Medicine and the moon landing

This week, people across the planet are remembering the 50th anniversary of the first lunar landing. That includes me.

I was a preteen when Neil Armstrong walked on the moon. I was a camper at an overnight camp near Haliburton, Ont. Back then, there were no cellphones, no email, no internet and no Wi-Fi. We had TVs, but not at camp. Still, the first landing on the moon being a historic occasion, the camp director brought a black-and-white TV into the mess hall so we could all watch the landing. We sat with our eyes glued to the grainy images on the screen. Under the summer stars, it was magical.

As a physician, I find myself a lot more interested in the medicine the astronauts took with them to the moon. Apollo missions had a medical accessory kit containing medical supplies and small medical equipment that included compress bandages, adhesive bandages, an oral thermometer and biomedical harness,  a contraption worn under the astronaut's spacesuit that measures the astronaut's ECG and heart rhythm.

The kit contained medications. According to a press package, there were:

• 60 antibiotic capsules.
• 12 anti-nausea pills.
• 18 pain relievers.
• 60 decongestants.
• 24 pills for diarrhea.
• 72 tablets of Aspirin.
• 21 sleeping pills.
• 12 pills containing the stimulant dexamphetamine.

The kit also included three motion sickness injectors containing the antinausea medication hyoscine, three injectable pain relievers, one bottle of "first aid ointment," two bottles of eye drops and three nasal decongestant sprays.

Astronauts Neil Armstrong and Buzz Aldrin brought a smaller kit to the moon with them. It contained four stimulants, eight pills to treat diarrhea, two sleeping pills, four painkillers and 12 tablets of Aspirin, plus a bottle of eye drops.

In 1970, the kit was transferred to the Smithsonian along with other artifacts from the mission.

Armstrong and Aldrin took preventative doses of the anti-diarrhea medication Lomotil so they wouldn't need a toilet. That's because the lunar module did not have one. Aldrin reportedly said he took two Aspirin every night to help him sleep. On the ride back to Earth, each astronaut took the hyoscine and a five-milligram tablet of dexamphetamine before re-entry into Earth's atmosphere, with a repeat dose after splashdown.

Medications aside, the crew of Apollo 11 remained in good health throughout the mission, BBC reported. Neil Armstrong was known for having a slow heart rate that went with his reputation for being unflappable under pressure. His average heart rate during the mission was 71 beats per minute but climbed to an unhealthy 150 beats per minute when he saw that the carefully-chosen landing site was strewn with rocks and fuel was running low. Armstrong's heart rate stayed that fast for a full two minutes until Armstrong found a decent landing site and mission control gave the approval to land.

Crew contended with cold, rash and flatulence

There were a few notable medical issues during the Apollo space program. Wally Schirra got a wicked cold while commanding Apollo 7. That mission did not involve a trip to the moon but was needed to prove the airworthiness of the command module. Schirra used up the entire supply of tissues and all 24 of the decongestant tablets carried in the spacecraft medical kit, and reportedly got pretty testy with mission control during the flight. On one mission, an astronaut got a rash because he wore a urine collection device too long. There were also reports of eye irritation, and several reports of flatulence.

On Apollo 15 there were reports of irregular heart rhythms believed to be caused by low potassium. One astronaut pulled his shoulder taking a lunar core sample.

The world held its breath after an onboard explosion crippled the Apollo 13 service module. The crew returned safely but had to spend extra time in space traveling around the moon before returning to the Earth. They suffered from dehydration because they had to ration the water on board. 

The Apollo missions lasted days. The space program is preparing to take care of medical needs on a lunar base and on a long-term mission to Mars. Doctors at the Canadian Space Agency and the Space and Life Sciences Directorate at the Johnson Space Center in Houston have acquired a good deal of experience observing astronauts aboard the International Space Station (ISS), where Canadian astronaut David Saint-Jacques recently spent six months before returning to Earth.

Surgery demands of Mars

Sick bay aboard the ISS has advanced medical diagnostic and emergency resuscitation equipment such as a point-of-care ultrasound machine and resuscitation equipment that includes a defibrillator.  The medicine kit contains 190 different medications that are deemed essential for immediate use. 

Should a medical emergency arise at a lunar base or on a mission to Mars, the crew will have to handle it on their own. They'll need to take medicines to handle both medical emergencies as well as the health effects of long-term space flight. Emergencies might include seizures, allergic reactions, heart attacks, strokes and agitation associated with psychosis.

Given the risk of orthopedic injuries, they'll have to be able to set broken bones and put on casts. They'll have to be able to stitch up or staple deep cuts.

For surgical emergencies at a lunar base, the crew may be equipped to stabilize the patient long enough to airlift a surgeon to the moon or bring the patient back to Earth. To meet surgical needs on Mars, they'll probably recruit an astronaut with medical and surgical training. 

Any way you look at it, the medicine that future astronauts bring to long-term space missions will be a lot more sophisticated than what Armstrong and Aldrin brought with them to the moon half a century ago.