with  subdural  hematoma  will  experience  facial muscle weakness. TREATMENT—Ensure  that  the  patient  has a patent airway. If oxygen is to be administered, a  nasal  catheter  is  the  preferred  method  of administration. Manipulation such as suturing or setting  fractures  should  be  held  to  a  minimum, if possible, until the patient’s condition is stable. If the patient demonstrates extreme restlessness that may further complicate his or her condition, sedate   quickly;   otherwise   avoid   sedation.   DO NOT  attempt  to  stem  bleeding  or  the  escape  of fluids  from  the  ears  or  nose.  Tell  the  patient  to try  to  avoid  sneezing,  coughing,  or  blowing  the nose. Evacuate the patient immediately. Herniated Disk In  most  cases,  herniation  or  rupture  of  an intervertebral disk is the result of trauma. It may occur with sudden straining of the back in an odd position or while lifting in the trunk flex position. Herniation  may  occur  immediately  or  may  take years  to  occur.  Most  herniation  occurs  in  the lumbosacral  area  but  may  also  occur  in  the cervical  or  thoracic  regions. SYMPTOMS—Over   90   percent   of   all herniated  disks  occur  at  the  fourth  or  fifth lumbar interspace. There is pain upon palpation, and  the  patient  will  have  a  limited  range  of motion.   The   posture   of   the   spine   will   be abnormal due to the loss of curvature of the spine. The  patient  may  exhibit  mild  weakness  of  the  foot or extensor areas of the great toe. There may be impaired  sensations  of  pain  or  touch,  and coughing or sneezing may cause radiation of the pain  to  the  calf. TREATMENT—Place the patient on bed rest with  a  backboard  and  administer  analgesics  for pain. If possible, apply traction and prevent the patient  from  using  any  severe  physical  effort. Applications of heat to the area of tenderness is beneficial.  Definitive  treatment  of  herniated  disks will  normally  require  surgery.  Therefore,  evacuate the  patient  as  soon  as  possible. PSYCHIATRIC  DISORDERS Psychiatric  disorders  are  more  commonly encountered now than at anytime in the past. This is due in part to improved diagnostic techniques, changing  technology,  and  many  other  factors. Psychiatric   disorders   run   the   gamut   from anxiety  reactions  to  schizophrenia.  The independent   duty   hospital   corpsman   is   not properly  trained  to  treat  acute  psychiatric disorders.  He  should,  however,  be  familiar  with the signs and symptoms of psychiatric disorders and be able to manage those individuals who may be a threat to themselves or to other personnel. Classification of Psychiatric Disorders The   major   classifications   of   psychiatric disorders  are  neuroses,  psychoses,  and  personality disorders. .   Neuroses—Emotional   maladjustments that may impair thinking and judgment, but cause minimal  loss  of  contact  with  reality.  Neuroses often   manifest   themselves   in   the   form   of anxiety   reactions,   phobias,   and   obsessive depressive states. (Suicide is a definite possibility in   depressive   states.)   The   management   of individuals  with  neuroses  includes  removing  them from  stressful  environments,  listening,  and  the presentation  of  alternatives  versus  being  given advice. .   Psychoses—Mental  disorders  in  which mental functioning is so impaired that it interferes with  the  capacity  of  the  individuals  to  meet  the ordinary   demands   of   life.   These   disorders manifest themselves in the form of schizophrenia, psychotic   depression,   and   paranoid   reactions. Tranquilizers and antipsychotic medications may be necessary to protect the patient if immediate evacuation  is  not  possible. l   Personality   Disorders—Characterized   by relatively  fixed  and  inflexible  lifelong  reactions to  stress.  Common  personality  disorders  include hysterias  and  antisocial,  paranoid,  obsessive compulsive,  passive  aggressive,  and  inadequate personalities.   The   processing   of   personality disorders is administrative in nature and medical department responsibilities in managing them may be  limited  to  confirmation  and  counseling. ENDOCRINE  DISORDERS The following are some of the more commonly encountered  disorders  of  the  endocrine  system. Diabetes Mellitus This is a hereditary disease characterized by an inadequate secretion and production of insulin 2-31