3.   RESULTS OF THE MR-4 PREFLIGHT AND POSTFLIGHT MEDICAL EXAMINATION CONDUCTED ON ASTRONAUT VIRGIL I. GRISSOM

By William K. Douglas, M.D. Astronaut Flight Surgeon, NASA Manned Spaceflight Center; Carmoult B. Jackson, Jr., M.D., Life Systems Division, NASA Manned Spacecraft Center; Ashton Graybiel, M.D., USN School of Aviation Medicine, Pensacola, Fla.; George Ruff, M.D., University of Pennsylvania; Edward C. Knoblock, Ph.D., Walter Reed Army Medical Center; William S. Augerson, M.D. Life Systems Division, NASA Manned Spacecraft Center; and C. Patrick Laughlin, M.D. Life Systems Division, NASA Manned Spacecraft Center.

This paper presents the results of the clinical and biochemical examinations conducted on Astronaut Virgil I. Grissom prior to and following the MR-4 mission. The objectives of such an examination program were presented in the MR-3 report on Astronaut Alan B. Shepard, Jr. (ref. 1). Basically, the health of the astronaut before and after the space flight was assessed and any alterations were sought out that might have resulted from the stresses imposed by the space flight. Similar medical and biochemical examinations had been accomplished during the Mercury-Redstone centrifuge training sessions and provided data of comparative value.

It is important to point out the limitations in correlating examinations findings with specific flight stresses. The last preflight examination was performed approximately 5 hours before lift-off and the final postflight examination 3 hours after spacecraft landing. The strenous effort by Astronaut Grissom during his recovery from the ocean may well have produced changes which overshadowed any flight induced effects.

Astronaut Grissom was examined several times in the preflight period as two launch attempts were canceled before the actual flight on July 21, 1961. The initial clinical and biochemical examinations were performed on July 17, 1961, at which time questioning disclosed no subjective complaints. Positive physical findings were limited to shotty, nontender inguinal and axillary adenopathy, and mild pharyngeal lymphoid hyperplasia. The skin at the lower sternal electrode placement site exhibited a well circumscribed area (1 cm in diameter) of eruption. This lesion appeared to consist of about 8 to 10 small pustules arising from hair follicles. Upon closer examination of this eruption in August 1961, it became apparent that the pustules seen in July, had, by this later date, become inclusion cysts. Culture of these lesions in August 1961 was sterile. These lesions were attributed to the use of electrode paste and were also noted on the pilot of MR-3 flight.

The preflight examination on July 21, 1961, is reported in detail. A feeling of mild "sore throat" was reported; otherwise the body systems review was negative. Psychiatric examination reported "no evidence of overt anxiety, that Astronaut Grissom explained that he was aware of the dangers of flight, but saw no gain in worrying about them." In fact, "he felt somewhat tired, and was less concerned about anxiety than about being sufficiently alert to do a good job." At the physical examination the vital signs (table 3-I) were an oral temperature of 97.8o F, blood pressure of 128/75 (right arm sitting), weight of 150.5 lb, pulse rate of 68, and respiration rate of 12. Inspection of the skin revealed there were small pustules at the site of the lower sternal electrode, but it was otherwise clear. The same shotty nontender inguinal and axillary nodes were felt. Eye, ear, nose, and mouth examination was negative. There was slight to moderate oropharyngeal lymphoid hyperplasia. The trachea was midline, the neck normally flexible, and the thyroid gland unremarkable. The lungs were clear to percussion and auscultation throughout. Heart sounds were of normal quality, the rhythm was regular, and the heart was not enlarged to percussion. Palpitation of the abdomen revealed no spasm, tenderness, or abnormal masses. The genitalia, back, and extremities were normal. Calf and thigh measurements were:

  Calf Thigh
Right
Left
15 7/8 in.
15 7/8 in.
21 in.
20 3/4 in.

Neurological examination revealed no abnormality. An electroencephalogram, electrocardiogram, and chest X-ray were normal, unchanged from September 1960. Vital capacity standing, measured with a bellows spirometer, was 5.0 liters. Analysis of the urine and blood (tables 3-II and 3-III) revealed no abnormality.

As with the MR-3 flight, members of the medical examining team were either transported to the Grand Bahama Island debriefing site a day prior to launch or flew down immediately after launch.

The initial postflight medical examination was conducted immediately after Astronaut Grissom arrived aboard the recovery aircraft carrier, USS Randolph, approximately 15 minutes after spacecraft landing in the ocean. The examination was conducted by the same physicians who examined Astronaut Shepard aboard the USS Lake Champlain.

The findings disclosed vital signs of rectal temperature of 100.4o F; pulse rate from 160 initially to 104 (supine at end of examination); blood pressure of 120/85 LA sitting, 110/88 standing, and 118/82 supine; weight of 147.2 pounds, and respiratory rate of 28. On general inspection, the astronaut appeared tired and was breathing rapidly; his skin was warm and moist. Eye, ear, nose, and throat examination revealed slight edema of the mucosa of the left nasal cavity and no other abnormalities. Chest examination showed no signs of atelectasis although there was a high noise level in the examining room. No rales were heard and the pilot showed no tendency to cough. Vital capacity measured with a bellows spirometer while still in suit was 4.5 liters.

Peripheral pulses were described as normal and a left axillary node was noted. The abdomen was soft with normal bowel sounds.

The pilot voided three times without fluid intake. The limited neurological examination disclosed no abnormalities. Extremety measurements were as follows:

  Calf Thigh
Right
Left
15 ¼
15 ¼ in.
20 ¾ in.
20 ¾ in.

After a short nap and breakfast he was flown to Grand Bahama Island, arriving approximately 3 hours after spacecraft landing. His general appearance was much improved. Vital signs were recorded as a temperature of 98.4 (oral); blood pressure of 125/85 sitting, 124/82 standing, 122/78 supine; pulse rate of 90; and weight of 147.5 pounds.

Ophthalmological examination approximately 6 hours postflight showed slight injection of the conjunctiva of the left eye. These findings, as well as nasal mucosa edema, were ascribed to salt water exposure. The lungs remained clear to percussion and auscultation. The abdomen, genitalia, back, and extremities were normal. Neurological examination revealed "changes consistent with muscular fatigue in a normal individual." The electroencephalogram, electrocardiogram, and chest X-ray revealed no abnormality. Vital capacity measurement was 4.8 and 4.9 liters. An exercise tolerance test (Harvard step) was within control range.

Additional examinations in the ensuing 48 hours revealed no changes when compared with preflight studies.

The vital signs are summarized in table 3-I. Results of the biochemical determination are presented in tables 3-II to 3-V. Control data from Redstone centrifuge experience are included.

Table 3-VI shows comparisons between clinical observations from single simulated Redstone missions conducted at the Johnsville human centrifuge (with a 5-psia 100-percent oxygen environment) and the MR-4 flight. The examinations were made before and after the simulation, at times comparable to those in the actual flight.

An evaluation of the clinical and biochemical studies permits the following conclusions:

(a) Astronaut Grissom was in good health prior to and following his MR-4 flight. The immediate postflight examination revealed changes consistent with general fatigue and sea water exposure.

(b) Clinical examination disclosed no specific functional derangement that could be attributed to the spaceflight stresses.

(c) No specific biochemical alteration occurred that could be attributed to a spaceflight stress effect.

Acknowledgements–Special acknowledgement is paid to Drs. Robert C. Lanning (USN) and Jerome Strong (USA) who conducted the physical examination aboard the USS Randolph; Dr. James F. Culver of the USAF School of Aviation Medicine, who performed the ophthalmologic examinations; and Dr. Francis Kruse of the Lackland Air Force Base Hospital, who performed the neurological examinations. Dr. Walter Frajola of Ohio State University made some of the biochemical determinations, and Miss Rita Rapp, Life Systems Division, NASA Manned Spacecraft Center, collected and processed the biochemical specimens.


Reference

1. Jackson, Carmoult B., Jr., Douglas, William K., et al.: Results of Preflight and Postflight Medical Examinations. Proc. Conf. on Results of the First U.S. Manned Suborbital Space Flight, NASA, Nat. Inst. Health, and Nat. Acad. Sci. June 6, 1961, pp. 31-36.

Bibliography

Glucose:

Nelson, M.: Photometric Adaptation of Somogyi Method for Determination of Glucose. Jour. Biol. Chem., vol. 153, 1944, pp. 375-380.

Total protein, albumin:

Cohn, C., and Wolfson, W. G.: Studies in Serum Proteins. I–The Chemical Estimation of Albumin and of the Globulin Fractions in Serum. Jour. Lab. Clin. Med., vol. 32, 1947, pp. 1203-1207.
Gornall, A. G., Bardawill, C. J., and David, M. M.: Determination of Serum Proteins by Means of the Biuret Reaction. Jour. Biol. Chem., vol. 177, 1949, pp. 751-766

Urea nitrogen:

Gentzkow, C. J., and Masen, J. M.: An Accurate Method for the determination of Blood Urea Nitrogen by Direct Nesslerization. Jour. Biol. Chem., vol. 143, 1942, pp. 531-544.

Calcium:

Diehl, H., and Ellingbroe, J. L.: Indicator for Titratiun of Calcium in Presence of Magnesium With Disodium Dihydrogen Ethylene Diaminetetraacetate. Anal. Chem., vol. 28, 1956, pp. 882-884.

Chloride:

Schales, O., and Schales, S. S.: A Simple and Accurate Method for the Determination of Chloride in Biological Fluids. Jour. Biol. Chem., vol. 140, 1941, pp. 879-884.

Epinephrine and norepinephrine:

Weil-Malherbe, H., and Bone, A. D.: The Adrenergic Amines of Human Blood. Lancet, vol. 264, 1953, pp. 974-977.
Gray, I. Young, J. G., Keegan, J. F., Meheman, B., and Southerland, E. W.: Adrenaline and Norepinephrine Concentration in Plasma of Humans and Rats. Clin. Chem., vol. 3, 1957, pp. 239-248.

Sodium potassium by flame photometry:

Berkman S., Henry, R. J., Golub, O. J., and Seagalove, M.: Tungstic Arid. Precipitation of Blood Proteins. Jour. Biol. Chem., vol. 206, 1954, pp. 937-943.

Vanyl mandelic acid:

Sunderman, F. W., Jr., et al.: A Method for the determination of 3-Methoxy-4-Hydroxymandelic Acid ("Vanilmandelic Acid") for the Diagnosis of Pheochromocytoma. Am. Jour. Clin. Pathol., vol. 34, 1960, pp. 293-312.

Table 3-I.   Vital Signs

  Preflight Postflight
-7 hr
(Cape Canaveral)
 
+ 30 min
(Shipboard)
 
+ 2 hr
(Grand Bahama
Island)
Body weight nude (post voiding) 150 lb 8 oz 147 lb 3 oz 147 lb 8 oz
Temperature, oF 97.8 (oral) 100.4 (rectal) 98.4 (oral)
Pulse per min 68 160 to 104 90
Respiration per min 12 28 14
Blood pressure, mm Hg:
 Sitting:
 Standing:
 Supine:
 
128/75
 
 
 
120/85
110/88
118/82
 
125/85
124/82
122/78
Vital capacity (bellows spirometer), litres
 
5.0
 
4.5
 
4.8
4.9

Table 3-II.   Results of Urine Tests

  Centrifuge MR-4 flight
Prerun Postrun Preflight Postflight
+30
min
+2
hr
-6
hr
During
count-
down
+1
hr
+3
hr
+6
hr
+13
hr
+24
hr
+26
hr1
Sample volume, ml 125 185 470 135 185 110 300 100 475 135 315
Specific gravity 1.023 1.005 1.011 1.020 1.011 1.010 1.022 1.020 1.022 1.025 1.015
Albumin Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg.
Glucose Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg.
Ketones Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg.
Occult blood Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg.
pH 6.4 6.2 6.2 6.6 6.8 6.4 6.0 6.0 6.0 6.0 6.8
Na, mEq/L 130 28 79 142 76 70 122 128 140 114 140
K, mEq/L 62 28 39 35 18 19 37 39 25 49 71
Cl, mEq/L       55 68 130 65 111 68 69 178
Micro-
scopic
exami-
nation
No formed elements observed
1 Breakfast eaten following previous sample.

Table 3-III.   Peripheral Blood Findings

  Preflight Postflight
-3 days +1 hr +5 hr +49 hr
Hematocrit, percent 42.5 42.2 42.5 42.7
Hemoglobin,1 g 14.1 14.4 14.6 14.2
White blood cells, per mm3 6,500 7,200 9,100 6,700
Red blood cells, millions/mm3 4.81 4.75 4.67 4.71
Differential blood count
   Lymphocytes, percent
   Neutrophiles, percent
   Band cells, percent
   Monocytes, percent
   Eosineophiles, percent
   Basophiles, percent
 
46
46
 
5
1
2
 
40
54
 
4
2
0
 
29
66
 
3
2
0
 
35
59
 
4
2
0
1 Acid Hematin method.

Table 3-IV.   Blood Chemistry Findings

  Centrifuge MR-4 flight
Prerun Postrun Preflight Postflight
+30 min +2 hr -4 days +1 hr +5 hr +49 hr
Sodium (serum), mEq/L 147 141 143 142 140 144 141
Potassium (serum), mEq/L 5.4 5.9 4.6 4.1 3.5 4.4 4.8
Chloride, mEq/L 89 94 90 97 95 101 99
Protein, total 7.5 8.0 7.6 7.4 7.3 7.1 7.9
Albumin, g/100 ml 4.1 4.3 4.0 3.25 4.2 5.0 4.2
Globulin, g/100 ml 3.4 3.7 3.6 4.15 3.1 2.1 4.7
Glucose, mg/100 ml 78 118 95 94 136 105  
Epinephrine,1 micro g/L < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1  
Norepinephrine,2 micro g/L 2.3 7.2 1.5 5.1 16.5 7.2  
1 Normal values: 0.0 to 0.4 micro g/L
2 Normal values: 4.0 to 8.0 micro g/L

Table 3-V.   Plasma Enzymes Determinations

  Normal range, units Centrifuge MR-4 flight
Prerun Postrun Preflight Postflight
+30 min +2 hr -4 days +3 hr +49 hr
Transaminases:              
  SGOT 0 to 35 15 19 13 19 21 28
  SGPT 0 to 20 8 8 8 6 6 7
Esterase acetylcholine 1 130 to 260 260 215 280 225 205 165
Peptidase leucylamino 100 to 310 190 250 200 370 375 385
Aldolase 50 to 150 19 28 22 6 13 3
Isomerase phosphohexose 2 10 to 20       42 86 17
Dehygrogenases:              
  Lactic 150 to 200 170 155 190 190 250 220
  Malic 150 to 200 140 220 170 235 275 220
  Succinic Neg. Neg. Neg Neg. Neg. Neg. Neg.
  Inosine Neg. Neg. Neg. Neg.      
  Alpha-ketoglutaric Neg. Neg. Neg. Neg.      
  Isocitric 0 to 10       3 6 3
L-Glutamic 0 to 10       11 3 11
Alk phos         4 3 8
1 Delta pH units.
2 Bodansky units.

Table 3-VI.   Comparison of Physical Examination Findings During Simulated and Actual Flight

  Simulated Redstone I Simulated Redstone II MR-4 flight
Temperature, oF:      
 Before 97.9 97.4 97.8
 After 99.0 98.0 98.4
 Change 1.1 0.6 0.6
Weight, lb:      
 Before 150.31 148.25 150.5
 After 147.10 146.36 147.5
 Loss 3.21 1.89 3.0
Pulse rate per min:      
 Before 68 69 68
 After 82 84 160 to 104
Blood pressure (LA), mm Hg:      
 Before 110/68 100/70 128/75
 After 100/70 128/80 120/84
Vital capacity, litres:      
 Before 5.9   5.0
 After 5.9   4.5
Postflight physical findings: Chest clear to P and A;
slightly increased DTR's;
no change in ECG; no petechia;
appears warm and tired.
Chest clear; DTR's 2+;
no petechia.
Chest clear; no petechia;
appeared fatigued.

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