In the religious communities of women, particularly, it has seemed to us that the occurrence of Graves' disease (the affection is three times more frequent in women than in men) in a Superior should always be the signal for relieving her of the responsible duties of her position. This action is quite as necessary for the patient's own health as for the peace and happiness of the community. The disease may exist in a {247} latent form and only develop strikingly after the assumption of the serious responsibilities of the position of Superior. When, however, the eyes are prominent, the pulse rapid, and the goitre, or swelling of the front of the throat, characteristic of the disease, is present, there are practically always mental symptoms that make it extremely inadvisable for her continuance in a position of serious responsibility. Professor Church of Chicago (Professor of Nervous and Mental Diseases and of Medical Jurisprudence, in the Northwestern University Medical School), in the last edition of his book on _Nervous and Mental Diseases_, [Footnote 5] has this to say with regard to the mental disturbances of Graves' disease: [Footnote 5: Nervous and Mental Diseases. Church and Peterson, 4th edition. Saunders, Phila., Pa., 1903.] "From the beginning, and often for a long period antecedent to the appearance of cardiac symptoms, the subjects of Graves' disease present a considerable mental erethism. There is an indefinable and tormenting agitation, marked by mental and motor restlessness and an imperative and impulsive tendency to be doing. Their emotions are too readily excited, and they are unusually impressionable and irritable, reacting in an exaggerated manner to all the incidents of daily life. In more pronounced cases they become voluble and manifest the greatest mobility of ideas, but have no persistent concentration of logical order. Their affections are likely to undergo modifications, and they become irascible, fault-finding, inconsiderate, ungrateful, and hard to live with. In some instances this disturbance of mentation carries them over the border into active mania, marked, perchance, by delusions of fear, due to the cardiac symptoms of sensations of heat. Insomnia is often added and the fitful sleep is disturbed by horrifying dreams that are likely to be projected into the waking moments and woven into delusions which are usually unsystematised, and constantly changing, furnishing the analogue of the motor restlessness. Hallucinations of sight and hearing are not uncommon. "The mental perturbance only rarely reaches the degree of actual mania, and then is, perhaps, equally dependent upon numerous other causes acting in a neurotic individual. But {248} a condition of abnormal mental stimulation is characteristic of the malady, and is as important an index as any of the cardinal triad." [Footnote 6]