[13] The salient features of NASA's biomedical program, as they were set down in Project Mercury and remained throughout the manned program, were summarized in 1963 by Dr. Charles Berry, chief of the Manned Spacecraft Center Medical Operations Office. "The nature of the challenge," Berry observed, required that ''the simplest and most reliable approach be used." This involved, first, adapting biomedicine "to engineering and operations," using "off the shelf items wherever possible," basing medical operations on mission operations, and using "engineering analogies" to communicate biomedical information to engineers, astronauts, and mission controllers. Second, it entailed a 'direct approach" to the qualification of humans for spaceflight: "thrusting" man into a "truly unknown environment," providing him with "the best protection and monitoring capabilities within the operational constraints of the mission," and using the observations of man in flight as "a means for evaluating the next step into space."¹ This approach was supported by NASA's engineering management and depended on the military services for the biomedical support of Project Mercury.

Initially, biomedical support requirements for Project Mercury could be satisfied through a small medical unit attached to the Mercury project office. However, as NASA began to look beyond Project Mercury, its administrators foresaw a need for a broadened biomedical program. This led to a reassessment of the initial organizational arrangements for biomedicine/ and of the agency's dependence on the military services, which eventually brought NASA into direct conflict with the Air Force.

Concurrently, a small but articulate and influential group of scientists, including some life scientists, began to question the wisdom behind the manned space program and the adequacy of the biomedical support for [14] Project Mercury. Generally unfamiliar with the practical aspects of medical operations and strongly biased in favor of basic research, these scientists were disturbed that NASA did not intend to conduct an intensive biomedical research program (including an extended series of animal flights) before proceeding to manned flight. They were convinced that NASA planned to expose astronauts to unnecessary risks and that NASA management was more concerned with engineering and mission priorities than with human health and safety.

In Project Mercury NASA faced a fundamental question that would endure for some time as a source of controversy in the manned space program: How to organize and administer a life sciences program that would meet the technical and operational requirements of the agency's major programs, be consistent with the agency's overall program administration, and be acceptable to scientific interests outside NASA.

BIOMEDICAL ADMINISTRATION OF PROJECT MERCURY

The requirements identified by the Working Group on Human Factors and Training (the Lovelace committee) and others posed challenges for NASA's management that were administrative as well as technical and operational. From the NACA the agency inherited personnel experienced in the physical sciences and engineering and facilities equipped for research in aeronautical engineering and the physical science aspects of aeronautics. It had no physicians or biomedical scientists on the staffs of its permanent headquarters or its centers.²

Nor did NASA have specific funds or authority to build capabilities in biomedicine. In the initial NASA authorization hearings, members of both the military and Congress had expressed opposition to any duplication of existing programs or facilities.³ Given Air Force capabilities in bioastronautics, NASA could not expect support for a large program in human factors research and development. Moreover, NASA Administrator T. Keith Glennan opposed any major increase in the number of NASA employees or the size of the NASA centers. A fiscal conservative, he shared Eisenhower's view that the space program should be small in scale and limited in its objectives.⁴

Finally, those who had studied the agency's human factors requirements were recommending a biomedical program to support long-range objectives and underestimated the pressure on NASA to place a man in Earth orbit at the earliest possible time, preferably before the Russians. If many Americans shared Eisenhower's opposition to a space race," many more believed that an active space program was essential to national prestige and security.

NASA therefore had little choice but to rely on the military services for [15] biomedical support. The use of military personnel and facilities would provide the support required for manned spaceflight without creating conflicts with Congress or the military services and without exceeding the limits set by Glennan and Eisenhower. It would contribute to the achievement of Mercury objectives quickly and economically, and it would allow NASA to use NACA personnel and facilities without disrupting existing personal and organizational relationships.⁵

Because NASA's biomedical objectives at the outset of the space program were limited to technical and operational support for Mercury, Glennan established a biomedical team under the authority of the director of the Space Task Group (STG).^* Since biomedicine was initially only an adjunct to spaceflight development and operations, both of which were the responsibility of the Space Task Group, this arrangement made good sense. It also did not require significant revision of existing authorities or transfer of NASA personnel.

The biomedical team for Mercury was composed entirely of military personnel on detached assignment. Initially, Glennan and his top administrators viewed this as a temporary arrangement and gave the team the designation "aeromedical consultants." Six months later, in April 1959, Glennan responded to advice from his staff and converted the biomedical team into a permanent operational component of the Space Task Group although it would continue to be staffed entirely by military personnel on temporary assignment.⁷ The initial group of aeromedical consultants consisted of Dr. Stanley C. White, an Air Force lieutenant colonel, physician, and specialist in human factors engineering and biotechnology; Dr. Robert Voas, a Navy lieutenant, psychologist, and specialist in f light crew selection and training and human engineering; and Dr. William S. Augerson, an Army major, physician, and specialist in human physiology.⁸

Although NASA had no immediate requirement for biomedical administration outside the Space Task Group, Glennan and his staff needed input to ensure effective coordination with the military services, to accurately apprise Congress and the President of life sciences requirements and developments, to provide life scientists outside NASA with a point of contact within the agency, and to deal with the important and politically sensitive issue of astronaut selection. Since Glennan was averse to creating new programs or enlarging the staff, he sought to resolve the problem by using consultants. He also formed a Special Advisory Committee [16] for Life Sciences, which he hoped would substitute for a life sciences program office. As he saw it, this committee would give NASA regular expert advice from leading specialists in space biomedicine without increasing headquarters personnel or changing the organization. Toward this end, he selected as members of the committee persons who were recognized leaders in the field and who held high-level, full-time positions outside NASA-in short, persons who would have no compelling reason to carve niches for themselves within NASA or to promote a permanent life sciences office.⁹

The chairman of this committee, W. Randolph Lovelace II, was possibly the most famous specialist in space biomedicine; he was internationally recognized as an expert in both the theoretical and practical aspects of the field. He was influential, having extensive and important contacts in Congress, the military services, and the scientific community. Moreover, he had nothing to gain from a permanent NASA position; his political contacts ensured that he could influence space program planning whether he worked for NASA or not, while his position as director of his own research corporation provided a considerably greater income than he could have earned at NASA. Lovelace then had precisely the biomedical expertise required for Project Mercury, the political clout required to ensure that NASA received the level of biomedical support required for Mercury, and no ambition to create a position for himself. Collectively, the other members of the committee had status comparable to that of Lovelace, if none equaled his prominence in the field.¹⁰

The Life Sciences Advisory Committee assumed many of the responsibilities of a life sciences program office. Glennan expected it to provide liaison between NASA and the other government agencies, particularly the military services, and between NASA and the scientific community, while serving as a link between the biomedical staff at the Space Task Group and top management at headquarters. It would review biomedical planning for Project Mercury and make recommendations to Glennan and his key administrators, but it would have no line authority.

Glennan considered creating an official program-level life sciences position on the basis of recommendations from Lovelace, other scientists, and some members of his staff. Lovelace foresaw a continuing need for life sciences input into the space program and favored a high-level life sciences office and a centralized life sciences research facility.¹¹ Responding to this advice, Glennan directed a staff assistant, W. L. Hjornevik, to review NASA's capabilities and requirements in the life sciences. Hjornevik concluded that NASA was underestimating the importance of biomedicine. He pointed out that the reliance on consultants was in marked contrast to practices in the physical sciences and engineering, where consultants were used rarely. Hjornevik contended that the [17] biomedical area was potentially at least as important as the hardware development area" and that the management concepts adopted in the engineering field" should be applied in the aero-medical field." He recommended that Glennan appoint a senior medical advisor" to his staff, create a permanent 'biomedical unit in the space development headquarters organization" and establish a small biomedical research laboratory" at one of the field centers.¹²

Although Glennan agreed to make the Space Task Group's aeromedical consultants team a permanent organizational component he believed that the other recommendations required further study.¹³ For the immediate future NASA could rely on the Life Sciences Advisory Committee for input at headquarters. From November 1958 through July 1959, administration of biomedicine remained the exclusive responsibility of Space Task Group management. The Life Sciences Advisory Committee continued to provide advice and recommendations, but played a major role only in the selection of the Mercury astronauts.¹⁴

BIOMEDICAL SUPPORT FOR PROJECT MERCURY

The biomedical tasks for Project Mercury were in three primary areas: selection and training of astronauts; design, development, and evaluation of life systems; and provision of medical support for flight operations. Accordingly, NASA selected three military specialists in these areas as the biomedical consultants to Project Mercury. The nominal head of this group of consultants was Lt. Col Stanley C White, who was selected because of his acquaintance with key members of the Space Task Group staff and his activities as a member of the Man-ln-Space-Soonest team at Wright-Patterson Air Force Base.¹⁵

A physician, White had more than 10 years of experience in human factors research and engineering. At the time of his detail to NASA, he was director of aeromedical research at the Wright Air Development Center, Wright-Patterson AFB, where he had been closely involved in research and development related to spaceflight life support systems and protective equipment He was also serving as project leader of the spacecraft design group of the Air Force's Man-in-Space-Soonest planning group.¹⁶ White selected Army Maj. William Augerson and Navy Lt. Robert Voas as his assistants.

Augerson, also a physician, was a specialist in human physiology and clinical medicine. Although he had very little experience with manned spaceflight, he had worked briefly with White at Wright-Patterson and had been involved in flight operations as part of the biological program of the Army Ballistic Missile Agency. In the latter capacity, he had monitored the [18] physiological responses of monkeys in a series of Thor-Able flights.¹⁷ Augerson's appointment assured representation from each of the services on the biomedical team; moreover, he was fully qualified for the position bringing to NASA a strong medical background and an intense interest in the space program.¹⁸

Voas, a psychologist, also had a keen interest in the space program especially the selection and training of flight crews. He began his career as a specialist in human engineering, a new field of psychology applied to the design of the workplace, procedures for improving worker motivation and satisfaction, and techniques for identifying and selecting management trainees. He came to NASA from the Naval School of Aviation Medicine where he had devised a psychological testing program that had resulted in a sharp decrease in the rate of failure among pilot trainees.²⁰

ASTRONAUT SELECTION

The aeromedical consultants began their assignment during the first week of November 1958 and concentrated on two tasks: the development of environmental and life support systems, and astronaut selection. Following the ground rule that the selection program should identify "individuals who would require a minimum of training in order to fulfill the Mercury job requirements,"²¹ they concluded that the job required persons with a high level of intelligence and physical stamina, exceptional health, advanced training in science or engineering, and psychological capabilities for effective performance under stress.²² In addition engineering constraints dictated that the astronauts be light in weight and not too tall. The consultants recommended the following basic requirements: maximum age, 40 years; maximum height, 5 feet 11 inches, excellent physical condition; bachelor's degree in engineering or a physical science; graduation from test pilot school; and a minimum of 1,500 hours flying time as a qualified jet pilot.²³

The consultants then faced the task of identifying prospective candidates. Initially, they favored an open selection program, with applications sought and accepted from all interested persons who met the basic requirements. Volunteers were so numerous, however, that they soon decided to conduct a closed program and extend invitations only to carefully screened individuals. Ultimately, President Eisenhower directed that they limit their search to test pilots within the military services.²⁴

The consultants first screened the medical records of 508 military pilots who had graduated from test pilot schools, identifying 110 who met the [19] basic requirements. This group was reduced to 69 on the basis of recommendations from command personnel and instructors at the test pilot schools. These 69 were interviewed by a team that consisted of the aeromedical consultants, Space Task Group Associate Director Charles Donlan, civilian test pilot Warren North, two military psychiatrists, and a psychologist from NASA s personnel office. Thirty-two of those interviewed volunteered to undergo intensive testing.²⁵

The final phase of the selection program began in February 1959. Testing included medical and clinical evaluations at the Lovelace Foundation for Medical Research and Education in Albuquerque, New Mexico, and physical and psychological stress tests at the Air Force's Wright Aerospace Development Center. The selection team wanted data that would show degrees of physical and mental soundness so that they could evaluate each candidate in comparison with the others.²⁶

Before testing began, physicians at the Lovelace Foundation analyzed the medical histories of the candidates and established a composite picture of the clinical norms (baselines) that should be expected in the typical candidate. Norms were established for each of the body systems (e.g., circulatory, nervous, musculoskeletal), major organs (e.g., eyes, heart, lungs, ear-nose-throat), and primary physiological functions (e.g., blood pressure, heart rate, pulmonary function). Data for each of these areas were obtained by subjecting the applicants to a broad range of procedures, including tissue cultures, blood and urine chemistry, x-rays, examinations by specialists, and general internal medical examinations. Subsequently, each candidate was assessed in terms of his degree of deviation from each of the norms.²⁷

In the second part of the testing program, Air Force personnel at the Wright Air Development Center conducted tests to measure "body efficiency,, in terms of heart and pulmonary function, physical response to stress, and psychological performance. Stress tests included responses to acceleration, heat, isolation, depressurization, and extreme exertion. Psychological and psychiatric tests were intended to provide measures of intelligence and special aptitudes and assessments of personality and motivation.²⁸

In late March 1959 the selection committee reviewed the test results and concluded that 18 candidates were comparably qualified in terms of medical and psychological factors. Instructed to reduce this number to 6, they reevaluated the medical results and individual technical qualifications, but could not reach a firm decision. Subsequently, final selections were made by NASA's top management.²⁹

From a purely medical standpoint, the selection program ran very [20] smoothly.^** It relied on standard procedures for evaluating candidates for Navy and Air Force test pilot schools, on personnel who were experienced in flight medicine clinical and psychiatric evaluations, and on facilities that were equipped for this type of evaluation. No radically new or different tests or modes of evaluation were developed for the Mercury selection program.³⁰

In April 1959, when Glennan authorized a permanent biomedical unit within the Space Task Group, the three original aeromedical consultants remained on detached assignment and were joined by other military detailees. Biomedical responsibilities were subsequently divided between two Space Task Group offices. One, the Life Systems Division (later a branch), came under the direction of White, with Augerson as his assistant. Life Systems was a line office within the jurisdiction of the Project Mercury associate director for development, Charles Donlan, to whom White reported. On matters related to medical operations, White also reported to Walter C. Williams, associate director for Mercury operations. The other, the Astronaut Medical and Training Office (later the Central Medical Operations Office), was a staff unit within the Office of the Director. The chief of this unit was a detailed Air Force physician, Lt. Col. William K. Douglas; Voas served as the assistant chief for training.³¹

LIFE SYSTEMS DESIGN

The Mercury biomedical personnel now turned their attention to critical development and operational concerns: human factors engineering, medical operations, and astronaut health and training. Although he was nominally the coordinator of all biomedical activities, White concentrated on human factors engineering, that is, the design, development, testing, and evaluation of life support systems and protective equipment.

His job also involved the sensitive task of coordinating the work of life scientists and engineers.

Two fundamental considerations influenced the approach to the design and development of life support systems. The first was that the absolute safety of the astronaut could not be guaranteed. A lengthy and systematic test program that began with animals and moved gradually to man was out of the question. Although a ''minimal animal test program" was planned and carried out, in the main the "guiding philosophy" would be to guarantee "an adequate margin of safety" and ensure that "the risk hazard would be no greater than in test pilot operations with experimental [22] aircraft."³² Vehicle weight and capsule design were the second consideration. Available launch vehicles made strict control on weight essential. Because of the pressure to achieve mission objectives at the earliest possible time, engineering design and development had to emphasize simplicity, with minimal use of new hardware. These two considerations dictated the approach to biotechnology. Wherever possible, life systems would be modifications of existing hardware. New hardware would be developed only if nothing was available to be modified, or the old hardware would not provide the "adequate margin of safety." Further, as long as the "risk hazard" was not in question, life systems would be selected on the basis of engineering considerations (weight and simplicity). Finally, life systems would be designed and developed with a minimum of redundancy.³³

The off-the-shelf approach was most apparent in components that were related to flight stresses, that is, protection against acceleration, reentry, and impact forces. The capsule was to be designed so that the couch would hold the astronaut in a supine (back down) position with his lower extremities elevated approximately 20 degrees from the horizontal. This, White believed, would provide maximum protection against the multiple G forces expected during spaceflight. The couch, cushion, and impact restraints were to be modifications of similar equipment that had been designed for high-performance military aircraft and tested extensively in Air Force facilities.³⁴

The pressure suit was a modification of a test pilot's high-altitude pressure suit, the Navy Mark IV. Evaluation by Mercury contractors resulted in numerous modifications. To minimize redundancy in the overall life systems, the suit would be designed to serve as the backup environmental system should the capsule life support system fail. This meant that it would have to provide for oxygen, atmospheric pressure, temperature and humidity control, and waste disposal. To meet weight limitations, it would be fabricated from a lightweight material. For the astronaut's comfort and performance, the suit would have to be flexible and capable of accommodating fittings for pressure gloves, helmet, and environmental control connections.³⁵

The environmental control system of the capsule was not so much a modification of existing hardware as an amalgam of features and components of environmental systems from submarines and high-altitude aircraft. Like the pressure suit, the capsule would have to meet the environmental requirements noted above and be subject to the same basic engineering constraints related to weight and simplicity.

Those constraints were most apparent in the areas of atmospheric pressure and air conditioning. At the outset, there was disagreement about whether the capsule atmosphere should be "normal" atmospheric air at sea-level pressure or highly oxygenated. The former was preferable in [23] terms of safety, as oxygen in high concentrations poses a serious fire hazard and can cause hyperoxia (oxygen intoxication) if the pressure is not properly adjusted. However, normal atmospheric air would complicate capsule engineering; heavier materials would he needed to hold in the higher pressure, and scaling the capsule would be more difficult. In addition. a normal atmosphere would increase the possibility of hypoxia (oxygen deprivation) in flight, necessitating the inclusion of sensors to monitor the partial pressure of oxygen in order to ensure an optimum level of blood oxygen.³⁶

NASA's engineers were not alone in favoring an oxygen-rich atmosphere. White believed it had physiological advantages that outweighed the potential hazards. As a flight physician, he knew that hypoxia was a far greater problem at high altitude than hyperoxia. The low-pressure system would be within weight constraints, yet would provide a partial pressure of oxygen sufficient to maintain the proper blood oxygen level. He also reasoned that a pure oxygen atmosphere would ensure the availability of the oxygen required during emergencies. In particular, it would minimize the effects of emergency decompression.³⁷

MEDICAL SUPPORT FOR FLIGHT OPERATIONS

While White concentrated on human factors and biotechnology, Augerson worked on the design of a medical plan for Mercury operations. This involved three major responsibilities: medical maintenance of flight crews, preflight and inflight assessment of astronaut health and performance, and postflight evaluation of astronaut response to spaceflight and the space environment. Each of these supported a specific Mercury objective Linked with astronaut training, medical maintenance should enhance an astronaut's ability to fulfill his responsibilities as a Mercury pilot. Preflight assessment and inflight monitoring would provide mission controllers with information needed to determine whether a mission plan should be followed or modified. Postflight evaluations would contribute to mission planning; physiological and performance data from one mission could be used by operations personnel in planning subsequent missions.

Although the Mercury missions involved more complex tasks and more sophisticated equipment, Mercury physicians had the same basic responsibilities as the flight surgeons for test pilots, and they could adapt tested techniques Like their aeronautical counterparts, Mercury physicians would be maintaining, monitoring, and evaluating the physical and mental health of abnormally healthy individuals placed in an abnormally Unhealthy environment and would not be able to base their assessments [24] on normative physiological values derived from a general population. As former jet pilots, the astronauts had an abnormally high tolerance for physical and mental stresses. In addition, for most spaceflight stress parameters (e.g., cardiac function relative to null G) there were no validated normative values and hence no proven methods for determining whether an astronaut was approaching the threshold of tolerance.

Augerson and his colleagues could rely to some extent on procedures and techniques used by flight surgeons who monitored high-altitude flights in balloons and high-performance aircraft. However, the Mercury undertaking demanded greater sophistication. Augerson believed that physiological data derived from aeronautical flights would not provide adequate predictive values for Mercury missions. Rather, physiological norms would have to be derived for each astronaut and used in evaluating the inflight status of the individual astronauts. These norms were to be based on numerous measurements made during centrifuge runs and flight simulations and would encompass both the physiological factors to be measured in flight (heart action, respiratory performance, body temperature, urine output) and the clinical assessments to be made later. During flights, medical monitors would use the individual norms as a basis for inflight clinical assessments. After each mission, Augerson's team would use the norms to evaluate their postflight clinical findings.³⁸

Augerson also foresaw a need for almost continuous monitoring of astronaut health and performance during missions, a task beset by both technical and nontechnical difficulties. In technical terms, spaceflight required remote clinical assessment with bioinstrumentation, which was not completely new, but few physicians had any experience with it. Some bioinstruments-such as pressure cuffs for taking blood pressure and sensors for recording changes in body temperatures-had been used during high-altitude balloon flights conducted by the Navy and the Air Force in the 1950s. While such instruments could serve as prototypes, their reliability was unproved and very few physiological responses could be measured with confidence.³⁹ Invasive techniques (implantation and insertion) were more likely to produce reliable measurements, but there was strong resistance to their use. Surgical implantation would cause discomfort and might introduce infection or interfere with pilot performance.⁴⁰ Moreover, the astronauts feared that a faulty instrument or misinterpreted data would be cause for grounding, while the engineers were concerned that elaborate instrumentation would complicate design problems, particularly those related to the pressure suit.⁴¹

Augerson decided to minimize the use of bioinstruments and to limit the number of inflight measurements to functions that seemed to be critical indicators of physiological distress and for which reliable, noninvasive bioinstrumentation existed or could easily be developed. These [25] functions included (in the early flights) body temperature (measured rectally),^*** respiratory performance (monitored through an instrument implanted in the microphone pedestal of the flight helmet), and cardiac performance (measured through special electrodes and a pressure cuff linked to the helmet microphone). These measurements would be transmitted from capsule to monitoring sites by radio signal.⁴²

Augerson planned to have specially trained medical monitors at each station of NASA's worldwide network of tracking sites. The monitors would record the biometric readings as the astronaut came into radio range and compare them with the known baseline values for the astronaut If the monitor discovered significant deviations from the baseline, he would radio this information to the next monitor down the line and to the center medical operations team (White, Augerson, and Douglas). This pattern would continue until a decision was reached about the future of the mission. If the monitors did not discover significant deviations, the flight would continue and the recorded data would be retained for future reduction and analysis.⁴³

The medical monitoring plan was based on the assumption that significant deviations would be accepted as justification for early termination of a flight mission, although Augerson knew that this was unlikely. He himself had little confidence in the reliability of bioinstruments and knew that it would remain open to question throughout the Mercury program. Moreover, he realized that guesswork would play a major part in operations, since it would be impossible in advance to establish precise correlations between degrees of deviation from baseline values and actual physiological dysfunction, and in any event the functions being monitored were not reliable indicators for all possible health problems that could develop in flight. Personally, Augerson favored a systematic program of basic medical research to establish these correlations before manned flights began; however, he accepted the fact that the time constraints and economics precluded this.⁴⁴ Thus, in fact if not in design, the principal value of the bioinstrumentation would be to test the instruments and monitoring procedures themselves and thereby contribute to the design and development of reliable devices for use in subsequent flight programs.

Because of the limitations of the bioinstruments and the likelihood that [26] reliable instruments would not be available for use in the early Mercury flights, Augerson planned to rely primarily on health indicators for inflight medical assessments. Initially, he lobbied for inclusion of a television camera in the Mercury capsule so that physicians could make visual inspections. The idea was quickly rejected by the operations team because of the design problems it would introduce.⁴⁵ Instead, Augerson and his colleagues relied on voice assessments and medical interviews as health indicators In the first mode, monitors would listen closely to the astronaut's voice for indications of physical distress (e.g., labored breathing) and neurological or behavioral dysfunction (garbled or slurred speech, disconnected word patterns). Besides being crude, this procedure was limited by distortions inherent in the communications system and by the high level of subjectivity involved. In the second mode, monitors would pose, at specified points during the flight, a series of questions that would lead the astronaut in making a personal assessment of his own physical condition This had the obvious limitations that the astronauts were not physicians, and, more important, were not likely to volunteer information or admit to any problems that could lead to early termination of the mission.⁴⁶

In an effort to minimize the biases of these modes, Augerson, in cooperation with Douglas and Voas, incorporated the training of medical monitors with the training of astronauts. First, the medical monitors would gain experience in procedures, familiarity with the astronauts, and a technical understanding of the Mercury missions by monitoring the astronauts during centrifuge runs and flight simulations. Second, in an effort to increase astronaut cooperation, basic physiology and clinical assessment would be made part of the astronaut training program.⁴⁷

Following reentry and recovery, the astronauts would receive an extensive clinical' evaluation. It would begin with an immediate assessment of the astronaut's present health. During the ensuing 24 hours, physicians would conduct a series of examinations to determine whether the spaceflight experience had caused physiological changes. These examinations would include urine and blood chemistry, vital signs (temperature, pulse, respiration, blood pressure), body mass and weight, body fluid volume, fluid intake and output, and general physical health and stamina. Physiological changes would be detected through comparison of these data with data obtained from similar examinations during preflight preparations.⁴⁸

Augerson also faced a troublesome problem unrelated to medicine. It would be logical to draw medical monitors from the military services because military physicians could be mobilized and transferred easily, worked at a pay scale far below that of their civilian counterparts, and were accustomed to working in an operational environment. Moreover, few civilian physicians had a practical knowledge of flight medicine. The [27] use of military physicians, however, posed a delicate diplomatic problem, since many tracking sites were on foreign soil. Augerson therefore proposed that NASA obtain some physicians from the Public Health Service. Although technically civilians, Public Health Service physicians were organized along military lines, holding rank and receiving pay equivalent to that of military physicians.⁴⁹

Augerson s work was directly linked with that of the Astronaut Medical and Training Office. William K. Douglas, chief of the office, worked primarily as the astronauts' personal physician, providing medical care and coordinating with Augerson activities that involved the astronauts in tests and measurements.

Robert Voas, Douglas's assistant and the astronauts' training officer, faced a major challenge in the astronaut training program. He was charged with training the astronauts to respond effectively to hazards that could not be predicted and preparing them for an environmental condition-weightlessness-that could not be simulated meaningfully. In addition, he had to develop procedures through which they could learn to operate a vehicle that was in the process of development. Since he could not anticipate or prepare them for all possible emergencies (with some notable exceptions, such as emergency decompression), he took the position that the training program should emphasize basic education and familiarization through repetition, including instruction in the sciences that underlay spacecraft design, spaceflight operations, and medical operations. In this way, he hoped to provide the astronauts with a body of information on which they could draw in an emergency, whether the emergency occurred in relation to spacecraft systems, the mission plan, or the pilot's health.⁵⁰

Three aspects of the training program had the purpose of instilling in each astronaut an instinct for spaceflight, and each emphasized familiarization through repetition. The first was regular aviation flight training in high-performance aircraft to maintain basic skills. The second was "familiarization" with the "conditions of space flight," which was intended to acclimate the astronauts' nervous systems through repeated exposure to spaceflight stresses (G forces) and discomforts (vertigo, heat, pressure) Voas hoped that this aspect of training would help the astronauts learn to cope with the effects of spaceflight and prepare them to respond instinctively to emergency situations. The third aspect was flight simulation in the Mercury capsule. Again, the intention was to make vehicle operation an instinctive action and the astronaut a functioning part of a man-machine system.⁵¹

Voas applied his knowledge of human and industrial engineering in the training program. Realizing that workers are most comfortable in an environment which they understand and feel they control, he encouraged [28] the astronauts to participate directly in the development and evaluation of the Mercury capsule and its component systems. In this approach, which became a standard feature of all subsequent manned programs, each astronaut monitored the development of a specific Mercury system or subsystem. He was expected to deal regularly with both contractor and NASA development engineers and to train the other astronauts in his specific system. This task had the primary purpose of giving the astronauts such a detailed understanding of the capsule systems that in the event of a systems failure, they could conceptualize the engineering problem, independently devise corrective action, and assist ground personnel in analyzing and solving the problem. Voas also believed that understanding the engineering principles involved in an emergency situation would reduce the astronaut's level of tension, since one fears most that which one cannot understand. In addition, he was convinced that many design and development problems could be avoided with the help of those who would be piloting the vehicle and would be alert to defects that might not be apparent to an engineer. In this sense, he was using an approach that was common in the aerospace industry, namely involvement of test pilots in engineering design and development.⁵²

By mid-1959, Voas, Augerson, White, and the other members of the Mercury medical team had made significant progress in providing biomedical support for Project Mercury. They had identified the critical biomedical problems, implemented plans and procedures for dealing with these problems, and achieved an effective integration of biomedicine with the engineering and operations components of the project.

PROBLEMS OF ADMINISTRATION

The arrangements for administering the Mercury medical program seemed sufficient, given the limited objectives of Project Mercury (i.e., to qualify man, life systems, and operational procedures for Earth-orbital missions lasting up to one day). But by early spring of 1959, NASA's top administrators were beginning to question the adequacy of these arrangements. First, the life sciences were not formally represented at the program level; input at NASA Headquarters came solely from the Special Advisory Committee for Life Sciences. Although able to review and make recommendations concerning the agency's life sciences programs, the members of the committee had no authority to issue directives or implement their recommendations. Stanley White, the nominal head of the Space Task Group biomedical team, did not have direct administrative access to the director of the Space Task Group and was subordinate to the two associate directors, both of whom were engineers. Further, the [29] biomedical staff had no authority to deal with the external biomedical community, and so, in effect, was isolated from scientists and clinicians who had an interest in the biomedical aspects of spaceflight but who were not among NASA s life sciences advisors.⁵³

NASA's top management-which included Glennan, Deputy Administrator Hugh Dryden, Director of Space Flight Development Abe Silverstein, and Silverstein s principal assistants, Homer Newell and George Low-consisted of engineers and physical scientists. The members of the Life Sciences Advisory Committee, which was intended to function as a headquarters life sciences program office, were highly respected in the rather narrow field of aerospace medicine. However, as government scientists their daily working relationships did not include the biomedical scientists in academia whose support could be important to the program.⁵⁴

This organizational arrangement was based on the assumption that NASA's requirements in biomedicine would never extend beyond operational support for the one approved manned program. Thus it failed to take into account the advanced research and development that would be required to support manned flights after Mercury, if such flights were ever approved. A small operations-oriented group of clinicians, psychologists, and bioengineers on temporary assignment from the military services could not sustain the basic and applied research that would be required to support flights of longer duration. Further, these arrangements failed to meet NASA's responsibility to support basic research in the space sciences, including purely scientific investigations in space. While NASA's programs in the space sciences (then managed by the Office of Space Flight Development) were expanding, activities were limited to the physical sciences; a program in the 'biosciences" was projected, but as late as March 1960 no such program had been implemented.⁵⁵

Through advice from his staff and communications from outside scientists,56 Glennan came to recognize that NASA was in danger of becoming totally dependent on the military services for biomedical research and development While this posed no immediate problem for Project Mercury, it could reduce NASA's chances of receiving authorization to manage a post-Mercury manned program. Without its own biomedical program and research facilities, NASA would have to rely on the Air Force to conduct and sponsor extramural research and development in biomedicine/ and this would make it difficult for NASA to establish independent ties to universities, research corporations, and industries in the area of biomedicine

Glennan and his associates knew that the Air Force was girding to fight for authorization to manage the post-Mercury manned effort, should [30] there be one, and was reorganizing its commands to provide more effective control over space-related activities. The Department of Defense had taken steps to improve coordination among the space-related components of the military services, which strengthened the position of the Air Force. When the Defense Department created the Advanced Research Projects Agency in early 1958 and gave it authority to coordinate the three manned military space programs and, eventually, to select one for official support, it was assumed that the agency would eventually tap the Air Force.⁵⁷

Moreover, in early 1958 Secretary of Defense Neil H. McElroy gave the Air Force responsibility for reviewing, monitoring, and coordinating all military-sponsored research and development in support of advanced manned space programs. Although operational control of existing programs remained with the individual services, it was clear that in the post-Mercury era the Air Force would call the space shots for the military.⁵⁸

The Air Force was also receiving some support from scientists. While many scientists had reservations about military control of the entire space program,⁵⁹ Science editor Philip Abelson and Jerome Wiesner of the Massachusetts Institute of Technology, among others, expressed the view that science would benefit if the scientific and manned components of the space program were divided, the former under civilian control, the latter under military. They reasoned that as long as NASA had charge of the manned program it would subordinate space science to manned flight, but if manned operations were transferred to the military NASA would be able to concentrate on science.⁶⁰

The military services had much to gain and little to lose by providing biomedical support to NASA. Their personnel and facilities would be fully used and they could justify requests for expanded research and development capabilities. They would receive a steady infusion of funds from NASA, their personnel would receive valuable operational experience, and their support would be good for public relations. If Mercury failed, NASA would be blamed, but the services would still be able to push their own manned space plans; if it succeeded, the chances for an advanced manned program would be increased, and the services would be fully prepared to compete with NASA for authorization to manage such programs.⁶¹

In light of this situation, NASA would have to develop an adequate biomedical program if it was going to justify a role for itself. An '`adequate" program in biomedicine for manned spaceflight would have to include support for basic research. Information on the biological effects of prolonged exposure to weightlessness, space radiations, and alterations of biological rhythms was badly needed and could be gained relatively quickly and inexpensively with subhuman organisms. Although NASA had a mandate to sponsor basic science in space, only the nonscientific [31] aspects of the life sciences-biotechnology and medical operations-were receiving funds.⁶²

By March 1959 Glennan realized that NASA's long-range interests indicated in-house capabilities in biomedicine and biotechnology and a diversified and expanded life sciences program. He appointed Dr. Clark T. Randt, an academic physician and clinical researcher, to his staff as special assistant for life sciences and authorized him to make a thorough study of NASA's long-range requirements and capabilities in the life sciences. Concurrently, he formed a Biosciences Advisory Committee composed of biologists and biomedical scientists with a basic research orientation to make recommendations concerning NASA's role and responsibilities in the life sciences and suggest organizational changes that would improve the management of biomedicine and the other life sciences. Their findings and recommendations laid the basis for NASA's life sciences program.

^** Many of those who went through the process would not agree. For the candidates, the testing was often grueling and demeaning. Some viewed the psychiatric and psychological evaluations as asinine and the overall procedures as humiliating. From the candidates' perspective the members of the medical team were frequently insensitive, aloof, and disdainful. This attitude reflected, in part, a traditional adversary relationship between pilots and medical personnel. Test pilots viewed physicians as potential enemies whose subjective judgments could ruin a pilot's career. Flight physicians often viewed test pilots as no more than guinea pigs, test subjects for their pet projects. To some extent, this attitude toward medical personnel endured among the astronauts throughout the manned space program. This adversary relationship is not explored here as there is no evidence that it was a significant factor in the growth and development of NASA's life sciences program at either the technical-operational or administrative level. Moreover it has been described effectively in other books, particularly Carrying the Fire by Michael Collins and The Right Stuff by Tom Wolfe.

^*** The use of the rectal thermistor bordered on being an invasive technique and was a source of tension between astronauts and physicians At the beginning of Project Mercury, however, instruments for measuring temperature orally were unreliable, and rectal thermistors were used during the first four Mercury flights. An oral thermistor was developed for, and evaluated during, the later Mercury missions and became standard equipment for subsequent manned flights. This development is described in Chapter 4.

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