respiration-rate measurement obtained through

t h e space-suit umbilical. Additional physiologic informat ion such as

s u i t or body temperature and carbon-dioxide l e v e l s , could not be obtained

due t o t h e limited number of monitoring leads a v a i l a b l e i n t h e umbilical.

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The medical objectives i n t h e manned space-flight program are t o

provide medical support f o r man, enabling him t o f l y s a f e l y i n order t o

answer the following questions:

(1) How long can man be exposed t o t h e space-flight environment

without producing s i g n i f i c a n t physiologic or performance decrement?

(2) What are t h e causes of t h e observed changes?

( 3 ) A r e preventive measures or treatment needed, and i f s o , what

are b e s t ?

Attainment of t h e s e objectives w i l l involve tasks with d i f f e r e n t

orientation. The most urgent t a s k i s obviously t o provide medical support

t o assure f l i g h t s a f e t y through t h e development of adequate p r e f l i g h t

preparation and examination, as w e l l as i n f l i g h t monitoring. The second

i s t o obtain information on which t o base t h e operational decisions f o r

extending t h e f l i g h t duration i n a safe manner. The t h i r d t a s k d i f f e r s

from t h e operational o r i e n t a t i o n of t h e f i r s t two i n t h a t it implies an

experimental approach t o determine t h e etiology of t h e findings observed.

Frequently, many t h i n g s t h a t would contribute t o t h e accomplishment of

t h e last t a s k must be s a c r i f i c e d i n order t o a t t a i n t h e o v e r a l l mission

objective. This required constant i n t e r p l a y between t h e experimental and

t h e operational medical approaches t o t h e missions.

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The medical profession requires a team effort by personnel with

varied training and backgrounds in order to reach a common objective,

the preservation or the restoration of health for mankind. This is no

less true in a space-flight environment where a strong team effort is

necessary, and a strong engineering interface is imperative. If man is

to be properly supported, medical requirements concerning the spacecraft

environment and the equipment performance must be supplied very early in

the hardware development cycle. A very long lead time is necessary to

meet realistic flight schedules, and ample time must always be left for
proper testing of the hardware. Flight-configured hardware should be

utilized to collect the baseline physiologic data which will be compared

with the inflight data.

ANTICIPATED PROBLEMS COMPARED WITH FLIGHT RESULTS

The review of a number of aerospace or space medicine texts published

since 1951, reveals a large number of anticipated problems involving man

and the hardware or vehicle in the space environment. It appears logical

to compare the predictions with the actual flight results.
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Maintenance of Cabin Pressure

Tn regard t o t h e vacuum of space, extrapolating from a i r c r a f t

experience l e d t o a prediction of d i f f i c u l t y w i t h t h e maintenance of

cabin pressure. To date, t h e spacecraft have maintained a cabin pressure

of approximately 5 p s i a throughout t h e manned f l i g h t s . The p r e s s u r i z a t i o n

f e a t u r e of t h e space s u i t s was a backup t o t h e cabin pressure, but was

not required except during t h e planned excursions outside t h e spacecraft

when t h e cabin w a s i n t e n t i o n a l l y depressurized. The normal s u i t pressures

have been approximately 3.7 psia.

Cabin Atmosphere

Reduction i n cabin pressure t o 5 p s i a , equivalent t o a pressure

a l t i t u d e of 27 000 f e e t , and t h e f u r t h e r reduction t o 3.7 p s i a i n t h e

space suit created some concern about t h e possible development o f dysbarism.

Before each mission, t h e crew was denitrogenated by breathing 100-percent

oxygen f o r 2 hours; t h i s , coupled w i t h t h e f u r t h e r denitrogenation

accomplished i n t h e spacecraft, has proved t o be ample protection. There

have been no evidences of dysbarism on any of t h e missions.

Cabin and S u i t Temperature

The maintenance of an adequate temperature i n t h e cabin and i n t h e

extravehicular p i l o t ' s s u i t was a l s o a matter of concern. The temperatures

were generally within t h e comfort range around 70' F, During one mission,
t h e crew reported being cold when t h e spacecraft was powered down and

rotating, The extravehicular p i l o t s generally have been warm while i n s i d e

t h e spacecraft because the extravehicular s u i t contains a d d i t i o n a l l a y e r s

of material.
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Micrometeorites

Micrometeorites are a subject heading i n every book r e l a t i n g t o

space f l i g h t . They are mentioned as a possible hazard t o cabin i n t e g r i t y ,

t o spacecraft window surfaces, and t o extravehicular crewmen. No

s i g n i f i c a n t micrometeorite or meteorite density has been observed i n t h e

f l i g h t s t o date. There has been no evidence of micrometeorite h i t s on

t h e extravehicular s u i t s although a micrometeorite p r o t e c t i v e l a y e r i s

provided,

Radiation

The r a d i a t i o n environment of space has been sampled by numerous

probes and has been calculated a t length. With one exception, t h e f l i g h t s

have not reached an a l t i t u d e involving t h e inner Van Allen b e l t , but t h e

f l i g h t s have routinely passed through t h e South A t l a n t i c anomaly. The

onboard r a d i a t i o n measuring system and t h e personal dosimeters attached

t o t h e crewmen confirmed that t h e r a d i a t i o n i n t e n s i t y w a s a t t h e lower end

of t h e c a l c u l a t e d range. I n a 160-nautical-mile o r b i t , t h e crew received

approximately 15 m i l l i r a d s of r a d i a t i o n i n each 24 hours of exposure.

Table 1 6 4 i n d i c a t e s t h e t o t a l doses received on the flights t o date.

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Light and Darkness

Many predictions were made concerning t h e e f f e c t of t h e changing

l i g h t and darkness producing a day and a night every 90 minutes. It w a s

generally predicted t h a t t h i s would t o t a l l y d i s r u p t t h e c i r c a d i a n rhythms,

producing grave consequences. Certainly no overt e f f e c t s of t h e 45 minutes

of day and 45 minutes of night were observed on t h e short missions. As

knowledge of sleep i n t h e space-flight environment increased, it w a s

determined b e s t t o arrange t h e work-rest cycles so t h a t s l e e p oecurred at

t h e normal Cape Kennedy sleep time. The spacecraft w a s a r t i f i c a l l y

darkened by covering t h e windows, and as f a r as t h e crew were concerned,

it was night. The physiological response i n h e a r t r a t e t o t h e regime

used on t h e 14-day f l i g h t i s shown i n f i g u r e 16-2.

Gravity Load

During space f l i g h t , t h e increase of gravity load during launch and

reentry, and t h e n u l l i f i c a t i o n of g r a v i t y load and production of a s t a t e

of weightlessness during a c t u a l f l i g h t , were expected t o produce

detrimental e f f e c t s . Actually, g r a v i t y loads during t h e missions were

well within qan's t o l e r a n c e s , with two 7g peaks occurring at launch, and

with g-forces varying from 4 t o 8.2g a t reentry. Much concern w a s

expressed about a decreased tolerance t o gravity following weightless

flight. No evidence of t h i s has been observed; following 4 days of

weightless f l i g h t , t h e Gemini IV crew sustained a peak of 8.2g without

adverse e f f e c t s .
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Weightlessness has been t h e subject of innumerable s t u d i e s and papers.

It has been produced f o r b r i e f periods i n parabolic f l i g h t i n a i r c r a f t ,

and simulated by water immersion and bedrest. The Gemini Program has

produced a f a i r amount of evidence concerning t h e e f f e c t of t h e weightless

space-flight environment on various body systems.

Skin

In s p i t e of t h e moisture attendant t o space-suit operations, t h e skin

has remained i n remarkably good condition through f l i g h t s up t o 1 4 days i n

duration. Following t h e 8-day f l i g h t , t h e r e was some drying of t h e skin

noted during t h e immediate p o s t f l i g h t period, but t h i s was e a s i l y t r e a t e d

with l o t i o n . There have been no i n f e c t i o n s , and t h e r e has been minimal

reaction around t h e sensor sites. Dandruff has been an occasional problem

but has been e a s i l y controlled with p r e f l i g h t and p o s t f l i g h t medication.

Central Nervous System

The b e s t indication of c e n t r a l nervous system function has been t h e

excellent performance of t h e crew on each of t h e missions. This w a s

graphically i l l u s t r a t e d by t h e demanding performances required during t h e

aborted launch of Gemini VI-A; t h e rendezvous and t h e t h r u s t e r problem on

Gemini V I I I ; t h e extravehicular a c t i v i t y on Gemini I V , IX-A, X, X I , and

X I I ; and t h e many accurate spacecraft landings and recoveries.

Psychological tests have not been conducted as d i s t i n c t e n t i t i e s unrelated

t o t h e i n f l i g h t tasks. Instead, t h e evaluation of t o t a l human performance

has provided an indication of adequate c e n t r a l nervous system function.

There has been no evidence, e i t h e r during f l i g h t or p o s t f l i g h t , o f any

psychological abnormalities.
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The electroencephalogram (fig. 16-3) w a s u t i l i z e d t o evaluate sleep

during t h e 14-day mission. A t o t a l of 54 hours and 43 minutes of

i n t e r p r e t a b l e d a t a was obtained. Variations i n t h e depth of s l e e p from

stage 1 t o t h e deep s l e e p of stage 4 were noted i n f l i g h t as i n t h e

ground-based data.

Numerous v i s u a l observations have been reported by t h e crews

involving i n f l i g h t s i g h t i n g s and descriptions of ground views. The

a c t u a l determination of v i s u a l a c u i t y has been made i n f l i g h t , as w e l l

as i n p r e f l i g h t and p o s t f l i g h t examinations. A l l of these t e s t s support

t h e statement t h a t v i s i o n i s not altered during weightless f l i g h t .

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As previously noted, t h e r e has been much conjecture concerning

v e s t i b u l e s changes i n a weightless environment. There has been no

evidence of altered v e s t i b u l a r function during any of t h e Gemini f l i g h t s .

P r e f l i g h t and p o s t f l i g h t c a l o r i c v e s t i b u l a r f’unction s t u d i e s have shown no

change, and s p e c i a l s t u d i e s of t h e o t o l i t h response have revealed no

s i g n i f i c a n t changes. There have been ample motions of t h e head i n f l i g h t

and during roll rates with t h e spacecraft. There has been no v e r t i g o nor

d i s o r i e n t a t i o n noted, even during t h e extravehicular a c t i v i t y w i t h

occasional l o s s of a l l v i s u a l references. Several crewmen have reported

a f e e l i n g of f u l l n e s s i n t h e head similar i n character t o t h e f u l l n e s s

experienced when me i s turned upside down, allowing t h e blood t o go t o

t h e head. However, there has been no sensation of being turned upside

down, and the impression i s t h a t t h i s sensation r e s u l t s from a l t e r e d

d i s t r i b u t i o n of blood i n t h e weightless state. In order t o c l e a r t h e

record, two of t h e Mercury p i l o t s developed d i f f i c u l t i e s involving t h e

labyrinth; t h e d i f f i c u l t i e s were i n no way r e l a t e d t o t h e space f l i g h t s .

One developed prolonged v e r t i g o as t h e r e s u l t of a severe blow over t h e

l e f t ear i n a f a l l , but he has completely recovered with no r e s i d u a l

effect. The other Crewman developed an inflammation of t h e l a b y r i n t h

some 3 years after h i s 15-minute space f l i g h t and while he continues t o

have some hearing l o s s , t h e r e have been no f u r t h e r v e s t i b u l a r symptoms.

It i s in%eresting t o note t h i s absolute l a c k of any i n f l i g h t v e s t i b u l a r

symptoms, i n s p i t e of t h e f a c t t h a t a number of t h e p i l o t s have developed

motion sickness while i n t h e spacecraft on t h e water.

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Eye, Ear, Nose, and Throat

There have been two i n f l i g h t incidents of rather severe eye

irritation. One was t h e result of exposure t o l i t h i u m hydroxide i n t h e

s u i t c i r c u i t ; t h e cause of t h e other remains a mystery. I n a f e w instances,

some p o s t f l i g h t conjunctival infection has been noted, but has lasted only

a f e w hours and i s believed t o have been t h e r e s u l t of t h e oxygen

environment. During t h e e a r l y portions of t h e f l i g h t s , normally t h e f i r s t

2 or 3 days, some'nasal s t u f f i n e s s has been noted. This a l s o i s

undoubtedly r e l a t e d t o t h e 100-percent oxygen environment and i s usually

self-limited. On occasion, t h e condition has been t r e a t e d l o c a l l y or by

o r a l medication.

Respiratory System

P r e f l i g h t and p o s t f l i g h t X-rays have f a i l e d t o reveal any a t e l e c t a s i s .

Pulmonary function s t u d i e s before and a f t e r t h e 14-day mission revealed no

alteration. There have been no s p e c i f i c d i f f i c u l t i e s or symptomatology

involving t h e r e s p i r a t o r y system; however, some r a t h e r high r e s p i r a t o r y

rates have been noted during heavy workloads i n t h e extravehicular a c t i v i t y .

Even when t h e s e rates have exceeded 40 breaths p e r minute, they have not

been accompanied by symptomatology.

 Cardiovascular System

The cardiovascular system was t h e f i r s t of t h e major body systems t o

show physiologic change following f l i g h t ; as a r e s u l t , it has been

extensively investigated by various means ( f i g . 16-4). A s previously

reported, t h e peak heart rates have been observed a t launch and a t

r e e n t r y (table 16-v1); t h e rates normally reached higher l e v e l s during

t h e r e e n t r y period. The midportions of a l l the missions have been

characterized by more stable heart rates a t lower l e v e l s w i t h adequate

response t o physical demands.

The electrocardiogram has been studied i n d e t a i l throughout t h e

Gemini missions. The only abnormalities of note have been very rare,

premature, a u r i c u l a r and v e n t r i c u l a r contractions. No s i g n i f i c a n t

changes have been detected i n t h e duration of s p e c i f i c segments of t h e

electrocardiogram.

Blood pressure measurements obtained during the Gemini VI1 mission

revealed t h a t s y s t o l i c and d i a s t o l i c values remained within t h e envelope

of normality and showed no s i g n i f i c a n t changes throughout 14 days of

flight. A s previously reported, t h i s included t h e pressures taken a t t h e

time of reentry.
 16

Some insight into the electrical and mechanical phases of the

cardiac cycle was gained during the Gemini flights. The data were
derived through synchronous phonocardiographic and electrocardiographic

monitoring. In general, wide fluctuations in the duration of the cardiac

/

cycle, but within physiological limits, were observed throughout the

missians. Fluctuations in the duration of electromechanical systole

correlated closely with changes in heart rate. Stable values were
observed f o r electromechanical delay (onset of ventricular activity,

&RS complexes, to onset of first heart sound) throughout the missions,

with shorter values observed during the intervals of peak heart rates

recorded during lift-off, reentry, and extravehicular activity. The

higher values observed for the duration of systole and for electromechanical

delay in certain crewmembers suggest a preponderance of cholinergic

influences (vagal tone). ~n increase in adrenergic reaction (sympathetic

tone) was generally observed during lift-off, reentry, and in the few

hours )preceding reentry.

As a further measure of cardiovascular status , Experiment M003,

Inflight Exerciser, determined the heart-rate response to an exercise
load consisting of one pull per second for 30 seconds on a bungee device

(force at full extension of 12 inches equaled 70 pounds) The responses

for one crewman on the Gemini V mission are shown in figure 16-5. The

results of the 4-day Gemini IV and the 14-day Gemini VI1 mission did not

differ. This variant of the step test revealed no physical o r

cardiovascular decrement after as much as 14 days in a space-flight
environment
 In c o n t r a s t t o t h e Project Mercury r e s u l t s , orthostatism r e s u l t i n g

from any Gemini mission has not been detectable except by means of passive

t i l t - t a b l e provocation. Typically, t h e heart-rate and blood-pressure

responses t o a 15-minute, 70' tilt performed p o s t f l i g h t a r e compared

w i t h i d e n t i c a l p r e f l i g h t t e s t i n g on t h e same crewmen. Consistently, such

t e s t i n g has demonstrated a g r e a t e r increase i n h e a r t r a t e , a g r e a t e r

reduction i n pulse pressure, and a g r e a t e r increase i n l e g volume, as

i n t e r p r e t e d from lower l i m b circumference gages during t h e p r e f l i g h t tilt

( f i g . 16-6). The changes observed i n t h e s e v a r i a b l e s may be most

s i g n i f i c a n t l y i l l u s t r a t e d by examining t h e heart-rate changes observed

during p r e f l i g h t and p o s t f l i g h t t i l t - t a b l e s t u d i e s . When t h e p o s t f l i g h t

increases i n heart r a t e during tilt a r e expressed a s percent of t h e

p r e f l i g h t tilt heart r a t e f o r each of t h e Gemini crews, t h e p o s t f l i g h t

increases a r e from 17 t o 105 percent g r e a t e r than those exhibited

preflight. The increasing trend i n t h e s e values was evident through t h e

8-day mission. A m u l t i p l i c i t y of a l t e r e d f a c t o r s such as b e t t e r d i e t ,

more e x e r c i s e , desuited periods, and no extravehicular a c t i v i t y make t h e

improved p o s t f l i g h t response t o t h e 14-day mission very d i f f i c u l t t o

i n t e r p r e t (f i g . 16-7 ) .
For purposes of comparison, f l i g h t data and d a t a from bedrest
s t u d i e s were viewed i n a l i k e manner and show a very s i m i l a r t r e n d ;

however, t h e magnitude of t h e changes shows marked d i f f e r e n c e s , again

i l l u s t r a t i n g , perhaps, t h e influence of f a c t o r s other than those

simulated by bed r e s t .
 When t h e t i l t - t a b l e t e s t s a r e considered, p o s t f l i g h t l e g volume was

u n i v e r s a l l y g r e a t e r than p r e f l i g h t . Postmission observations ranged from

1 2 t o 82 percent increase i n volume over premission values,

The Gemini V p i l o t wore i n t e r m i t t e n t l y occlusive lower-limb c u f f s

f o r t h e f i r s t 4 days of t h e 8-day mission. The Gemini V I 1 p i l o t wore t h e

c u f f s f o r t h e e n t i r e 14-day mission; however , h i s heart-rate increases

and pulse-pressure narrowing were g r e a t e r than f o r t h e command p i l o t ; t h e

c u f f s seemingly did not a l t e r t h e v a r i a b l e s .

Average r e s t i n g h e a r t r a t e s have ranged from 18 t o 62 percent higher

a f t e r missions. I n s p i t e of higher r e s t i n g pulse r a t e s , t h e changes

r e s u l t i n g from tilt were s t i l l g r e a t e r . The exception presented by t h e

Gemini V I 1 crew i s more apparent. The bed-rest d a t a a r e not remarkable.

To d a t e , t h e observations of t h e e f f e c t of space f l i g h t on body

systems have shown s i g n i f i c a n t changes involving only t h e cardiovascular,

hematopoietic, and musculoskeletal systems. Even t h e s e changes appear

adaptive i n nature and are measured p r i n c i p a l l y during t h e readaptive

phase t o t h e one-g environment. It appears t h a t adequate information

has been obtained t o permit a n t i c i p a t i o n of a nominal lunar mission

without being surprised by /unforeseen physiologic changes. Medical r e s u l t s

from t h e United S t a t e s space f l i g h t s appear t o d i f f e r from t h e r e s u l t s

reported by t h e U.S.S.R., where t h e r e seems t o be a unique problem i n t h e

area of v e s t i b u l a r response. I n t h e cardiovascular a r e a , t h e United S t a t e s

has not confirmed t h e U.S.S.R. r e p o r t s of electromechanical delay i n

cardiac response, and t h e U.S.S.R. has not confirmed t h e United S t a t e s

findings of decreased red-cell mass.

 The Gemini flights have also provided some excellent examples of

human variability and have emphasized the necessity f o r care in making

deductions. In making projections based on very limited results in a few

people, the current trend is to bank heavily dpon comparisons in a given

individual; that is, differences between baseline data and responses

observed during and after a flight. The crewmen who have flown twice have

shown variability between flights in the same manner as have different men
on the same flight. Figure 16-8 shows the heart rates for one crewman

during the launch phase of his Mercury and also of his Gemini missions.
The two curves show little correlation and could as easily have come from
different individuals. Obviously, confidence in the results and the

definition of variability will be improved as more information is gained

on future flights. Also, these are gross system findings, and much must
still be accomplished in the laboratory and inflight if the mechanisms of
the findings are to be understood.
 20

Although physiological adaptation is d i f f i c u l t t o define, it might

be s t a t e d as any a l t e r a t i o n o r response which favors t h e s u r v i v a l of an

organism i n a changed environment. This d e f i n i t i o n implies a u s e f u l

alteration. I n t h e space-flight s i t u a t i o n , man i s adapting t o a

weightless environment i n t o which he has been t h r u s t i n a matter of

minutes and where he s t a y s a v a r i a b l e time; a second adaptation i s required

after r e t u r n t o t h e one-g environment of e a r t h , which can be measured by

d i r e c t observation. Some of t h e physiological changes r e t u r n t o normal

over an extended time; f o r instance, t h e tilt responses have a l l returned

t o normal within a 50-hour period, regardless of t h e duration of exposure

t o t h e space-flight environment.
 21

Blood
Significant increases have been observed in white blood-cell counts

manifested as an absolute neutrophilia following most flights. This

condition has always returned to normal within 24 hours. Hematologic

data derived from Gemini missions of 4, 8, and 14 days demonstrated a

hemolytic process originating during flight. Specific data points
include red-cell mass deficits of 12, 20, and 19 percent (command pilot)

following the Gemini IV, V, and VI1 missions, respectively (fig. 16-9).

The 12-percent Gemini IV data point is probably inaccurate. This 4-day

point was calculated from RISA-125 plasma volume and peripheral hematocrit
data, a method predicted on a constant relationship between peripheral and

total body hematocrit. Subsequent direct measurements showed that

alterations of the peripheral total body hematocrit ratios do occur,

thereby introducing an obvious error into the calculations. Based upon the
direct measurements, the Gemini IV calculated red-cell mass deficits were

re-examined and found to more closely approximate 5 percent. Other

hematologic tests corroborated this disparity; however, to date, no

satisfactory explanation of the phenomenon exists. Complete interpretation

of the red-cell mass deficit noted in the comand pilot of Gemini VI1 also

required special consideration. It appears that no significant progression

of the hemolysis occurs after the 8th day in orbit; however, this may be

more apparent than real. Analysis of the related mean corpuscular volume

values shows a significant increase in this parameter during the 14-day

space-flight interval. If each individual erythrocyte increased in volume,

a measurement of the total red-cell volume (red-cell mass) would not '
 22

accurately r e f l e c t t h e a c t u a l loss o f erflhrocytes. Correcting f o r t h e

postflight corpuscular volume s h i f t , a 29-percent c i r c u l a t i n g red-cell

deficit iS derived, The l a t t e r f i g u r e more accurately describes t h e

hernoly-tic event; t h e r e f o r e , it i s p o s s i b l e t h a t t h e t r u e extent of t h e

hemoly%ie process has not y e t been de.ternined.

 23

Possible causative f a c t o r s of t h e red-cell loss are hyperoxia

(166-mm oxygen a t t h e a l v e o l a r membrane) , lack of i n e r t d i l u e n t gas

( n i t r o g e n ) , r e l a t i v e immobility of t h e crew, d i e t a r y f a c t o r s , and

weightlessness. Only increased oxygen t e n s i o n , immobility, and d i e t a r y

f a c t o r s a r e w e l l known t o influence t h e red c e l l . Dietary considerations

may be of considerable importance; however, at t h i s point no d e f i n i t e

incriminations can be l e v i e d against t h e f l i g h t d i e t . A program t o

define c e r t a i n d i e t l e v e l s of l i p i d soluble vitamins has r e c e n t l y been

initiated. S p e c i f i c a l l y , alpha-tocopherol i s an important a n t i l i p i d

oxidant and i s e s s e n t i a l i n protecting t h e l i p i d at t h e red-cell plasma

membrane. Immobility is e f f e c t i v e i n reducing r e d - c e l l m a s s by c u r t a i l i n g

erythrocyte production; however, a l l f l i g h t observations support hemolysis

as t h e s i g n i f i c a n t event. Although not demonstrated by any previous

s t u d i e s , it i s possible t h a t weightlessness i s a contributing f a c t o r i n

t h e hemolysis observed. Altered hemodynamics, r e s u l t i n g in.hemostasis,

could r e s u l t i n t h e premature demise of t h e c e l l . The r o l e of a d i l u e n t

gas (nitrogen) i s not w e l l understood; however, some i n v e s t i g a t o r s have

shown s i g n i f i c a n t reduction i n hematologic and neurologic t o x i c i t y i n

animals exposed t o high oxygen pressure when an i n e r t gas i s present.

Therefore , t h e absence of an i n e r t atmospheric d i l u e n t could be

s i g n i f i c a n t at t h e hy-peroxic l e v e l s encountered within t h e Gemini

spacecraft.
 24

O f a l l t h e mechanisms previously s t a t e d , oxygen has t h e g r e a t e s t

proven p o t e n t i a l as a hemolytic agent. Basically, two modes of oxygen

t o x i c i t y are described. It has been demonstrated t h a t red-cell plasma

membrane l i p i d s undergo peroxidation when exposed t o conditions of

hyperoxia. It has a l s o been demonstrated t h a t t h e l i p i d peroxides thus

formed are detrimental t o t h e c e l l . S p e c i f i c a l l y , l i p i d peroxides a r e

known t o a f f e c t enzyme systems e s s e n t i a l f o r normal red-cell function.

It i s a l s o possible t h a t peroxidation of t h e erythrocyte plasma membrane

l i p i d s changes t h i s t i s s u e t o c u r t a i l erythrocyte survival. The second

mode of oxygen / t o x i c i t y expression may be more d i r e c t , for i n f e r e n t i a l

evidence is a v a i l a b l e showing a d i r e c t i n h i b i t o r y e f f e c t on some

g l y c o l y t i c eneynes. Oxygen has s e v e r a l documented d e l e t e r i o u s e f f e c t s

on red-cell plasma membranes and metabolic functions; any combination of

t h e s e e f f e c t s could be operative within a Gemini spacecraft.

Biochemic a1

The a n a l y s i s of u r i n e and plasma has been used as an i n d i c a t i o n of

crew physiological s t a t u s p r e f l i g h t , inflight, and p o s t f l i g h t . Analyses

of t h e r e s u l t s obtained on a l l t h r e e phases were performed on t h e 14-day

Gemini V I 1 f l i g h t , and e s s e n t i a l l y complete analyses were performed on

t h e p r e f l i g h t and p o s t f l i g h t phases of t h e 3-day Gemini IX-A mission.

 25

The first attempt at accumulation of i n f l i g h t data was e s s e n t i a l l y

a shakedown and provided an n of two, which f o r b i o l o g i c a l data i s

insignificant. Some of t h e data a r e presented, but i n t e r p r e t a t i o n i s

dependent upon more r e f i n e d techniques and upon accumulation of a

s u f f i c i e n t number of observations t o e s t a b l i s h v a r i a b i l i t i e s and trends.

The high degree of individual v a r i a t i o n should be noted. The Gemini V I 1

p i l o t and command p i l o t d i d not always respond q u a l i t a t i v e l y or

q u a n t i t a t i v e l y i n t h e same way.

The biochemical determinations a r e grouped i n t o s e v e r a l p r o f i l e s ,

each of which provides information concerning t h e e f f e c t of space f l i g h t

on one or more of t h e physiological systems. The first p r o f i l e , water

and e l e c t r o l y t e balance, i s r e l a t e d t o an examination of t h e weight l o s s

which occurs during f l i g h t and t h e mechanisms involved i n t h i s l o s s . To

t h i s end, t h e l e v e l s of sodium, potassium, and chloride i n t h e plasma

were measured p r e f l i g h t and p o s t f l i g h t , and t h e rates of excretion of

t h e s e e l e c t r o l y t e s i n t h e urine were observed i n a l l t h r e e phases of t h e

study. Total plasma p r o t e i n concentration measured both p r e f l i g h t and

p o s t f l i g h t was used as an indication of possible dehydration. Water

intake and urine output w e r e measured t o determine whether t h e primary

loss of weight was due t o sweat and insensible l o s s e s or t o changes i n

r e n a l function. The vasopressin ( a n t i d i u r e t i c hormone) and aldosterone

hormones were measured i n t h e urine i n an attempt t o e s t a b l i s h t h e

functional contribution o f baroreceptors i n a zero-gravity condition.

 26

As may be expected, s i n c e one of t h e prime functions of t h e

homeostatic mechanisms of t h e body i s t o maintain t h e composition of

blood and e x t r a c e l l u l a r f l u i d as n e a r l y constant as p o s s i b l e ; s i g n i f i c a n t

changes i n plasma were not observed, As seen i n f i g u r e 16-10, 48-hour

pooled samples of f l i g h t urine i n d i c a t e a s l i g h t reduction i n t h e output

of sodium during f l i g h t . A s indicated by t h e hashed bars, t h i s i s

associated w i t h some increase i n aldosterone excretion. P o s t f l i g h t , there

i s a marked r e t e n t i o n of sodium. As expected, chloride excretion p a r a l l e l s

t h e sodium excretion. Potassium excretion during f l i g h t ( f i g . 16-11)

appears depressed, and i n a l l but t h e command p i l o t of Gemini V I I , it w a s

depressed immediately p o s t f l i g h t . This depression could be observed i n

t o t a l 24-hour output and i n minute output. The a n t i d i u r e t i c hormone

appeared elevated i n only t h e first p o s t f l i g h t sample of t h e Gemini VI1

pilot. The c r u d i t i e s of t h i s b i o l o g i c a l assay may account f o r t h e

i n a b i l i t y t o observe any gross changes. The retenkion of e l e c t r o l y t e s

i s very c l o s e l y associated w i t h t h e r e t e n t i o n of water p o s t f l i g h t .

 27

The second profile involves the estimation of the physiological

cost of maintaining a given level of performance during space flight.

This could be considered-ameasure of the effects of stress during space

flight. Two groups of hormones were assayed; the first,

17-hydroxycorticosteroids, provides a measure of long-term stress responses.

The second, catecholamines, provides a measure of short-term or emergency

responses. The results obtained with the catecholamine determinations
are anomalous and changes observed could be considered well within the error

of the methodology. As seen in figure 16-12, the 17-hydroxycorticoster~id

levels are depressed during the flight. A n elevation immediately postflight

may be related to the stress of reentry and recovery. Although there may
be considerable speculation regarding the low inflight steroids, it must
be reemphasized that these results are from a single flight, and much

more data will be essential before a valid evaluation is possible.

 e8

The t h i r d p r o f i l e c o n s t i t u t e s a continuing e w l u a t i o n of t h e e f f e c t s

of space f l i g h t on bone demineralization. Calcium, magnesium, phosphate,

and hydroxyproline are measured i n plasma and i n u r i n e obtained p r e f l i g h t ,

i n f l i g h t , and p o s t f l i g h t . This i s an attempt t o determine whether t h e

s t a t u s , o r t h e changes i n t h e s t a t u s of bone mineral, are accompanied by

a l t e r a t i o n s i n plasma calcium and hydroxyproline, and by a l t e r a t i o n s i n

urinary excretion of calcium, phosphate, magnesium, and hydroxyproline.

The amino a c i d , hydroxyproline, i s unique t o collagen, and it w a s presumed

t h a t an increased excretion of hydroxyproline might accompany

demineralization along with d i s s o l u t i o n of a bone matrix ( f i g . 16-13).

The first p o s t f l i g h t plasma samples following t h e 14-day f l i g h t show a

marked i n c r e a s e i n t h e bound hydroxyproline, while l a r g e r q u a n t i t i e s of

calcium were excreted l a t e r i n t h e f l i g h t than during t h e e a r l y phases of

the flight. This i s c o n s i s t e n t with a change i n bone s t r u c t u r e .

The f o u r t h group may be related t o p r o t e i n metabolism and t i s s u e

status. When t o t a l nitrogen was related t o intake during f l i g h t , a

negative balance w a s noted.

 29

Gastrointestinal Systew

The design and fabrication of foods for Consumption during space

flights have impose& unique technological considerations. The volume

of space Food per man-day has varied in the Gemini missions from

130 to 162 cubic inches (2131 to 2656 ccl. Current menus are made up of
approximately 50 to 60 percent rehydratables (foods requiring the addition
of water prior to ingestion); therefore, food packaging is required that
permits a method for rehydration and for dispensing food in zero gravity.

The remaining foods are bite-size; that is, food items which are ingested
in one bite and rehydrated in the mouth. About 50 percent of the

rehydratable and the bite-size foods are freeze-dried products, the

remaining are other types of dried or low-moisture foods, some of which

are compressed. A typical menu (table 16-v11) has an approximate calorie

distribution of 17 percent protein, 32 percent fat, and 51 percent

carbohydrate. Total calories provided and eaten per day varied from flight

to flight. Food consumption during Gemini I V , V, and V I 1 is summarized

in figures 16-14, 16-15, and 16-16. Food consumption during Gemini I V

and V I 1 was very good, but weight loss on the short-duration Gemini TV

mission was definitely substantial. The anorexia of the Gemini V crew is

unexplained although many hypotheses could be presented. Although weight

loss has occurred on all missions, it has not increased with mission
duration (table 16-v111). Obviously, more calories and water must be
consumed in flight to maintain body weight at preflight levels.
 G a s t r o i n t e e t i n a l t r a c t function on a l l missions has been normal, and

no evidence e x i s t s f o r excess n u t r i e n t l o s s e s due t o poor food

d i g e s t i b i l i t y during f l i g h t . Before t h e missions, t h e crews ate a low-

residue d i e t ; on a l l f l i g h t s beginning w i t h t h e Gemini V mission, an

o r a l and usually a suppository l a x a t i v e were used within two days of

launch. On t h e s h o r t e r extravehicular missions, t h i s p r e f l i g h t

preparation has generally allowed t h e crew t o avoid defecation i n f l i g h t .

Genitourinary System

There have been no d i f f i c u l t i e s involving t h e g e n i t a l system.

Urination has occurred normally both i n f l i g h t and p o s t f l i g h t , and t h e r e

has been no evidence of r e n a l c a l c u l i .

 Musculoskeletal System

Here again, i n t e r p r e t a t i o n of t h e information gathered t o date on

bone and muscle metabolism as a f f e c t e d by space f l i g h t must be cautious due

t o t h e very f e w s u b j e c t s observed under varying d i e t a r y intakes and exposed

t o multiple f l i g h t s t r e s s e s .

I n f i g u r e s 16-17 and 16-18, t h e bone demineralization (percent change

i n d e n s i t y ) which occurred i n t h e os c a l c i s ( h e e l ) and phalanx 5-2 ( l i t t l e

f i n g e r ) during space f l i g h t i s compared w i t h t h e demineralizatiqn which

occurred under equivalent periods of bed rest and analogous intakes of

calcium. A s compared w i t h bed r e s t , t h e changes were d e f i n i t e l y l e s s i n

t h e 14-day f l i g h t where calcium intake approached 1000 mg p e r day and t h e

crew r o u t i n e l y exercised. The phalanx changes a r e remarkable because

s i g n i f i c a n t differences i n density have not been observed during 30 days

of complete bed rest when calcium intake of over 500 mg per day has been

adequate.
 32

I n a l l instances t h e data f o r t h e bones examined i n d i c a t e a .negative

change, and t h e calcium balance d a t a collected on Gemini VI1 v e r i f y a

negative balance trend. None of t h e changes a r e pathological but i n d i c a t e

t h a t f u r t h e r research i s needed, and t h a t ameliorative methods f o r use

during long-duration f l i g h t s need t p be examined.

The d e t a i l e d 14-day i n f l i g h t balance study revealed some l o s s i n

protein nitrogen.

Exercise Capacity Tests

Previous i n v e s t i g a t i o n s have shown t h a t a l i m i t a t i o n of optimal

cardiovascular and r e s p i r a t o r y function e x i s t s when a heart r a t e of

180 b e a t s per minute i s reached during a gradually increased workload.

With t h i s i n mind, an exercise capacity t e s t vas incorporated i n t o t h e

Gemini operational p r e f l i g h t and p o s t f l i g h t procedures i n order t o

determine whether changes occur i n crew physiologic reaction t o work.

The t e s t s have been performed by t h e crewmembers of t h e Gemini VI1

mission and by t h e p i l o t s of t h e Gemini IX-A, X, XI, and XI1 missions.

All but one of t h e t e s t e d crewmen exhibited a decrease i n exercise

capacity as monitored by heart rate, and a concomitant,reduction i n oxygen

consumption t o a quantitated workload. These findings are graphically

demonstrated i n f i g u r e 16-19,
 33

.
Additionally, the heart-rate/workload information collected
preflight has been of value as a very rough index of the metabolic rate

of crewmen during extravehicular activity. It is realized that many

other stresses above and beyond the simple imposition of workload can

and do affect heart rate. The heart rate as measured during extravehicular

activity is not considered an exact index of the workload being performed,

but rather as a reflection of total physiological and psychological strain.

Inflight Metabolic Data

Metabolic measurement during United States space flights has been

limited to the determinations of the total carbon-dioxide production by

the chemical analysis of the spent lithium-hydroxide canister. This
method is of value only in establishing the average heat-production rate

for crewmen during space flight. Figure 16-20 shows close agreement

between metabolic data fromthe U.S.S.R. and the American space flights.
The higher metabolic rates observed during the Mercury flights are

explained by the fact that these were short-duration flights in which

the crewmen did not sleep.

 34

Other Observations Concerning Weightless F l i g h t

The crews have never s l e p t w e l l on t h e f i r s t n i g h t i n space, and

many f a c t o r s o t h e r than weightlessness may be a c t i v e i n l i m i t i n g t h e

s l e e p obtained, r e g a r d l e s s of f l i g h t duration. All crewmembers have

reported a tendency t o s l e e p with t h e arms folded a t chest height and

t h e f i n g e r s interlocked. The l e g s a l s o tend t o assume a s l i g h t l y elevated

position. On r e t u r n t o t h e one-g environment, t h e crews a r e aware of t h e

readaptation period because they a r e qware f o r a s h o r t t i m e t h a t t h e

arms and l e g s have weight and r e q u i r e e f f o r t t o move. There has been some

p o s t f l i g h t muscle stiffness following t h e prolonged missions t h a t may

be more associated with t h e confinement of t h e spacecraft than with

weightlessness.

The amount of i n f l i g h t exercise by t h e crew has varied even on t h e

long-duration f l i g h t s . On t h e 14-day mission, t h e r e were t h r e e 10-minute

exercise periods programmed and completed per day. On t h e short-duration

f l i g h t s with g r e a t demands upon t h e crew for rendezvous and extravehicular

a c t i v i t y , no s p e c i f i c conditioning e x e r c i s e s have beeh conducted. There

appears t o be a need f o r a d e f i n i t e e x e r c i s e regime on long-duration

flights.
 35

Crew Perfomnance
Strange reactions to the iaolation and the monotony of space flight
were originally predicted. Hallucinations and a feeling of separation

from the world, described as the breakoff phenomenon, had also been
predicted along with space euphoria, The experience to date has shown no
evidence of the presence of any of these responses. There have been no

abnormal psychological reactions of any sort, and the flights have been

far from monotonous. In the single-man flights of the Mercury series,

there was always ample ground contact and certainly no feeling of

isolation or monotony. In the two-man Gemini flights, the same was true

and of course these has always been a companion crewman, thus avoiding

isolation. The crews have exhibited remarkable psychomotor performance

capabilities, and by performing a number of demanding tasks under stress

they have demonstrated a high level of central nervous system function.

 36

Drugs

A number of predictions were made t h a t man would require t h e

a s s i s t a n c e of drugs t o cope with t h e space-flight environment. In

p a r t i c u l a r , sedation p r i o r t o launch and stimulation p r i o r t o r e e n t r y

have been mentioned. A s a result of t h e e a r l y planning f o r space f l i g h t ,

a drug k i t was made a v a i l a b l e f o r i n f l i g h t p r e s c r i p t i o n . The crews have

been p r e t e s t e d t o each of t h e drugs c a r r i e d ; t h u s , t h e individual reaction

t o t h e p a r t i c u l a r drug i s known. Aspirin and APC's have been used i n

f l i g h t f o r occasional mild headache and f o r relief of muscular discomfort

p r i o r t o sleep. Dextroamphetamine s u l f a t e has been taken on s e v e r a l

occasions by fatigued crewmen p r i o r t o reentry. A decongestant has been

used t o r e l i e v e n a s a l congestion and a l l e v i a t e t h e necessity f o r frequent

clearing of t h e ears p r i o r t o reentry. The antimotion sickness medication

has been taken i n one instance p r i o r t o reentry t o reduce motion sickness

r e s u l t i n g from motion of t h e spacecraft i n t h e water. An i n h i b i t o r of

g a s t r o i n t e s t i n a l propulsion has been prescribed when necessary t o assist

i n avoiding i n f l i g h t defecation. No d i f f i c u l t y has been experienced i n

t h e use of t h e s e medications which have produced t h e desired and expected

effects. None of t h e i n j e c t o r s has been used i n f l i g h t .

Inf 1ight Disease

Preventive medicine e n t h u s i a s t s have predicted t h e possible

development of i n f e c t i o u s disease i n f l i g h t as a r e s u l t of p r e f l i g h t

exposure and t h e l a c k of symptoms o r s i g n s which can be detected i n a

p r e f l i g h t examination.
 Quarantine of t h e crews f o r a period of t i m e p r e f l i g h t has been

discussed, and has been r e j e c t e d as impractical i n t h e missions t o date.

The immediate p r e f l i g h t period i s very demanding of crew p a r t i c i p a t i o n ,

and e f f o r t s have been d i r e c t e d at screening t h e contacts insofar as

possible t o reduce crew exposure t o possible v i r a l and b a c t e r i a l

i n f e c t i o n s , p a r t i c u l a r l y t h e upper r e s p i r a t o r y type. A number of short-

l i v e d f l u - l i k e syndromes have developed i n t h e immediate p r e f l i g h t period

as w e l l as one exposure t o mumps and one incident of betahemolytic

streptococcal pharyngitis. Each s i t u a t i o n has been handled without

a f f e c t i n g t h e scheduled launch and, i n r e t r o s p e c t , t h e policy of modified

quarantine has worked w e l l . S t r i c t e r measures may have t o be adopted as

longer f l i g h t s are contemplated,

Fatigue

It w a s predicted t h a t markedly fatigu d f l i g h t rews would r e s u l t

from t h e discomfort of f l i g h t i n a s u i t e d condition, a confined

spacecraft, and inadequate rest. I n reviewing t h e f l i g h t program t o date,

it appears t h a t t h e crews obtained less sleep than i n similar circumstances

on t h e ground, but were not unduly fatigued. Intermittent periods of

f a t i g u e have r e s u l t e d from t h e demanding a i s s i o n requirements and f r o m t h e

f a s c i n a t i o n of t h e crew with t h e unique opportunity t o view t h e universe.

This has been c y c l i c i n nature and on t h e long-duration f l i g h t s has always

been followed by periods of more restful sleep. No interference with

performance has been noted due t o i n f l i g h t fatigue.

 38

MEDICAL SUPPORT

I n preparing f o r t h e medical support of manned space f l i g h t s , t h e

p o s s i b i l i t y of i n j u r y at t h e time of launch and recovery was c a r e f u l l y

evaluated. A d e t a i l e d plan of support involving medical and surgical.

s p e c i a l i s t s i n the launch and recovery areas w a s evolved and modified as

t h e program progressed. I n r e t r o s p e c t , it might appear t h a t t h e support

of surgeons, a n e s t h e s i o l o g i s t s , and supporting teams i n these areas has

been overdone i n view of t h e r e s u l t s , This i s always a d i f f i c u l t area t o

evaluate, however, because none of t h e support i s needed unless a

d i s a s t e r occurs. The b e s t t h a t can be said a t t h e moment i s t h a t t h i s

support w i l l be c r i t i c a l l y reviewed i n t h e l i g h t of t h e experience t o

date and rendered more r e a l i s t i c i n t h e demands placed on highly t r a i n e d

medical personnel.

When o r i g i n a l l y established, t h e p r e f l i g h t and p o s t f l i g h t

examinations were aimed at i d e n t i f y i n g gross changes i n man r e s u l t i n g

from exposure t o t h e space-flight environment. The examinations have

been t a i l o r e d along standard c l i n i c a l l i n e s , and although t h e s e

I
I
techniques have been s a t i s f a c t o r y , l i t t l e i n t h e way of change has been

noted. The procedures have been modified t o include more dynamic t e s t s

such as bicycle ergometry, and t o reduce t h e emphasis on those s t a t i c

' t e s t s which showed l i t t l e o r no change. Increased use of dynamic t e s t i n g

should continue i n t h e support of future manned space-flight programs.

 38

CONCLUDING REMARKS

There has been increased s c i e n t i f i c i n t e r e s t i n t h e e f f e c t of t h e

space-flight environment on man. The s c i e n t i f i c requirements for

a d d i t i o n a l information on man's function must be evaluated i n regard t o

operational and mission requirements and t h e e f f e c t upon f u t u r e manned

space f l i g h t . The input of t h e crews and t h e operations planners must be

weighed along w i t h t h e b a s i c medical and s c i e n t i f i c requirements, and a

r e a l i s t i c plan must be e s t a b l i s h e d t o provide needed medical answers a t

t h e proper time and allow projections of man's f u r t h e r exposure. T h i s has

been one of t h e most d i f f i c u l t t a s k s i n t h e medical support a r e a . The

e n t i r e manned space-flight program has required t h e s t r i c t e s t cooperation

and understanding between physician and engineer, and it i s believed t h a t

t h i s has been accomplished. The medical management of t h e diverse personnel

necessary t o provide proper medical support f o r manned space missions has

provided experiences of g r e a t value t o f u t u r e progress.

I n reviewing t h e f l i g h t s , t h e o r d e r l y plan of doubling man's f l i g h t

duration, and observing t h e . r e s u l t s i n r e l a t i o n t o t h e next s t e p , has been

successful and e f f e c t i v e . There i s no reason t o a l t e r t h i s plan i n

determining t h e next increments i n manned space f l i g h t .

 40

I n general, t h e space environment has been much b e t t e r than

predicted. Additionally, man has been far more capable i n t h i s environment

than predicted, and weightlessness and t h e accompanying stresses have had

less e f f e c t than predicted. While a l l t h e s e items are extremely

encouraging and are t h e medical legacy of t h e Gemini Program, it i s

important t o concentrate on some of t h e possible problems of very long-

duration f u t u r e f l i g h t s , and t h e application of Gemini knowledge.

Consideration must be given t o t h e following: (1)obtaining a d d i t i o n a l

information on normal b a s e l i n e reactions t o stress i n order t o p r e d i c t

crew Yesponse , ( 2 ) determining psychological implications of long-duration

confinement and crew i n t e r r e l a t i o n s , ( 3 ) solving t h e d i f f i c u l t l o g i s t i c s

of food and water supply and of waste management, and ( 4 ) providing easy,

noninterfering physiologic monitoring.

 The f i r s t s t e p s i n t o space have provided a r i c h background on which

t o build. I n addition t o t h e information provided f o r planning f u t u r e

space a c t i v i t i e s , b e n e f i t s t o general medicine must accrue as smaller

and better bioinstrumentation with wider a p p l i c a b i l i t y t o ground-based

medicine i s developed; as normal values a r e defined f o r various

physiologic responses ie man; and as ground-based research i s conducted,

such a$ bed-rest s t u d i e s . These r e s u l t s should y i e l d a large amount of

information applicable t o hospitalized p a t i e n t s . It has been observed

how t h e human body can adapt t o a new and h o s t i l e s i t u a t i o n and then

readapt i n . a s u r p r i s i n g l y e f f e c t i v e manner t o t h e normal one-g earth

environment. Continued observation of t h e s e changes w i l l help determine

whether t h e space environment may be u t i l i z e d f o r any form of therapy i n

t h e fueure. The space-flight environment w i l l c e r t a i n l y prove t o be a

v i t a l laboratory, allowing study of t h e basic physiology of body systems,

such as t h e v e s t i b u l a r system. Even i n c i d e n t a l findings, such as t h e

red-cell membrane changes which a r e markedly applicable t o hyperbaric

applications i n medicine, may be of benefit t o general s c i e n t i f i c and

medical research.
 JI 2

TABLE 16-1.- FROJZCT MEFtCURY MANNED FLIGHTS

Launch d a t e
I Description
I Duration,
hr :min

May 5 , 1961 Suborbit a1 0:15

July 21, 1961 Suborbital 0:15

Feb. 20, 1962 Orbital 4:56

May 24, 1962 Orbital 4:56
Oet. 3, 1963 Orbital 9:14
May 15, 1963 Orbital 34:20
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 TABLE 16-111. - SPACE FLIGHT ENVIRONMENT
i

Predicted Observed
, _ _ r _

Micrometeorite density Low micrometeorite density

Lass of cabin pressure- 5 psi except during

vacuum extravehicular activity

Loss of suit pressure- / Spacesuit, wear unpressurized

vacuum (pressurized on extravehicular
flights )
Toxic atmosphere 100 percent oxygen
Cabin and suit Minimal variation about
temperature comfort zone
Radiation levels Insignificant
Isolation None
Physical confinement Physical restraint

Weightlessness Weightlessness
Gravity loads Gravity loads, no problem with
performance
Vibration Minimal vibration

Severe glare Varying illumination

Work load
 TABLE 16-IV. - HUMAN RESPONSE TO SPACEFLIGHT

Predicke d Observed

Dysbarism None

Disruption of circadian rhythms None

Decreased Q tolerance None

Skin infections and breakdown Dryness, including dandruff

Sleepiness and sleeplessness Interference (minor 1

Reduced v i s u a l a c u i t y None

Eye i r r i t a t i o n

Nasal s t u f f i n e s s and
hoarseness

Disorientation and motion

sickness None

Pulmonary at e l e c t a$i s None

High heart rates Launch, r e e n t r y ,

extravehicular a c t i v i t y

Cardiac arrhythmias None

High blood pressure None

Low blood pressure None

Fainting p o s t f l i g h t None

Electromechanical delay None

i n cardiac cycle

Reduced cardiovascular responst None

t o exercise
 TABLE 16-1v.- HUMAN RESPONSE TO SPACEFLIGHT - Continued

Predicted Observed

Absolute n e u t r o p h i l i a

Reduced blood volume Moderat e

Reduced plasma volume Minimal

-- Decreased red-cell mass

D ehy dr a t ion Minimal

WeiGht loss Variable

Bone demineralization Minimal calcium loss

Loss of a p p e t i t e Varying c a l o r i c intake

Nausea None

Renal stones None

Urinary r e t e n t i o n None

Diure s i s None

Muscular incoordination None

Muscular atrophy None

-e Reduced e x e r c i s e capacity

Hallucinations None

Euphoria None

Impared psychomotor performance None

- .
 TABLE 16-1V.- HUMAN RESPONSE TO SPACEFLIGHT - Concluded

Predicted Observed
- - .

Sedative need None

Stimulant need Before r e e n t r y occasionally

Infectious disease None

Fatigue Minimal
 TABLE 16-v.- RADIATION DOSES ON GEMINI MISSIONSa

Mean cumulative dose,

Mi ssion Duration, mad
day:hr:min
. , ,
Command pilot Pilot

I11 0:04:52 420 42 * 15

IV 4:00:56 42 f 4.5 50 f 4.5
V 7:22:56 182 f 18.5 170 f 17
VI4 1:01:53 25 f 2 23 * 2

VI1 m 1 8 : 35 155 * 9 170 f 10

VI11 0:10:41 a0 10

IX-A 3:01:04 17 f 1 22 * 1
x 2: 22:46 670 f 6 765 * i o
XI 2 :23:17 29 f 1 26 f I
XI1 3:22 :37 <2Q <20

%oaimeters located in helmet, rfght and left chest, and thigh.

TABLE 16-VI.- PEAK HEART RATES DURXNG LAUNCH AND REENTRY

Peak rates Peak rates

Crewman
during launch, during r e e n t r y ,
(a) b e a t s /ruin beats/min

CP 152 165
P 120 130

CP 148 140
P 128 125
CP 148 170
P 155 178
CP 125 125
P 150 140

CP 152 180
P 125 134
CP 138 130
P 120 90

CP 142 160
P 120 126
CP 120 110
P 125 90

CP 166 120
P 154 117
C? 136 142
P 120 137

command p i l o t ; F Lndicates p i l o t .
 TABLE 16-vrr.- TYPICAL GEMINI MENU
[Days 2. 6. 10. and 1 4 1

Meal A Calories
Grapefruit drink .................. 03
Chicken and gravy . . . . . . . . . . . . . . . . . 92
Beef sandwiches . . . . . . . . . . . . . . . . . . 268
Applesauce . . . . . . . . . . . . . . . . . . . . . 165
Peanut cubes . . . . . . . . . . . . . . . . . . . . 297
.
905

Meal B

Orange-grapefruit drink .............. 83

Beefpot roast . . . . . . . . . . . . . . . . . . . 119
Bacon and egg bites . . . . . . . . . . . . . . . . 206
Chocolate pudding . . . . . . . . . . . . . . . . . 307
Strawberry cereal cubes . . . . . . . . . . . . . . . 114
829

Meal C

Potato soup .................... 220

Shrimp cocktail . . . . . . . . . . . . . . . . . . 119
Date fruitcake ................... 262

Orange drink ....................

Total calories .................. i~12418

TABLE 16-v1r1.- FLJGHT CREW WIGHT LOS6 TO THE NEAREST HALF POUND

Command pilot Pilot weight

weight 1066, loss,

3 3.5
4*5 8.5
7.5 ' 8.5
2-5 a
10 6
Not available Not available

5.5 13.5

3.0 3.0

2.5 0

6.5 7
 52

Figure 1.- Gemini biosensor harness.

 L
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 54

Figure 3.- Electroencephalogram equipment.

 55

Figure 4.- Gemini cardiovascular evaluakion techniques.

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