Man Living in the Arctic; Proceedings of a Conference, Quartermaster Research and Engineering Center, Natick, Massachusetts, 1, 2 December 1960 (1961)

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SESSION No. 3 THEME: SCIENTIFIC APPROACHES TO SOLVING THE PROBLEMS OF MAN LIVING IN THE ARCTIC CARL R. EKLUND, presiding CHAIRMAN EKLUND: This session will be devoted to a discussion of the physio- logical and psychological problems of the individual living in the Arctic and the scientific means that can be taken to solve these problems. Our first speaker, Colonel Joseph Blair, has long been interested in Polar research. Right after the war he was assigned to a project to improve the thermal boot and that was one of his first research problems concerning the cold. At one time he was Director of the Army Medical Research Laboratory at Fort Knox and is now the Medical Corps representative to the Tripartite Group in Canada. The Army has been fortunate to have a man with Colonel Blair's interest in and knowledge of the problems of the individual living in the Arctic, and it is our pleasure to have him here today to discuss "Health Maintenance". HEALTH MAINTENANCE COLONEL JOSEPH R. BLAIR Medical Corps U. S. Army Standardization Group Ottawa, Ontario, Canada Introduction Health maintenance has been and will continue to be one of the major problems of man living in the Arctic. For people living in the "Far North" maintenance of health can follow no fixed set of rules because of the great variety of conditions to be found there; and research is yet to find answers to many of our questions. If a man is living in a modern community or military base in the Arctic, many of his health problems have been solved by the move- ment of civilization into the Arctic area. But man's health problems in the Arctic are many if he is a member of a small isolated group or living in a survival situation somewhere in the "Far North". It is with these latter groups that this presentation will be primarily concerned. Probably in no part of the world do environmental conditions vary so greatly as in the Arctic—from season to season and in different geographical areas. The Arctic summer presents health problems largely non-existent during the winter months; for example, some of these problems include immobility over Arctic muskeg and the pres- ence of huge numbers of biting insects—mosquitoes, deer flies, etc. Insect control is a major summer problem in the Arctic. A high priority research project of the Army Medical Service is the develop- ment of a safe and effective oral insect repellent. It would be a chemi- cal agent taken by mouth and excreted through the sweat glands to 79

WEATHER STATION YEARS OF DATA JANUARY AVERAGES MINIMUM TEMP (°F) FROST FREE DAYS TEMP(°F) PRECIP (IN.) VERKHOYANSK, U.S.S.R. 38 - 58 0.I6 -90 CHURCHILL, CANADA I2 - I9 0 48 -57 52 BARROW, ALASKA 25 - I7 0. I5 -56 I 7 FAIRBANKS, ALASKA 34 - I2 0.97 -66 89 GODTHAAB, GREENLAND 44 + I4 3.27 -20 — ADAK, ALEUTIANS I2 t 33 6.53 + 8 I65 LANGDON.NO. DAK. 35 - I 0.63 -5I I I 0 CHICAGO, ILLINOIS 40 + 25 I.75 -23 I96 FIGURE 1. Climatic data at various Arctic and U. S. Weather Stations. repel insects. It would always be present—not washed off by the rain or rubbed off on the clothing. Winter in Arctic areas, though eliminating biting insects, creates even more difficult health problems largely associated with the snow and extreme cold. Research programs directed toward maintenance of health and efficiency of personnel in the Arctic must be planned to meet widely varying climatic conditions, as shown in Fig. 1: 1. "Wet-cold" of the Aleutians (Adak) where the winter tem- peratures are warmer than those of northern United States, but produce a severe cold stress on personnel because of the heavy precipitation and high winds present. 2. Dry intense cold of Siberia (Verkhoyansk) and interior Alaska (Fairbanks). 3. Severe "windchill" (combination of low temperatures and high winds) of Churchill and Barrow. Such temperature extremes present a formidable environment for efficient functioning or even survival of mankind. Effectiveness of man living under such Arctic conditions is largely dependent upon a combination of training, Arctic equipment, and climatic adaptation. Fig. 2, showing performance of Signal Corps personnel in opera- tion of radar, radio, and switchboard equipment under Arctic condi- tions, demonstrates that efficiency is affected both by Arctic mittens 80

and cold exposure (1). Performance in each case could be improved by the development of better mittens and by more complete adaptation of man to the cold. There are five factors which determine the state of health and efficiency of man living in the Arctic. Research designed to improve any of these will result in an over-all higher level of health and per- formance. These five factors for maintenance of health in the Arctic are: 1) Selection and training of personnel; 2) Environmental pro- tection of personnel; 3) Adequate supply of food and water; 4) Proper waste disposal; 5) Management of medical emergencies. Selection and Training of Personnel for Arctic Duty More knowledge is badly needed on the best methods of selection of personnel for Arctic duty, for we know that the elimination of unfit personnel will prevent many problems from ever occurring. Present knowledge indicates that the following groups are probably unfit for duty in the Arctic: 1. Individuals suffering from circulatory disorders of the ex- tremities (Buerger's disease, Reynaud syndrome, arterio- sclerosis). 2. Persons with history of previous severe cold injury; they are twice as susceptible to cold injury as other individuals. AVERAGE EFFICIENCY ( Percent of Normal) I00- 50- o 0- o in k_ c 0 03 c o .~ O S t_ o < I00- 50- ^ 0- o in a> l_ o c o •*: o o S < I00- 50- -= 0- Control Mittens 0 tJ •S Radar Trainer Radio Switchboard Controls- in fatigues at23°C Mittens - in fatigues ft mittens at 23° C Arctic - in arctic clothing first hour at-I5° C FIGURE 2. Effect of Arctic conditions upon operational efficiency of Signal Corps personnel. From Blair and Gottschalk (1). 81

3. Persons showing mental instability—a condition which will be increased by the isolation and severe stresses of Arctic duty. 4. Persons belonging to certain racial groups which show an un- usually high susceptibility to cold injury. Cold injury experience in Korea revealed that Negroes and Puerto Ricans were six times more likely to suffer cold injuries. Combat experience in World War II and the Korean conflict has taught us that the "best bet" for Arctic duty is a healthy stable young man who grew up in the rural area of one of our northern states. Also there must be developed the best possible training program for people on assignment to the Arctic. This training must include physical conditioning and acclimatization in a cold climate. Dr. Davis (2) and his associates at the U. S. Army Medical Research Laboratory have shown that such a program of acclimatization to cold will in- crease a man's efficiency, endurance, and probably his resistance to the harmful effects of cold. Fig. 3 (from Davis) indicates that there I40r- I20- 30 FIGURE 3. Shivering, heat production, and respiratory heat loss in unclothed man exposed to a cold environment (12°C) over a 30-day period. From Davis (2). 82

I20 APR MAY JUN JUL AUG TIME IN MONTHS SEP FIGURE 4. Shivering during a 5-month period of men acclimatized to 12 °C over a 30-day period. From Davis (2). is a definite decrease in shivering and in heat production as a man is acclimatized to an environment of 12 °C over a 30-day period. Fig. 4 demonstrates that such acclimatization may persist for at least 6 months. These studies support the thesis that man can be condi- tioned for more effective performance in a cold environment. Similar changes have been observed in animals (rats and rabbits) and are associated with a definite increase in resistance to the harm- ful effects of cold exposure (3). Fig. 5 compares cold injuries suffered by non-acclimatized rats and previously "cold-acclimatized" rats (to 23°F for fifty days) after 5 hours exposure at 5°F. The cold- acclimatized rats tolerated this period of exposure without harmful effects, namely, hypothermia and cold injury (frostbite). On the other hand, all non-acclimatized animals suffered progressive hypothermia and frostbite. Fig. 6 shows the type and degree of cold injuries incurred by the non-acclimatized rats. Fig. 7 compares the survival times of non-acclimatized and cold- acclimatized rats when exposed to — 15°C (5°F) until death occurs. Mean survival time for the non-acclimatized rat was 10.1 hours com- pared to 35.8 hours for the cold-acclimatized rat, representing an increase of 254%. These observations show that animals, under 83

NORMAL (NON-ACCLMATIZED) RATS "COLD-ACCLIMATIZED" RATS | RAT COLD INJURY RAT NO. COLD INJURY NO. EARS FEET TAIL EARS FEET TAIL 9-A 0 0 + + + I-B 0 0 0 I0-A 0 + + + + 2 -A 0 0 0 I0-B + + + + H- 2-B 0 0 0 II-A + + + + + + 3 -A 0 0 0 II-B 0 + •H + + I7-A 0 0 + I2-A 0 + + + + I7-B 0 0 0 I2-B 0 0 + + I8 -A 0 0 0 I3-A 0 + + + I8-B 0 0 0 I3-B + +++ + + + I9 -A 0 _ 0 0 I5-A 0 + + + + I9-B 0 0 0 I5-B 0 0 + 20-A 0 0 0 I6-B 0 _ 0 + + 20 -B 0 0 o ! -(-FIRST-DEGREE FROSTBITE (ERYTHEMA AND SWELLING). ++=SECOND-DEGREE FROSTBITE (BLISTERING AND FISSURING) +++*THIRD<DEGREE FROSTBITE (GANGRENE AND TISSUE LOSS) FIGURE 5. Cold injury of normal and cold-acclimatized (to 23 °F for 50 days) rats following five hours exposure at 5°F. From Blair (3). "COLD-ACCLIMATIZED" RATS NORMAL (NON-ACCLIMATIZED) RATS FIGURE 6. Photographs of tails of normal and cold-acclimatized (to 23°F for 50 days) rats taken two weeks after five hours exposure at 5°F. From Blair (3). 84

"NON- ACCLIMATIZED" RATS "COLD-ACCLIMATIZED" RATS MRS. EX- POSURE ALIVE DEAD % SUR- VIVAL MRS. EX- POSURE ALIVE DEAD % SUR- VIVAL 0 I8 0 I00 0 18 0 I00 I2 4 I4 22.2 I2 I8 0 I00 24 0 I8 0.0 24 I8 0 I00 36 - — — 36 6 I2 33.3 48 - — - 48 2 I6 M.I 60 — - - 60 o I8 0.0 FIGURE 7. Survival times of normal and cold-acclimatized (to 23°F for 50 days) rats when exposed to 5°F until death occurs. From Blair (3). appropriate conditioning to moderate cold, acquire an unusual resist- ance to the pathological effects (hypothermia, frostbite, death) of severe cold exposure. Of course, the important question is: How far do these animal studies apply to man in increasing his resistance to cold? Environmental Protection of Personnel Dr. Kennedy, in his presentation, has already discussed many aspects of this subject, therefore I shall take time to state only a few pertinent facts. It is certainly of great importance to a man's health Date Outside air Ground surface beneath Interior of and 3 /(. above undisturbed snow, 20 ft. snow shelter time snow surface from snow shelter 't'np Centre Floor Feb. 28, 1956 1530 -17 +19 +16 +18 +16 Feb. 29, 1956 0815 -36 +20 +20 +20 +19 March 1, 1956 0800 -40 +19 +18 +18 +19 March 5, 1956 0800 -36 +16 +16 +16 +16 1630 -12 +17 +15 +16 +16 FIGURE 8. Temperatures of unoccupied snow shelter and environs (°F). From Eisner and Pruitt (4). 85

that he be given adequate protection against the climatic stresses of the Arctic, especially during the winter months. This protection applies to both shelter and clothing. In an Arctic survival situation protec- tion from wind and use of ground warmth are primary considerations for any shelter. Fig. 8, taken from a paper by Eisner and Pruitt (4), shows that a snow shelter, excavated down to ground level, will assume thermal equilibrium with the ground. Such a shelter, together with its protection from the wind, will give its occupant a very great thermal advantage over the external environment—in this case, up to 60°F. Ground warmth should always be utilized to maximum advantage as a source of heat in the Arctic. Adequate Supply of Food and Water An adequate supply of pure food and water is essential to mainte- nance of health in the Arctic. People assigned to duty in the Far North who sleep in well-heated barracks and carry on sedentary activities in warm buildings often receive but certainly do not require any addi- tional calorie intake over that of similarly employed personnel in temperate zones. But such is not true of men engaged in strenuous outdoor physical activity in the Arctic. They require additional calo- ries because of increased metabolism from cold exposure and heavy GEOGRAPHICAL LOCATION MEAN TEMP. TOTAL CALORIES CALORIES SUPPLIED BY ARCTIC: (IN'F.) PROTEINS CARBO- HYDRATE FATS CHURCHILL, CANADA OPERATION MUSKOX - I7 + 5 5,235 4,400 I2% I3% 46% 42% 42% TEMPERATE: 45% CAMP CARSON, COL. U.S. TRAINING CAMPS 65 3,900 3,790 I4% I3% 42% 44% 44% 43% TROPICS: PACIFIC ISLANDS 38 TH DIV., LUZON 79 83 3,400 3,200 I3% I3% 54% 54% 33% 33% FIGURE 9. Environment and food intake in man. From Johnson and Kark (5). 86

physical work in Arctic clothing. The papers of Johnson and Kark (5), LeBlanc (6), Welch, Buskirk, and lampietro (7) have given us much information on the effect of climate and temperature on the food and water requirement in man. But further information on work load and energy expenditures for various Arctic tasks must be ob- tained before the optimum nutritional requirements for various types of Arctic duty can be established. Fig. 9, compiled from world-wide nutrition surveys by Kark and Johnson, gives some idea of nutritional requirements in the Arctic as compared to temperate and tropical areas. The validity of this data as applying to all Arctic areas and conditions is open to question and needs further evaluation. During the 1957 winter exercises held in Alaska, one of the most important observations was the apparent dehydration of many soldiers, resulting in decreased effectiveness, fatigability, and consti- pation. This dehydration was probably due to water loss through sweating, cold diuresis, and in the expired air—without adequate replacement because of lack of easily available water and the absence of a strong thirst drive in extreme cold. That there is a minimal water requirement for maintenance of health in the Arctic can be seen from Fig. 10. These data, compiled from many research reports, show water exchange in soldiers under arctic, temperate, tropical, and desert conditions. Arctic studies at Adak, Fairbanks, and Churchill indicate that soldiers need two liters of water daily in food and drink to maintain a healthy state. Efforts should be made to devise better methods of supplying and distributing drinking water to field troops in the Arctic. Place Mean TempfF Water In Drink Liters Water in Food Liters Urine Vol. Liters Sweat Vol. Liters Adak 23 I.I6 0.75 I.27 — Fairbanks Churchill I 7 -20 I.20 I.20 I.I3 0.99 I.20 I .I5 0.8 5 « Knox 4I 2.05 0.9 I I .74 0.67* Desert * * 85 5.90 — 0.94 4.95 Tropics** 80 3.26 — 0.92 2.33 * Calculated from weight loss. * * Data from Adolph et al. FIGURE 10. Environment and mean daily water exchanges in man. 87

Proper Waste Disposal In Arctic military posts waste disposal is not a problem to the individual soldier, but one for the Post Engineer. However, in the field great care must be taken to dispose of waste properly so that it will not become a hazard to the health of all concerned. Newer and better methods of waste disposal should be constantly sought. Dis- posal of human excreta is always an Arctic problem. It has been for years and will probably remain so for some time. At present there is no better method for the individual soldier than that employed for many years—collecting in containers and then chemically treating or burning before depositing on the terrain. Management of Medical Emergencies All first aid and health procedures normally employed in temperate and tropical areas apply equally well in the Arctic but may be more difficult of application because of the extreme cold and the heavy clothing. However, there are certain medical conditions that are more common or more likely to occur in Arctic and Antarctic areas than in other parts of the world. Among these are cold injuries, snow blindness, and carbon monoxide poisoning. Prolonged exposure to cold without proper protection and care of the extremities may result in severe cold injuries, such as the approxi- mately 100,000 cases of trench foot suffered by our troops in World War II and the severe frostbite experience in Korea. Either could have been prevented to a large degree had adequate preventive measures been carried out by the individual and the command. Fig. 11 shows a cold exposure graph, a modification of the original windchill chart of Siple (8). This graph suggests under what weather conditions stringent frostbite or trench foot preventive measures should be carried out. A much more accurate chart can be developed when more knowledge of the epidemiology of cold injury becomes available. Among the preventive measures that may be car- ried out are: 1) Proper use of cold weather equipment; 2) Drying of clothing and replacing wet socks; 3) Exercise of the extremities; 4) Rest and rewarming; 5) Examining the face, hands, and feet for the first signs of cold injury. That a cold injury prevention program can be very effective is shown by the almost total absence of cold injury in Antarctic operations effected by the preventive medicine program of the Deepfreeze Task Force Surgeon and his staff. When cold injury does occur, it is mandatory that proper first aid and early treatment be given. Clinical experience with cold injuries in Korea during the winter of 1950-51 (9) has given us certain basic principles of cold injury therapy, as follows: 1. Immediately remove or loosen any constricting clothing, such as boots, gloves, or socks. 88

2. Avoid trauma to injured part—all casualties with involvement of the lower extremities must be treated as litter cases. 3. Rapidly rewarm frozen part in warm water (45°C or 113°F), or if unavailable, use body heat to thaw part. 4. Walking, massage, exposure to open fire, or rubbing with snow are contraindicated. 5. Give booster dose of tetanus toxoid. 6. Administer penicillin or broad spectrum antibiotics as pro- phylaxis against infection. 7. Leave all vesicles or bullae intact—only cover with dry gauze for protection. 8. Apply no pressure or petrolatum-impregnated dressings. 9. Maintain general body warmth and encourage sleep and rest. 10. Smoking prohibited. 11. Active physiotherapy (whirlpool baths, Buerger's exercises) should be instituted as early as possible. 12. No surgery should be performed until definitely indicated, such as in the following cases: a. Superficial debridement of necrotic tissue in presence of frank or threatened suppuration. b. Amputation in cases of extensive "wet gangrene" with lymphadenopathy and general infection. TRENCH FOOT (IMMERSION FOOT) PREVENTIVE MEASURES FROSTBITE PREVENTIVE MEASURES 60 50 40 30 20 I0 0 -I0 -20 -30 -40 TEMPERATURE (FAHRENHEIT) FIGURE 11. Cold exposure graph for prevention of cold injuries. 89

We should continually explore every possibility in the treatment of cold injury to insure that the best knowledge of medical science is employed in the management of this important military medical problem. One of the most disabling conditions that may be encountered by man living in the Arctic is snow-blindness. This condition is a painful inflammation of the eye caused by sunburn from ultraviolet rays re- flected up from the snow. The position of the eye, together with the eyebrows and eyelashes, protect the eye from the direct rays of the sun but not from snow-reflected rays. Such protection can be accom- plished only by wearing dark glasses when outside in Arctic daylight. If one's sunglasses are lost or broken, new ones may be improvised by cutting a narrow horizontal slit in pieces of leather, cloth, or wood, and then tying same in front of the eyes. This has been done by Eski- mos for many years and will give adequate protection against snow- blindness. The U. S. Navy has developed in the Antarctic a sunglass which not only prevents snow-blindness but increases contrast and depth perception under "white-out" conditions. Carbon monoxide is a deadly peril to man living in the Arctic. In small, tight shelters, heated by poorly ventilated stoves, it causes more accidental deaths in the Arctic than any other hazard. Fig. 12 shows the danger levels of carbon monoxide acting over certain periods of time. But since carbon monoxide is an odorless, colorless, tasteless, non-irritating gas, one is seldom aware of these danger levels until he is in serious physical difficulty. A simple alarm system is needed to give adequate warning to unsuspecting victims before it is too late. In conclusion, it must be pointed out that the secret of good health in the Arctic lies in prevention, not cure. It is in this direction that our research should be oriented. Simple protective measures, which anyone can apply, will keep a person in good health and physically effective. Only the untrained and undisciplined individual becomes unfit as the result of living in the Arctic. s I No Effects Just Perceptible ^T DANGEROUS DANGEROUS Death No Effects No Appreciable Effects Perceptible Ml HEADACHES NAUSEA DANGEROUS Death No Effects No Appreciable Effects No Appreciable Effects A(s&r DANGEROUS Death No Effects No Appreciable Effe«ts No Appreciable Effects Appreciobk Effects HEADACHE! NAUSEA DANGEROUS No Effects No Appreciable Effects No Appreciable Effects K* ABpreeioM< "Bar HEADACHES NAUSEA 0 PPM. 50 PPM • Pain per million I00 PPM 200 PPM 400 PPM I000 PPM DANGEROUS FIGURE 12. Physiologic effects on man of different concentrations of carbon monoxide. 90

References 1. Blair, E. A. and Gottschalk, C. W., Performance of Signal Corps personnel under Arctic conditions, USAMRL Report, Fort Knox, Ky. (1947). 2. Davis, T. R. A., Johnston, D. R., and Bell, F. C., Seasonal acclimatization to cold in man, USAMRL Report No. 386, Fort Knox, Ky. (1959). 3. Blair, J. R., Acclimatization to cold, in Trans of 1st (1951) Cold Injury Con- ference, 248 pp., Josiah Macy, Jr. Foundation, New York (1952). 4. Eisner, R. W. and Pruitt, W. 0., Jr., Some structural and thermal character- istics of snow shelters, Arctic, 12, 20 (1959). 5. Johnson, R. E. and Kark, R. M., Environment and food intake in man, Science, 105, 378 (1947). 6. LeBlanc, J. A., Effect of environmental temperature on energy expenditure and calorie requirements, J. Appl. Physiol., 10, 281 (1957). 7. Welch, B. E., Buskirk, E. R., and lampietro, P. F., The relation of climate and temperature to food and water intake in man, Metabolism, 7, 141 (1958). 8. Siple, P. A. and Passel, C. F., Measurements of dry atmospheric cooling in subfreezing temperatures, Proc. Am. Philos. Soc., 89, 177 (1945). 9. Orr, K. D. and Fainer, D. C., Cold injuries in Korea during winter of 1950-51, Medicine, 31, 177 (1952). 10. Department of the Army Field Manual FM 31-70, Basic Arctic Manual (1951). CHAIRMAN EKLUND: Our next speaker, Dr. Otto Edholm is well known to any of you who have been concerned with human physiology in cold environments. He has been a leader in the United Kingdom in civilian and military research in cold adaptation. He has written extensively on the subject and is a recognized author- ity in the field. At present he is a Director of the Division of Human Physiology at the National Institute of Medical Research in London. It is my privilege and pleasure to give you Dr. Otto Edholm. PHYSIOLOGICAL PROBLEMS IN POLAR REGIONS O. G. EDHOLM National Institute for Medical Research London, England This paper will deal briefly with some aspects of Polar physiology as they have been studied in recent years by members or associates of the Division of Human Physiology of the British Medical Research Council. Mention will also be made of plans for future work. There has been developed a close connection between the Medical Research Council and the Falkland Islands Dependencies Survey (F.I.D.S.). The survey, which is under the direction of Sir Vivian Fuchs, has maintained for many years a number of bases on the Antarctic Continent, in Graham Land. Recently F.I.D.S. has also taken over the base at Halley Bay orginally established by the Royal Society for the International Geophysical Year (see map, Fig. 1). A number of the medical officers recruited for F.I.D.S. have been trained at the Division of Human Physiology, several members of which have polar experience. Dr. H. E. Lewis spent a year with the British North Greenland Expedition. Dr. R. Goldsmith was medical 91

Horseshoe Island X Shackleton Halle>\ Bay FIGURE 1. Map of Antarctic Continent indicating some of the bases at which physiological observations have been made. officer for the first-year party of the Trans-Antarctic Expedition. Dr. H. Wyatt spent two years in Graham Land. The medical officers spend one to two years in the Antarctic making observations on members of their base. Adequate radio contact is maintained, and problems arising in the course of the investigation can be discussed. On return from the South, the results are worked up in the Division of Human Physiology. In this way a considerable volume of data has been acquired, although most of these data deal necessarily with very simple measurements. Experience in the problems of Polar physiology was gained by Lewis and Masterton, who formed a joint Physiological Medical Team with the British North Greenland Expedition of 1952-54. A number of different factors were studied and included Basal Metabolic Rate; haemoglobin, cell counts, cell fragility; physical fitness assessment, energy expenditure and food intake, body weight and skinfold thick- ness, and sleep rhythms. The expedition was completely isolated for the greater part of the year, but in the summer a relief party was 92

flown in to replace some 7 men of the original 29 who were returning to England. This made possible some useful comparisons between first and second year men. In the Antarctic bases the men are isolated for periods of nine to eleven months. In certain cases relief has been difficult owing to ice conditions. Generally there are a number of men who stay over for two years, thus there is usually a mixture of first and second year men. There are considerable advantages for physiologists in Polar regions. There is a small community physically isolated except for radio for the greater part of the year. Subjects are available for measurement during all of this time, except when on sledging parties. Furthermore, the physiologist can be on the job the whole time. This has made it possible to get extended series of observations which are virtually unique. For example, the measurements made in Greenland on weight changes and skinfold thickness can be quoted (1). Regular records were kept of 26 men for two years. There was evidence of a small seasonal change in body weight and subcutaneous fat thickness. However, no comparable data covering such a range of observations in temperate countries have been found, and it was difficult to know whether a seasonal change in body weight might be a usual observa- tion. A check was obtained by examining the average body weight of recruits on entry to the British Army. Intakes of recruits were re- ceived every two weeks throughout the year. Average body weight was similar in all intakes and there was no evidence of a seasonal trend. This example is intended to illustrate the fact that extended series of simple observations on normal human subjects are difficult to obtain and that there is a valuable opportunity offered to make such studies under Polar conditions. The work which has been done so far has been mainly concerned with attempts to obtain evidence of acclimatization to cold in man. Apart from local response of the hands and feet to cold, where adap- tive changes do appear, the results as far as acclimatization is con- cerned are negative. Some of these results are briefly discussed in a recent report (2). It gradually became evident that much more detailed knowledge was required of the life and activities of men in these Polar bases. In par- ticular, answers were needed to such questions: "How cold do men become in the Antarctic?" "What is the degree and duration of cold exposure?" "How does the environment affect the performance of physical work?" "How hard do men have to work?" Dr. Norman has completed a year of such studies at Halley Bay, and a similar investigation was carried out by Dr. Gumming at the Argentine Islands off Graham Land. Both of these bases are essen- tially static, being concerned with meteorology, high altitude physics, some geology, and surveying. No long sledging journeys were made— at Halley Bay a few trips were made with manhauling sledges as there were no dogs; in the Argentine Islands outdoor activities were largely 93

recreational and included skiing. A full account of the work will be published later, but some of the main findings which are of importance in the study of human physiology can be briefly described. Four sub- jects were studied throughout the year for a day each month. A com- plete time and motion record was kept of activities and of time spent indoors and outdoors. In addition, the environmental conditions inside and outside were measured, including temperature and windspeed. Each subject wore a vest consisting of a resistance thermometer woven into a garment so the sub-clothing temperature could be measured at frequent intervals (3). Similar studies were also made during sledging journeys. The year was divided into "dark" and "light" months, i.e. May to October as the dark or winter months and November to April the light or summer months. The average time spent outside was 13% in the summer and 5% in the winter at Halley Bay. In the Argentine Islands, outside time was 8% in winter and 15% in summer. Though the time out of doors was related to outside temperature, it was more closely related to windchill. Except for an emergency, outside activity ceased as soon as the wind speed reached 15 knots. The average tem- perature inside the base hut was 20°C, and the mean exposure tem- perature for the whole year was 13 °C at Halley Bay. In the Argentine Islands the latter temperature was lower (11.5°C), and the bunk room temperature was much lower than 20 °C. The sub-clothing tem- perature, which is almost identical with skin temperature (4), aver- aged 32.2°C at Halley Bay and 32.5°C in the Argentine Islands. The figures obtained at Halley Bay and in the Argentine Islands are very similar although there is a difference of 10° in latitude. The computed energy expenditure is higher for the Argentine Islands than for Halley Bay, the annual average being 3,500 kcal and 3,300 kcal, respectively. It was possible to be out of doors skiing and climb- ing for rather longer periods in the Argentine Islands than in Halley Bay, and this accounts for the higher energy expenditure. The energy expenditure during sledging was estimated to be approximately 5,000 kcal which is nearly identical with the estimate made by Masterton, Lewis, and Widdowson (5) for sledging in North Greenland. The sub-clothing temperature during sledging was irregu- lar and tended to fall when activity diminished. Shivering out of doors was not observed. Some tentative conclusions can be drawn from these observations of Norman and Gumming and from other data obtained at other Antarctic bases. At static bases, the time spent out of doors is short and is related to windchill. Men are adequately dressed for the climate and do not experience body cooling except for brief periods. Under the conditions studied, the degree of cold exposure is unlikely to be adequate to stimulate any physiological adaptation to cold. Estimates of energy expenditure give figures which are comparable with those of military personnel both in the United Kingdom and the 94

U.S.A. Sledging is an activity with a high energy expenditure. How- ever, it can be provisionally concluded that the relatively high energy expenditure, and hence high food intake, is due to the demands made by the environment and the work required to meet these demands, rather than a direct effect of cold stimulating metabolism. The problems of physical work in Polar regions have only been studied indirectly. The opinion of those who have made time and motion studies is that heavy work, such as load carrying and dig- ging, is carried out as efficiently in Polar as in temperate climates. With high wind and drifting snow, work can be slowed because snow can accumulate in apertures of the clothing. Manipulative work, in which delicate work with the hands must be done, is frequently much slower in the cold. The ability to work in the cold with bare hands or wearing thin gloves varies greatly among individuals. As an example of the slowing of fine work, Norman describes the taking of mag- netic observations by two men using an instrument which required delicate manipulation. The particular operation was usually com- pleted within 15 minutes at temperatures about — 20°C. On one occasion when the temperature dropped to — 38°C, the same opera- tion required 50 minutes. It has been suggested that even with fine manipulative work it is not the time spent on the job itself which becomes longer, but that, as temperatures fall, an increasing length of time is spent in rewarming the hands. Mackworth (6) has shown that local adaptation to cold can develop in the hands, and this finding has been confirmed by Massey (7) in the Antarctic. Further work is needed, however, to establish how such local adaptation improves the ability to work in the cold. A moderate number of subjects will be required for such a study because of the wide variation among individuals. This brief account of some of the work currently being undertaken by the Division of Human Physiology in the Antarctic has been given as an introduction to the wider problem of the range of physiological investigations which could fruitfully be carried out in Polar regions. Some suggestions concerning further work are therefore given. 1. Repetition of activity and exposure study. The work of Norman and Gumming indicates very convincingly that man effectively shields himself from a cold environment by use of clothing and shelter. In particular, the time spent out of doors is short. These findings need to be checked by studies at bases where more traveling is done and where outside activity is likely to be much longer in time. It would clearly be important for such studies to be made at U.S.A. bases as well as British ones. Such studies would gain in value if agreement could be reached on the methods to be employed. 2. Problems of outdoor work in the cold. A comprehensive review of the problem of hand protection and hand function in the cold was published in 1957 by the Advisory Board on Quartermaster Research and Development (8). This report was based largely on laboratory 95

work and field trials of handgear. It is still necessary to make more observations in the field to determine the actual conditions under which work is done and the limitations experienced. 3. Windchill. The evaluation of meteorological data in terms of the cooling effects on man is still far from adequate. Siple's windchill scale has proved to be of considerable value, but a revision is overdue since it is clear that the effect of windchill is exaggerated at least in the larger figures for windchill. 4. Energy expenditure and food intake. Dr. Austin Henschel has already discussed the food intake of men in the cold (see p. 68). His conclusion, which is shared by many, was that there is no demonstrable effect of cold climates on food intake. However, there does appear to be a need for further investigation. The surveys described by Dr. Henschel were made on men under carefully controlled conditions. The activity pattern was in most respects dictated. In addition, infor- mation is needed on what men actually do in the Arctic or Antarctic and on what they eat under such conditions, particularly over long periods. Such a study would be difficult and laborious since it would require a sizable team to spend a great deal of time in the field. It is undoubtedly important to get such information if only to resolve the present controversy on the importance of cold on food intake. The figures available from studies at Polar bases indicate that energy expenditure and food intake are moderately high. If Norman and Cumming's results are confirmed at other Polar bases, then the question of the effect of cold on food consumption becomes academic. If cold exposure and body cooling are as limited as Norman and Cumming's findings indicate, then further studies may be needed in which the degree of cold exposure is deliberately increased. There are clearly two problems: a) What happens under existing conditions at Polar bases? b) What might happen under conditions of emergency, including military, when the degree and duration of cold exposure may be severe? 5. Weight change and skinfold thickness. A number of studies at different Polar bases have shown that there is a small seasonal fluctua- tion in body weight and skinfold thickness, rising in the winter and falling in the summer (1). It would be interesting to know if similar changes are found in bases manned by personnel from the U.S.A. 6. Water balance. The assessment of calorie balance should include measurement of water balance and sodium chloride balance. Prelimi- nary observations indicate that there are considerable falls in body weight during sledging journeys. There is some evidence that the fall is due to water imbalance. This preliminary finding requires con- firmation and further investigation. 7. The following problems have been studied only briefly or in particular circumstances and warrant more detailed work. a. Stress of Polar environment. There are many references on the effects of Polar life; a large number consists of assessment of 96

selection techniques. Actually, relatively few studies have been made in Polar bases by physiologists on men. This general field of work overlaps with psychological research. There are a number of ways in which the field can be divided. b. Effects of polar pattern of day and night. Lewis and Masterton (9) recorded sleep in North Greenland and showed that there was a disruption of the normal pattern both in periods of 24 hour daylight and 24 hour darkness. The average number of hours of sleep did not appear to alter with the seasons. During continuous daylight or night, sleep was not taken in one period but was broken into two or more periods separated by several hours. Similar findings have been re- ported from other Polar bases, however, the degree of disruption has usually been less marked. All the results agree that there is little, if any, seasonal change in sleep duration. On the other hand, there are frequent hearsay accounts of the difficulty experienced by men in sleeping during the continuous daylight of the summer. The phe- nomenon of "big eye", when the day length may be unwittingly extended to more than 24 hours, has been described. A repetition of the type of studies made by Lewis and Masterton, at U.S.A. bases, would be of great interest since there may be sociological and not physiological differences. The phenomenon of "big eye" does not appear to have been observed at British bases in Antarctica. c. Disturbance or changes in other diurnal rhythms. The effect of the pattern of light and darkness on body temperature and renal rhythms should be investigated. Lobban (10), who has studied renal rhythms at a high latitude (79°N) in Spitzbergen, observed a tem- porary disturbance in rhythm during the journey to Spitzbergen when the subjects just entered the zone of continuous daylight. The dis- rupted sleep rhythm and hence the irregular pattern of rest and activity is likely to affect the diurnal rhythm of body temperature. Other body rhythms, such as adrenocortical activity, may also be altered. d. Other evidence of stress. Eosinophil levels have been studied in the Antarctic by Simpson (11). Considerable changes were ob- served during sledging journeys and also on occasions at base. Simpson concluded, however, that these changes represented emotional re- sponses rather than a direct environmental effect of cold. The leader of the sledging party, who had a difficult and responsible task, had the largest change during the sledging journey. Pace and his colleagues (12) carried out a detailed investigation of men prior to departure for the Antarctic and during a part of their time in the Antarctic. Detailed urinary analyses were made. Relatively small but none-the- less suggestive changes were found, indicating an increased ad- renocortical activity. There has been mention of hypertension in members of Polar expeditions although no precise evidence appears to be available. Some accounts have been published of hypertension in labor-camps 97

in Siberia, including details of a marked rise in blood pressure on days of very severe weather (13, 14). A preliminary study of blood lipids at an Antarctic base is currently being undertaken. The ratio of protein, fat, and carbohydrate in polar diets (at British bases) is similar to those found in the United Kingdom, but the total intake of fat is relatively high since food intake is on the average greater. Further work in this field could well be correlated with studies of dietary intake and with investigations of stress. e. The effects of isolation. Psychological studies in the Antarctic have already started in American bases. Such studies could be of great interest if they were linked with physiological observations, including sleep and diurnal rhythms. 8. There are a number of practical problems related to physiology whose solution require work in several disciplines, including physiology. a. The desirable environment in Polar regions. What is the most satisfactory design of shelter, and what thermal conditions are re- quired in Polar buildings? In the past and probably in many cases today, carbon monoxide has provided a serious hazard, owing to the problems of heating with inadequate ventilation. The conditions ob- served indoors in temperate houses may well be the most suitable for Polar shelters, but these conditions are frequently difficult to achieve. Suitable compromises are required. There are data on conditions actually experienced in Polar bases, but it seems uncertain how far these data have been interpreted and can be used by designers. b. Clinico-physiological problems. The incidence of illness and trauma experienced in Polar regions needs to be evaluated. This evaluation would have been an academic task twenty years ago as the number who had been at risk was so very small. The total number of men who have spent three months or more in the Arctic or Antarctic is now sufficient to make such a survey worthwhile. The incidence of cold injury is of particular interest to the physiologists, especially in view of the frequent reports that frostbite is less frequent amongst those who have experience in the cold. c. Bacteriology and virology. The story of Polar explorers being completely free from upper respiratory tract infection until they come into contact with the outside world again, and then all get severe colds immediately, has sufficient basis to warrant investigation. It is clear, however, that there are many departures from the conventional ac- count, such as the failure to develop a cold at the end of the period of isolation and the development of various infections during the period of isolation. Although primarily a problem for the microbiologist and the allergist, the physiological aspects should not be overlooked. The mucosa of the upper respiratory tract overlies a well developed vascular network which plays an important part in temperature regulation. If adaptation to cold does take place, it seems probable 98

that the vascular reactions in the nasal mucosa may be considerably modified. If such modification does occur, then the local conditions for the proliferation of bacteria or viruses may be profoundly changed, d. Physical fitness. This subject is introduced with some trepida- tion since definitions of physical fitness are so inadequate. The question is: "How much physical activity is required of men stationed at high latitudes to maintain the optimum state of efficiency?" Perhaps to a greater extent than hitherto suspected, the polar life is an indoor, sedentary one. This situation is also true of the great majority of people living in more temperate climates; but the difference is that emergencies are not unusual in the Arctic, and the man in the hut has to get out and be active. How efficient is he likely to be ? Another way to ask a similar question is: "What effect does physical fitness have on the ability to adapt to low temperatures?" In field experiments on cold adaptation, Carlson (15) has shown that changes in physical fitness can mask the effects of cold. Further investigation of this difficult problem would seem to be of considerable interest to the physiologist and of practical importance to those interested in Arctic life. Summary The foregoing suggestions concerning future research are not put forward as a complete program. The ideas are based on discussions with many colleagues who have worked in Polar regions. Admittedly, the suggestions do not have much originality. Many of the problems have been tested in the field. A number of proposals have been rejected because of the difficulties of field work. The quality of simplicity should be considered of paramount importance in connec- tion with future studies. Unless it is essential to attempt some very complex research, field work must be technically easy and carefully designed. The main point, which has been implied throughout this paper, is: Polar physiology must be studied in the field. Laboratory work cannot substitute for field work. In the field, observations must precede any experimental work. We need to know, and at present we do not know, the details of activities, food consumption, and all the other aspects of life in Polar regions. Until we have these facts, laboratory work can be unrealistic and field experiments unrewarding. References 1. Lewis, H. E., Masterton, J. P., and Rosenbaum, S., Body weight and skinfold thickness of men on a Polar expedition, Clin. Sci., 19, 661 (1960). 2. Edholm, 0. G., Polar physiology, Proceedings of a Symposium on Cold Acclimation, Buenos Aires, August 5-7, 1959, Fed. Proc., 19, 3 (1960). 3. Wolff, H. S., A knitted wire fabric for measuring mean skin temperature or for body heating, J. Physiol., 142, 1-2 (1958). 4. Adam, J. M., Subjective sensations and sub-clothing temperatures in Ant- arctica, J. Physiol., 145, 26-27 (1959). 99

5. Masterton, J. P., Lewis, H. E., and Widdowson, E. M., Food intakes, energy expenditures and faecal excretions of men on a polar expedition, Brit. J. Nutr., 11, 346 (1957). 6. Mackworth, N. H., Finger numbness in very cold winds, J. Appl. PhysioL, 5, 535-543 (1953). 7. Massey, P. M. O., Finger numbness and temperature in Antartica, J. Appl. PhysioL, 14, 616-620 (1959). 8. Protection and Functioning of the Hands in Cold Climates, Advisory Board on Quartermaster Research and Development, National Academy of Sciences—• National Research Council, Washington (1957). 9. Lewis, H. E. and Masterton, J. P., Sleep and wakefulness in the Arctic, The Lancet, 1262-1266 (June 22, 1957). 10. Lobban, M. C. and Simpson, H. W., Diurnal excretory rhythms in man at high latitudes, J. PhysioL, 154 (1961). 11. Simpson, H. W., M.D. Thesis "Eosinophils and stress", Edinburgh (1960). 12. Pace, N., et al, The physiological stress produced in men during an Antarctic expedition (Operation Deepfreeze I), Final Report Sub-Contract ONR-170 between the Arctic Institute of North America and the Regents of the University of California, Department of Physiology, University of California, Berkeley (June 1959). 13. Ott, H., Hypertension and sub-Arctic climate, Die Medizinische (Stuttgart), 22, 872-876 (June 1957). 14. Hohorst, H. E., Occurrence of high blood pressure in northern climates, Die Medizinische (Stuttgart), 1, 48-49 (January 1957). 15. Carlson, L. D., Human tolerance to cold, J. Occup. Med., 2, 129-131 (1960). CHAIRMAN EKLUND: Our next speaker, Dr. John Meehan, spent almost three years in physiological research at the AeroMed Laboratory at Ladd Field, Alaska, and is now Associate Professor of Physiology at the School of Medicine at the Uni- ersity of Southern California. His topic today is "Auxiliary Heating". Dr. Meehan. AUXILIARY HEATING JOHN P. MEEHAN University of Southern California Los Angeles, California The soldier's ability to operate effectively in very cold environ- ments is largely determined by the performance of the clothing he is wearing. This clothing must not only provide the physiologically acceptable personal environment for the man, but must also permit him to perform efficiently all of the many tasks required of him. Providing adequate cold weather protection for the hand and at the same time maintaining useful and desirable dexterity presents a particularly difficult problem. The subject of this paper is the special problems associated with hand protection in cold environment. The blood circulating through the tissues of the hands and fingers is the primary source of heat for these tissues. When one is exposed to a cool "personal" environment, the blood flow to the hands and feet is reduced. The consequence is that the hands and feet, particularly the fingers and toes, will cool more than any other part of the body (1). It has been observed that when finger temperatures drop below 100

60 °F the loss in manual performance is very large and painful fingers become a primary complaint (2). Further, tactile sensitivity is im- paired thus making the problem even greater (3). In addition to reduction in the heat supply to the hands and fingers resulting from general body cooling, significant and critical reductions in hand temperatures will occur when the adequately protected man removes part or all of his hand protection in order to perform some manual task. The problem here is particularly acute if materials of high heat conductivity, such as metals, are handled. The problem of hand protection is two-fold. If sufficient insulation is provided to give adequate protection, manual dexterity is impaired if not completely inhibited. On the other hand, to retain the highly desired manual dexterity necessitates a compromise in insulation resulting in good performance while the hand is warm but failing performance as the hand cools. The many physiological and psycho- logical problems associated with hand function and protection were all thoroughly discussed at a conference on the "Protection and Functioning of the Hands in Cold Climates" sponsored by the Ad- visory Board on Quartermaster Research and Development, Committee on Environmental Protection, held in Natick, Massachusetts, in April of 1956. Since the meeting, the Committee on Hand Functioning and Handwear has been actively interested in seeking workable solutions to the problem of hand protection. After consideration of all possible approaches, the Committee con- cluded that very serious consideration should be given to some type of heated handwear. The first set of requirements to be met by such an approach must satisfy the pertinent physiology of the hand. We have already discussed the reduction in blood flow to the hand that occurs in whole body cooling. The blood flow may be reduced to less than a teaspoonful per minute in the hand of the cooled individual. In terms of temperature, the same phenomenon may be expressed another way. Suppose a comfortably warm individual has his hand placed in a water bath maintained at a constant comfortable tem- perature, the finger temperatures will remain several degrees higher than the temperature of the water bath. If the person is cooled, how- ever, a reduction in blood flow to both hands will occur and the hand in the water bath will soon have the same temperature as the water bath (1). This principle is important in the matter of applying heat to the hand since the blood flow to the hand will not only supply heat, it also will dissipate excessive heat, within limits, of course. If heat is to be applied to the hand, it must be controlled thermostatically at the hand in order to avoid overheating of the tissues. Further, suitable attention must be given to proper distribution of the heat over the hand in order to avoid hot spots that may burn the adjacent tissue. If these criteria can be met, the physiological requirements of the method •would be satisfied. The technical feasibility of providing heated gloves depends on the 101

materials available for the actual construction of the gloves and also on the amount of power required. A heated glove should supplement, not replace the usual insulated handwear. The heating feature of such a glove assembly should be incorporated in the innermost component of a glove assembly in order to make the most efficient use of the applied heat. The amount of energy required will depend on the actual tempera- ture that is to be maintained for the hand as well as the amount of exposure of the inner glove assembly component to the environment. Further, the length of time the device is to be operative must be con- sidered. A rechargeable battery-type supply may be desirable for individual use. The individual may be able to use such an assembly for 24 hours and then recharge the batteries at some suitable point— perhaps a charger attached to a convenient vehicle. In some uses, the wearer may be able to receive the necessary power directly from the vehicle or equipment he is operating. Justification for this type of approach to the handwear problem must rest in better performance on the part of the soldier in carrying out his primary mission. Consideration must be given to the particular tasks required of the soldier in connection with the use of new types of armaments and equipment. The problem of maintaining useful functional hands may be a very important factor in determining the ultimate effectiveness of any such new pieces of equipment. With the improvement in the technology of providing small power sources, it is entirely feasible to think in terms of providing heated handwear to at least a limited number of field personnel. Presently, there are available small rechargeable batteries with good perform- ance characteristics. In the future we may look toward the develop- ment of energy cell and other similar devices that should provide very small lightweight sources of electrical energy. In view of the technical developments that we can foresee at the present time, it is indeed a worth-while venture to look ahead towards the practical design of heating garments for use in very cold weather. References 1. Meehan, J. P., General Body Cooling and Hand Cooling, Protection and Func- tioning of the Hands in Cold Climates, 45-62, National Academy of Sciences- National Research Council, Washington (1957). 2. Dusek, E. Ralph, Effect of Temperature on Manual Performance, Protection and Functioning of the Hands in Cold Climates, 63-75, National Academy of Sciences-National Research Council, Washington (1957). 3. Mills, A. W., Tactile Sensitivity in the Cold, Protection and Functioning of the Hands in Cold Climates, 76-85, National Academy of Sciences-National Research Council, Washington (1957). CHAIRMAN EKLUND: Our next speaker, psychiatrist Dr. David Rioch, has had many interesting experiences in the course of his career. I understand that he is the only person ever known to have given ulcers to a monkey. Seriously, though, Dr. Rioch has always taken an active interest in the problems associated with 102

isolated groups. Recently he completed a year with the Advanced Study Group at Princeton and at present is Chief of the Neuro-Psychology Division of the Walter Reed Army Medical Center. It is a pleasure to introduce Dr. David Rioch, who will speak on "Psychiatric Problems of Man in the Arctic." PSYCHIATRIC PROBLEMS OF MAN IN THE ARCTIC DAVID McK. RIOCH Walter Reed Army Institute of Research Washington, D. C. The present period of extension of human activities in the Arctic is one of rapid transition. It includes further need for study of the problems of personal survival and of training men to live in the cold, while at the same time introducing new problems, such as those of moderately large units maneuvering independently on the ice and of small groups living for months in isolation in permanent, circum- scribed shelters. Surveying reports from men who have experienced these different situations, one may summarize the major stresses on man in the Arctic as: the cold; the narrow margin between relatively comfortable effectiveness and disaster; isolation; and the resulting necessity for changing to a new set of personal values and of patterns of interpersonal relations. The more isolated the group with modern equipment, the more important is the problem of the changed social conventions. Two rather dramatic psychiatric problems are frequently referred to as possible major concerns. One is the possibility of a member of a small, isolated group becoming psychotic; the other is the report that in isolation "normal" people develop hallucinations and delusions. With regard to the probability of the development of psychosis, it appears that the threat of physical danger is not a precipitating factor. Colonel Albert J. Glass, U. S. Marine Corps, and his associates pointed out that the rate of psychosis in the Army varied negligibly between two and three per 1,000 men per year, over a long period, regardless of war or peace (1). The success of the Navy psychiatric screening program for Antarctica and other evidence (2) indicate that incipient psychotic symptoms can be recognized reasonably accurately. Finally, the availability now of tranquilizing drugs greatly reduces the problems of managing over-active, disturbed behavior if by chance it should occur. One may conclude that with reasonable care psychosis does not represent a probable hazard for man in the Arctic. It is clear that under certain experimental conditions of isolation, sensory deprivation, and sleep loss normal people may develop hallu- cinations quite rapidly. Similar phenomena have been reported by people under other circumstances such as solitary sailing, isolation in a meteorological station, trapping, and so on. In such reported experi- ences it is evident that the symptoms did not prevent adequate func- tion. In some cases one is inclined to suspect that the hallucinations 103

represented a bland, symbolic structuring of the environment, almost as a substitute for a threatened breakdown, with disorganization of symbolic behavior and resulting panic. However, when two or more people are together hallucinations do not occur. The dramatic symptoms of psychosis, hallucinations, and so forth, thus do not appear of importance. What is of importance to life, however, and sometimes to the lives of men in rescue parties, is a phenomenon which is rarely mentioned. It was called to my attention by Colonel Frederick W. Timmerman, U. S. Marine Corps, who has had extensive experience in cold weather medical problems. The symptom which costs lives was known earlier but has been more frequent with improved mechanical transportation. It consists essentially of a form of distorted thinking in which, even at times without any warning sensation of "anxiety", a decision is made to act and is promptly put into effect. The disaster results from the decision being the wrong one. The only indication of "panic" may be the failure to scan the total situation and to assess the probable outcome of different possible plans. The symptom appears under conditions in which there is a sudden change in the anticipated course of events, as in the forced landing of a plane, the breakdown of a sno-cat, and so on, far from a fixed installation. Even carefully indoctrinated men who have had Arctic experience, when precipitated from modern, mechanized comfort into the Arctic waste may decide to "walk out". This decision is often made despite knowledge that they could not make the trip on foot and is also put into effect without taking- adequate bearings of direction. For many men the life-long tendency "to get home" appears to wipe out knowledge that the machine is the best shelter they have until help comes and that it takes time and preparation to travel in the Arctic. The type of disorganized think- ing in which the world is seen and recognized, according to an over- simplified formula derived from earlier experiences and determined by wishes rather than facts, is not a problem on which consistent studies can be performed. The anecdotal evidence is convincing, how- ever, and analogous phenomena are known to occur in other situations involving sudden, unexpected, and threatening change. Thus, well trained surgeons have been known to sew up dirty wounds during the stress following a disaster such as a tornado. Instead of cleaning the wound and leaving it open (in order to prevent buried infection), they acted as though they wanted to deny the problem. This kind of failure in thinking can be greatly reduced by rehearsed planning for emergencies. Another psychiatric problem which is peculiar to the transition period of Arctic travel and mobility is often labelled "carelessness". It consists of pilots and drivers of vehicles with heated cabs starting on a mission or trip without their cold weather equipment. Even a minor repair job can prove fatal without adequate protection from the cold. The attitudes which result in this type of carelessness vary con- 104

siderably but always include a lack of personal commitment to the objective of the outfit to which the man belongs. A variety of theo- retical motives may be invoked to explain this behavior, such as un- conscious suicidal wishes, needs to prove that someone will take care of you, a magical sense of omnipotence to cover up fear of taking responsibility, and so forth. By and large, all men are potentially capable of these attitudes at some time in their lives. Practically, however, such potentialities are reduced to negligible significance by serious emphasis throughout the outfit on the relevant factors in the situation and the development of reasonable expectations of accom- plishment by all echelons of command. In military units there is a clearly observable difference between commanders who give orders, as it were, from a distance but have their minds on other things, and commanders who allow it to become known that they know what is important under the circumstances and that they are genuinely concerned with it. There is little difficulty in pointing out the logic of protective measures, but it may take considerable effort to establish a general expectation in the unit that certain minimal requirements will always be met and that failure to meet these minimal requirements constitutes a threat to the group integrity, i.e., a threat to the safey of one's immediate associates. The importance of the personal attitude of the commander toward preven- tive measures was discussed by Colonel Eugene R. Inwood, U. S. Marine Corps, at the Symposium on Stress held at the Walter Reed Army Medical Center in 1953 (3). In an infantry division in France in World War II, recommendations were made at Division level for prevention of trenchfoot. One regimental commander transmitted the recommendations verbatim but was privately of the opinion that the men would not carry them out and that they could not be enforced. In the succeeding period trenchfoot remained a major cause of loss of personnel in his regiment. The commander of the other two regiments transmitted the recommendations as commands, with subsidiary com- mands for foot inspection, and so forth. The message thus implied personal involvement in the effectiveness of the group and in the importance of maintaining this effectiveness. The result was a marked decrease in rate of trenchfoot under conditions similar to those in which the first regiment showed an increase. Now that larger numbers of troops are being sent to the Arctic, either to fixed installations or on maneuvers, it seems likely that problems due to neuroses and—often of greater nuisance value—due to the "acting out" and asocial symptoms of the so-called character and behavior disorders will be more frequent than when the units were smaller. In part this is a problem of selection, but to a larger extent it is due to the greater efficiency with which a small group, as compared with a large one, can develop intrinsic personal support and control measures. The neurotic symptoms and the forms of asocial behavior will inevitably be characterized by the environment. For 105

example, an epidemic of cold injury is likely to be accompanied by neurotic complaints of "cold feet" which are regarded by the sufferer as frostbite. Further, it is highly unlikely that AWOL will be of significance, but "accidental" to "premeditated" self-exposure to the cold is likely under certain circumstances. A great deal of work has been done during and since World War II on these problems. The basic principles for dealing with them in combat psychiatry have been formulated and tested (4). Further, these principles have been applied to peacetime neurotic problems in camps (5) by the Mental Hygiene Consultation Service, and also to the problems of more efficient handling of military offenders (1, 6). In general, it appears useful for commanders to regard neurotic and asocial symptoms as an inadequate form of communication for the purpose of getting attention and personal support. Such inadequate communication appears to be increased by lack of clarity in transmission through the chain of command of the immediate objective of the group and of personal commitment to its reasonable accomplishment. These problems, however, are problems of the art of leadership, discussion of which is too general an area to take up here. It should be noted, however, that neurotic and asocial behavior tends to increase under moderate stress and discomfort, particularly if it appears that some- one else is receiving preferential treatment or assignments. Never- theless, when stress increases sharply, such as during rapid move- ment or under severe threat of survival and it is quite clear that no one can give the desired personal attention, these symptoms are much less likely to occur. Thus, they are unlikely to increase the danger when, as it were, the chips are down. The difficulties presented by inadequate performance of men on expeditions and isolated stations naturally result in the demand for methods of selection which will eliminate those who are potentially ineffective. A very good case can be made for the proposition that a completely effective selection procedure is impossible. Man lives and behaves according to his symbolic representation of the world around him. Over the course of time every man finds himself in situations with others that he handles less well and from which, under ordinary circumstances, he has socially very appropriate means of escape, so appropriate that neither he nor his associates notice them. Further, with time and experience the symbolic systems for processing social data, i.e., the data of living, change and become more efficient for certain purposes, less for others. Since we cannot predict the future circumstances, it is clear we cannot predict a man's future perform- ance in any absolute sense. We have to settle, therefore, for reasonable probabilities. The practical problem of selection of personnel reduces to three major questions. The first is the question of the ratio of the number of positions to be filled to the manpower pool available. The second is the accuracy with which the combined job-situation is known for 106

which selection is made. The last is the knowledge available on the man's previous performance. A study was conducted at the Walter Reed Army Institute of Research under the direction of Colonel Glass on the military performance of 505 men randomly selected on whom detailed psychiatric data were obtained by the Office of the Surgeon General during the first three weeks they were in basic training (2). These authors also reviewed the literature and discussed the general problem of selection. One may estimate that, with a large pool to select from and reasonably adequate information on which to base judgments, some 97 per cent of the selectees or more should perform satisfactorily or better. It further seems clear that an experienced psychiatrist can recognize incipient psychotic reactions and other serious disturbances which are likely to become manifest in the near future. The Navy psychiatric screening program for scientists and Naval personnel going to Antarctica during the IGY and since has proved effective in that no psychotic reactions have developed amongst the wintering-over personnel. None of these selection methods, how- ever, has been practically useful for differentiating between more effective and less effective men within the generally satisfactory group. William M. Smith (7) has reported on the selection procedures used by the U. S. IGY Committee for civilian scientists. A questionnaire devised by men with considerable Arctic experience was used. Answers were obtained from several people with personal knowledge of the applicants, and the data so obtained were analyzed and rated by a panel of judges. The ratings so obtained correlated very well with the perfomance of the scientists as reported by the scientific leaders of the respective Antarctic stations. The good correlation found indicates the importance of knowing the relevant factors for which selection is made. However, in this case the problem of motivation was very different from that involved in the average military unit under present conditions. It is clear that from the standpoint of selection and also from that of training, it is important to know what are the relevant stresses that must be dealt with. Since I do not have personal experience in studying this directly, my comments will be limited to certain general principles derived from behavioral research. A great deal of work has been done on the anatomical, physiological, metabolic, endocrinologic and other changes of animal and human organisms on exposure to cold, acutely and chronically. These studies have provided the necessary data determining the baseline of what has to be provided in the form of food, protective clothing, shelter, and so forth to support life in the Arctic and to permit additional activity. The question of cold acclimation has been of considerable interest and a number of authors are of the opinion that man does not have appreciable capacity in this direction (8, 9). The studies of Davis, 1960 (10), however, suggest that longer, more severe exposure demonstrates such ability in man as well as in animals. It is of interest 107

in this regard to note that many people living in cold climates are seldom seriously exposed to cold. Their immediate somatic environ- ments—inside their clothing and shelters—tend at times to present the problem of heat dissipation rather than retention. Physiologists have paid attention to the automatic homeostatic mechanisms, particularly since Walter B. Canon coined the term "homeostasis". Much less attention has been given to the capacities of animals and men to manipulate the environment in order to survive or to be more effective. Dr. Curt P. Richter is one of the few biologists who has called attention to the latter phenomena. He showed, for example, that rats could select an appropriate diet to compensate for deficiencies, a function which was lost if their taste nerves were cut. Wild Baltimore sewer rats of the same species failed to show this function under the psychological stress of being brought into the strange environment of the laboratory (11). Dr. Richter also showed that thyroidectomized rats would die if kept in a cold laboratory. When, however, they were provided with more nest-building material, they build nests larger than ordinarily and so provided shelters in which they survived (12, 13). Other evidence from field studies of animal behavior also demonstrates that survival depends on adequate manipulation of the environment and not merely on autonomic reflexes and so-called "instincts". This becomes increasingly true for the higher primates, and it is quite clear that manipulation of the environ- ment is a natural procedure, necessary for survival, and is not an accident of civilization nor a cultural artifact. In contrast, it has also been shown that the so-called automatic, homeostatic mechanisms can become disorganized and lead to illness and death. In experimental studies on monkeys at the Walter Reed Army Institute of Research a considerable number of animals in con- ditioned reflex experiments—in which the animal was under psycho- logical, but not under physical stress—developed peptic ulcers or other disturbances of the digestive system (14). The mechanisms of these diseases have not yet been identified, though it appears that inter- mittent stress alternating with relaxation is necessary and that hormonal changes may be involved which occur following and not during the stress (15). In a recent article Goldstein (16) has pointed out that hormonal effects on the tissues of the body depend on the proportions of hor- mones circulating rather than on the absolute amounts. He also shows that this secretion of hormones is increasingly under the control of the brain in the phylogenetically higher forms. This control provides greater anticipatory sensitivity but is also less stable. Dr. Richter (17) has demonstrated even more dramatic, lethal effects of psycho- logical reactions. Wild rats were trapped and brought to the laboratory for comparison of their behavior with the laboratory strain of the same species (grey Norwegian). They were subjected to a sequence of threatening and frustrating experiences. A cone-shaped bag of 108

black velvet was fitted to an opening in the cage and the rat chased into it. He was then held by head and body and the bag drawn back, inside-out, exposing his legs and face. The rat lay still and failed to struggle. The whiskers were cut depriving him of an important sensing device, and he was dropped into a cylinder of water. All of the wild rats died within seconds, swimming to the bottom of the cylinder. On examination no water was found in the lungs, so death was not due to drowning. Taking the electrical record of the heart showed that it suddenly slowed and stopped, probably due to a vagal reflex. Rats which were given graduated experience with the succes- sive procedures separately did not die but swam normally when dropped in the water. Dr. Richter's interpretation was that the threat and "hopelessness" of the situation caused the autonomic responses which killed the uninitiated rats. Experimental work in the field of lethal behavior patterns, whether overt or covert, is rare. However, experienced clinicians have many very convincing anecdotes confirming the occurrence of such behavior in humans. A comprehensive review of the literature concerning observations on humans has recently been presented by Herbert and Mead, 1961 (18) in a panel discussion of the psychophysiology of death. Attention should also be given to observations on combat, such as those of S. L. A. Marshall, Brig. General (ret.). Using a method of debriefing troops soon after particular episodes, he has accumu- lated a store of eye-witness reports of performance under extreme stress. Marshall (19) reports that the landing at Omaha Beach was accompanied by an extreme, abnormal weakness so that men drowned in two to three feet of water through inability to walk carrying their regular equipment. The common explanation of weakness as due to "fear" is not adequate, since "fear" is also credited in other situations as increasing a man's energy and strength. Further, there are no operational criteria for its measurement. No measurements of vital functions—such as blood pressure, blood sugar, and so forth—were made at Omaha Beach so that the physiological state of the men is not known. All one can say is that under the circumstances the body failed to support the brain. Whether or not the sudden exposure to extreme danger following a long passage in a landing craft, with physical inactivity and plenty of time for ruminative anticipation, is a matter of speculation. It may be noted, however, that equivalent factors would be involved in flying paratroopers from distant fields into the Arctic for a dangerous jump. I should like to make two comments on the general problem of "the support of the brain by the body" which can also be formulated as "the maintenance of efficiency under changing condition and increas- ing load". The first concerns the rather widespread concept that the autonomic and endocrine control of visceral functions—in other words, the internal household working of the body—is innate and behaves as a set of stereotyped reflexes, influenced only by emotions, 109

attitudes, and anticipation of reward or punishment. This concept is probably too extreme. A great deal of work in Russia and scattered observations in Western laboratories indicate that the nervous mechanisms controlling the cardiovascular, visceral, endocrine, and other support systems can learn and change their patterns of func- tion so as to more efficiently meet particular stresses and loads im- posed by the environment. It seems probable, for example, that much of athletic training is to "teach" the autonomic system a pattern of activity for supporting a program of action. Training for the 100-yard dash is thus quite different from training for the marathon. The second comment is related and concerns the importance of attitudes in accomplishing the transition from life in the temperate zone to life in the Arctic. Even with some 10 billion nerve cells in his brain, it is impossible for man to handle all the separate "bits" of information arriving from his sense organs. Hence, he integrates vast quantities of data into relatively few patterns which may be thought of as "images" or conceptual models. The process of integration of data into "images" in large part is controlled by previous experience, including what was done in the earlier experience and the resulting pleasure or pain, success or failure. A man's images or conceptual models thus both determine his perception of his situation in the environment and also define his plan of action. The "image" of cold and snow which a man brings with him to the Arctic may be very inadequate. In Washington, D. C., for example, a child observes that six inches of snow is so unmanageable that the schools are closed. He also learns, however, that it is so unimportant that he is supposed to play in it. This is in sharp contrast with the "images" of winter developed by children raised in northern, rural communities where respect for the cold and utilization of the snow and ice for travel in hunting or trapping are part of everyday living and on which social status as an adequate person depends. In southern climates a boy gets concurrence from his peers in his unrealistic attitudes toward cold, but not in unrealistic attitudes towards swimming, care of horses, checking water supplies, and so forth. On coming into the Arctic a man from a warm climate has to learn a new set of "templates" for processing the routine data of living. If he has previously learned to learn—that is, to commit himself to the environment and to act with it, rather than fearing-fighting it— the transition period is rapid. Otherwise his transition requires the supportive pressure of his group associates. When man commits him- self to a group and to the group objectives, he demonstrates his sense of identification by learning and using the conceptual models which the group uses. Obtaining a man's commitment to a mission in the Arctic is probably the major task of cold indoctrination. Together with information on the routine of living in the cold, it also reduces apprehension and other attitudes which interfere with his cardio- vascular, respiratory, metabolic, and other physical adjustments to 110

the environment. It is always surprising how quickly physical adjust- ments to a new set of environmental factors can be accomplished when not interfered with either by misinformation or by fearing-fighting the situation. Attitude thus facilitates or inhibits acclimation and in this sense may be regarded as of prime importance. A social psychological study of personal and group problems in several stations in Antarctica has been published recently by Rohrer, 1960 (20), and his findings are generally substantiated by other, less formal evidence. Rohrer describes four independent factors which determine different aspects of the social-psychological stress encoun- tered. The first is the accessibility of the station, i.e., whether it is difficult but feasible to reach at any time; whether help is available in emergencies; or whether for a period of time it is completely cut off. The second factor is the size of the group involved, the smaller the group the greater the necessity for maintaining workable per- sonal relationships with all the other members; the larger the group the greater the freedom of personal association, but also the greater the need for formal organization. The third factor is the size of the living and work areas which determines both the possibility of privacy when desired and the efficiency of operation. The fourth factor is danger of extreme cold and the necessity for constant vigilance to maintain the safety of the installation, supplies, and men. This prob- lem of vigilance becomes more acute in certain situations such as occur with a small group traversing dangerous terrain. In addition to the factors noted by Rohrer, attention must be given to the composition of the group. The structure of a group as meas- ured by its performance is determined largely by the mission or objectives of its members, separately and collectively. In small groups in isolated stations, survival to return "home" becomes dominant and produces a remarkable degree of control of interpersonal relations. The necessity for limiting the ordinary social freedom of direct ex- pression of attitudes results in a closed system, as it were, of intra- group communication with its own values and nuances, its own private language. This inevitably results in an attitude of "us against the world", since the connotations of words change and even direct verbal communication by radio with "home" becomes limited to more general "facts". Under these conditions the customary "planning for the future" must be held in abeyance, a result which is of particular stress for upper echelons of technical and professional personnel. In our presently expanding bureaucratic system the need for reliable friends in the organization at home is acutely sensed. The question "Have they forgotten me at home?" is one of the major modes of expression of the stress of separation, isolation, and limitation of freedom of action. Other aspects of the role of objectives are important from the standpoint of conflicting interests within the group itself though these aspects are subordinate to the requirements for survival. There 111

are great differences in attitude between the professional explorer for whom an expedition is part of his life career; the scientist who is going for the purpose of getting particular data and who is dependent on his apparatus working; the trained technician who has a well denned job; less well trained men who volunteer for a curious variety of "reasons" but which amount in general to "being there" rather than to any clearly definable function; men who are ordered to the Arctic "for training" or only to maintain installations; and so forth. The scientist who wants additional help with recalcitrant equipment and personnel who are only concerned with establishing and main- taining the installation can easily set up an anxious dichotomy in a group with a good deal of limited antagonism. It is of interest that, although such groups often express considerable distress and resent- ment, limited antagonism can prove to be a strong unifying system against external dangers; and the sense of hostility and distress may be unpleasant, but does not necessarily curtail superior productivity during a tour of a definitely limited period of time. The problems of divergent objectives obviously are reduced in small groups (12 men or less) of technically trained personnel. In such "face-to-face" groups with well defined missions, leadership becomes of little importance and consensus on the course of action can be readily achieved. With groups of 20 to 30 men, vertical channels of communication (command) become necessary but can be maintained by personal, informal contact. In groups of 50 or more, vertical and horizontal formal channels of communication need to be organized. Since the objectives of the subdivisions of such groups vary, the problems of what is called "leadership" also vary, and no inclusive formula will perform the magic which is often wished for from so- called "leadership" with a capital "L". This is an area of human behavior which needs much more study and includes such ques- tions as: What information is relevant at different echelons? What informal channels of information are necessary for maintaining the reliability of the formal channels ? What feed-back from the periphery is relevant to the course of action ? How can such problems be opera- tionally defined to permit testing and development before they become critical ? The facts that the margin of safety is much narrower in the Arctic and that Arctic operations require more specialized equipment and therefore more diversity of technical training make the problems of group organization more acute than they are in temperate zones. Although current academic studies of human information processing and communication can provide certain guide-lines for investigating these problems, operational investigations with careful reporting will be of greater significance in arriving at workable solutions. It appears quite clear that we may anticipate a considerable in- crease in the number and size of permanent installations in the Arctic, with improved communications and other facilities. Under such con- ditions it is inevitable that we will take a great part of our culture 112

with us. It is to be anticipated that the conventions and mores we take with us—including our neurotic and psychotic problems—will be modified by local factors but will more resemble the forms we have already developed than anything new. The question has been raised as to the problems arising from the introduction of women to life in the Arctic. This is basically a question of cultural roles and limita- tions imposed on certain roles by the environment. In permanent in- stallations, however, there is no reason to anticipate problems other than those encountered in isolated communities elsewhere. These problems are relatively well known, and most communities accom- modate themselves sufficiently well so as not to interfere with the major purpose of the installation. It should be noted, however, that the American culture expects all its members—whether higher or lower in the organizational hierarchy—to react with consistent con- trol to practical necessities and also to react against undue discrep- ancies in the facilities for "self-expression" provided for different levels or for different units. In brief summary one may say that the present major psychiatric problems of man in the Arctic appear to be those of a transition period—transition from the era of the hero explorers who pitted themselves personally against the cold, isolation, and Arctic waste to the era when we will have virtually "taken our preferred climate with us" by mechanical means and developed a set of acceptable conven- tions and mores to go with it. We have started on the latter bul; still have to prepare a considerable proportion of our people in the Arctic in the lore and for the functions of the former. In this transition period we need operational investigation with careful records of the transmission of information through groups operating under dif- ferent conditions, since organizational effectiveness depends on clear information. This includes the vertical, reciprocal transmission of commands-responses and the horizontal, reciprocal transmission of expectations-responses. Guide-lines for such operational investiga- tions can be provided by the social and behavioral sciences, but there is no magical solution either in modern "science" or in mythological "leadership". References 1. Glass, A. J., Artiss, K. L., Gibbs, J. J., and Sweeney, P. C., The Current Status of Army Psychiatry, The Am. J. Psychiat., 117 8 (February 1961). 2. Glass, A. J., Ryan, F. J., Lubin, A., Ramana, C. V., and Tucker, A. C., Psychiatric Prediction and Military Effectiveness. Part I. U. S. Armed Forces M. J., 7, 1427-1443 (October 1956) ; Part II U. S. Armed Forces M. J., 7, 1575-1588 (November 1956) ; Part III U. S. Armed Forces M. J., 8, 346-357 (March 1957). 3. Inwood, E. R., The Role of the Leader in the Prevention of Disease, Sym- posium on Stress (16-18 March 1953), p. 261-267, Army Med. Service Grad- uate School, Walter Reed Army Medical Center, U. S. Govt. Print. Off. (1953). 113

4. Glass, A. J., Principles of Combat Psychiatry, Military Med., 117, 27-33 (1955). 5. Bushard, B. L., The U. S. Army's Mental Hygiene Consultation Service, Symposium on Preventive and Social Psychiatry, Walter Reed Army Insti- tute of Research, Washington, D. C., 431-443 (April 1957). 6. Rioch, D. McK., Recent Contributions of Neuropsychiatric Research to the Theory and Practice of Psychotherapy, Eighth Annual Karen Homey Lec- ture, Amer. J. Psychoanal., Vol. XX, No. 2 (1960). 7. Smith, W. M., Scientific Personnel in Antarctica: Their Recruitment, Selec- tion and Performance, Psychol. Rep. Monograph (In press). 8. Hardy, J. D., The Physiology of Temperature Regulation, Bureau of Medi- cine and Surgery, Task MR005.15-2002.1, Report No. 22, Aviation Medical Acceleration Laboratory, NADC-MA-6015, U. S. Naval Air Development Center (June 1960). 9. Smith, R. E., Proceedings of the International Symposium on Cold Acclima- tion, Proceedings of the Federation of Am. Societies for Experimental Biology, Suppl. No. 5 (December 1960). 10. Davis, T. R. A., Experimental Cold Acclimatization in Man, Report No. 457 USAMRL Project No. 6X64-12-001-08, U. S. Army Medical Research Lab., Fort Knox, Kentucky, USA Medical Research and Development Command (December 19, 1960). 11. Richter, C. P., Domestication of the Norway Rat and its Implications for the Problems of Stress, Proc. Assn. Res. Nerv. Merit. Dis., p. 19, Baltimore, Md. Williams and Wilkins (1950). 12. Richter, C. P., Total Self Regulatory Functions in Animals and Human Beings, The Harvey Lectures, 38, 63 (1942-1943). 13. Richter, C. P., Behavioral Regulation of Homeostasis, Symposium on Stress (16-18 March 1953), p. 77-78, Army Med. Service Grad. School, Walter Reed Army Medical Center, U. S. Govt. Print. Off. (1953). 14. Porter, R. W., Brady, J. V., Conrad, D. G., Mason, J. W., Galambos, R., and Rioch, D. McK., Some Experimental Observations of Gastrointestinal Lesions in Behaviorally Conditioned Monkeys, Psychosom. Med., 20, 379-394 (1958). 15. Mason, J. W., Brady, J. V., Polish, E., Bauer, J. A., Robinson, J. A., Rose, R. M., and Taylor, E. D., Patterns of Corticosteroid and Pepsinogen Change Related to Emotional Stress in the Monkey, Science, 133, 1596 (1961). 16. Goldstein, M. S., The Psychophysiology of Death (Panel Discussion), The Physiology of Emotions, p. 209, Springfield, Illinois, Charles C. Thomas (1961). 17. Richter, C. P., On the Phenomenon of Sudden Death in Animals and Man, Phychosomat. Med., 19, 191 (1957). 18. Herbert, C. C. and Mead, N. E., The Psychophysiology of Death (Panel Dis- cussion), The Physiology of Emotions, p. 177, Springfield, Illinois, Charles C. Thomas (1961). 19. Marshall, S. L. A., The Soldier's Load and the Mobility of a Nation, Wash- ington, D. C., The Combat Forces Press (1950). 20. Rohrer, J. H., Human Adjustment to Antarctic Isolation, ONR Technical Report, Contract NONR 1530 (07), Washington, D. C. (1960). CHAIRMAN EKLUND: Now we come to our last presentation—the Summation of Man's Future Conquest of the Arctic. As you heard yesterday, Dr. Horvath was on the treadmill along with Sir Hubert Wilkins and, fortunately, survived. Now he is faced with an equally taxing situation—summing up this conference without any opportunity to read the papers prior to their presentation. Ladies and gentle- men, Dr. Steven M. Horvath. 114

SUMMATION: MAN'S FUTURE CONQUEST OF THE ARCTIC STEVEN M. HORVATH University of California Santa Barbara, California A stress much more extreme than exposure to cold is an attempt to summarize a conference without benefit of the manuscripts con- tributed by the participants. We are faced with the problem of de- ciding whether or not man has reached a point where he has become so familiar with the Arctic that he looks upon it with a certain degree of contempt—that the problems of Arctic living are no longer serious because man brings his own environment with him. He lives under ice or, in fact, may soon be living under the permafrost. His only exposure to the Arctic is the fact that he receives an Arctic clothing issue. He flies into the Arctic, wears his clothing from the plane to the point where he is stationed, and then stays there. Approxi- mately three or four per cent of his remaining time is spent going outside and taking pictures of himself to show the people back home that he has been in the Arctic. And to make it even simpler, he need not worry about the cold, the crossing of ice ridges, pressure ridges, or ice hills because he has with him a heating device which con- stantly clears his path. He flies along gracefully on new air-supported vehicles and never needs to walk any distance. He has nothing to do with the Arctic except as a transient who is there only because he has been, as Dr. Rioch pointed out, properly motivated, properly trained, and completely indoctrinated that he is competent to survive in the Arctic. This is one impression that you can obtain from listening to the papers presented in the last two days, i.e., that we have solved the problems of the Arctic because we have brought our environment with us. It is my impression that the major difficulty with any environmental situation is that those of us who are concerned with it are so im- pressed by our ability to manipulate the environment that we forget that the individual human being sometimes refuses to respond in the manner in which we anticipated. He not only fails to utilize properly the clothing and protective devices provided him, but also his attitude is wrong. The fact that he is there in the Arctic tells him that he has survived its rigors, and the fact of survival wrongly makes him feel that he is a superior being. Actually, it is quite possible that Man will one day again be completely at the mercy of the Arctic environment. He may be at the mercy of high winds, low temperatures, and much more continuous exposure to the low environmental tem- peratures than he is today. There are two points about the Polar regions which must be re- membered. The first is that the environment in these regions is not always as nicely defined as we have been led to believe. The second 115

is that we do not know Man's capability to perform and survive in the cold. With regard to definition of environment, our geographers spend a great deal of time looking at the environment of the Polar regions but have not really obtained the information which is absolutely necessary for Man's survival in the Polar regions. They know very little about the so-called microclimates—a term which is used so easily and with such great facility by all of us. They know little about the microclimate of a fully equipped man. Most of our geographic information and meteorological information comes from places where beautifully-arranged standard facilities are available to measure these things without inconvenience to the observer. But, the man, who will have to fight in the cold or will have to survive in the small environments away from these nice facilities, will have a different microclimate. It is absolutely necessary that in the future a very clear-cut delineation of the actual microclimate be obtained. This information cannot be obtained by the facilities which are presently available. We have to take the soldier into the field. We have to obtain analogous microclimate information on the trapper and ex- plorer actually working and living in this environment. Thus we can learn something about the stresses that are placed upon the human being. Concerning the ability to perform, how much time does a man actually spend in the Cold? With all these years of experience in cold environment, why have we had to wait to obtain information about the precise length of time a man can work at level "A," "B," "C," or "D" out in the cold? All of us here have experienced this difficulty of obtaining precise information. Such information is usually obtained from groups who are isolated with no real need to get out in the cold. We must obtain similar data from those people who must be in the cold and must perform in the wet cold or dry cold extant in Polar regions. Such information we don't have. We have utilized some vague observations obtained in temperate climates on the length of time a man works at certain tasks and the intensity with which he works. But we have not translated this into absolute information about Man in cold or semi-cold environment. No one can tell you, for example, how long a man can work continuously under a certain kind of en- vironmental stress. If I asked you to define clearly the length of time and the level at which a man can work continuously for two or three weeks, I think you would be hard put to give me any figures. In relationship, for instance, to Man's maximum capacity to work, what is the best pattern for a man to work in cold climate? Is it better for him to work at levels at which he will have energy expenditures of eight or nine times his basal metabolic rate for a period of 5 seconds, 10 minutes, 25 minutes, an hour? Or, is it better for him to be working at these metabolic rates or even higher with rest periods of 5 minutes, 116

20 minutes, 30 minutes? What do each one of these particular parameters of a working man in a cold environment do to all the protective devices that we are designing for him? Is the clothing we have today adequate and the best type of clothing? Is the nutritional standard we are setting up for the soldier the proper one? The last question was frequently raised in this conference. Although it is perfectly evident that we all have pretty strong convictions, are we correct in our interpretation in terms of nutri- tional requirements, in terms of clothing protection, in terms of thermal insulation? There is sufficient available information to prove all of us are somewhat wrong. But, we are basing this information not upon the man who is truly working hard day in and day out and may be faced with the necessity of trying to stem an invasion attempt where he may be caught out on the ice and in the snow just as some of our men were caught in Siberia after the first World War and as the Germans, the Russians, and the Finns were caught. We actually don't know how man will perform in cold environments because we spend too much of our time in setting up a series of problems and never providing the opportunity to get an answer. We actually do not take the information that we have and translate it into the kind of information which we need to solve this basic problem. How long can you keep a man out in the cold without his incurring certain degrees of frostbite or immersion foot? How long can he be out in the cold before a state of hypothermia develops? What degree of inefficiency can be tolerated in a man? Is efficiency improved by altering the thermal protection to his fingers or his feet in a situation which requires the utmost expenditure of energy? Is it important to know whether his feet might be cooler or warmer than they need be ? We really don't know these answers. We have become rather complacent about the development of our knowledge of Man in the Cold—dry cold, wet cold. I think that we have now attained a state of knowledge where we are beginning to see the need for real facts. So far we have developed vague and nebulous concepts. The Polar region is one that is never going to be conquered simply by moving in our thermal reactors, utilizing heat pumps and ground pumps, or easily transporting Man into and out of this area using primarily low-speed transportation close to the ground where the men are never actually exposed to the Cold. The only way that we can conquer the Arctic regions is to learn, again, a little bit from the past. Although I have never been an ex- plorer myself, I think that sometimes explorers made their own tasks much more difficult for themselves than they needed to. Yet, I think there is a certain amount of information which can be obtained by repeating some of the episodes explorers went through in order to determine by physiological, by psychiatric, and by psychological measurements the extent to which these men were placed under stress. If this stress is as great as we thought or if it is less than we 117

thought, then maybe we can organize those training programs that have been mentioned so frequently—the training, the indoctrination, and the development of high level motivation and confidence; com- petence in the necessary tasks. We have no basis upon which we can make these beautiful training programs work because our knowledge of what a man needs to do and how he can best function in the Arctic still is in its infancy. I think it is time we grow up. It is time to start thinking about cold environments, not from the standpoint of whether a man is ac- climated to the cold or not acclimated; nor whether he has adequate or new types of garments or new types of insulated boots. We have to think about it from the standpoint his being a sociological as well as a physiological instrument. This may become much more important than we realize because if it is true that we will be moving the prob- lem of sex into the Polar regions, then we may have other problems which have to do with successful maintenance of our field of superi- ority in the Arctic. We are facing a serious problem; namely, that the amount of effort we are placing upon Polar research, both in terms of the individual man and of men as a colony, is so small that we will be far behind in the race for survival in this particular area. I hope, if there is any- thing this conference has done is to bring forth the full realization that our knowledge is insufficient and much more work has to be done. 118