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`SP-368
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`National Aeronautics and Space Administration
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`NASA History Office
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`Biomedical Results of Apollo
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`SP-368
`
`Managing Editors
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`Richard S. Johnston, Lawrence F. Dietlein, M.D., and Charles A. Berry, M.D.
`
`Lyndon B. Johnson Space Center
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`Scientific and Technical Information Office
`National Aeronautics and Space Administration
`Washington, D.C., 1975
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`Table of Contents
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`SP-368
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`Updated: August 6, 2004.
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`Steve Garber, NASA History Web Curator
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`For further information E-mail histinfo@hq.nasa.gov
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`HTML work: Chris Gamble.
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`SP-368 Biomedical Results of Apollo
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`[41] SECTION II
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`Crew Health and Inflight Monitoring
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`
`
`The health of Apollo crewmembers was a matter of genuine concern. An inflight illness, particularly should it
`occur during a critical mission phase, could have had serious consequences. To minimize the chance of illness,
`an extensive health maintenance program was conducted to ensure the highest of health standards. This section
`describes the clinical practices which were followed and certain special projects conducted to obtain information
`bearing on the health of astronauts.
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`CHAPTER 1
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`CLINICAL ASPECTS OF CREW HEALTH
`
`by
`
`W. Royce Hawkins, M.D.
`John F. Zieglschmid, M.D.
`Lyndon B. Johnson Space Center
`
`Introduction
`
`[43] While the primary goal of the Apollo Program was to land men on the moon and return them safely to
`Earth, there were other very important medical objectives. The earlier Mercury and Gemini programs had raised
`some concerns about the health and safety of future crews. For example, the high metabolic energy expenditure
`of extravehicular activity during the Gemini missions was unexpected. Before Apollo astronauts could safely
`explore the lunar surface, reliable predictors of energy cost and real-time monitoring techniques had to be
`developed. Physiological changes were noted in individual crewmen, some more consistently than others. The
`most important of these changes was in cardiopulmonary status demonstrated by decreased exercise capacity,
`loss of red blood cell mass, and cardiovascular deconditioning demonstrated by a decrease in the effectiveness of
`antigravity cardiovascular responses during posflight stress testing.
`
`At the end of the Gemini program, with 2000 man-hours logged in space, it was clear that man could engage in
`relatively long space flight without any serious threat to health. However, clarification was still required in many
`areas. First of all, because of the small number of individuals who flew in space and because of the variability of
`their responses, it was impossible to distinguish between space-related physiological changes and individual
`physiological variations. Secondly, for those changes which were directly related to space flight, the relatively
`short mission durations precluded the identification of trends.
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`In view of the foregoing considerations, four medical objectives were specified for the Apollo Program:
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`1 Ensuring crew safety from a medical standpoint. This objective required that every effort be made to
`identify, eliminate, or minimize anything which posed a potential health hazard to the crew.
`
`[44] 2. Improving the probability of mission success by ensuring that sufficient medical information was
`available for management decisions.
`
`3. Preventing back-contamination from the lunar surface.
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`4. Continuing to further the understanding of the biomedical changes incident to space flight. This
`objective was formulated to detect, document, and understand changes occurring during space flight.
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`The program to ensure crew safety commenced long before the Apollo Program itself with the development and
`implementation of the medical selection and screening program for astronauts. Apollo astronauts were drawn
`from a pool of individuals who were thoroughly screened to preclude any physical or physiological problems
`which would jeopardize either the mission or the astronaut candidate. Later, special measures were taken to
`further protect the health and enhance the safety of those astronauts chosen for specific Apollo missions. These
`included preflight medical examinations, a health stabilization program, drug sensitivity testing of astronauts for
`all medications aboard the spacecraft, and other measures.
`
`The preflight medical program was designed to preclude, as far as possible, the development of any clinical
`medical problems during space flight. Since no preventive medicine program, however carefully conceived, can
`ever guarantee the absence of illness or disease, medications were carried onboard the Apollo spacecraft. The
`contents of the medical kit were revised as need indicated throughout the Apollo Program. Onboard
`bioinstrumentation was provided to monitor vital signs for rapid diagnosis of any physiological difficulty in a
`crewmember and to provide medical information required for mission management. Additional information was
`transmitted via voice communication between the crew and the ground-based flight surgeons. During
`extravehicular activity, methods were added to provide metabolic rate assessment. In addition to heart rate,
`oxygen consumption was monitored along with inlet/outlet temperature of the liquid cooled garment worn by the
`crewmen.
`
`Opportunities for inflight medical investigations were severely restricted on the Apollo missions because of
`conflict with the principal operational objectives. Furtherance of the understanding of the effects of space flight
`on human physiological functioning had to rely almost exclusively on comparison of preflight and postflight
`observations. These were carefully selected to focus attention on the areas which appeared most likely to be
`affected, for example, cardiovascular function. Other areas were also investigated for unforeseen changes and
`corroborative information.
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`The sections which follow describe medical procedures and findings for Apollo astronauts in the preflight,
`inflight, and postflight phases of the Apollo missions.
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`Preflight Procedures and Findings
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`The procedures implemented in the preflight period for Apollo missions had five major objectives. These were:
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`1. The discovery of latent illnesses during the process of selection of astronauts and preparation for
`missions.
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`[45] 2. The implementation of the health stabilization program and other preventive measures.
`
`3. Determination of individual drug sensitivity to the contents of the Apollo medical kits
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` 4
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` Providing baseline data against which to compare postflight data for determination of space flight
`effects.
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`5. Prevention of any situations which might delay or otherwise interfere with operational aspects of the
`missions.
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`The procedures performed in the preflight period ensured improved performance of flight tasks and, with rare
`exceptions, prevented the outbreak of illness inflight. This outcome was, in part, the result of medical screening
`and selection programs designed to provide physically competent crews. Observation and semi-isolation
`programs also helped to detect latent ailments which might have produced frank symptoms during flight. Finally,
`a training course was presented to astronauts to acquaint them with stresses of space flight and their effects upon
`the human organism.
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`
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`Medical Screening/Examinations
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`Preventive health care in a population which has been chosen for a particular job begins with the medical
`selection of that population. Rigorous astronaut selection standards were established to identify:
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`1. Individuals who were physically capable of performing astronaut duties; specifically those possessing
`the necessary physical and psychomotor capabilities and not subject to incapacitating physiological
`disturbances when exposed to the various stresses of space flight.
`
`2. Individuals who were free of underlying physical defects or disease processes which could shorten their
`useful flight careers.
`
`Apollo astronauts were initially medically screened by techniques which varied only in minor degree from those
`applied to the first seven Mercury astronauts. The standards used closely approximated U. S. Air Force Flying
`Class I Standards, except in the selection of scientist-astronauts where visual standards were relaxed to qualify a
`sufficient number of candidates. These examinations were performed at the U. S. Air Force School of Aerospace
`Medicine, with final review and medical acceptance of candidates by the NASA Lyndon B. Johnson Space
`Center medical staff. Listed below are the components of the examination used for medical selection.
`
`
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`1. Medical history and review of systems.
`
`2. Physical examination.
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`3. Electrocardiographic examinations, including routine electrocardiographic studies at rest, during
`hyperventilation, carotid massage, and breath holding, a double Master exercise tolerance test, a cold
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`pressor test, and a precordial map.
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`[46] 4. Treadmill exercise tolerance test.
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`5. Vectorcardiographic study.
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`6. Phonocardiographic study.
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`7. Tilt table studies.
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`8. Pulmonary function studies.
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`9. Radiographic studies, including cholecystograms, upper Gl series, lumbosacral spine, chest, cervical
`spine, and skull films.
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`10. Body composition study, using tritium dilution.
`
`11. Laboratory examinations, including complete hematology workup, urinalysis, serologic test, glucose
`tolerance test, acid alkaline phosphatase, BUN, sodium, potassium, bicarbonate, chloride, calcium,
`phosphorus, magnesium, uric acid, bilirubin (direct and indirect), thymol turbidity, cephalin flocculation,
`SGOT, SGPT, total protein with albumin and globulin, separate determinations of Alpha 1 and Alpha 2,
`Beta and Gamma globulins, protein bound iodine, creatinine, cholesterol, total lipids and phospholipids,
`hydroxyproline, and RBC intracellular sodium and potassium. Stool specimens were examined for occult
`blood, and microscopically for ova and parasites. A urine culture for bacterial growth was done, and a 24-
`hour specimen analyzed for 17-ketosteroids and 17-hydroxycorticosteroids.
`
`12. Detailed examination of the sinuses, larynx, and Eustachian tubes.
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`13. Vestibular studies.
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`14. Diagnostic hearing tests.
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`15. Visual fields and special eye examinations.
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`16. General surgical evaluation.
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`17. Procto-sigmoidoscopy.
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`18. Dental examination.
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`19. Neurological examination.
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`20. Psychologic summary, including Wechsler Adult Intelligence Test, Bender Visual-Motor Gestalt Test,
`Rorschach Test, Thematic Apperception Test, Draw-A-Person Test, Gordon Personal Profile, Edwards'
`Personal Preference Schedule, Miller Analogies Test, and Performance Testing.
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`22. Electroencephalographic studies.
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`23. Centrifuge testing.
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`
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`The preflight medical examinations for Apollo crewmembers included detailed physical examinations and
`special studies. The physical examinations commenced 30 days prior to launch and ended on the day of lift-off.
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`The special studies involved collection of baseline data for comparison with postflight findings. The areas of
`particular interest were microbiology, immuno-hematology, clinical chemistry, and cardiopulmonary function.
`Baseline data collection in each of these areas, of course, had bearing on crew health, but was additionally
`obtained in order to answer the following critical questions:
`
`
`
`
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`1. Did a change take place in a particular dependent variable?
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`[47] 2. Was the change significantly different from that occurring in a control group?
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`3. What was the extent of the change?
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`4. What was the time course of the observed change?
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`5. Was it possible to provide causal interpretations?
`
`The following sections provide details concerning the preflight physical examinations and special baseline
`studies.
`
`Physical Examinations. The physical examinations of Apollo crewmembers were intended to document the
`crewmembers' physical qualifications for the mission, to detect any medical problems which might require
`remedial or preventive intervention, and to provide baseline data for postflight comparison. Physical
`examinations were conducted in the following manner:
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`1. Preliminary examination at F-30 days. At this time, interval history, vital signs and a general physical
`examination were conducted.
`
`2. Interim examination at F-15 days. General physical examination, dental examination, and monitoring of
`vital signs were accomplished.
`
`The preliminary and interim examinations included the following procedures:
`
`
`
`An interval history and detailed review of systems, vital signs-to include oral temperature, blood pressure,
`and pulse rate.
`ENT examination to include visual inspection of the external ears, auditory canals, and tympanic
`membranes, the nose and nasal passages, transillumination of the frontal and maxillary sinuses, and visual
`inspection of the anterior and posterior middle pharynx.
`Examination of the eyes to include visual inspection and palpation of the lids and lacrimal apparatus,
`visual inspection of the conjunctiva, sclera, and cornea, and ophthalmoscopic examination of the lens,
`media, and fundus.
`Examination of the heart to include palpation, percussion, and auscultation.
`Examination of the lungs to include palpation, percussion, and auscultation.
`Examination of the abdomen to include palpation, percussion, and auscultation.
`Examination of the genitalia and anal regions.
`Examination of the extremities for recent trauma or limitation of function.
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`Neurological examination to include a brief examination of the cranial nerves and motor, sensory and
`proprioceptive modalities.
`Skin, visual inspection.
`Lymph nodes, by palpation.
`Dental examination (interim examination only).
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`3. Comprehensive examination at F-5 days. The comprehensive examination consisted of the procedures
`on the following page.
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`[48] Interval history, vital signs, including height, weight, oral temperature, pulse rate, and blood pressure.
`ENT Examination:
`a. Ears: Visual inspection of external ears, auditory canals and tympanic membranes, screening
`Rudmose audiometry.
`b. Nose: Visual inspection, sinus transillumination, if indicated by recent history.
`c. Throat: Direct examination of middle pharynx.
`d. Eyes: Same as for preliminary examination, plus distant and near visual acuity, near-point of
`accommodation, phorias, and visual fields.
`Heart: Palpation, percussion, and auscultation, plus standard twelve-lead EKG.
`Lungs: Palpation, percussion, and auscultation, plus PA chest film.
`Abdomen: Palpation, percussion, and auscultation, plus abdominal scout film.
`Genitalia and anus: inspection, plus digital rectal examination.
`Extremities: Examination for recent trauma, range of function.
`Neurological examination: Detailed examination of cranial nerves, motor, sensory, and proprioceptive
`modalities.
`Skin: Visual inspection, plus photographs of any areas of significant interest.
`
`4. Cursory examination - F-4 to F-O days. Brief physical examinations and histories were conducted in the
`last four days before flight. These included recording of vital signs, oral temperature, pulse, blood
`pressure, weight, plus a brief examination of the ears, nose, throat, heart, and lungs. Other signs and
`systems were examined as indicated by the medical history.
`
`The scheduled physical examinations varied slightly with mission requirements. However, these had to
`commence not earlier than 30 and not later than 21 days prior to lift-off in order to provide sufficient time to
`diagnose and treat any illnesses of recent onset. Some of the significant medical findings that occurred during
`the 30-day preflight period are listed in table I. The comprehensive examination performed five days prior to
`launch was intended to accurately document the physical status of each crewmember at the outset of the mission.
`The final examination prior to flight involved last minute recordings of critical parameters to provide the most
`reliable basis that could be obtained for postflight comparisons.
`
`The following paragraphs provide some detail on various aspects of the physical examination.
`
`Dental Examinations. Dental care was provided as a regular part of the ongoing health care program of
`astronauts. However, special measures were taken prior to missions to preclude, wherever possible, dental
`problems during flight. All crewmen were evaluated at or about F-15. Because of the relatively short duration of
`the Apollo flights, emphasis was placed on general observation rather than definitive quantitative research.
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`[49] Table 1
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`Preflight Medical Findings in Apollo Mission Crews
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`Diagnosis
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`Number of Occurrences
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`2
`1
`1
`1
`1
`3
`3
`2
`1
`2
`7
`1
`3
`1
`3
`1
`1
`1
`3
`4
`5
`1
`3
`1
`1
`1
`1
`1
`2
`3
`1
`1
`2
`2
`8
`
`.P
`
`ressure suit abrasions
`Blister, left toe
`Pressure suit callouses, scapulae and iliac crests
`Carious lesion, mesial
`Cellulitis of the hand secondary to laceration
`Conjunctival injection
`Dermatitis
`Dermatophytosis, feet
`Folliculitis, abdomen
`Furunculosis
`Gastroenteritis
`Gingival burn
`Hematomas, secondary to trauma
`Inflammation, medial canthus, right eye
`Influenza syndrome
`Keratosic plaque
`Traumatic lesion of the right buccal mucosa
`Viral lesion of the buccal mucosa
`Viral Iymphoid hyperplasia of the postpharynx
`Pyuria
`Papules/pustules
`Paronychia
`Viral pharyngitis
`Pulpitis, tooth No 31
`Prostatitis
`Tinea crura
`pedis
`Viral tympanic membrane infection
`Seborrhea
`Viral rhinitis
`Ringworm, arm
`Beta-hemolytic pharyngitis
`Sunburn, face and torso
`Ulcer, aphthous
`urinary tract infection
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`[50] Again, because mission duration was short, no special inflight dental treatment capability was provided for
`Apollo. It was felt that the risk of a problem occurring was slight and, when weighed against limitations of
`weight, space, and training time, providing an inflight treatment capability was not indicated. Analgesic and
`antibiotic drugs were provided for symptomatic treatment of any dental problems. As a further precaution,
`restorative dental treatment was avoided in the three-month period prior to launch. The object of this measure
`was to minimize the possibility of barodontalgia, a sudden, severe toothache which can occur when barometric
`pressure is reduced as a result of expansion of air entrapped in a dental restoration. When a dental problem arose
`in the three-month period prior to flight and a restoration became necessary, the astronaut in question was
`subjected to reduced barometric pressure to ascertain the condition of the tooth.
`
`Dental problems that occurred among crewmembers during the Apollo Program resulted in no appreciable
`mission impact. During the 90-day preflight period, five of the thirty-three Apollo crewmen had dental problems
`requiring treatment. One preflight and one postflight occurrence of pulpitis could have caused significant
`crewmember impairment if the pulpitis had occurred during a flight. Pulpitis, an inflammation of the dental pulp,
`causes severe pain that usually can be stopped only by root-canal therapy, performed by a skilled dentist in a
`fully equipped dental suite, or by extraction. Prediction of such occurrences is virtually impossible, although the
`preventive treatment of known causative factors can lower the risk of occurrence. The only other preflight
`problems were minor fractures of previously placed restorations or minor fractures of part of a crown of a tooth.
`Inflight, no problems were experienced. No case of barodontalgia ever occurred, although some astronauts bad
`experienced this discomfort during their flying careers.
`
`Experience with Apollo astronauts in an intensive preventive dentistry program led to the conclusion that the
`probability of a disabling dental emergency in the astronaut population is one occurrence in 9000 man days. The
`probability of dental problems of lesser severity, but associated with significant discomfort, is one in 1500 man-
`days. These figures are comparable to those recorded for Navy personnel on long submarine patrols. From these
`estimations, it is obvious that a provision for emergency inflight dental care must be made only for very long-
`duration missions.
`
`Visual Function Testing. Visual function testing was a part of the pre and postflight physical examination of
`Apollo astronauts. Ten visual parameters were tested during the Apollo Program:
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`
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`Unaided visual acuity, 7 m (20 ft)
`Amplitude of accommodation
`Near point of convergence
`Fusional amplitudes, base-in and base-out
`Horizontal phorias, 7 m and 33 cm (20 ft and 13 in.)
`Refraction
`Intraocular tension
`Color perception
`Depth perception
`Visual fields
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`[51] One of the major considerations in flight was the amount of harmful ultraviolet (UV) radiation to which the
`crewmen would be subjected during extravehicular activity. Prior to Apollo missions, the UV threshold of the
`eye was unknown. Over a three-year period, NASA-sponsored research determined these levels. The problem
`was, however, subsequently resolved with the development and use of Lexan in the extravehicular visor
`assembly. since Lexan was opaque to UV radiation. A minimum of 2000 hours of exposure would be required to
`produce a corneal "burn" through this plastic.
`
`Table 2 gives the data ascertained for ocular thresholds to UV radiation.
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`Table 2
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`Ocular Thresholds for Ultraviolet Radiation
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`Waveband (nm) Solar Flux (J/cm2/sec X 10-4) Relative Effectivity Effective Flux (J/cm2/sec x 10-4)
`
`0.40
`0.31
`0.53
`0.50
`0.53
`1.00
`0.68
`0.57
`0.57
`0.29
`
`0.1058
`0.1639
`0.2803
`0.3305
`0.7707
`2.1152
`1.7080
`2.7127
`3.3909
`2.0703
`
`0.2644
`0.5288
`0.5288
`0.6610
`1.4542
`2.1152
`2.5118
`4.7592
`5.9490
`7.1388
`
`.2
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`15 - 225
`225 - 235
`235 - 245
`245 - 255
`255 - 265
`265 - 275
`275 - 285
`285 - 295
`295 - 305
`305 - 315
`
`Total ultraviolet effective flux :13.6483 X 10-4J/cm2/sec
`Ocular burn threshold for ultraviolet: 40 X 10-4W/cm2
`Ultraviolet band threshold time : 2.93 seconds
`
`
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`The harmful effects of UV radiation extend over an area slightly greater than the 215 to 315 nanometer range
`noted above; however, the relative effectivity outside these extremes is very low. Summating these slight effects
`into the flux listed above could possibly lower the total UV band threshold time to about two and one-half
`seconds in a Zero Air Mass environment.
`
`Special Studies. A number of special preflight examinations were conducted and measurements made to
`provide a baseline against which to compare postflight findings in the areas of microbiology, immuno-
`hematology and clinical chemistry, and cardiopulmonary function. Details of each of these studies are provided
`in the related chapters in Section III of this book. The preflight examination procedures required for each are
`discussed only briefly here.
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`In order to study any microflora alterations which could have occurred in space flight, preflight samples were
`taken to catalog the microorganisms found on the crewmembers and their clothing, and on spacecraft surfaces.
`Samples collected for culture [52] included swabs of various parts of the body, throat gargle, and urine and fecal
`samples. These were collected on four occasions in the month prior to flight. Blood samples were also collected
`on three occasions in this same time frame.
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`Baseline data were obtained on the cellular elements of the blood, the chemical constituents of the blood and
`urine, and the humoral and cellular factors involved in immunity. The hematological and chemical
`measurements of various blood constituents were one portion of comprehensive examinations designed to
`disclose the state of well-being or the presence of occult disease in the crews. Blood analyses furnished data
`which, when integrated with facts obtained from histories and physical examinations, permitted an objective
`assessment of the physical status of the astronauts and allowed for remedial action if required. However, no
`values outside of the normal range were observed.
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`Biochemical and hematological baseline information was obtained, in part to quantitate the effect of the stresses
`inherent in space flight, and in part to aid medical personnel in medical management of crews in the postflight
`period.
`
`Cardiopulmonary evaluations and findings are discussed at length in Section III, Chapter 4 Apollo Flight Crew,
`Cardiovascular Evaluations, and Chapter 5, Exercise Response. Preflight orthostatic tolerance tests and exercise
`response tests were performed to provide baseline information to facilitate assessment of space flight effects.
`
`Cardiopulmonary data were obtained to develop heart rate versus metabolic rate calibration curves that would be
`used for estimating real-time work output during extravehicular activity. Utilization of Douglas bags, a Tissot
`spirometer, and an oxygen consumption computer or metabolic rate meter also made determination of
`cardiopulmonary efficiency possible. Evaluation of cardiopulmonary data was accomplished by observing how
`the dependent variables - workload, oxygen consumption, blood pressure response, respiratory response, and
`EKG-changed in response to the independent variable, heart rate.
`
`The extent of cardiovascular system "deconditioning" was assessed also by comparison with preflight baseline
`responses to the application of negative pressure to the lower half of the body by means of the lower body
`negative pressure (LBNP) device. Preflight evaluations were made at least three times in the month preceding
`flight. The test procedures involved five minutes with the subject at supine rest in the LBNP device, a total of
`fifteen minutes at negative pressures ranging from -40 x 102N/m2 to -67 x 102N/m2 (-30 to -50mm Hg), and five
`minutes of recovery. Because missions involving postflight quarantine could not accommodate the size of the
`LBNP device in the Mobile Quarantine Facility, a static stand-type of orthostatic tolerance testing was
`substituted. This involved obtaining five minutes of electrocardiographic data while the crewman was standing
`still with his back to the wall and his feet apart. Test conditions were controlled and standardized to exclude
`unnecessary variables such as environmental temperature, time of day, food intake, physical exertion, or
`venipuncture.
`
`
`
`Health Stabilization
`
`The problem of communicable disease exposure prior to flight, with subsequent development of symptoms in
`flight, was recognized as a potential hazard from the beginning of the United States space program. Total
`isolation of flight crews for a period [53] of time prior to launch offered indisputable advantages but was initially
`thought to be infeasible because of the operational difficulties involved. Flight crews were required to be in
`contact with large numbers of people and to move from place to place during the last few weeks of their training
`in preparation for a space flight.
`
`When clinical illnesses impacted preflight mission operations during Apollo 9 and 13, it became apparent that
`some type of preflight health stabilization program was imperative Prior to Apollo 14, 57 percent of the Apollo
`crewmembers experienced some illness of varying degrees of severity at some time during the 21 days before
`launch. Based on observations of the first several flights and on the observation of crewmember activities during
`earlier manned Mercury and Gemini missions, the Flight Crew Health Stabilization Program was developed and
`implemented for the Apollo 14 mission and subsequent missions. Such a program, rigorously enforced, can
`result in a significant reduction of infectious disease hazard, although the hazard cannot be eliminated
`completely.
`
`Table 3 lists the illness events in Apollo crewmen and shows the dramatic reduction in illness following the
`implementation of the health stabilization program.
`
`
`
`Table 3
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`s2ch1
`Effect of Flight Crew Health Stabilization Program (FCHSP) on the Occurrence of illness in Prime Apollo
`Crewmen
`
`Illness
`
`Number of crewmen
`involved
`
`Mission Phase
`
`Before Implementation of FCHSP
`
`Upper respiratory infection
`Viral gastroenteritis
`Upper respiratory infection
`Upper respiratory infection
`None
`Skin infection
`Rubella infection
`
`3
`3
`3
`2
`-
`2
`1
`
`Preflight, inflight
`Preflight, inflight
`Preflight
`Preflight
`-
`Inflight
`Preflight
`
`Mission
`.
`
`.A
`
`pollo 7
`
`8
`9
`10
`11
`12
`13
`.
`
`After implementation of FCHSP
`
`-
`-
`-
`1
`
`-
`-
`-
`Preflight
`
`-
`-
`-
`Skin infection
`
`.A
`
`pollo 14
`15
`16
`17
`
`
`
`
`
`Drug Sensitivity Testing
`
`Drug sensitivity testing was performed to determine the response of flight crewmembers to each item in the
`medical kit to preclude allergic reactions and other able side effects in flight. Each Apollo crewmember was
`tested under controlled [54] conditions to determine his response to medical kit items carried onboard the
`spacecraft. (The medical kit is described later in this chapter in the section concerning inflight Procedures and
`Findings.) After a medical history was obtained by a physician regarding the experience of each crewmember
`with each medication under test, and it had been determined that (1) no adverse reaction had been experienced,
`and (2) there was no evidence of impaired health at the time of testing, the medication was administered to the
`astronaut. The crewmember was observed by the physician for an appropriate period of time following
`administration of the medication and was queried about subjective responses. If positive subjective findings
`were reported, the test was either repeated with a double-blind placebo method, or an appropriate drug was
`substituted for which no undesirable side effects had been reported. Individuals were additionally tested for any
`allergic reaction to the electrode paste.
`
`Table 4 indicates the drug administration and observation constraints applied. All medications used were treated
`in a similar fashion.
`
`
`
`Medical Training
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`To perform their inflight tasks optimally, Apollo crewmen required an understanding of the interaction of space
`flight stresses and their effects on the human organism, including the manner in which the body adapts to space
`flight factors. Further, these crewmen had to recognize any abnormalities in their health status and understand
`the therapeutic measures which might have been prescribed for inflight problems. Medical training began shortly
`after astronaut selection with a series of lectures concerned with space flight physiology and therapeutics. The
`curriculum encompassed about 16 hours of didactic instruction provided by experts in each area. The principal
`elements were as follows:
`
`Cardiovascular System. Brief outline of anatomy and physiology, methods of observing and monitoring
`cardiac activity, system response to acceleration, weightlessness, work and other stresses, functional testing,
`such as tilt table, lower body negative pressure, bicycle and treadmill systems.
`
`Pulmonary System. Brief outline of anatomy and physiology, pulmonary function, gas exchange, problems
`related to hypo- and hyperbaric environments, physiologic limits of spacecraft atmospheres, contemplated
`atmospheres for future vehicles, respiratory response to acceleration, weightlessness and work, physical
`conditioning and testing, respiratory capacity.
`
`Hematology and Laboratory Medicine. Review of Mercury and Gemini findings involving blood elements
`and chemistries, review of programs scheduled for Apollo and Skylab Programs, illustration of the need to
`establish good baseline data, controls, and possible expansion of the present program.
`
`The Role of Psychiatry in Cre