[103] Discussion of the organization and management of NASA's life sciences programs waned while Project Gemini missions were flown, March 1965 through November 1966. Like Mercury before it, Gemini was, in biomedical terms, an unqualified success. The Gemini flights demonstrated that man was fully qualified to perform effectively on 14-day missions, that he was capable of performing complex and arduous extravehicular activities, and that the life support systems were fully adequate for both purposes In short, the Gemini flights gave assurance that NASA was ready for the next phase of the manned program, the lunar landing operations of Project Apollo.

Although Apollo depended to some extent on the Gemini experience, the projects were organized independently and overlapped in time. Biomedical personnel, planning operations and developing hardware, were nearly as active on Apollo during this period as those working on Gemini. Still other life scientists and bioengineers were attempting to define the biomedical requirements for the first post-Apollo manned program, Apollo Applications (which evolved into Skylab).

Concurrently, NASA's space biologists, though functionally separated from the manned program, were developing a flight program that they believed had an indirect bearing on manned spaceflight. In December 1966, NASA launched the first of a projected six Biosatellite missions. Unmanned and nominally oriented toward basic biological research, the Biosatellite flights were intended to provide data concerning the biological effects of space environment factors on living matter and animals. As Gemini came to a close, space biologists were preparing for a series of 15 to 30-day flights with primates. With these flights, they hoped to [104] strengthen NASA's basic biology program and demonstrate its value to manned spaceflight development.

BIOMEDICAL RESULTS OF PROJECT GEMINI

Project Gemini qualified man and life support systems for lunar operations in two stages. Through Gemini 7, biomedical interest centered on man's physiological and psychological reactions to, and the adequacy of the environmental control systems for, spaceflights of up to 14 days. Through the rest of the series, biomedical attention focused on the evaluation of human performance and life support related to extravehicular activities (EVAs).

Evaluation of the physiological and performance aspects of the Gemini flights involved standard clinical procedures (pre- and postflight physical evaluations, inflight monitoring) combined with selected medical experiments. Special emphasis was given to the cardiovascular and musculoskeletal systems. Measurements revealed that "some of the major human physiological systems exhibit consistent and predictable changes" during and after exposure to spaceflight lasting up to 14 days, but that such changes "are completely reversible." In addition, the data indicated that the 'observed changes" would 'not degrade human performance or crew safety during missions required to achieve the goals of the Apollo Program."¹ Analysis of data related to"human functional systems" that physicians viewed as critical to manned spaceflight revealed no 'flight-related changes" in the neurological, pulmonary, gastrointestinal, or genitourinary systems or in behavioral or metabolic functions. Physicians identified no serious decrements in these areas that could be correlated with the environmental factors that were of specific concern to physicians before the Gemini flights-acceleration forces, weightlessness, radiation, and space capsule environment. ²

Similarly, observations of specific reactions to the spaceflight experience failed to reveal the adverse responses that many biomedical scientists predicted would occur during longer flights. Table 2 summarizes the predicted and observed reactions.

Equally important, physicians observed no significant decrease in astronaut performance during the Gemini flights. Visual acuity tests (inflight sightings and descriptions of ground views) and the absence of any evidence of vertigo or disorientation implied that long flights would not impair the functioning of the central nervous system and the vestibular apparatus. Data from electroencephalograms for nearly 55 hours of sleep revealed only minor variations in the four levels of sleep compared with baseline recordings obtained on the ground. Finally, the performance of....

Predicted	Observed		Predicted	Observed
.			.
Electromechanical delay in cardiac cycle	None		Stimulant need	Occasionally before reentry
Reduced cardiovascular response to exercise	None		Infectious disease	None
			Fatigue	Minimal
(a)	Absolute neutrophilia		Dysbarism	None
Reduced blood volume	Moderate		Distribution of circadian rhythms	None
Reduced plasma volume	Minimal
(a)	Decreased red-cell mass		Decrease g-tolerance	None
Dehydration	Minimal		Skin infections and breakdown	Dryness, including dandruff
Weight loss	Variable
Bone demineralization	Minimal calcium loss		Sleepness and sleeplessness	Interference (minor)
Loss of apetite	Varying caloric intake
Nausea	None		Reduced visual acuity	None
Renal stones	None		(a)	Eye irritation
Urinary retention	None		(a)	Nasal stuffiness and hoarseness
Diuresis	None
Muscular incoordination	None		Disorientation and motion sickness	None
Muscular atrophy	None
(a)	Reduced exercise capacity		Pulmonary atelectasis	None
			High heart rate	Launch, reentry, extravehicular activity
Hallucinations	None
Euphoria	None
Impaired psychomotor performance	None		Cardiac arrhythmias	None
			High blood pressure	None
Sedative need	None		Low blood pressure	None
			Fainting postflight	None

 

a Not predicted

 

SOURCE: Charles Berry and Allen D. Catterson, "Pre-Gemini Medical Predictions versus Gemini Flight Results," in Manned Spacecraft Center, Gemini Summary Conference, NASA SP-138 (Washington, 1967), p.199.

.....the astronauts during the complex inflight maneuvers of Gemini and during two emergencies provided unequivocal evidence that performance decrements should not be a factor in the Apollo program.³

The data obtained during the 4-, 8-, and 14-day Gemini flights did point to physiological anomalies in the cardiovascular and musculoskeletal systems' however. As anticipated, evidence of decrements in bone density, skeletal calcium, and muscle nitrogen was obtained, but the decrements did not approach clinical significance for the period in question, and all three conditions returned to normal within 50 hours of landing. That the peak decrements were observed in the 8-day flight and were significantly lower during the 14-day flight suggested that adaptation was occurring. This remained only a possibility, however, since the pertinent variables were not the same for the several flights. There was also a strong Possibility that mission variables (such as exercise, diet, and fluid intake), rather than environmental ones, were the source of these changes and their fluctuations The absence of clearly identifiable causes for the changes led NASA's physicians to conclude that intensive investigation of the musckloskeletal systems was essential before longer missions were at [106] tempted. However, they did not view these findings as matters of significant concern to Apollo operations.⁴

As expected, observations of the cardiovascular system also provided evidence of anomalies, some of which were considered insignificant. As in the Mercury flights, electrocardiograms revealed rare" and minor' irregularities in the heartbeat. Variations in blood pressure were observed, but in the critical 14-day flight, blood pressure and heart rate of both astronauts were within the envelope of normality" during weightlessness and acceleration.⁵

However, the blood pressure and heart rate readings obtained during the 4- and 8-day flights caused some concern. Trends based on measurements along these parameters gave projections for the 14-day mission that were enough to scare the pants off you " The fact that these projections were not borne out during the 14-day flight suggested cardiovascular adaptation to the conditions of spaceflight Here again, the multiplicity of variables precluded certainty. ⁶

Oddly, orthostatic hypotension, which had been a cause of serious biomedical concern following the Mercury flights, at first did not appear to be a problem during Gemini. It became evident only during postflight examinations with a tilt table (an examination table that can be tilted about three separate axes) Once again, the absence of uniform controls during the missions precluded precise correlation of this condition with specific spaceflight variables.⁷

NASA physicians were surprised by some of the cardiovascular data, which pointed to a potentially serious anomaly Blood samples taken before, during, and after the Gemini 4, 5, and 7 missions revealed postflight deficits in red blood cell mass ranging from 5 to 20 percent Adding to the concern was the absence of clear evidence indicating the specific cause. Oxygen toxicity (hyperoxia), immobility, diet, and weightlessness were all possible contributing factors. Since the deficit peaked during the 8-day flight (at 20 percent) and dropped significantly during the 14-day flight (to 5 percent), it seemed likely that the body was adapting. Since the anomaly did not appear to affect the health and performance of the astronauts during these flights and the condition reversed itself during the first 50 hours after flight, NASA's physicians did not believe it would pose a problem for the Apollo missions. However, as with the other anomalies, this loss in blood cell mass indicated yet another line of biomedical research required before longer flights.⁸

The Gemini flights also demonstrated the capability of the life support systems for 8- to 14-day flights. No significant problem developed in the functioning of the environmental control (atmosphere, humidity, temperature) or waste management systems. The astronauts encountered no unanticipated problems with drinking, eating, defecating, and urinating [107] in flight. Finally, there were no indications that levels of radiation, atmospheric contaminants, or toxins in the spacecraft ever reached significant proportions.⁹

While NASA's biomedical scientists and physicians continued the program of pre- and postflight evaluations and inflight recordings, their major concern during Gemini 8 to Gemini 12 was the assessment of astronaut health and performance during extravehicular activities, in which one of the astronauts would leave the spacecraft and attempt various tasks. The spacewalks were spectacular; the astronauts put on a good show. But from a biomedical standpoint, extravehicular activity was deadly serious. The spacesuit had to maintain a pressure environment and provide essential levels of metabolic oxygen (i.e., oxygen actually absorbed by the body, as opposed to atmospheric oxygen), heat, and humidity. At the same time it had to allow the body-joint mobility and flexibility required for performance of tasks. As described by the engineers responsible for the suit, it

. . . was a multi-layer fabric system consisting of a comfort liner, a gas bladder, a structural restraint, and an outer protective cover To permit easy donning and doffing . quick disconnects were located at the wrists for glove connections, and at the waist for ventilation-gas connections Suit entry and body waste management were provided by a structurally redundant pressure-sealing zipper. Internal to the suit, a gas distribution system directed a flow of oxygen to the helmet area for metabolic use and thermal control, and over the limbs and body for thermal control . [additional protective equipment] included: 1) extravehicular cover layer, 2) pressure thermal gloves, 3) visor temperature-control coating, and 4) sun visor.¹⁰

Spacesuit environmental control was provided through an Extravehicular Life Support System, consisting of a chest pack (which controlled heat through recirculation of gases), hoses and connectors for inlet and output of gases, and an umbilical cord and electrical cable that linked the suit to the space capsule oxygen and electrical systems. The functions of this environmental control system were to provide for metabolic oxygen, maintenance of suit pressure, removal of thermal load created by extravehicular effort, ventilation gas for removing carbon dioxide (respiration waste product), and emergency oxygen supply.¹¹ Although the equipment "operated satisfactorily within the design capabilities," three problem areas were identified. First, during extravehicular activity the pilots tended to become overheated due to design limitations in the thermal control system. As a result, engineers took steps to increase the "cooling and metabolic heat-rejection capabilities" in advance of the lunar landing mission. This was viewed as a relatively minor engineering problem. Second, certain design features related to attaching equipment (e.g., the sun [108] visor) required an inordinate amount of work by the astronaut, and this pointed to the need for modifications in the positioning of equipment Finally, the astronauts felt that the equipment packages were too bulky and interfered with their comfort and performance.¹²

From a clinical perspective, the overall response of the astronauts to extravehicular activity was satisfactory and indicated that with "careful planning of the workload'' the efficiency of the astronauts would not be significantly reduced. However, in two of the flights (Gemini 9A and Gemini 11) pilots involved in extravehicular activity experienced extreme exhaustion and evidenced significant decrements in performance. Subsequent medical evaluations led to the conclusion that these decrements stemmed from operational procedures and design limitations, rather than from the extravehicular experience per se. The astronauts had not been trained to conserve personal energy or to relax tensed muscles. They became fatigued partly because they were tense and working harder than....

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[109] .....necessary In addition, the astronauts apparently were fatigued prior to extravehicular activity due to inadequate sleep, exhaustive preflight training, and elaborate pre-EVA preparations In addition, the spacesuit environmental control system was designed to handle thermal levels below those actually created by the astronauts' activities. Prior to Gemini 12 the System was modified to increase its thermal dissipation capability, and changes were made in operational procedures to correct the problems noted above. As a result, the final extravehicular experience was highly satisfactory.¹³

To a great extent, NASA's physicians were making educated guesses when they tried to pinpoint the causes of exhaustion from extravehicular activity on Gemini 9A and Gemini 11. Engineering and operational considerations had precluded inclusion of the type of bioinstrumentation that would have been necessary to establish precise correlations between workload and metabolic cost. The bioinstrumentation for extravehicular activity was limited to one lead for electrocardiograms and one for respiration rates. While these provided gross indications of general physical condition, they could not accurately indicate body temperature or metabolic energy resources. Prior to Gemini 12, Manned Spacecraft Center physicians made a major effort to obtain accurate assessments of metabolic costs through ground-based simulations. Results were used in establishing the operational workload for Gemini 12. ¹⁴

BIOMEDICAL PREPARATIONS FOR THE APOLLO PROGRAM

Apollo was dependent on Gemini for assurance that astronauts could endure the rigors of the translunar flight and perform effectively in the lunar operations. Apollo, however, also had unique biomedical requirements. First, the Apollo missions would be the first in which clinical space medicine would be critical. As Apollo flights would take the astronauts out of Earth orbit, inflight illnesses could become serious problems Once the spacecraft was en route to the Moon, an ill astronaut would have to complete the entire journey before he could return to the Earth for treatment. As a result, Apollo required a clinical program to minimize inflight illness and provide for inflight emergency treatment if illness occurred.¹⁵

The clinical program that evolved had three parts: preflight preventive medicine' preflight paramedical training for the astronauts, and an inflight medical kit. Prevention of illness was the major focus, and it included identification of latent illnesses during preparation for missions, reduction Of contact with nonessential personnel, and determination of individual Sensitivity to drugs that would be carried in the medical kit. The "health stabilization" program was planned to go into effect 30 days before each [110] mission. It relied on intensive medical screening and physical examinations for early detection of infections. NASA's physicians recommended total isolation of the astronauts during this period; however, this was deemed impractical.^* Preflight paramedical training was designed to enable the astronauts to recognize health abnormalities and select appropriate therapeutic measures. The program covered the cardiovascular, pulmonary, and neurological systems, vestibular and otologic functions, human behavior, pharmacology, and preventive medicine. This training also acquainted the astronauts with the emergency medical kit, which included 17 drugs for various respiratory, intestinal, eye, ear, nose, and skin infections. ¹⁶

The need for a portable life support system for lunar surface extravehicular activity was a second unique biomedical requirement of the Apollo program. While Gemini had demonstated the basic capability of man and equipment, the duration of extravehicular activity had been a much shorter operation. The Apollo astronauts would have to carry their life support with them as they performed a variety of activities, so the environmental system had to be lightweight and not interfere with astronaut maneuverability.

To meet these requirements, NASA's engineers developed a Portable Life Support System that would operate as a backpack unit. Subsystems supplied oxygen for both spacesuit pressurization and metabolic consumption; cooled water for thermal control; filtered out carbon dioxide, odors, and trace contaminants; warned of malfunctions; and provided communications and telemetry. The life support system was a major component of the Extravehicular Mobility Unit, which consisted of the extravehicular spacesuit, a liquid cooling garment, an oxygen purge system, and special visor and overshoe assemblies.¹⁷

The third unique biomedical requirement of the Apollo program was the need to prevent contamination of the lunar surface, as well as contamination of the Earth's biosphere by possible lunar biota. Although most scientists considered the possibility of life (even at the subcellular or viral level) to be remote, back-contamination had to be considered. In 1963, the Space Science Board recommended that NASA ensure effective quarantine procedures during the Apollo program. Subsequently, NASA joined the Public Health Service, the Department of Agriculture, and the Department of Interior in forming an Inter-Agency Committee on back-contamination. Responding to the recommendations of this committee, .....

[113] .....NASA implemented a program with three objectives: preventing contamination of the lunar surface by human biological wastes, preventing contamination of the space capsule by astronauts returning from the lunar surface, and preventing contamination of the Earth's biosphere.¹⁸

To avoid contamination of the lunar surface, three vectors of contamination had to be contained: waste products (feces, urine, and residual food), terrestrial microorganisms released during lunar-landing module depressurization, and microorganisms present in the lunar module waste water system. Their containment posed an engineering problem-and meant that additional weight had to be lifted from the lunar surface. It was finally decided that the only feasible procedure would be to collect all wastes in special bags that would be stored in the equipment bay of the lunar module descent stage (which would remain on the lunar surface). These bags were not expected to leak, but if they did it was expected that the leakage would remain contained within the descent stage.

Of much more concern to biomedical scientists was the possibility of contaminating the Earth. NASA proposed to avoid this in three ways. First, special equipment would be included in the spacecraft to maintain cleanliness and reduce the amount of lunar dust returned to Earth. Second, a Mobile Quarantine Facility would be constructed to carry the astronauts from the recovery site to a fixed quarantine facility. Immediately after landing, the astronauts were to don special garments that included respirators to filter and sterilize their exhalations. They would wear the garment until they had entered the mobile facility. Waste products were to be transferred to the facility through special locks. The astronauts would remain in the mobile facility for an undetermined period of time (provision was to be made for 10 days) until transferred to a special quarantine facility.

Finally, NASA planned to construct a Lunar Receiving Laboratory to house both the returned lunar samples and the astronauts. This was to be both a containment facility and a testing facility. The astronauts would live there for 21 days, while scientists, using remote sensing devices and neoprene gloves, would conduct biological and biochemical analyses of the lunar samples and the astronauts. The receiving laboratory was constructed to match the specifications of the U.S. Army biological laboratories at Fort Detrick, Maryland, which was the nations's center for research on biological warfare.¹⁹

The kinds of biomedical data gathered during Mercury and Gemini would also be collected during Apollo. To further investigate the physiological anomalies discovered or studied during the earlier flights, detailed pre- and postflight assessments would be made. Special attention was to be given to the cardiovascular and musculoskeletal systems, and a special effort would be made to obtain precise information on metabolic [114] requirements Bioinstrumentation had been refined during the Mercury and Gemini missions. Notable changes included an instrument for measuring overall body temperature through electrode sensors (as opposed to rectal or oral temperature) and provision for comprehensive measurements during extravehicular activity. To make the latter measurements, NASA's physicians and engineers cooperated in designing a biomedical harness that wrapped around the pelvis like a belt, rather than around the chest. This version was expected to reduce interference with operational performance. ²⁰

Initial biomedical planning for Apollo called for seven experiments that would measure reactions of the cardiovascular and musculoskeletal systems and metabolic function to the space environment Following the Apollo 204 accident, a fire which killed three astronauts and led to a 20-month delay in the Apollo program, the biomedical experiments were eliminated on the grounds that they were not critical to Apollo and could be postponed to a later program. Public attention after the fire focused on astronaut health and safety rather than science; in such a traumatic environment it was easy to emphasize medical preparedness rather than medical experiments.²¹ Some biological and biomedical experiments were flown in the later Apollo missions, but they did not approach the comprehensiveness of the program that was originally planned. ²²

BIOMEDICAL PLANNING FOR ADVANCED MANNED SPACEFLIGHT PROGRAMS

Reduction and analysis of the biomedical data derived from the Mercury and Gemini flights and from extensive ground-based research and simulations led biomedical scientists, both inside and outside NASA, to the cautious conclusion that man was qualified for spaceflights of 28 days. ²³ Scientists were troubled by the physiological and performance decrements observed in these missions and were disturbed that precise measurements had not been obtained. However, the consensus was that the Apollo mission and support system changes would not jeopardize the health, safety, and performance of the astronauts. Biomedical scientists felt certain, however, that flights exceeding 28 days should not be attempted until the observed anomalies had received thorough investigation.

While NASA's post-Apollo manned missions were only vaguely defined at the end of Gemini, NASA management assumed that the manned program would continue to expand after the lunar landing. They expected that there would be missions of gradually increasing duration, so that human responses in one mission would indicate possible areas of concern for the next. Management hoped to begin with an orbiting laboratory, [115] proceed to a permanent manned space station, and continue to a manned planetary mission. ²⁴

In 1966 a space station and a manned planetary mission were little more than visions on the horizon; however, studies of an orbiting laboratory and firm planning were moving forward. In 1963 NASA had received congressional authorization to establish design requirements for an orbiting laboratory' using Apollo systems, and had conducted several studies to determine both overall design requirements and specific biomedical requirements Initially designated Apollo Extended Systems, the program was redesignated Apollo Applications Program in 1965. It subsequently flew as Skylab. The Apollo Applications Program was projected as a two-mission program in which flight crews would spend 28 and 56 days in orbit. Since the primary objective was to qualify man for even longer spaceflight, major emphasis was placed on biomedical investigations and life support systems.²⁵ In view of the anomalies already observed in manned flights, management recognized a pressing need for comprehensive biomedical planning well in advance of the actual missions. Toward this end, NASA asked the Space Science Board to investigate and make recommendations concerning the biomedical requirements for advanced manned programs.

The board presented NASA with its recommendations in February 1966 While satisfied with NASA's overall management of medical operations for Mercury and Gemini, the report noted the absence of acceptable and verifiable biomedical measurements and pointed out that reliable data were limited or nonexistent in several significant areas:

1) the behavior of physiological and behavioral systems that respond slowly with time, such as metabolism and smooth muscle mass; 2) the extent to which physiological degradation or deconditioning" may occur over an extended period of time; 3) the ability of man to adapt to the space environment, to attain a steady state of physiological and psychological adjustment, or, subsequently, to readapt to gravity and other planetary stresses; and 4) the possibility or likelihood of a combination of stresses producing a response greater than the sum of the responses to individual stresses Finally, it cannot be ruled out that the space environment may induce totally unexpected responses. ²⁶

The report cited three sets of factors that NASA should consider in advanced biomedical research. All could have significant effects on astronaut health and performance as the duration of flights increased, even though none had yet compromised health and performance. The first set of factors, ''medical and physiological," included weight loss, body fluid volume and electrolyte balance, calcium loss, change in blood volume and coagulation and in red blood cell mass, metabolic changes, compatibility of bacterial flora (i.e., tendency of normal human bacterial [116] populations to undergo unpredictable and possibly adverse genetic changes when humans are in confined spaces), space radiation, readaptation to gravity, and combined stresses. The report recommended that investigation of these factors begin immediately with ground-based research in settings that simulate spaceflight and later be complemented by primate investigations in Biosatellite. This would provide a fundamental base on which a plan for inflight research on men could be structured.²⁷

The report found that the second set of factors, "psychological and behavioral," was largely being neglected" in the manned space program In prolonged spaceflight, the psychological reactions of the crew could be more important than the physiological reactions. In spite of this, the report said, there were few data on the long-term effects of isolation, confinement, monotony, social restrictions, threat of danger, noise and silence, and the enforced proximity of differing personalities." Research was recommended to correlate decrements in "crew motivation and performance" with mission duration and restricted environment, to identify physiological disturbances that might result from psychosocial factors, to define the levels and types of activity" needed to maintain physiological systems and behavioral skills," and to measure the time required to perform tasks in space and the percentage of errors made."²⁸

Finally, the report cautioned that the proven capabilities of "current life-support systems" did not justify confidence that those capabilities would extend to longer missions NASA had developed effective life support systems quickly by compromising between the engineering and physiological requirements. This was satisfactory for missions that depended on ' man's very considerable ability to adapt to adverse conditions." However, advanced missions would need a more substantial basis that stressed 'clearly defined optimal conditions for effective performance" in space. In this regard, the report urged research and development into space cabin atmospheres (in particular, to explore the feasibility of a two-gas system), toxic contaminants, waste management, human engineering, biomedical data collection and data analysis, and inflight medical care. ²⁹

The findings and recommendations of the Space Science Board were consistent with those of NASA's own Biomedical Experiments Working Group and Space Medicine Advisory Group and provided the basis for the biomedical research that preceded Apollo Applications and the biomedical experiments package that was flown aboard Skylab. In addition, NASA management decided to adopt the board's recommendations concerning inflight animal experiments. Plans were made to use the Biosatellite primate flights to assess a two-gas atmosphere and the combined effects of weightlessness and radiation on primate circulation, metabolism, neurophysiology, and behavior.³⁰

[117] The increasing importance of inflight biomedical investigations warranted procedures for economically and efficiently designing and packaging biomedical experiments However, it was difficult to define experiment packages with only vague indications of the types of missions that would be flown and virtually no information on the vehicles. Consequently, Dr. Sherman P Vinograd and his associates concluded that NASA should design a flexible, modular biomedical experiments system capable of supporting a broad range of investigations, yet adaptable to any flight System that NASA selected. The result was the Integrated Medical and Behavioral Laboratory Measurement System.

The integrated measurement system was conceived in 1963, when a Technical Advisory Committee of NASA's life scientists considered ways in which NASA could accomplish the inflight biomedical research that various groups, such as the Space Science Board, had recommended. The committee identified two impediments First, available bioinstrumentation was capable of providing gross evaluation of specific physiological responses, but not precise measurements. Second, traditional procedures relied on the use of individual items of equipment rather than comprehensive systems. The committee concluded that NASA should develop a single biomedical support system that would integrate the required measurement, support and data-management facilities" and could function as both "a compact, miniaturized spaceborne medical center" and 'a self-sufficient biomedical research facility".

As NASA's first attempt to apply engineering development principles to biomedicine, the integrated measurement system was conceived as a means for reducing lead times and preparing well in advance for the integration -of biomedical systems with other spaceflight systems Heretofore, the approach to biomedicine had largely been adaptive; that is, procedures were adapted to existing engineering arrangements and biomedical research requirements were often compromised. The system conceived by Vinograd and his associates would greatly facilitate the integration of biomedical research requirements with other systems and minimize the degree to which biomedical requirements had to be compromised In 1966, however, the system was no more than a concept, and its development remained in doubt. ³¹

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