Produced by Bryan Ness, Hazel Batey and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
file was produced from images generously made available
by The Internet Archive/American Libraries.)









    ADENOIDS AND DISEASED TONSILS

  THEIR EFFECT ON GENERAL INTELLIGENCE

                   BY

      MARGARET COBB ROGERS, Ph.D.


         ARCHIVES OF PSYCHOLOGY
       Edited by R. S. WOODWORTH

                 No. 50


  Columbia University Contributions to Philosophy and Psychology


                NEW YORK
               April, 1922


  AGENTS: G. E. STECHERT & CO.: London: (2 Star Yard Carey St., W. C.);
  Paris (16, Rue de Conde)




CONTENTS


    Introduction

      Purpose of the Study.                                     5


    Chapter I.                                                  7

      Previous Literature Concerning the Relation of Nose and
      Throat Defects to Intelligence.


    Chapter II.                                                24

      Method and Procedure.

        1. A Statistical Study.

        2. A Study of Improvement After Treatment.
           Selection of Cases.
           The Tests.


    Chapter III.                                               29

      Discussion of the Results.

        1. The Statistical Study.

        2. The Study of Improvement after Operation.


    Chapter IV.                                               53

      Measurement of Improvement after a Second Interval of
      Six Months.


    Chapter V.                                                68

      Summary.

      Conclusions.




INTRODUCTION--PURPOSE


During the last decade or two there has been a growing interest among
physicians in defects of the nose and throat. This interest has centered
in part upon those two afflictions of childhood--adenoids and diseased
tonsils,--or even tonsils that are merely enlarged. There is no doubt of
the physical handicap borne by a child who is possessed of them. As a
seat of inflammation, a source of infection, a hindrance to proper
breathing,--in a multitude of ways they have seemed to deserve the
verdict,--"Have them out." Many physicians, to be sure, have cautioned
against the wholesale removal of tonsils, saying that tonsils which are
large in early childhood very commonly are absorbed at an early age.

But it is not my purpose to discuss the question of the efficacy of
removing adenoids and tonsils. The aim of this study is, rather, to
determine experimentally whether or not there exists any causal relation
between defect in this respect and lowering of intelligence level. One
hears statements made both pro and con by physicians and laymen but
there has been little experimental proof. It would seem to be rather
useful for a physician to know in advance with how much probability of
correctness he is speaking, when he advises a mother that the removal of
adenoids and tonsils from the throat of her backward child will make him
"bright." The question in the present case, however, is broader than
that of relation between these afflictions and mental defect. We are
inquiring not merely whether adenoids and tonsils are causes of sub
normality or dullness, but also whether they tend to lower the
intelligence quotient in general however high it may be. Would the
mentally normal child with adenoids and tonsils have been superior
without them, and would the superior child have been still more
superior? What is the relation between adenoids and tonsils, and
intelligence?

The method employed in the present experiment would seem to give it
value from the point of view of the clinical psychologist. With the
present emphasis upon exactitude in mental testing, investigators have
become interested in problem of the constancy of the I.Q. Adenoids and
abnormal tonsils have been suggested as possible factors affecting this
constancy. The results of the experiment should throw some light on the
question.

It should be understood that this study is concerned with general
intelligence, and not with the child's efficiency as a member of
society. The latter question is much broader than the one we are
investigating. It includes not only intelligence, but physical state,
emotional make-up, volition: in short, the personality as a whole.
Success in school work for example, depends upon all of these factors.
For that reason, the results to be reported here, cannot be interpreted
as applying to this broader conception. We cannot say at the end whether
or not the physical defects under consideration affect the child's
success as a member of society. We hope to be able, however, to
determine their effect upon one element of that success, namely
intelligence.

In presenting the results of this experiment, the writer is especially
indebted to Professor R. S. Woodworth, under whose auspices the
investigation was carried out, for his interest and advice; and to Dr.
Leta S. Hollingworth for the suggestion of the problem, practical aid in
obtaining subjects, and constant inspiration. She is indebted to the
School of Education, Teachers' College, for the provision of operative
treatment for the subjects; to Mr. Mark and his officers at Public
School 64; and to Superintendent O'Brien of the Manhattan Eye, Ear and
Throat Hospital. It must be said that by their hearty and generous
cooperation they have contributed in a large measure to whatever value
this study may possess.




ADENOIDS AND DISEASED TONSILS: THEIR EFFECT UPON GENERAL INTELLIGENCE

CHAPTER I.

PREVIOUS LITERATURE

Concerning the Relation of Nose and Throat Defects to Intelligence


There are very few experimental studies of the relation between
intelligence and the two defects considered here. There are a few
statistical studies, and among earlier writers especially many
statements of opinion on the matter. Characteristic of the latter is the
following extract from an article in the Boston Medical and Surgical
Journal, March, 1886.[1]

    [1]: F. Hooper, M. D., quoting from a paper by B. Frankel.

"... it is a fact that their intelligence may become weakened and their
characters changed. They do not progress in their studies at school, are
generally at the bottom of the class and remain in it longer than the
prescribed time.... That the impairment of intellect and want of energy
manifested by these children is real, and not merely in the expression
of countenance, is made evident by watching these same children after
the growths have been removed. To the gratification and astonishment of
the parents and teachers, the children hitherto sluggish and dull of
comprehension, now make rapid progress, and their comrades soon cease to
make a laughing stock of them."

The following quotation from an article by Irving Townsend, M. D., is in
the same vein:[2]

    [2]: Adenoid Growths of the Naso-pharynx. Read before the
    Homeopathic Medical Society of New York, February, 1895.

"Aprosexia is the rather imposing term applied to the imperfect or
arrested mental development attributed to this condition. This is
denied by some authors, who claim that the dullness of comprehension and
inattention are only apparent, and due only to defective hearing. A
strong evidence of its reality lies in the fact that these children show
most marvelous intellectual development after the removal of the growth,
even in cases where deafness is not markedly improved."

A most enthusiastic denouncer of adenoids and abnormal tonsils is H.
Addington Bruce. Concerning their direful effects upon the intelligence,
and the magical results of their removal, he is continually
reiterating:[3]

    [3]: H. Addington Bruce, Psychology and Parenthood, 1916.

"Often a surprising development of both mental and physical power
follows the removal of adenoids. In one case reported by Professor
Swift, a girl of fourteen grew three inches within six months after an
operation for adenoids, and at the same time showed an improvement in
her school work that contrasted strikingly with the dullness that
preceded it. Another, three years younger, grew six inches in about five
months, and from being a sad idler was transformed into an unexpectedly
attractive and bright pupil. A boy of twelve, backward both mentally and
physically, likewise lost his dullness and laziness within an
astonishingly short time after the impediment had been removed."

And again:

"The boy or girl suffering from adenoids[4] is usually a mouth-breather
because of the difficulty experienced in breathing through the nose. But
mouth-breathing means difficult breathing, and this in turn means
deficient oxidation of the tissues, with a resultant lowering of vital
activities generally and of the activity of the brain in particular.
Accordingly, the psychologist of today insists that every
adenoid-afflicted child should be given prompt medical attention, with a
view to correcting the vicious mouth-breathing habit, and thus aiding
the child to gain a fair start in the development of mental and physical
health."

    [4]: H. Addington Bruce in the Century Magazine, 1916--The
    Mind of the Child.

The following extracts are quoted from Burgerstein's "Handbuch der
Schulhygiene":

"Bresgen und Heymann machen endlich darauf aufmerksam, dass die Ursache
der Kephalalgie haufig in der Behinderung der Nasenatmung zu suchen
ist, als Folgerscheinung von Verengerung der Nase bei ingen Baue des
Knochengerustes, Knochenkaries und Geschwulsten, Schwelungen der
Scheimhaute, akuten Schnupfen, Verstofungen der Highmorshöhle,
Vergrosserung der Mandeln u. s. w."...

"Viele Kinder erscheinen schwachbegabt, ohne os zu sein, da bei
denselben entweder nach behebung von Ohrenkrankheiten, nach Herstellung
der freien _atmung oder Gebrauch einer entsprechenden Brille die
scheinbare Geistesschwache schwindet_."[5]

    [5]: The italics are mine.

Quotations like these, and equally unsupported by experimental evidence,
might be multiplied indefinitely, especially if we look into the
literature of a dozen years ago. Since they can have little
authoritative value, I shall limit myself to two more specimens, one
taken from the Psychological Clinic, 1916.[6]

    [6]: Psych. Clinic, 1916, 10, 45-48. Anna Johnson. The
    Teacher in the Retarded School.

"But when these physical defects (poor eyesight, defective hearing,
adenoids, bad tonsils, etc.) are corrected so that the mind can function
without any outcry from the physical body, these children recuperate
mentally and often make greater progress than the so-called normal
children in the regular grades."

The second is a quotation from Jelliffe and White, "Diseases of the
Nervous System." Lee and Ferbiger, 1917, p. 903.

"An important group (of mental defects) is due to adenoid vegetations in
the posterior pharynx. Under such conditions of ill health, development
is impaired and does not proceed at a normal rate. With ... infected
tonsils, which produce a constant toxemia, the child cannot be expected
to proceed in his development with normal rapidity."

In the medical and psychological literature of the last few years, along
with the growth of general discussion into the various phases of the
operation itself, we find a general disinclination to take on faith the
magic effect of adenectomy and tonsillectomy. This growth of critical
spirit has shown itself in statistical investigations, and in studies of
pedagogical and mental improvement after operation.

The statistical studies of physical defects in the schools reveal almost
universally a positive relationship between school retardation and
possession of adenoids and diseased tonsils. One of these was conducted
by Ayres for the Backward Children Investigation of the Russell Sage
Foundation in New York City.[7] The investigators examined the school
records of 20,000 children from fifteen schools in Manhattan. Eight
thousand of these had been examined by school physicians. The records of
the physical examinations showed that 80 per cent of the children who
were normal for their grade had physical defects while only about 75 per
cent of the retarded children were physically defective.

    [7]: Psych. Clinic, 1909, 3, 71-77. The Effect of Physical
    Defect on School Progress.

This astonishing result was found upon re tabulation of the data by
ages, to be due to the fact that for each defect there is a gradual
falling off in frequency from the age of six up to fifteen--eye-defect,
only, excepted. Since the retarded children in each grade will be the
older children in that grade, and since older children have fewer
defects, the retarded children will show a smaller proportion of defect.

To overcome this difficulty, Ayres used an age basis instead of a grade
basis in interpreting his results. Records of all the children at the
ages of 10, 12, 13, and 14 were re tabulated, a group of 3304 children,
and rated as dull, normal or bright according to the grade in which they
were found. The results were worked out in percentages of a group, and
are shown in the following tables:

                                  Dull     Normal     Bright

    Number of children examined    407      2588       309
    Defects per child                1·65      1·30      1·07
    Enlarged glands                 20        13         6
    Defective vision                24        25        29
    Defective breathing             15        11         9
    Defective teeth                 42        40        34
    _Hypertrophied tonsils_        _26_      _19_      _12_
    _Adenoids_                     _15_      _10_       _6_
    Other Defects                   21        11        11

    Defective                       75        73        68
    Not defective                   25        27        32

Average number of grades completed by pupils having no physical defects,
compared with the number completed by those suffering from different
defects:

        3304 Children, 10-14 years, grades 1-8


                                           Average grades
                                             completed       % lost

    Children having no physical defects         4·94
    Children having enlarged glands             4·20           14·9
    Children having defective vision            4·94            0
    Children having defective breathing         4·58            7·2
    Children having defective teeth             4·65            5·9
    _Children having hypertrophied tonsils_    _4·50_          _8·9_
    _Children having adenoids_                 _4·24_         _14·1_
    Children having other defects               4·52            8·5

Cornell reports several investigations in the Psychological Clinic,
January and May, 1908. Three of these, in which children were rated on
the basis of grades received in school work, are here combined to show
the grades of normal children, "average" children, generally defective
children, those possessing adenoids and tonsils, and the deaf.

                                    General    Adenoids
    No. of cases  Normal  Average  Defective  and Tonsils  Adenoids  Deaf

     Allison               219
     9th St.        64      84        21                       8
     Claghorn      179     252        13

    Grade in language
     9th  St.       72·9    70·5      63·3                    60
     Claghorn       74·4    72·7      71·4

    Grade in Arith.
     9th St.         75·5   74        70                      66·7
     Claghorn        72     70        65·1

    Grade in spelling
     9th St.         75·4   72·8      64·8                    65

    Grade in geography
     Claghorn        76·6   76·5      76·2

    Average of grades
     Allison         75     74        72·6        72                  67
     9th St.         74·6   72·4      66                      63·9
     Claghorn        74·3   73·1       0·8

An additional investigation of four classes in the same grammar grade of
the Claghorn School gives the following results:

                          Class 1  Class 15    Class 9  Class 11
                           Bright  Children    Dull     Dullest

    Number of children       50        39       32        29
      Normal                 36        32       20        13
      Defective              14         7       12        16

    Percentage of normal     72        82       62·5      44·8

In the same article, Dr. Cornell gives the results of another study of
Philadelphia schools, made in 1906. The study comprised a comparison of
children exempt from examinations on account of high standing, with
those not exempt. The results follow:

                          Exempt  Children    Non-exempt  Children
                          Normal  Defective    Normal      Defective

    9th St. Primary         56       28          39           38
    Rutledge School         87       35          75           34
    Allison  School        128       65          81           49
    Camac School           183       71         103           75
    Claghorn  School       193       61         127           66
                           ---      ---         ---          ---
                           647      260         425          262

    Percentage Defective       28·8                    38·1

When the four classes of bright and dull children were examined again,
and the different sorts of defects compared for the groups, enlarged
tonsils, adenoids, deafness, and nasal catarrh, were found to occur much
more frequently among the two classes of duller children.

                              Class 1  Class 15  Class 9  Class 11
                              Bright   Children    Dull    Dullest

    Number of children           50       39       32       29

    Nose and throat conditions,
      number defective            6        4        9        9
        _Tonsils_                _3_      _4_      _3_      _3_
        _Adenoids_               _2_      _1_      _5_      _6_
        Deaf                      2                 5        1
        Catarrh                                     2        3

    Percentage of children,
      nose and throat defects    12       10·2     28·1     31

During the same year, another examination along the same lines was
conducted in the William McKinley Primary School,[8] where a large
number of dull children had been grouped in special classes.

    [8]: Cornell, Psychological Clinic, 2, 1909.

None of these children were mentally defective, says Dr. Cornell, and
only a few were really backward. The proportion of physical defect was
found to be very large,--in 174 pupils, 188 physical defects (68
eye-strain, 40 nasal obstruction, 80 miscellaneous, 11 hypertrophied
tonsils.) In a special class at the Wharton school, numbering 22
children, 14 of the children suffered from adenoids, associated in 3
cases with enlarged tonsils. Since no comparison is made with normal
classes, this survey cannot be regarded as conclusive.

Wallin, in his book, "Mental Health of the School Child," discusses
several other investigations of the relation of intelligence to physical
defect. Only those studies in which were included adenoids and tonsil
conditions will be reviewed here. Those by Ayres and Cornell have been
described above.

In Elmira, New York, says Wallin, "an investigation of repeaters in the
second grade showed that 21 per cent of those who required three years
and 40 per cent of those who required four years to complete the grade
had adenoids, as against only 19 per cent of those who required only two
years to do the grade."

Another study described by Dr. Wallin was made by Heilman in 1907 of
1000 Camden repeaters. The correlation between pedagogical retardation
and percentage of defect in each group was as follows:

    Defects                       Retardation
                      1 yr.  2 yr.  3 yr.  4 yr.  5 yr.
                                  Per Cent
    Health            16·5   21·3   28·0   19·0   37·5
    Nutrition         13·4    8·9   17·2   20·2   17·5
    _Adenoids_        _6·2_  _7·3_  _8·1_  _9·6_  _7·5_
    Speech             5·2    5·1    4·2   10·5   20·0
    Visual defects    15·5   15·9   18·2   22·8   22·8
    Auditory           8·2    6·7    4·9    6·1   10·0

Burpitt[9] describes an investigation of 400 children, 200 male and 200
female, considered by their teachers to be "dull and backward, but not
to fall within the meaning of feeble-mindedness as given in the Mental
Deficiency Act of 1913." The children were examined for physical defects
and other abnormal conditions. The author says that in 36 per cent of
the cases, the cause for backwardness was found to be "inherent
dullness." (The basis for judgment of inherent dullness is not given.)
Adenoids and tonsillar tissue were found in 18·75 per cent of the cases,
and were "more prevalent than among the children of the area as a
whole."

    [9]: H. R. Burpitt. Relative Degrees of Dullness and
    Backwardness in School Children and their Causation. Journal of
    Mental Science, 1916.

The degree of retardation, based upon the number of school standards
below normal, was ascertained for pupils who suffered from various
defects. The relative retardation was expressed by the fraction n/(A-5)
where n = number of years retarded, and A = age. Eighteen per cent of
the children were so retarded that the fraction was greater than 3-9.
These were divided into two groups,--3-9 to 4-9 and 4-9 to 5-9. The
results are given in the following table:

         Causes                               46 children   24 children
                                              3-9 to 4-9    4-9 to 5-9

    Inherent dullness only                        8             3
    Inherent dullness and one or more physical
       defects                                    7             2
    Irregular  attendance  with  one  or  more
       physical defects                           9             6
    Irregular attendance                          2             3
    _Adenoids only_                              _2_           _0_

Turning to what the author calls single causes,--present in 170 cases out
of the 400,--

         Causes                               151 children  19 children
                                              1-9 to 3-9    3-9 to 6-9

    Irregular attendance                         51             6
    _Adenoids_                                  _24_           _2_
    Inherent dullness                            59            11

The term "cause" seems to be rather loosely used in this study. The
author says concerning this,

"Dealing with physical defects first, although they amount in the
aggregate to 53 per cent (omitting defective speech, which is a
secondary condition), in 10 percent only do they represent the whole
cause. This is made up of those cases where the defect is of such
intensity as to produce retardation in otherwise ordinary children, and
of other cases of less intensity, but sufficient to weigh down the
balance against those near the level of what we may call for convenience
the lower limit of normal intelligence." How he determines, without
removing a defect, what the child's intelligence would be without it he
does not explain.

The following table compares the physical condition of two groups, one
comprised of children examined in the regular routine examinations
during the year 1912,--the other a group of retarded school children,
given a special examination:--[10]

    [10]: Transactions of the International Congress on School
    Hygiene, 1913, The Physical Condition of Retarded School Children.

                                Group I          Group II

    No. of children examined    287,456          1,541
    No. with physical defects   206,720--71·9%   1,383--89·8%
    No. of defects found        226,639          2,986

      Defect                       No.        %     No.    %

    Anaemia                                         335    23
    Malnutrition                   8,303     2·9    557    36·1
    Defective vision              21,078     9·3    536    34·7
    Defective hearing              1,206     0·5     47     3
    _Defective nasal breathing_  _21,931_   _7·6_  _316_  _20·4_
    _Hypertrophied tonsils_      _30,021_  _10·4_  _297_  _19·2_
    Defective teeth              142,168    49·4    796    51·6
    Pulmonary disease                335     0·1     47     3·0
    Cardiac disease                1,597     0·5     35     2·3

    Average No. of defects per child     1·1            2·5

In an investigation of 3,587 exempt and 1,418 non-exempt children in the
Philadelphia schools,[11] Dr. Newmayer found the following percentages
of defect:

    [11]:  Ayres: "Laggards in Our Schools." 1909.

                           Exempt Children       Non-exempt Children

        Defect             No. Examined   %      No. Examined    %
    Defective vision            371      10·0        171       12·0
    Defective hearing            49       1·4         29        2·0
    _Defects of nose_           _54_     _1·5_       _21_      _1·5_
    _Defects of throat_        _137_     _3·8_       _53_      _3·7_
    Orthopedic defects           25        ·7         25        1·8
    Mentally defective            6        ·1         80        5·6
    Skin diseases               918      26·0        423       30·0
    Miscellaneous               214       6·0        128        9·0
        Total                 1,774      49·0        930       65·0

It is evident from the majority of these investigations that there is
some relationship between physical defects and pedagogical retardation.
But whether or not the relationship is a causal one, they do not
indicate. Simple co-existence of two characteristics is not necessarily
significant that one is cause of the other. Plainly, though, if the
removal of a physical defect is followed by improvement in the school
progress, it may be argued that the presence of the defect was a causal
factor in the previous retardation. The method in the few following
studies, which seems to be employed to a greater degree than formerly,
consists of measurement of such improvement.

The Journal of Psycho-Asthenics, March and June, 1918, contains a paper
on the "Results obtained from the Removal of Tonsils and Adenoids in the
Feeble-minded," by Wm. J. G. Dawson, M. D. The author starts out rather
discouragingly by regarding his hypothesis as an axiom. He says,

"It is a well-known fact that hypertrophy of the tonsils and presence of
adenoids may produce more or less dullness of the intellect in normal
children. This is a result of the imperfect aeration of the blood which
supplies the brain, on account of obstruction to respiration. In the
Feeble-minded, conditions are more or less similar."

One hundred and twelve cases in the Sonoma State Home, Eldridge,
California, were operated on. Of these 6 are recorded as borderline, 39
as morons, 50 as imbeciles, and 17 as idiots. Adenoids were always
removed when they were present. The results of the operation are as
follows:


                                        Number      Number
                                        before      after
                                       Operation   Operation

    Mouth breathing                       43          31
    Eneuresis                             33          32
    Sore throats                          70           2
    Ear trouble                           19           2
    Change in voice                                   38 improved
    Tonsillar tissue recurred in                       5
    General physical health                           90 improved
                                                       6 borderlines
                                                      33 morons
                                                      42 imbeciles
                                                       9 idiots

    Mental improvement from observation               27 improved
                                                       4 borderlines
                                                      15 morons
                                                       7 imbeciles
                                                       1 idiot


The inaccuracy of this investigation is evident. The mental improvement
was measured by "observation," which is at best inexact, and susceptible
to the influence of any expectation of improvement on the part of the
observer. The degree of improvement is not mentioned, nor is the time
interval allowed for the appearance of such improvement. There is no
control group, and consequently, no way of knowing whether the
improvement was due to the removal of the defect.

A similar, though rather more careful study is reported by Dr. Charles
James Bloom in the New Orleans Medical and Surgical Journal for April,
1917. Dr. Bloom's experiment consisted of eighteen months' observation
on the mental and physical state following the removal of adenoids and
tonsils from one hundred and fourteen children. This number was later
reduced to fifty-seven, because of the fact that a number failed to
return. There was no selection, all the patients being taken as
admitted.

The patient's physical and mental state was recorded at the time of
admission. School reports were used as an index of intelligence. From
this time on the patients were examined, weighed and measured at monthly
intervals.

The ages of the children ranged from four to fourteen years, inclusive.
Thirty-five per cent were under six years, and sixty-five per cent,
therefore, over six. Twenty-nine were boys, twenty-eight girls.

Omitting a part of the study which though interesting has no bearing
upon our problem, we turn to results in the way of mental status. There
were fifty-seven cases, ten of whom were under the school limit. Of the
remaining forty-seven, seven sent in no report. In four, or ten percent
of the forty remaining, there was no progress. In thirty-six, or ninety
per cent, appreciable progress was reported. One of the four unimproved
cases was syphilitic, the other, the author says was a moron.

Quotation of the teachers' reports will be of interest.

"'Some improvement.' 'Better work than previous year.' 'More effort
displayed.' 'Improved wonderfully.' 'Improvement first term, not so much
second.' 'Before removal, not transferred; after removal transferred.'
'Very much improved, both mentally and physically.' 'Has made progress.'
'Remarkable improvement.' 'Not transferred before removal, but after.'
'More attentive.' 'A very small but gradual improvement.' 'Am happy to
tell you that he is studying more since tonsils and adenoids were
removed.' 'Greatly improved.' 'Attention better.' 'More concentration.'"

In this experiment like the preceding, the judges are liable to the
effect of expectation of improvement. Although the reports are more
explicit, they are still couched in general terms, and not
commensurable. Some reports refer to intelligence and some to
pedagogical standing. There is no control group.

On the basis of these results, the author concludes:

"Children exhibiting some alternatives in the normal histology of
tonsils and adenoids, give marked evidences of mental impairment." This
seems to be a rather sweeping statement in consideration of the number
of intellectually superior children who suffer from adenoids and
diseased tonsils.

Another investigation was made by Dr. Cornell in the Philadelphia
schools,[12] where seventy more or less retarded pupils in grades one to
four were operated on for adenoids. According to the teachers' reports--

      30 per cent improved considerably.
      40 per cent improved.
      25 per cent did not improve.
       1·6 per cent deteriorated.
       3·0 per cent deteriorated considerably.

    Of those who had two chances of promotion,
       6·3 per cent were promoted twice.
      16·0 per cent failed twice.
      33·3 per cent were promoted once.
      33·3 per cent failed once.

    With one opportunity,
      11·0 per cent were promoted.
      31·7 per cent failed.

    [12]: Wallin: "Mental Health of the School Child." 1914.

"The promotion record was thus decidedly poor. It is possible, however,
that the time for promotion came before the orthogenic effects of the
operations had become effective."

The same criticisms may be brought against this investigation as were
mentioned in connection with the preceding ones. Teachers' estimates of
improvement, especially when such improvement is expected, and without
means of measuring it objectively, are necessarily inaccurate. Again
there is no control group. Of even less value are the results of an
investigation in New York City by Cronin, where, out of eighty-seven
cases operated on for enlarged tonsils and adenoids, "many advanced
three grades during the rest of the school year, and only three lost
time."

An interesting study is one that is described by John C. Simpson, M. D.,
in the Journal of the American Medical Association, April 1, 1916.

Dr. Simpson's results are based on a study of 571 boys of Girard College
who had been operated on for adenoids and tonsils. Improvement was
studied along several different lines, among them scholastic ability.
For this part of the study, 45 were chosen alphabetically, 3 from each
section. The only selection was for boys who were operated on long
enough after coming to school to give an idea of scholastic ability; and
long enough before the present study to permit a judgment as to their
improvement. Monthly averages were taken of each boy up to the time of
the operation and from then to the time of this study. They were based
on an average of 100 per cent. As a control group, there were chosen 45
boys who had had no operation, and who lived and worked under the same
conditions. They also were taken alphabetically, 3 from each section.

The general average of the operative cases at the first measurement was
74·04. Of these 25, or 55·5 per cent gave an average increase in monthly
standing of 4·45 after operation, while the remaining 20, or 44·5 per
cent suffered a decrease of 6·09.

The average of the boys in the control group was 74·21 and for the first
group after operation 74·06. "It is interesting to note," says the
author, "that the standing of slightly more than half of those operated
on was improved, but when compared with those not operated on, no
difference is seen."

In a similar study of younger boys who had undergone the operation on
entering college, and who had since had a year's study (again a group of
45), the general average was 76·61. Compared to 45 in the same classes
not operated on, who had an average of 74·56, the operative group is
very slightly superior, 2·05 points.

Another study of pedagogical improvement, and a valuable contribution,
is that reported by A. H. MacPhail in Pedagogical Seminary for June,
1920, entitled "Adenoids and Tonsils; a Study showing how the Removal of
Enlarged or Diseased Tonsils affects a Child's Work in School."

"The children studied were pupils in the Adams and Cranch Schools. Only
cases were considered where there was a record of ten school months
before the date of the operation, and where there was a record for at
least ten month after the operation. There were thirty-one cases in all.

"School records were looked up for the ten school months preceding
operation, and for each school month subsequent--up to the date of
leaving school, or in the case of children still in school, up to the
date of the study. There were thus longer school records for some than
for others.

"The history of each case was divided into periods of ten school months
each. Eighteen cases had a record of twenty months after operation and
eleven cases of thirty months.

"Comparing the first period after the operation with the period before,
it is found that only about one-third showed improvement, and a little
over half were doing poorer work. By comparing an average of _all_ work
done subsequent to the operation with what was done before, it became
evident that improvement in school work is not often observed until
after a year from the date of the operation."

In the cases that had records for twenty months, 16 show that better
work was done in the second period after the operation than in the
period before.


                           TABLE A

              Table showing where improvement begins.

                          _Per Cent of cases showing improvement_
                          Period 1      Period 2      Period 3

    Based on 31 cases       32·2
    Based on 18 cases       33·3          66·6
    Based on 11 cases       36·3          63·5          100
    Based on all groups     33·9          65·           100

These cases were compared with a control group chosen at random. They
comprised a total of 100 children who had records for four consecutive
school years.


                            TABLE B

  Table showing how time of improvement of "operated cases" compares with
              improvement among children at random.

                                     Period 1    Period 2    Period 3
    A--Per cent of 31 cases            32·2
         (operated upon)
       Per cent of 100 children        42
        at random

    B--Per cent of 18 children--20     33·3       66·6
        months (operated upon)
       Per cent of 100 children at     42         41
         random

    C--Per cent of 11 cases for 30     36·3       63·5         100
         months (operated upon)
       Per cent of 100 children at     42         41            41
         random

"... Immediately after operation, there seems to be a dropping off in
the quality of school work done," but thereafter a marked improvement
while the random group shows a comparatively static percentage of
improvement from year to year. The conclusion of the author is:

"Here seems good reason to believe that the removal of diseased tonsils
and adenoids is a factor in beneficially influencing the mental life of
the school child. Not only is the health impaired by failure to remove
these diseased parts but the mental life and activity of the child as
well."

It is conceivable that pedagogical retardation might exist without any
defect of intelligence. The physical effects of adenoids and tonsils
might produce a tendency to fatigue, an emotional instability and
consequent lack in attention, which would seriously influence the
quality of school work, even though the child were of normal or superior
intelligence. The relation of physical defects to intelligence has been
investigated experimentally by a method which will be employed to some
extent in the present investigation. In the two studies to which I refer
psychological tests, rather than school standings were used as a basis
for judging the intelligence. In each the effects of treatment were
measured, and in one, a control group makes possible a more accurate
interpretation of results.

The first of these investigations is described by Wallin.[13] It was "an
attempt to determine by controlled, objective, mental measures the
influence of hygiene and operative dental treatment upon the
intellectual efficiency and working capacity of a squad of twenty-seven
public school children in Marion School, Cleveland, Ohio (ten boys and
seventeen girls), all of whom were handicapped to a considerable degree
with diseased dentures or gums, and an insanitary oral cavity." The
experiment extended over one year, from May, 1910, to May, 1911. The
treatment included corrective work upon the teeth and mouth, and also
instruction in oral hygiene, and follow-up work by an employed nurse.
Five series of psychological tests were given at stated intervals during
the course of the experiment. They included tests of immediate recall,
spontaneous and controlled association (opposites), adding, and
attention-perception (cancellation). There were six sets of each test,
numbered from one to six, of equal difficulty, and given under uniform
conditions. Tests 1 and 2 were given before the treatment began, and the
average was taken as the "initial efficiency." The last four, or the
last two, were averaged to represent the pupils' "terminal efficiency."

    [13]: Wallin: "Mental Health of the School Child." 1914.

The results show the following influence of dental treatment upon the
working efficiency of the pupils.

1. The indices of improvement are about the same for boys and girls.

2. Improvement was about the same for older and younger pupils.

3. There were great individual differences in initial proficiency and in
improvement.

4. Improvement in one test does not presuppose improvement in another.

5. There is a decided gain in every test, "and not only are the gains
decidedly more frequent than the losses but the largest gains are
invariably emphatically larger than the largest losses."

6. The average gains in the tests were:

    Memory, 19 per cent with 8 losses and 19 gains.
    Spontaneous association, 42 per cent with 2 losses and 25 gains,
    Addition, 35 per cent with 1 loss and 26 gains.
    Controlled association, 29 per cent with 0 losses.
    Perception-attention, 69 per cent with 0 losses.
    Average gain for all tests, 57 per cent.

Unfortunately, Wallin was unable to form a control group, so that it is
impossible to estimate accurately how much of this gain is due to the
treatment of the defect, and how much to other causes, such as growth,
etc. "But," the writer adds, "if we concede that one-half of the
gain--and that is, I believe, a sufficiently liberal concession--is due
to a number of extrinsic factors, such as familiarity, practice and
increased maturity, the gain solely attributable to the heightened
mentation resulting from the physical improvement of the pupils would
still be very considerable. There is corroborative evidence to show that
there was a general improvement in the mental functioning of these
pupils. This evidence is supplied by the examination of the pedagogical
record of scholarship, attendance and deportment. Most of the members of
this experiment squad were laggards, and repeaters, pedagogically
retarded in their school work from one to four years, but during the
experiment year only one pupil failed of promotion, while six did
thirty-eight weeks of work in twenty-four weeks, and one boy finished
two years of work within the experimental year."

The second investigation was equally careful in its method. It was
pursued by the Rockefeller Foundation, under the direction of E. K.
Strong, with the purpose of examining the "Effects of Hookworm Disease
on the Mental and Physical Development of Children."

The children were divided into five groups and tested at intervals of
three and one-half months. The tests used were opposites, calculation,
logical memory, memory span, hand-writing, form-board, and Binet-Simon.
After the first test-series was given, the five groups were divided into
sub-groups on the basis of this initial performance, so that the
improvement was compared only for those sub-groups in which this was
equal.

The improvement of Group A--uninfected children--proved to be greatest,
and was taken as 100 per cent. On this basis, Group B--infected children
not treated--showed the least improvement,--only 34 per cent. Group
C--children completely cured of infection--improved 60 per cent. Group
D--severely infected children, treated but not completely
cured--improved 38 per cent, and Group Du--an older sub-group of
D--improved 9 per cent as much as the normal children, and much less
than the untreated younger children. Dr. Strong reaches the following
conclusion:

"The figures show, then, that hookworm disease unmistakably affects
mental development. Treatment alleviates this condition to some extent
but it does not, immediately, at least, permit the child to gain as he
would if he had not had the disease. And the figures apparently further
show that prolonged infection may produce prolonged effects upon
mentality,--effects from which the individual may never recover."




CHAPTER II.

METHOD AND PROCEDURE


The following investigation was carried on during the year and a half
from October, 1919, to April, 1921. The subjects were pupils at Public
School 64, Manhattan, or patients at the Manhattan Eye, Ear and Throat
Hospital. All were boys, between the ages of six and fourteen years. The
testing in the study of improvement was done by the investigator,
assisted by three other examiners, all competent and experienced in the
technique of giving psychological tests.


A Statistical Study

In addition to the more lengthy experiment, a statistical study was
made, comparing the intelligence levels of two groups of children, the
one selected for the presence of tonsils, the other for freedom from
them. These two groups were obtained from a large group of 530 children
whose I.Q.'s were gained from the records of Public School 64, where, so
far as possible, all children are tested upon entering school. We had,
therefore, a group unselected for intelligence level.

All the children for whom we had I.Q.'s were examined by the school
nurse or physician. On the basis of this examination the two groups were
selected. The tonsil group consisted of those cases which in the opinion
of the nurse or doctor, were pronounced enough to deserve treatment. The
normal group was composed of those who were not defective, or in whom
the defect was so slight as not to demand treatment. The two groups were
arranged each in a surface of distribution according to the I.Q.'s of
the members. The results of the distribution appear in Table I, and in
Figs. I. and II.


A Study of Improvement After Treatment

The method employed here is based on the hypothesis that if a physical
defect is the cause of retardation in mental or physical development,
removal of the cause will tend to lessen the retardation. In other
words, if a child's working efficiency is lowered by the effects of
adenoids and bad tonsils, their removal should, unless such lowering be
permanent, be followed after a reasonable time by an improvement. But
improvement in efficiency, following the removal of adenoids and tonsils
proves nothing unless we shall compare it with the change in efficiency
of a control group, whose members have not been operated on, and who
thus still suffer from the effects of the growths.


Selection of Cases

The selection of the children for the experiment was effected in the
following manner. The teachers at Public School 64 were asked to report
any cases which had come to their notice, as being seriously afflicted
with adenoids and diseased tonsils. In this way a fairly large group was
obtained. The parents of the children were visited with the purpose of
obtaining permission for examination and operation at the Post Graduate
Hospital. It was fairly easy to obtain permission to have the children
examined. They were taken in groups of four or five to the clinic, the
experimenter attending in person every examination in order to learn
from the doctors the degree of the defect. As a result of this method,
we discarded all those cases where there was any doubt as to the serious
nature of the defect.

From the large group examined, we were finally successful in securing
operative treatment for 10 children. Discarding the cases where defect
was slight, there remained a number of children who, for one reason or
another, did not undergo operation. In some instances the parents
refused their permission, in some they failed to keep appointments, in
one or two there was sickness in the family, and in a number the
hospital was overcrowded and could not receive the children. All members
of this group were examined,--to the number of fifty-six, and from them
the control group was finally selected.

Since we were unable to secure a large test group from Public School 64,
the experiment was continued at the Manhattan Eye, Ear and Throat
Hospital where opportunity was given for testing the children after they
had been admitted for operation. In order to be sure that in each case
the defect was sufficiently pronounced to render decisive the results of
the experiment, each child's card was examined. Only those children
were included who were undergoing operation for both adenoids and
tonsils.

It may be here remarked that mental tests were given to these children
on the morning of operation, and in some cases only a short time before
it. The possibility suggests itself, therefore, that the results of the
tests may have been influenced by excitement or fright on the part of
the patients. Actually, however, this did not seem to be the case. The
children were perfectly cheerful and showed no signs of nervousness. The
tests were given in a waiting room with the door closed so that any
disturbing sights and sounds were eliminated. The possible lowering of
the performance by the causes mentioned would tend to exaggerate the
improvement shown by the retests, so that in the light of the results,
it will be seen that they could have had little effect.

The test group, then, was composed of forty members; ten from Public
school 64, who received operation at the Post Graduate Hospital, and the
remaining thirty from various schools throughout the city, patients at
the Manhattan Eye, Ear and Throat Hospital. The control group of forty
was selected as previously described, and the pairs were arranged so as
to have the ages of the members of one pair as nearly as possible the
same.


The Tests

Since the main interest of this investigation lies with intellectual
development, two tests of intelligence were given: namely, Terman's
revision of the Binet test, and Healy's Picture Completion Test, number
II. The starred Terman was always used, since it was necessary to
economize time.

It was expected that improvement in general health would probably follow
the removal of the defects. This physical gain should come to light in
increased height and weight. In every case, therefore, height and weight
were measured.

It is conceivable that adenoids and tonsils might have no effect upon
general intelligence, and yet might cause a noticeable pedagogical
retardation, simply as a result of the child's physical handicap,
tendency to fatigue and consequent defect in attention or sustained
effort. In order to gain some measure of this physical factor, strength
of grip and speed in tapping were found. An effort was made, also, to
obtain teachers' estimates of the pedagogical rankings, but this was
for the most part unsuccessful, since in many cases teachers
misunderstood directions, and in others the tests were made too soon
after the opening of school for any such estimates to be possible.

The tests described above were given before the operation to each child
in the test group, allowing as short an interval as possible between
test and operation. In the case of the Manhattan Hospital children, test
and operation fell on the same day. In no case did the interval exceed
ten days. The members of the control group were tested, each one within
a week of his partner.[14]

    [14]: In a few cases where the operation was postponed after
    the test had been given, the child and his control were retested
    just previous to the operation. Since both cases were retested,
    practice effect is of no great importance.

Six months after his first test, each child was retested, whenever
possible. Since some children had dropped out of the groups for one
reason or another, the final number in each group was twenty-eight. It
was necessary to rearrange the control cases somewhat in order to fill
in spaces left vacant by those who were lost. In this rearrangement, the
effort was made, 1. to pair cases whose ages were approximately the
same; 2. to pair cases whose first tests were dated fairly close
together. Since all the children were tested and retested under
approximately the same conditions, this rearrangement will probably not
greatly influence the results. The tests were always given in the same
order.

The following table shows a list of the two groups, as originally
paired, and as finally rearranged, with dates of tests and retests.
Dates of operation are given for the first group.

          Test Case                    Original Control   Final Control
       Test I    Op.    Test II       Test I    Test II  Test I   Test II

  JB 10-15-19 10-20-19  lost     SS 10-15-19  4-15-20
  LL 10-15-19 10-20-19  4-15-20  LJ 10-15-19  lost   SS 10-15-19  4-15-20
  HK 10-30-19 11- 6-19  4-30-20                      MG 10-21-19  4-30-20
  MS 11-11-19 11-12-19  5-17-20                      AA 11-20-19  5-17-20
  GF 12-11-19 12-26-19  6-11-20                      SD 12- 4-19  6-11-20
  RJ 12-16-19 12-30-19  6-16-20                      NF 12-10-19  5-14-20
  JJ 12-16-19 12-30-19  6-16-20                      ML 12- 5-19  6- 9-20
  AG  1-15-20  1-16-20  7-15-20                      LP  1-15-20  7-15-20
  IK  2-14-20  2-16-20  8-11-20                      AL  2-14-20  8- 2-20
  HG  2-10-20  2-11-20  moved      control removed
  AC  2-11-20  2-12-20  8- 2-20                      JF  2-11-20  8- 3-20
  CL  2-26-20  3- 1-20  8- 3-20                      JF  2-26-20  8- 3-20
  MR  2-26-20  3- 1-20  moved      control removed
  SR  2-26-20  2-27-20  8- 3-20                      PG  2-26-20  8- 3-20
  IK  3-17-20  3-17-20  moved      control removed
  AO  3- 8-20  3- 8-20  9-20-20                      SK  3- 9-20  9-24-20
  RB  3- 8-20  3- 8-20  moved      control removed
  DT  3- 8-20  3- 8-20  mastoid    control removed
  AL  3- 9-20  3- 9-20  moved      control removed
  JD  3- 9-20  3- 9-20  9-23-20                      DD  3-11-20  9-16-20
  LS  3- 9-20  3- 9-20  9-25-20                      KS  3-16-20  9-24-20
  JB  3-12-20  3-12-20  moved      control removed
  HS  3-13-20  3-13-20  9-21-20                      MR  3-15-20  9-15-20
  AM  3-13-20  3-13-20  9-20-20 JM  3-13-20   lost   HH  4- 6-20 10- 1-20
  SO  3-18-20  3-18-20  9-22-20 SS 3-22-20 wrong boy MA  3-23-20  9-23-20
  IF  3-18-20  3-18-20  9-23-20            (adenoids PK  3-22-20  9-21-20
  AD  3-19-20  3-19-20  9-20-20 LC 3-22-20 (removed  IB  3-23-20  9-24-20
  JR  3-19-20  3-19-20  moved   IB 3-23-20  9-24-20
  JN  3-20-20  3-20-20  moved   MA 3-13-20  9-23-20  LF  3-20-20 10- 1-20
  HS  3-20-20  3-20-20  9-21-20                      SB  3-25-20  9-21-20
  II  3-26-20  3-26-20  9-24-20                      BF  4- 5-20 10- 1-20
  UF  3-27-20  3-27-20  9-29-20                      LF  4- 7-20 10- 1-20
  SM  3-27-20  3-27-20  9-30-20                      LG  4- 6-20 10- 1-20
  AM  3-29-20  3-29-20  9-29-20                      BG  4- 6-20 10- 1-20
  CK  3-29-20  3-29-20  9-29-20                      NF  4- 7-20 10- 1-20
  FB  3-30-20  3-30-20  9-29-20                      JF  3-26-20 10- 1-20
  AA  3-30-20  3-30-20  9-23-20
  LS  3-31-20  3-31-20  moved      control removed   MA  4- 5-20  9-30-20
  FT  3-31-20  3-31-20  9-28-20
  LP  4- 1-20  4- 1-20  moved   HH  4- 6-20 10- 1-20




CHAPTER III.

DISCUSSION OF THE RESULTS


Statistical Study

The statistical study compared two groups of cases in respect to I.Q.
These groups were selected from one large group, on the basis of
presence or absence of tonsillar defect. The tonsil group was composed
of 236 cases, and the normal group, of 294. The distribution of the two
groups according to intelligence is set forth in Table I, and in Figs. I
and II.


                         TABLE I

              Tonsil Group         Normal Group

    I.Q.     No. of  Per cent of  No. of  Per cent of
              Cases     Cases      Cases     Cases

     40- 50     2        ·8          0         0
     50- 60     1        ·4          2          ·7
     60- 70     7       2·9          4         1·4
     70- 80    21       8·9         29         9·8
     80- 90    45      19·0         52        17·7
     90-100    80      33·9        107        36·4
    100-110    55      23·3         67        22·8
    110-120    17       7·2         24         8·1
    120-130     6       2·5          9         3·0
    130-140     2        ·8          0         0
    140-150     1        ·4          0         0

    Average    94·9                 95·4
    Median     95·3                 95·6
      Q         8·705                8·27
    [Sigma]    14·4                 12·2

From these it is evident that the two groups are practically equal in
intelligence. The average I.Q. for the normal group is 95·4, as compared
with 94·9 for the tonsil group. The medians are equally close,--95·6 in
the normal group and 95·3 with the tonsil cases. The difference in
variability is negligible, Q being 8·705 and [Sigma] 14·4 in the
tonsil group, while in the normal Q is 8·27 and [Sigma] 12·2. The
two cases with the lowest I.Q.'s were tonsil cases, but the three
highest I.Q.'s also belong in this group.

    Fig. 1. Distribution of I.Q.'s. Number of cases.

    Fig. 2. Distribution of I.Q.'s by percentage of total number of
    cases in the group.

If the frequencies are expressed in terms of per cent of the total
number of cases in the group, the two may be compared further. The
following details are noticeable.

    I.Q.          Per cent of         Per Cent of
                  Tonsil Group       Normal Group

    Below 70           4·1                2·1
    Below 90          32·0               29·6
    Above 110         10·9               11·1
    Above 120          3·7                3·0
    Above 130          1·2                0

In other words, in the percentage of cases below normal intelligence,
the tonsil group exceeds by 2·4 per cent. The percentage of defective
cases is also slightly greater in the tonsil group--the difference here
being 2 per cent. The normal group has a negligible predominance of
bright cases,--only two-tenths of one per cent difference, while with
the very superior cases, the tonsil group again exceeds,--by 1·2 per
cent. The per cent of the tonsil group which reaches or exceeds the
median of the normal is 49 per cent.

These figures seem to indicate remarkable similarity between the two
groups considered. The two distributions are almost identical. While the
slight predominance of cases below normal mentality in the tonsil group
may indicate a very feeble tendency toward coincidence of tonsillar
defect and mental dullness, it does not seem large enough to be at all
significant. This is especially true when we consider that the tonsil
group exceeds in superior children. If we allow the preceding contention
of coincidence between dullness and tonsils, must we not argue here in
the same manner for a tendency toward coincidence of superiority and
tonsils?

The chief source of error in this part of the study is the fact that the
throat examinations were not conducted by the same person throughout the
investigation. For this reason there must have been some slight
disagreement as to what should constitute a reportable case. In the
event, then, of a positive relationship between tonsil defect and
lowering of the intelligence quotient, placement of normal tonsils in
the "tonsil" group, and of diseased tonsils in the "normal" group would
raise the first, and lower the second, thus tending to conceal the
difference between the two. On the other hand, the cases where
disagreement would occur would naturally be those of slighter defect, in
which the intellectual retardation would be less likely to occur, so
that the result would probably be merely an increased height at the
overlapping portion of the curves, with no change at the ends.

In any case, the two examiners had worked together previously, so that
each must have been somewhat familiar with the opinions of the other.
They were aware, also, that pronounced tonsillar defect was what we were
attempting to detect. However this may be, there must always be some
disagreement in diagnosis. When this is allowed for, the results of the
investigation may be taken for what they are worth. Contrary to
expectation, there seems to be very little difference in intelligence
between a group of children whose throats are normal, and one in whom
the tonsils are diseased or badly enlarged.


STUDY OF IMPROVEMENT AFTER OPERATION

The complete results of the tests and retests are collected in Table II,
where each control case is listed immediately below its respective test
case, and where age, height, weight, grip, tapping rate, I.Q., and score
in Healy Picture Completion are shown. From these data the more detailed
observations have been made. The improvement of each child in the
various tests has been computed, and a comparison drawn between the two
groups. As we have previously stated, any improvement shown by the test
group in excess of that of the control group, may be looked upon as
significant.

Let us consider first the improvement of the children in general health,
as shown by height and weight. In Tables III and IV we have tabulated
the results, in such shape as to permit of comparison. An inspection of
these tables will establish the fact that after a six months' interval,
the test group shows, in respect to height and weight, a very slight
gain over the control group. In weight, the average of the amounts by
which the test group gains exceed the control group gains is 1·37 lbs.,
and in height, only ·16 inches. The medians of these amounts are 1·2
lbs. and ·2 inches respectively. Comparing the improvements for the two
groups, we find that in the case of the weights, the smallest gain (a
loss of 1·2 lbs.) occurs in the control group, while the largest gain
(10·7 lbs.) is in the test group.

                     TABLE II. RESULTS OF TESTS

  Blank spaces indicate where tests were omitted for one reason or another

    N         Age          Weight        Height     Grip, Kg.
                            lbs.           in.      best hand

            1      2       1     2       1     2      1     2

     1     7- 7   8- 1    50·4  54·2    46    47·6   13    12
     1C    8- 1   8- 7    53·5  57·2    46·4  47·8   11    13

     2     6- 9   7- 3    40·9  42·9    42·6  41·1    9     9
     2C    7- 1   7- 7    52·3  57·4    45·2  47     10    12

     3     8-     8- 6    55    59·5    47    48·4   12·8  14·5
     3C    9- 9  10- 3    61·5  62·9    51·7  52·9   14    15

     4     8-10   9- 4    51·1  54·2    47·5  49·2    9
     4C    9-10  10- 4    49·4  51      48·9  52      9·5

     5     6- 1   6- 7    45    47      44·9  45·2   11
     5C    8- 2   8- 8    56·2  57      46·6  48·1   12

     6     5- 2   5- 8    43·8  44·5    43·1  43·9    8
     6C    7- 1   7- 7    50·6  52·5    45·4  47·3   10·5

     7     6- 7   7- 1    39·9  41      42·9  44·8    7     6·5
     7C    6- 7   7- 1    38·4  38·7    41·9  43·2    9    10

     8     8- 6   9-      60·8  63·3    50·8  51·8   10
     8C    8- 5   8-11    45·4  52·1    46·8  47·6   15    16

     9     9- 4   9-10    50·6  53·2    48·1  49·4   10·5  13
     9C    9- 6  10-      59·8  61·4    51·9  55·2   16·5  21

    10     6- 7   7-1     48·9  51·4    46·1  47·7   12·5  11
    10C    7-     7-6     47·1  47·5    45·6  47·2   10    15

    11     6- 7   7-      47·8  47·5    45·8  47·7   11    15
    11C    6- 8   7-1     41·6  42·5    43·6  44·9   11·5  11·5

    12     7- 8   8-2     48    52·5    44·8         14
    12C    7- 1   7-8     41    44·5    41·5  43·3    6     4·5

    13    13- 3  13-10    90    98      61·5  65     26·5  28·5
    13C   14- 6  15-      74·7  76·8    56·8  57·8   22    23

    14    11- 9  12-4     56    62      51    51·6   16    15
    14C   11-10  12-4     81·9  86      57·9  58·3   22    24

    15    10- 3  10-10    57·5          51·1               15·5
    15C   10- 1  10-7     67·2  70·3    50·1  51     15    15·5

    16    10- 9  11-3     56    57      51·6  52·3   19    17·5
    16C   10- 9  11-3     51·2  50      48·7  49·5   10    10

    17     8- 1   8-7     57            48·7         14
    17C    7-10   8-4     45·3          44·8         10     8·5

    18     7- 2   7-8     58·2          47·3         11
    18C    6-11   7-5     45·3  47      46·7  47·1    8     6·5

    19    11- 4  11-10    90    96·3    57·7  59     22    21
    19C    7-11   8-5     52·4  54·4    46·7  47·2   15    12

    20     7- 1    7- 7   44·2          47·2         11·
    20C    7- 3    7-10   61·3   66     49·6  55     15    12·5

    21    11-     11- 6   70·7   76·5   54·1         16·5  16·5
    21C   10- 1   10- 7   62·4   67     49·6  50·4   19    15

    22    10- 9   11- 3   73·3          53    56·4   18    22·5
    22C   11- 7   12- 1   70·7   80·5   56·8  58·1   19·5  21·5

    23     8- 7    9- 1   51·7          47·8         11·5  15·5
    23C    8-11    9- 4   64·1   66·5   51·4  53·1   14·5  14

    24     9- 8   10- 2   58·5   62·5   51           19    20
    24C   10- 2   10- 8   60     61     50·1  51·5   15    15

    25    10- 1   10- 7   55·5   59·5   50    50·8   14
    25C   10-10   11- 4   63·3   63·8   50·2  50·9   12·5  21·5

    26     9- 8   10- 2   63·8   74·5   51·6  54·3   14
    26C   10- 4   10- 9   64·2   67     51·4  52·3   20    16·5

    27     6- 7    7- 1   43·7          45·4          9     6
    27C    6- 3    6- 9   41     44     44·6  45·4    8     9

    28    12-11   13- 5   71·3   75·5   54·9  55·8   23·5  21
    28C   13- 8   14- 2   74·2   79·8   53·4  54·5   21


                 TABLE II. RESULTS (Continued)

  Blank spaces indicate where tests were omitted for one reason or another

       N    Tapping, 1/2 min.      I.Q.     Healy, Score
                best hand

               1         2       1     2     1        2
       1      135       120      82    83   -25      -2
       1C     106       115      80    76   -50     -16

       2      105       112     107   114    28·5    30
       2C     152       114      91    96     3     -11

       3      136       139      94    91    21·5    22·5
       3C     135       129      82    85    17      19

       4      103                96    96     8·5
       4C     109                83    85    33

       5      110                95    99   -25
       5C     156               114   117    40·5

       6      110                95   101   -33
       6C     126                88    89   -32

       7      125       113      91    99     6     -28
       7C     105                95    99     4·5    27·5

       8      113       110      91    86    32·5
       8C     131       101      98   104     4      23

       9      149       135      83    93     3·5    10·5
       9C     144       150      87    90    34      55

      10     68+ 74    88+ 82   110   109   -12       6·5
      10C    70+ 54   135+109   104   100    27      65

      11    125+ 90    98+ 87   103   100   - 8       6
      11C   155+125   101+107   101   102   -29      -3·5

      12     98+69               98    95    20      21
      12C   102        84        98   101   -10     -12

      13    160+165   142+134    70    78    43      42
      13C   150+109   122+ 94    66    64   - 1·5    30·5

      14    190+172   138+130    96   107    12·5    48·5
      14C   175+152   175+164   140   137   - 5      25·5

      15    172+167   170+156    97    94     7      25
      15C   140+115   137+115    78    79     1      42·5

      16    145+131              65    73    49      47·5
      16C   145+99    135+135    74    82    30      37

      17     90+89    150+100    71    77    29·5    12
      17C   125+116   121+ 97    96    99     1·5    15

      18    133+115   135+111    98    98   -13·5   -12
      18C   100+ 99    84+ 74    90    94   -32     -28

      19    168+136              96   101    57·5    49
      19C   100+115   118+ 92    98    98   -22     -11

      20    105+115   110+ 93   106   102     0     -11
      20C   150+120   155+149   118   131    30      35

      21    152+111   132+125    64    67    20      32
      21C   140+136   138+110    86    97    70·5    58·5

      22    164+148   183+141    91   100    48·5    43·5
      22C   120+116   157+127    63    62    34·5    33·5

      23    150+119   141+136    85    94    49·5    68
      23C   122+115   140+110    81    96     4      25

      24    157+136   142+126   131   124    54·5    63
      24C   155+135   155+100    89    92    31·5    59·5

      25    140+127   150+119    77    76     8      25
      25C   148+134   151+135   145   137    29·5    29

      26    137+113   138+117    80    76    22·5     7
      26C   125+105   125+ 79    90    88    56      61·5

      27    108+ 92    97+ 92   110   109   -25      15
      27C   115+105   112+109    72    96     2      27·5

      28    150+148   162+143    81    84    29·5    73·5
      28C   178+148   170+163    95    98    64·5    51·5

  We have therefore:

    28 pairs of I.Q.'s to be compared
    21 pairs of weights
    19 pairs of heights
    16 pairs of grip measurements
    20 pairs of tapping speeds
    24 pairs of Healy Completion scores.

Again, in only five pairs does the gain of the control exceed that of
the test case, while in the remaining sixteen pairs the gains of the
test cases are greater than those of their respective controls. The
greatest loss of test as compared to control is 4·2 lbs., while the
largest gain is 7·9. It would seem then, that after a six months'
interval a child who has been operated on for adenoids and tonsils will
tend to show a slightly greater increase in weight than a child who
continues to suffer from the defects. The very small group renders this
conclusion far from assured. Since it doubtless takes some little time
to recover from the effects of the operation, and since there is
comparatively little gain in weight in a six months' interval, it would
be well to extend the experiment over another year. For the greater
reliability of results, some degree of after-care should be given the
operative cases, the control cases of course receiving the same
treatment. While this was impracticable in the present study, it
happened that three pairs of cases were members of a nutrition class,
and therefore underwent some hygienic treatment. In one pair, (no. 11)
the test case lost ·3 of a pound, while the control gained ·9. The test
cases of pairs 7 and 10 gained ·8 lb. and 2·1 lbs. respectively, over
and above their controls. However, these three cases alone are of little
significance.

A study of increase in height suffers even more than one of weight gains
from the short interval which elapsed between measurements. Normally,
there is very little growth in six months. There are only nineteen pairs
of cases in this portion of the study, a fact which renders it of even
less value. However, results are offered for what they are worth. The
smallest increase in height (·3 in.) is in the test group, while the
greatest growth (3·5 in.) is also in the test group. There is, however,
a gain of 3·3 inches in the control group as well as one of only ·4
inches. There are seven pairs in which the test group growth is less
than that of the controls, one in which the two are equal, and in the
remaining eleven the growth of the test cases exceeds that of the
controls. The variability

                         TABLE III

             Gain in weight, 6 months, 21 pairs


      N[16]       Test Group (A)       Control Group (B)   Lbs.

           Test 1  Test 2   Gain  Test 1 Test 2  Gain   A-B

        8   60·8    63·3    2·5    45·4   52·1    6·7  -4·2
        2   40·9    42·9    2·0    52·3   57·4    5·1  -3·1
       28   71·3    75·5    4·2    74·2   79·8    5·6  -1·4
        6   43·8    44·5     ·7    50·6   52·5    1·9  -1·2
       11   47·8    47·5    -·3    41·6   42·5     ·9  -1·2
        1   50·4    54·2    3·8    53·5   57·2    3·7    ·1
        7   39·9    41·0    1·1    38·4   38·7     ·3    ·8
        9   50·6    53·2    2·6    59·8   61·4    1·6   1·0
       12   48·0    52·5    4·5    41·0   44·5    3·5   1·0
       14   56·0    62·0    6·0    81·9   86·0    4·9   1·1
        5   45·0    47·0    2·0    56·2   57·0     ·8   1·2
       21   70·7    76·5    5·8    62·4   67·0    4·6   1·2
        4   51·1    54·2    3·1    49·4   51·0    1·6   1·5
       10   48·9    51·4    2·5    47·1   47·5     ·4   2·1
       16   56·0    57·0    1·0    51·2   50·0   -1·2   2·2
       24   58·5    62·5    4·0    60·0   61·0    1·0   3·0
        3   55·0    59·5    4·5    61·5   62·9    1·4   3·1
       25   55·5    59·5    4·0    63·3   63·8     ·5   3·5
       19   90·0    96·3    6·3    52·4   54·4    2·0   4·3
       13   90·0    98·0    8·0    74·7   76·8    2·1   5·9
       26   63·8    74·5   10·7    64·2   67·0    2·8   7·9

     Av.    56·86   60·61   3·76   56·24  58·60   2·39  1·37

     M                      3·8                   1·9   1·2
     75%ile                 5·8                   4·6   3·1
     25%ile                 2·0                    ·9    ·1
     Q                      1·9                   1·85  1·5
     P. E. (distribution)   1·76                  1·39  1·63
     P. E. (average)        ±·38                  ±·30  ±·48
                                             ----------------
                                              Av. =2·85 P. E.
                                              M.  =2·80 P. E.


    [16]: Numbers refer to cases as listed on Table II.

of the test group growth is greater than that of the control group. The
three nutrition pairs show the following records of growth,--in number
7, the test case shows a growth of·.6 in. more than his control. Number
10 is the pair in which the growth is equal. In number 11 the test case
again exceeds in growth by ·6 of an inch.

More reliable than height and weight considered separately, as an index
of physical welfare, is weight in relation to height and age. Table V
shows the improvement in this relationship for the two groups. The
numbers in columns 1, 2, 4 and 5 show the per cent under or over weight
of the individual cases, in relation to their respective heights and
ages. The authority upon which the figures are based, is the table
published by the American Child Health Association, giving standard
weights for height and age in boys.

There was an average loss of ·28 per cent in the weight-height-age
relationship for the test group, and of 2·11 per cent for the control
group. The average improvement of the test group in excess of the
control group is, then, 1·83 per cent. The median improvement of test
group over and above control is 4·00 per cent. The test group is more
variable than the control in improvement. The greatest improvement, 8
per cent, is found in both groups.


                               TABLE IV

                   Gain in Height--6 Months, 19 Pairs

      N[16]         Test Group (A)         Control Group (B)      Inches

              Test 1  Test 2  Gain     Test 1  Test 2  Gain      A-B

        9      48·1    49·4    1·3      51·9    55·2    3·3     -2·0
        4      47·5    49·2    1·7      48·9    52·0    3·1     -1·4
        5      44·9    45·2     ·3      46·6    48·1    1·5     -1·2
        6      43·1    43·9     ·8      45·4    47·3    1·9     -1·1
        2      42·5    44·1    1·6      45·2    47·0    1·8      -·2
       28      54·9    55·8     ·9      53·4    54·5    1·1      -·2
       16      51·6    52·3     ·7      48·7    49·5     ·8      -·1
       10      46·1    47·7    1·6      45·6    47·2    1·6       0
       25      50·0    50·8     ·8      50·2    50·9     ·7       ·1
        1      46·0    47·6    1·6      46·4    47·8    1·4       ·2
        3      47·0    48·4    1·4      51·7    52·9    1·2       ·2
        8      50·8    51·8    1·0      46·8    47·6     ·8       ·2
       14      51·0    51·6     ·6      57·9    58·3     ·4       ·2
        7      42·9    44·8    1·9      41·9    43·2    1·3       ·6
       11      45·8    47·7    1·9      43·6    44·9    1·3       ·6
       19      57·7    59·0    1·3      46·7    47·2     ·5       ·8
       26      51·6    54·3    2·7      51·4    52·3     ·9      1·8
       22      53·0    56·4    3·4      56·8    58·1    1·3      2·1
       13      61·5    65·0    3·5      56·8    57·8    1·0      2·5
       Av.     49·26   50·79   1·53     49·20   50·62   1·36      ·16
       M                       1·4                      1·3       ·2
       75%ile                  1·90                     1·75      ·65
       25%ile                   ·78                      ·8      -·43
       Q                        ·56                     ·48       ·54
       P. E. (distribution)     ·53                     ·44       ·44
       P. E. (average)         ±·12                    ±·10      ±·16
                                                      Av.=1     P. E.
                                                        M=1·25  P. E.

The greatest loss, 10 per cent, is in the control group. Eight cases
show a loss in comparison to their controls, and nine reveal a gain. On
the whole, there is some significance in the small net improvement
manifested by the test group. The average is 2·02 P. E.'s, and the
median 4·40 P. E.'s.

The dynamometer results show no gain in strength of grip six months
after operation. Indeed the average of the gains of the operative cases
is slightly less than the average gain of the controls. Comparing the
test group with the control, we find the average of the differences to
be -·24. But the variability is so high (P. E. = ±·48) as to render this
figure unreliable. The greatest loss in strength of grip is found in the
control group, but the greatest gain is also in this group. Seven cases
in the test group show a loss, as compared with only three control
cases. In eight, or one-half of the sixteen cases, the control member of
a pair gained more than the test member. Considering the three pairs of
nutrition cases, we find that in pair number 7 the test case loses 1·5
Kg. when compared with the control; and in pair number 10, 6·5 Kg.,
while the test case in pair 11 gains 4 Kg. The conclusion from the data
would seem to be that, within the space of six months at any rate,
operation for adenoids and tonsils brings about no increase in strength
of grip.

                              TABLE V

  Showing change in per cent over or underweight for height and age,
                              18 pairs

                            A                       B       A-B

    N[16]   1       2       3       4       5        6        7

     8    - 1     - 1       0     -13     - 5      + 8      - 8
    11    - 3     -12      -9     - 9     -11      - 2      - 7
    10    - 1     - 5      -4     - 6     - 8      - 2      - 2
    28    - 7     - 7       0       0     + 2      + 2      - 2
    13    -13     -19      -6     -11     -15      - 4      - 2
    19    + 6     + 8      +2     + 1     + 5      + 4      - 2
     6    + 2     - 3      -5     + 5     + 1      - 4      - 1
    14    -13     - 9      +4     - 5       0      + 5      - 1
     7    - 8     -15      -7     - 7     -14      - 7        0
     2    - 8     - 6      +2     + 9     +10      + 1      + 1
     3    + 6     + 8      +2     - 5     - 8      - 3      + 5
    16    -16     -15      +1     -13     -17      - 4      + 5
    25    - 8     - 7      +1     + 4     - 1      - 5      + 6
     5    - 4     - 1      +3     + 8     + 4      - 4      + 7
     9    - 8     -11      -3     - 7     -17      -10      + 7
    26    - 1     + 5      +6     + 1       0      - 1      + 7
     4    - 7     - 7       0     -15     -23      - 8      + 8
     1      0     + 8      +8     + 8     + 4      - 4      +12

   Av.    - 4·67  - 4·94   - ·28  - 3·06  - 5·17  - 2·11    + 1·83
   M                       +  ·5                  - 3·5     + 4·00
   75%ile                  +2                       0         6·5
   25%ile                  -2                     - 4·5     - 2
   Q                        2                       2·25      4·25
   P. E. (distribution)     3                       2·39      1·33
   P. E. (average)       ±·71                      ± 57       ± 91

                                                    Av.=2·02 P. E.
                                                     M.=4·40 P. E.

Is there, after operation, an improvement in motor control and
attention, and a lessening of fatiguability as these may be demonstrated
in the tapping test? Table VI gives the number of taps in the first half
minute of tapping for both groups before and after the six months
interval. The test group suffers an average loss of 2·24 taps, and a
median loss of 2. The average loss of the control group is 2·33, and the
median 2.

                              TABLE VI

                   Gain in Grip--6 Months--16 Pairs

   N[16]     Test Group (A)          Control Group (B)

         Test 1  Test 2   Gain     Test 1  Test 2   Gain    A-B

    10    12·5    11      -1·5      10      15       5      -6·5
    27     9       6      -3         8       9       1      -4
     1    13      12      -1        11      13       2      -3
    14    16      15      -1        22      24       2      -3
     2     9       9       0        10      12       2      -2
     9    10·5    13       2·5      16·5    21       4·5    -2
     7     7       6·5    - ·5       9      10       1      -1·5
    16    19      17·5    -1·5      10      10       0      -1·5
     3    12·8    14·5     1·7      14      15       1        ·7
    13    26·5    28·5     2        22      23       1       1
    24    19      20       1        15      15       0       1
    19    22      21      -1        15      12      -3       2
    22    18      22·5     4·5      19·5    21·5     2       2·5
    11    11      15       4        11·5    11·5     0       4
    21    16·5    16·5     0        19      15      -4       4
    23    11·5    15·5     4        14·5    14      - ·5     4·5
   Av.    14·58   15·22     ·62     14·19   15·06     ·875  - ·24
   M                       0                         1      -1·0
   75%ile                  3                         2       2·25
   25%ile                 -1                         0      -2·5
   Q                       2                         1       2·38
   P. E. (distribution)  1·58                        1·02    2·49
   P. E. (average)       ±·40                        ±·26    ±·48

                                                  Av.= -·50 P. E.
                                                  M.= -2·08 P. E.

There is practically no change then in the tapping ability of either
group. The high unreliability of the difference (P. E. = ± 3·10) is
noteworthy. It would seem that incidental causes have a much greater
effect upon tapping ability than can be demonstrated as resulting from
the removal of adenoids and tonsils.

Use of the tapping test as a measure of the decrease in tendency to
fatigue similarly brings out no indication of any improvement in the
operative group of cases. The measure of fatigue was taken as a ratio;
namely, the number of taps in the first, minus the number in the second
half minute over the number of taps in the first half minute. Then, if
there is a greater number of taps in the second, the ratio will be
minus, indicating that fatigue effect is so small as to be overcome by
practice effect. This was a fact in only four cases. Since what we are
measuring is improvement, the ratio for test 2 is subtracted from the
ratio for test 1 to find the gain in overcoming fatigue. Table VIII
shows the average gain for group one to be -·0196, and the median -·045.
That is, there is an average increase in fatiguability of ·0196 units
and a median increase of ·045 with a P. E. of ± ·02. This increase in
fatiguability occurs also in the control group, average 0, and median
·03 with P. E. of ± ·03. The average gain of test group over control
group is -·02 and the median gain is -·015. Again variability is
relatively large, P. E. being 1·04, so that the median and average gains
are -·50 P. E. and -·38 P. E. respectively.

We may say, then, that the capacities brought out by the tapping test
seem to undergo no improvement in six months after removal of adenoids
and tonsils.

The main line of interest in the present experiment lay with the
relation of adenoid and tonsil defects to general intelligence. The
results of the two tests dealing more specifically with this side of the
problem are here set forth. Table IX shows the I.Q.'s. of the two groups
before and after the six months' interval, together with changes plus or
minus in I.Q., and a comparison of the separate pairs in respect to
improvement.

We find that the test group shows an average gain in I.Q. of 2·25
points. The median gain is 2 points, the total range 18 points and P. E.
of the average is ± ·99. The control group shows an average gain very
slightly higher, 3·25 points, the median gain being 3. The range in this
case is 32 points, but P. E. is only ± ·47. The average of the compared
gains of separate pairs is -1·035. These numbers are so small as to be
insignificant. Actually, we may say that the operative group as a whole
showed no gain over the control group. If we examine individual cases we
find that the greatest loss in I.Q. was in the control group, (8 points)
but the greatest gain (24 points) also appears in this group. In the
test group 11 cases

                          TABLE VII

  Gain in number of taps in one-half minute, 21 pairs--right hand

  N[16]     Test Group (A)        Control Group (B)

        Test 1  Test 2   Gain    Test 1 Test 2   Gain    A-B

   14    190     138     -52      175     175       0     -52
   10     68      88      20       70     135      65     -45
   23    150     141     - 9      122     140      18     -27
    1    135     120     -15      106     115       9     -24
    9    149     135     -14      144     150       6     -20
   21    152     132     -20      140     138     - 2     -18
   22    164     183      19      120     157      37     -18
   24    157     142     -15      155     155       0     -15
   27    108      97     -11      115     112     - 3     - 8
   20    105     110       5      150     155       5       0
   15    172     170     - 2      140     137     - 3       1
   26    137     138       1      125     125       0       1
   25    140     150      10      148     151       3       7
    3    136     139       3      135     129     - 6       9
   13    160     142     -18      150     122     -28      10
   18    133     135       2      100      84     -16      18
   28    150     162      12      178     170     - 8      20
    8    113     110     - 3      131     101     -30      27
   11    125      98     -27      155     101     -54      27
    2    105     112       7      152     114     -38      45
   17     90     150      60      125     121     - 4      64

  Av.    135·19  132·95  - 2·24   136·47  134·14  - 2·33     ·09

  M                      - 2                      - 2       0
  75%ile                   6·5                      4·5    16·0
  25%ile                 -15                      -14      19·5
  Q                       10·75                     9·25   17·75
  P. E. (distribution)    12·24                     7·33   18·09
  P. E. (average)         ±2·66                    ±1·59   ±3·10

                                                 Av. = ·03 P. E.
                                                  M. = ·0  P. E.

lost in I.Q., as compared with 7 in the control group. Thirteen test
cases lost in comparison with their respective controls. Two gained
equally with their controls, and the remaining thirteen showed a larger
gain. In regard to the three pairs taken from the nutrition class,
number 7 gained 8 points and his control, 4. Number 10 lost a point and
his control lost 4, while number 11 lost 3 points with a gain of 1 point
by his control. So that these cases, in spite of most favorable
conditions, show no consistent gain in I.Q.

The results of the Healy tests are similar. There is a slightly higher
average gain in the control group. The test group contains eight cases
which made a poorer score at the end of the interval, the control group
six. The range of gains is from -22 to +44, or 66 points, in the test
group, while in the control group the gains range from -14 to +41·5 or
55·5

                       TABLE VIII

  Decrease in fatigue in tapping--Difference in rates of second half
           minute over first half minute. Sixteen pairs

     N[16]    Test Group (A)     Control Group (B)

          Test 1 Test 2  Gain  Test 1 Test 2  Gain    A-B

      13   -·03   ·05    -·08   ·27    -·28    ·55   -·63
      28    ·01   ·11    -·10   ·17     ·04    ·13   -·23
      20    ·10   ·15    -·05   ·20     ·04    ·16   -·21
      10   -·09   ·07    -·16   ·23     ·19    ·04   -·20
      17    ·01   ·33    -·32   ·07     ·20   -·13   -·19
      25    ·09   ·21    -·12   ·09     ·11   -·02   -·10
      11    ·28   ·11     ·17   ·19    -·06    ·25   -·08
      15    ·03   ·08    -·05   ·18     ·16    ·02   -·07
      22    ·10   ·23    -·13   ·03     ·19   -·16    ·03
      27    ·15   ·05     ·10   ·09     ·03    ·06    ·04
      14    ·09   ·06     ·03   ·02     ·06   -·04    ·07
      18    ·14   ·18    -·04   ·01     ·12   -·11    ·07
      24    ·13   ·11     ·02   ·13     ·35   -·22    ·24
      26    ·18   ·15     ·03   ·16     ·37   -·21    ·24
      23    ·21   ·04     ·17   ·06     ·21   -·15    ·32
      21    ·27   ·05     ·22   ·03     ·20   -·17    ·39

      Av.   ·104  ·124   -·020  ·121    ·121   ·0    -·020
      M                  -·045                 -·03  -·015
      75%ile              ·03                  +·04   ·07
      25%ile             -·12                  -·16  -·20
      Q                   ·075                  ·10   ·135
      P. E. (distribution) ·09                  ·11   ·05
      P. E. (average)     ±·02                 ±·03  ±·04

                                          Av. = -·5  P. E.
                                           M. = -·38 P. E.

points. Seventeen of the operative cases showed a smaller gain than
their respective controls. The three pairs of cases from the nutrition
class show the following gains:--pair 7; the test case loses 22 points,
the control gains 23 points; pair 10, test case gains 18·5, but control
gains 38 points; pair 11, test case gains 14 points, and control gains
25·5 points. From this test then, we can find no general tendency for
cases operated on to improve in intelligence in excess of improvement in
a control group which was not so treated.

This question presents itself:--is there any relationship between
improvement in physical well-being as revealed in weight, and
improvement in intelligence? If, as has been supposed, adenoids and
diseased tonsils cause mental retardation indirectly through physical
deprivation, it would seem as though greater improvement in intelligence
after operation should accompany greater improvement in weight, and
smaller intelligence gain should accompany slighter gain in weight. In
order to determine whether this was true for our cases, improvement in
I.Q. was correlated with gain in weight, for the test group. The order
of merit method was used, and the formula [Rho] = 1 - ((6 [Sum] D_n) /( n(n²-1)))
where f = 2 sin ([Pi]/6)[Rho]. The resulting value of r was -·10 with
unreliability of ·226, calculated by the formula [Sigma]t.r - obt.r =
(1·05(1-r²)) / [sqrt]n. There is therefore no correlation between
improvement in intelligence and gain in weight.

                          TABLE IX

                 Improvement in I.Q., 28 Pairs

    N[16]     Test Group (A)        Control Group (B)

          Test 1  Test 2  Gain    Test 1  Test 2  Gain    A-B

    27     110     109     -1       72      96     24     -25
    20     106     102     -4      118     131     13     -17
     8      91      86     -5       98     104      6     -11
    24     131     124     -7       89      92      3     -10
    21      64      67      3       86      97     11      -8
     3      94      91     -3       82      85      3      -6
    12      98      95     -3       98     101      3      -6
    23      85      94      9       81      96     15      -6
    11     103     100     -3      101     102      1      -4
    15      97      94     -3       78      79      1      -4
    18      98      98      0       90      94      4      -4
     4      96      96      0       83      85      2      -2
    26      80      76     -4       90      88     -2      -2
    16      65      73      8       74      82      8       0
    28      81      84      3       95      98      3       0
     5      95      99      4      114     117      3       1
     2     107     114      7       91      96      5       2
    10     110     109     -1      104     100     -4       3
    17      71      77      6       96      99      3       3
     7      91      99      8       95      99      4       4
     1      82      83      1       80      76     -4       5
     6      95     101      6       88      89      1       5
    19      96     101      5       98      98      0       5
     9      83      93     10       87      90      3       7
    25      77      76     -1      145     137     -8       7
    13      70      78      8       66      64     -2      10
    22      91     100      9       63      62     -1      10
    14      96     107     11      140     137      3      14

    Av.     91·53   93·78   2·25    92·93   96·21   3·285  -1·035
    M                       2                       3      -1
    75%ile                  7                       4       5
    25%ile                 -3                      -1      -6
    Q                       5                       2·5     5·5
    P. E. (distribution)    5·25                    2·5     5
    P. E. (average)         ±·99                    ±·47   ±1·10
                                                    Av. = -·94 P. E.
                                                     M. = -·99 P. E.

                             TABLE X

          Improvement in Performance of Healy Test, 24 Pairs

    N[16]   Test Group (A)           Control Group (B)

        Test 1  Test 2   Gain      Test 1  Test 2  Gain      A-B

     7     - 6     -28    -22         4·5    27·5    23      -45
    13      43      42    - 1       - 1·5   30·5    -32      -33
    17     29·5     12    -17·5       1·5   15       13·5    -31
    15      7       25     18         1     42·5     41·5    -23·5
    26     22·5      7    -15·5      56     61·5      5·5    -21·5
    10    -12        6·5   18·5      27     65       38      -19·5
    19     57·5     49    - 8·5     -22    -11       11      -19·5
    24     54·5     63      8·5      31·5   59·5     28      -19·5
    20      0      -11    -11        30     35        5      -16
     9      3·5     10·5    7        34     55       21      -14
    11     -8        6     14       -29     -3·5     25·5    -11·5
    16     49       47·5  - 1·5      30     37        7      - 8·5
     1    -25        2     27       -50    -16       34      - 7
    22     48·5     43·5  - 5        34·5   33·5    - 1      - 4
    18    -13·5    -12      1·5     -32    -28        4      - 2·5
    23     49·5     68     18·5       4     25       21      - 2·5
     3     21·5     22·5    1        17     19        2      - 1
    12     20       21      1       -10    -12      - 2        3
    14     12·5     48·5   36       - 5     25·5     30·5      6·5
    27    -25       15     40         2     27·5     25·5     14·5
     2     28·5     30      1·5       3    -11      -14       15·5
    25      8       25     17        29·5   29      -  ·5     17·5
    21     20       32     12        70·5   58·5    -12       24
    28     29·5     73·5   44        64·5   51·5    -13       57
    Av.    17·29    24·94   7·64     12·12  25·69    13·56   - 5·85
    M                       4·25                     12·25   - 7·75
    75%ile                 18                        25·5      3
    25%ile                - 5                       -  ·5    -19·5
    Q                      11·5                      13       11·25
    P. E. (distribution)   10·6                      10·56    13·65
    P. E. (average)        ±2·16                    ± 2·16   ± 3·05

                                                    Av. = -1·92 P. E.
                                                     M. = -2·54 P. E.

Similarly, it might be thought that the children who had suffered from
the defects for a comparatively short time, might reveal greater
improvement in intelligence after six months than those who had been
afflicted for a longer space of time. We had no way of knowing
definitely how long the defects had been present in the cases studied.
Roughly, though, we may say that in general the older boys have had
defective tonsils and adenoids for a longer time than the younger ones,
and that the older the boy, the older the defect. On this basis, if
correlation of youth with gain in I.Q. should give a larger positive
value for r, we might be justified in saying that the younger boys, who
have been handicapped for a lesser period, show greater mental
recuperation than their older companions. Such a correlation was
attempted in the test group, correlating age at the first test with gain
in I.Q. The same methods and formulae were used as in the weight and
intelligence comparison, the greatest gain in I.Q. being given first
position, and the lowest age. The resulting value for r was -·24, with
an unreliability of ·186. The relationship would appear to be in the
other direction but it is so small, with an unreliability measure so
large as to be insignificant. Once more, then, we find in our results no
correspondence between recency of defect and quick mental recovery.

                      TABLE XI

  Showing percentile ratings of the members of the two groups at the
       beginning and end of the six months' interval

         Weight     Height      Grip      Tapping

    1   ·29  ·44   ·25  ·40   ·47  ·40   ·51  ·33
    1C  ·43  ·54   ·27  ·45   ·33  ·47   ·17  ·30

    2   ·04  ·10   ·04  ·11   ·16  ·16   ·16  ·25
    2C  ·38  ·55   ·20  ·32   ·25  ·40   ·80  ·28

    3   ·46  ·59   ·32  ·49   ·44  ·56   ·52  ·58
    3C  ·65  ·69   ·74  ·81   ·54  ·67   ·51  ·42

    4   ·33  ·44   ·39  ·52   ·16        ·13
    4C  ·27  ·32   ·51  ·78   ·18        ·19

    5   ·16  ·20   ·18  ·20   ·33        ·23
    5C  ·50  ·53   ·28  ·47   ·40        ·87

    6   ·12  ·15   ·06  ·10   ·10        ·23
    6C  ·31  ·40   ·22  ·38   ·27        ·41

    7   ·03  ·07   ·05  ·15   ·07  ·06   ·40  ·27
    7C  ·01  ·02   ·03  ·07   ·16  ·24   ·16

    8   ·62  ·71   ·63  ·75   ·24        ·27  ·23
    8C  ·18  ·37   ·31  ·40   ·67  ·72   ·43  ·11

    9   ·31  ·41   ·47  ·53   ·26  ·47   ·71  ·51
    9C  ·60  ·65   ·76  ·89   ·76  ·89   ·63  ·78

    10  ·26  ·35   ·26  ·43   ·44  ·33   ·01  ·04
    10C ·21  ·22   ·23  ·37   ·24  ·67   ·02  ·51

    11  ·24  ·23   ·25  ·43   ·33  ·67   ·40  ·08
    11C ·08  ·09   ·09  ·17   ·36  ·36   ·86  ·11

    12  ·25  ·40   ·15        ·53        ·08
    12C ·06  ·15   ·02  ·08   ·04  ·01   ·12  ·03

    13  ·95 1·00   ·99 1·00   ·99 1·00   ·90  ·66
    13C ·87  ·89   ·93  ·96   ·94  ·96   ·78  ·36

    14   ·49  ·66   ·67  ·74   ·72  ·67  1·00  ·57
    14C  ·92  ·93   ·96  ·98   ·93  ·98   ·97  ·97

    15   ·56        ·68        ·70        ·95  ·94
    15C  ·79  ·80   ·59  ·66   ·67  ·70   ·62  ·54

    16   ·49  ·53   ·74  ·79   ·81  ·77   ·69
    16C  ·34  ·28   ·50  ·54   ·24  ·24   ·69  ·51

    17   ·53        ·50        ·53        ·05  ·78
    17C  ·17        ·15        ·24  ·11   ·40  ·34

    18   ·57        ·38        ·33        ·45  ·51
    18C  ·17  ·20   ·30  ·34   ·10  ·06   ·09  ·03

    19   ·95  ·99   ·94  ·98   ·94  ·88   ·93
    19   ·38  ·45   ·30  ·37   ·67  ·40   ·09  ·31

    20   ·13        ·37        ·33        ·16  ·23
    20C  ·63  ·75   ·56  ·88   ·67  ·44   ·78  ·86

    21   ·83  ·89   ·84        ·76  ·76   ·80  ·44
    21C  ·67  ·77   ·55  ·61   ·81  ·67   ·62  ·57

    22   ·85        ·81  ·91   ·78  ·95   ·92  ·99
    22C  ·83  ·92   ·93  ·97   ·82  ·91   ·33  ·89

    23   ·36        ·45        ·36  ·70   ·78  ·63
    23C  ·73  ·74   ·70  ·82   ·55  ·53   ·36  ·62

    24   ·59  ·69   ·67        ·81  ·85   ·89  ·66
    24C  ·62  ·63   ·59  ·71   ·67  ·67   ·86  ·86

    25   ·47  ·60   ·57  ·63   ·53        ·62  ·78
    25C  ·73  ·74   ·60  ·64   ·44  ·91   ·70  ·79

    26   ·74  ·89   ·74  ·85   ·53        ·54  ·57
    26C  ·76  ·81   ·70  ·79   ·84  ·76   ·40  ·40

    27   ·11        ·23        ·16  ·04   ·18  ·06
    27C  ·07  ·12   ·12  ·23   ·10  ·16   ·30  ·25

    28   ·86  ·90   ·87  ·90   ·97  ·88   ·78  ·91
    28C  ·87  ·93   ·83  ·86   ·88        ·98  ·94

TABLE XI (Continued)

Showing percentile ratings of the two groups at the beginning and end of
the six months' interval

    N[16]     I.Q.      Healy      Total    Possible  Average
                                                        Gain

    1      ·25  ·27   ·10  ·29      ·30        415      ·05
    1C     ·21  ·15   ·01  ·12      ·53        462      ·089

    2      ·84  ·89   ·60  ·66      ·38        416      ·063
    2C     ·45  ·51   ·29  ·18     -·07        358     -·011

    3      ·49  ·44   ·49  ·51      ·40        328      ·066
    3C     ·25  ·32   ·44  ·45      ·30        287      ·05

    4      ·59  ·59   ·38           ·22        168      ·073
    4C     ·27  ·32   ·71           ·42        195      ·14

    5      ·53  ·71   ·10           ·42        213      ·14
    5C     ·89  ·90   ·77           ·24        133      ·08

    6      ·53  ·77   ·02           ·55        229      ·183
    6C     ·37  ·38   ·04           ·27        210      ·09

    7      ·45  ·71   ·22  ·07      ·37        478      ·062
    7C     ·53  ·71   ·34  ·59      ·74        393      ·148

    8      ·45  ·34   ·70          -·50        303     -·125
    8C     ·67  ·81   ·33  ·52      ·10        241      ·025

    9      ·27  ·46   ·23  ·39      ·71        375      ·118
    9C     ·35  ·40   ·73  ·89      ·72        217      ·12

    10     ·88  ·86   ·15  ·35      ·34        400      ·056
    10C    ·81  ·73   ·57  ·97     1·39        392      ·218

    11     ·79  ·73   ·20  ·34      ·21        379      ·035
    11C    ·77  ·79   ·05  ·23     -·44        379     -·073

    12     ·67  ·53   ·47  ·49     -·11        161     -·036
    12C    ·67  ·77   ·19  ·15      ·19        208      ·032

    13     ·09  ·19   ·79  ·78      ·02        129      ·003
    13C    ·06  ·05   ·24  ·67      ·06        178      ·01

    14     ·59  ·84   ·41  ·84      ·69        212      ·115
    14C    ·97  ·96   ·21  ·56      ·41        104      ·068

    15     ·62  ·49   ·38  ·55      ·12        106      ·04
    15C    ·19  ·20   ·26  ·79      ·66        193      ·11

    16     ·05  ·12   ·86  ·82      ·15        205      ·03
    16C    ·13  ·25   ·66  ·76      ·24        313      ·04

    17     ·09  ·17   ·63  ·40      ·66        223      ·220
    17C    ·59  ·71   ·27  ·43      ·21        174      ·053

    18     ·67  ·67   ·13  ·15      ·08        175      ·027
    18C    ·40  ·49   ·04  ·07      ·18        247      ·03

    19     ·59  ·69   ·91  ·85      ·16         67      ·032
    19C    ·67  ·67   ·11  ·18      ·16        287      ·027

    20     ·82  ·79   ·25  ·18     -·06        177     -·02
    20C    ·91  ·94   ·66  ·75      ·20         65      ·066

    21     ·05  ·07   ·47  ·69     -·16        209     -·032
    21C    ·34  ·62   ·99  ·92      ·46        157      ·077

    22     ·45  ·73   ·84  ·81      ·87        120      ·174
    22C    ·03  ·02   ·74  ·72      ·74        275      ·123

    23     ·32  ·49   ·86  ·98      ·65        168      ·163
    23C    ·23  ·59   ·33  ·50     1·26        253      ·21

    24     ·94  ·92   ·88  ·95    - ·06         89     -·012
    24C    ·38  ·46   ·68  ·93      ·54        179      ·09

    25     ·17  ·15   ·37  ·55      ·49        280      ·098
    25C   1·00  ·97   ·63  ·60      ·53        134      ·088

    26     ·21  ·15   ·51  ·36     0           226     0
    26C    ·40  ·37   ·90  ·94      ·04        184      ·007

    27     ·88  ·86   ·10  ·43      ·05        268      ·013
    27C    ·11  ·59   ·29  ·59     1·49        320      ·25

    28     ·23  ·29   ·63 1·00      ·59        153      ·097
    28C    ·53  ·67   ·96  ·87      ·24         83      ·048

Table XI expresses the results of Table II, with the scores given in
percentile values. In each test, the group was taken as composed of the
two scores of every individual--the total number of scores in tests and
retests, eliminating those scores where the other member of the pair was
lacking, or where no retest was given. Thus case number 1 was just
within the lowest 27% of the group in weight at the first weighing, but
had advanced to the 44 percentile at the second. In height he gained
from the 25 percentile to the 40 percentile. His total gain in all tests
is 30 percentile out of a possible 415, and the average gain is·.05. The
reader may see by scanning the table that the gains in the test group
are practically equaled by those in the control group. There seems to be
no consistent relationship between a low score in the first test and a
large gain. This is true even though the method of calculation tends to
minimize gains at the high end of the group, and losses at the low end.
In table XII this may be seen more clearly in respect to I.Q. and the
results for all the tests taken together with the I.Q. weighted by being
counted twice. A large possible gain indicates that the score at the
first testing was low, and vice versa. Considering I.Q. values, the
largest possible gain in the test group was 95 per cent of the group.
This occurred twice, in one case the actual gain being 7% of the group
and in the other 2%. In the control group, the largest possible gain was
97% of the group, but actually this case fell 1% of the group. If we
correlate possible gain with actual gain for each group, using the
formula r = 2sin(([Pi]/6)[Rho]) when [Rho] = 1 - ((6 [Sum] D²)/(n(n²-1)))
we get a coefficient of correlation ·36 in the test group, and ·19

                             TABLE XII

  Showing gains in percentile rating for I.Q., and for a total of all the
           tests with I.Q. weighted by being counted twice.

            I.Q.                                      Total
                           A         B
         1st     2d    possible   actual   possible   actual  Av. Gain
         P.R.   P.R.      gain      gain      gain      gain

    1      25     27      75          2        415        30      5
    1C     21     15      79         -6        462        53      8·9

    2      84     89      16          5        416        38      6·3
    2C     45     51      55          6        358       - 7     -1·1

    3      49     44      51         -5        328        40      6·6
    3C     25     32      75          7        287        30      5

    4      59     59      41          0        168        22      7·3
    4C     27     32      73          5        195        42     14

    5      53     71      47         18        213        42     14
    5C     89     90      11          1        133        24      8

    6      53     77      47         24        229        55     18·3
    6C     37     38      63          1        210        27      9

    7      45     71      55         26        478        37      6·2
    7C     53     71      47         18        393        74     14·8

    8      45     34      55        -11        203       -50    -12·5
    8C     67     81      33         14        241        10      2·5

    9      27     46      73         19        375        71     11·8
    9C     35     40      65          5        217        72     12

    10     88     86      12         -2        400        34      5·6
    10C    81     73      19         -8        392       139     21·8

    11     79     73      21         -6        379        21      3·5
    11C    77     79      23          2        379       -44     -7·3

    12     67     53      33        - 6        161      - 11    - 3·6
    12C    67     77      33         10        208        19      3·2

    13      9     19      91         10        129         2       ·3
    13C     6      5      94        - 1        178         6      1

    14     59     84      41         25        212        69     11·5
    14C    97     96       3        - 1        104        41      6·8

    15     62     49      38        -13        106        12      4
    15C    19     20      81          1        193        66     11

    16      5     12      95          7        205        15      3
    16C    13     25      87         12        213        24      4

    17      9     17      81          8        223        66     22
    17C    59     71      41         12        174        21      5·3

    18     67     67      33          0        175         8      2·7
    18C    40     49      60          9        247        18      3

    19     59     69      41         10         67        16      3·2
    19C    67     67      33          0        287        16      2·7

    20     82     79      18        - 3        177      -  6    - 2
    20C    91     94       9          3         65        20      6·6

    21      5      7      95          2        209      - 16    - 3·2
    21C    34     62      66         28        157        46      7·7

    22     45     73      55         28        120        87     17·4
    22C     3      2      97        - 1        275        74     12·3

    23     32     49      68         17        168        65     16·3
    23C    23     59      77         36        253       126     21

    24     94     92       6        - 2         89      -  6    - 1·2
    24C    38     46      62          8        179        54      9

    25     17     15      83        - 2        280        49      9·8
    25C   100     97       0        - 3        134        53      8·8

    26     21     15      79        - 6        226         0      0
    26C    40     37      60        - 3        184         4       ·7

    27     88     86      12        - 2        268         5      1·3
    27C    11     59      89         48        320       148     25

    28     23     29      77          6        153        59      9·7
    28C    53     67      47         14         83        24      4·8

in the control group. With the small number of cases involved the
probable error is too great to allow either of these measures as
indicative of relationship. We may say, then, that there is no definite
tendency for those of low I.Q. to improve in six months after operation
to a greater degree than those of higher I.Q.

Finally, in order to compare the results of the various tests, the
measures of the gains of the test group in excess of the control were,
for each test, expressed in terms of P. E. The averages and medians of
these measures are collected in Table XIII. They show a very slight
tendency toward gain in weight, height, and weight-height-age
relationship; neither improvement nor loss in grip, tapping
fatigueability and I.Q., and a rather curious tendency to loss in the
Healy scores. This latter is very probably not a true measure since
performance in the Healy Picture Completion test shows a rather high
variability, and the cases are so few as to make the influence of single
very high or low scores unduly great.

                            TABLE XIII

  Showing improvement in various tests of operative group over and above
     such improvement in control group. Expressed in Terms of P. E.

          Weight Height Height-  Grip Tapping  Tapping I.Q.  Healy
                        Weight                 fatigue

           P. E. P. E.  P. E.   P. E.  P. E.    P. E.  P. E.  P. E.

  Average  2·85  1·00   2·02    -·50   ·03      -·50   -·94  -1·92
  Median   2·80  1·25    ·55    -·83   ·32      -·50   0     -2·54




CHAPTER IV

MEASUREMENT OF IMPROVEMENT AFTER A SECOND INTERVAL OF SIX MONTHS


In view of the fact that one of the experimenters[15] found improvement
in school work when her study was extended to cover a second time
interval after operation, it was deemed advisable to similarly extend
the present investigation in order to determine whether our operated
cases showed any improvement after twelve months. To this end, the
fifty-six children composing the final groups of the first study, were
sought after a second interval of about six months. Conditions made it
impossible to give all the retests exactly twelve months from the time
of the operation. As a matter of fact, the period ranges from ten to
seventeen months. An effort was made to keep the interval between tests
equal for the two members of a given pair.

    [15]: A. H. MacPhail, Adenoids and Tonsils: A study showing
    how the Removal of Enlarged or Diseased Tonsils Affects a Child's
    Work in School. Ped. Sem., June, 1920, pp. 188-194.

The same tests were given as in the first study. About half of the
testing was done by one of the former examiners, but she was obliged to
turn the work over to another before it had been completed. The second
examiner was highly recommended, and had had training and practical
experience in the giving of tests. She was instructed in the methods
which had been employed previously, so that conditions were as far as
possible kept constant.

The results of the tests are collected in Table XIV. In the first column
is given the length of the time interval for each case. It may be seen
that the final group was composed of forty-two children, forming
twenty-one pairs. There were fifteen pairs which received a second
rating in weight; thirteen in height; thirteen in grip; fifteen in
tapping, eleven in fatigue as shown by tapping, twenty-one in I.Q., and
eighteen in the Healy Test. These numbers while they are smaller than we
could wish, would seem to be great enough to indicate

                          TABLE XIV

      Results of the Tests after an Interval of from 10 to 17 Months

   N[16]   Mos.      Weight              Height              Grip

                 Test 1  Test 3      Test 1  Test 3      Test 1  Test 3

   1       15     50·4    63·5      46      49·7      13      18
   1C      15     53·5    62·8      46·4    49·7      11      15

   2       15     40·9    47·9      42·6    45·9       9      10
   2C      17     52·3    65·5      45·2    49·8      10      15

   3       16     55      67·5      47      50·2      12·8    13
   3C      14     61·5    57·8      51·7    54        14      14·5

   4       13     51·1    60·2      47·5    50·5       9
   4C      13     49·4    54·2      48·9    50·8       9·5

   7       14     39·9    45·8      42·9    45·6       7       6
   7C      12     38·4    42·1      41·9    43·7       9      14

   8       11     60·8    69·2      50·8    52·3      10
   8C      11     45·4    57·9      36·8    48·7      15

   10      11     48·9    56·7      46·1    48·6      12·5    12
   10C     11     47·1    51·8      45·6    48·1      10      12

   11      12     47·8    55        45·8    49·5      11      11
   11C     12     41·6    47        43·6    46·8      11·5     7·5

   12      12     48      66·5      44·8              14
   12C     11     41      69·6      41·5               6

   13      12     90     112        61·3    61·8      26·5    28·5
   13C     12     74·7    88        56·8    60·0      22      27

   14      12     56      66        51      53·3      16      17
   14C     12     81·9    98        57·9    59·5      22      22·5

   15      12     57·5              51·1              15·5
   15C     10     67·2              50·1              15

   16      12     56      60·3      51·6    53·5      19      18·5
   16C     11     51·2    55        48·7    50·1      10      10

   18      12     58·2              47·3              18
   18C     11     45·3              46·7               8

   19      12     90     108        57·7    60·5      22      20
   19C     11     52·4    59        46·7    48        15      18

   20      12     44·2              47·2              11
   20C     11     61·3              49·6              15

   21      12     70·7    85·5      54·1              16·5    15
   21C     10     62·4    69·2      49·6              19      17

   23      12     51·7              47·8              11·5    15
   23C     11     64·1              51·4              14·5    16

   27      12     43·7              45·4               9       6
   27C     11     41                44·6               8       9

   28      12     71·3    78·5      54·9    56·3      23·5
   28C     11     74·2    85·8      53·4    55·9      21


                      TABLE XIV (Continued)

   N[16]       Tapping                 I.Q.                Healy

          Test 1    Test 3         (1)    (3)            (1)    (3)

   1      135       142             82     93            -25     11
   1C     106       134             80     85            -50     11

   2      105       135            107    113             28·5   24·5
   2C     152       139             91     86              3     19·5

   3      136       144             94     91             21·5   15·5
   3C     135       135             82     96             17     25·5

   4      103                       96    111              8·5
   4C     109                       83    102             33

   7      125                       91     93            - 6     16
   7C     105                       95    112              4·5   11

   8      113       128             91     92             32·5
   8C     131       121             98    111              4

   10      68+ 74   145+106        110    116            -12     11
   10C     70+ 74   148+124        104    107             27     48·5

   11     125+ 90   120+125        103    102            - 8     15·5
   11C    155+125   102+112        101     95            -29    -20

   12      98+ 69                   98     86             20      1
   12C    102                       98     90            -10     41·5

   13     160+165   176+187         70     61             43     62·5
   13C    150+109   188+174         66     60             -1·5   21·5

   14     190+172   228+215         96    102             12·5   77
   14C    175+152   165+186        140    138            - 5     48·5

   15     172+167   192+186         97     97              7     19
   15C    140+115   145+133         78     98              1     54·5

   16     145+131                   65     74             49     79
   16C    145+ 99                   74     81             30     45·5

   18     133+115   126+145         98    101            -13·5   13·5
   18C    100+ 99   108+ 92         90     92            -32    -35

   19     168+136                   96     97             57·5   60·5
   19C    100+115                   98     90            -22    -15

   20     105+115   122+118        106    116              0     55
   20C    150+120   154+154        118    140             30     48·5

   21     152+111   154+155         64     66             20     38
   21C    140+136   174+150         86     93             70·5   88

   23     150+119   157+157         85     80             49·5   62·5
   23C    122+115   141+141         81     88              4     64

   27     108+ 92   114+ 95        110    112            -25     25·5
   27C    115+105   101+118         72     98              2     39·5

   28     150+148   176+168         81     83             29·5   77·5
   28C    178+148   172+157         95     94             64·5   83·5

any very consistent tendency toward improvement. The question, whether
or not the results are affected by the differences in time interval,
will be considered later.

In weight, the test group showed an average gain of 11·013 pounds, with
a median of 9·1 (Table XV). The average gain of the control group was
9·113 pounds and the median 6·8. The gains in the test group are less
variable than those of the control. The average of the gains of the test
group in excess of those of the control is 1·9 pounds, and the median is
2·2 pounds; while the unreliability of the difference is ± 1·46 The
average, then, is only 1·30 P. E. and the median 1·51 P. E.

If we turn to Table III and compare the results there set forth with the
results at the end of the second period, we find the gains of the test
group exceed those of the control in the following manner.

                        TABLE XV

             Weight, Second Retests, 15 Pairs

    N[16]  Test Group (A)       Control Group (B)

          Test 1 Test 3 Gain   Test 1 Test 3 Gain    A-B

    12    48     66·5   18·5   41     69·6   28·6   -10·1
     2    40·9   47·9    7     52·3   65·5   13·2   -6·2
    14    56     66     10     81·9   98     16·1   -6·1
    28    71·3   78·5    7·2   74·2   85·8   11·6   -4·4
     8    60·8   69·2    8·4   45·4   57·9   12·5   -4·1
    16    56     60·3    3·7   51·2   55      3·8   -·1
    11    47·8   55      7·2   41·6   47      5·4     1·8
     7    39·9   45·8    5·9   38·4   42·1    3·7     2·2
    10    48·9   56·7    7·8   47·1   51·8    4·7     3·1
     1    50·4   63·5   13·1   53·5   62·8    9·3     3·8
     4    51·1   60·2    9·1   49·4   54·2    4·8     4·3
    21    70·7   85·5   14·8   62·4   69·2    6·8     8
    13    90    112     22     74·7   88     13·3     8·7
    19    90    108     18     52·4   59      6·6    11·4
     3    55     67·5   12·5   61·5   57·8   -3·7    16·2
    Av.   58·45  69·50  11·01  55·13  63·58   9·11    1·9
    M                    9·1                  6·8     2·2
    75%ile              13·52                12·67    5·22
    25%ile               7·15                 4·47   -4·07
    Q                    3·18                 4·1     4·65
    P. E. (distribution) 3·81                 4·19    6·1
    P. E. (average)     ±1·00                ±1·07   ±1·46
                                           Av. = 1·30 P. E.
                                            M. = 1·51 P. E.

                                                      6 months  12 months
    Average of gains in test group in excess of control 1·37     1·9
    Median                                              1·2      2·2
    P. E. of difference                                 ±·48    ±1·46
    Average in terms of P. E.                           2·85     1·30
    Median in terms of P. E.                            2·80     1·51

After a twelve months' interval, therefore, the actual average and
median gains are slightly larger than after the first six months, but
the variability is very much greater. Therefore, when expressed in terms
of P. E., the gains are smaller. One of the test group cases (No. 13)
who had gained 8 pounds after six months, gained 14 pounds in the second
period of six months, making a total gain of 22 pounds. This gain is
exceeded, however, by one in the control group (No. 12) who gained 3·5
pounds in six months, and 25·1 pounds more in the ensuing five months.
This is certainly an enormous gain for five months, under any
circumstances. Turning to Table XIV we find no corresponding gain in
I.Q. for this child. Indeed there is a loss of five points.

Other children in the test group who made large gains, were case 12,
with a gain of 18·5 pounds after twelve months, compared with 4·5 pounds
after six months; case 19, gain of 6·3 pounds after first six months,
and 18 pounds after 12 months; case 21, whose gain after the first
period was 5·8 pounds, but who gained 14·8 pounds after twelve months.
In these cases the gain in the second period greatly exceeds that for
the first.

                             TABLE XVI

                Height, Second Retests, 13 Pairs

    N[16]     Test Group (A)          Control Group (B)

         Test 1  Test 3   Gain     Test 1  Test 3   Gain    A-B

    13     61·3    61·8    ·5       56·8      60     3·2   -2·7
     2     42·6    45·9   3·3       45·2      49·8   4·6   -1·3
    28     54·9    56·3   1·4       53·4      55·9   2·5   -1·1
     8     50·8    52·3   1·5       46·8      48·7   1·9   - ·4
    10     46·1    48·6   2·5       45·6      48·1   2·5     ·0
     1     46      49·7   3·7       46·4      49·7   3·3     ·4
    11     45·8    49·5   3·7       43·6      46·8   3·2     ·5
    16     51·6    53·5   1·9       48·7      50·1   1·4     ·5
    14     51      53·3   2·3       57·9      59·5   1·6     ·7
     3     47      50·2   3·2       51·7      54     2·3     ·9
     7     42·9    45·6   2·7       41·9      43·7   1·8     ·9
     4     47·5    50·5   3         48·9      50·8   1·9    1·1
    19     57·7    60·5   2·8       46·7       4·8   1·3    1·5

    Av.    49·63   52·17  2·5       48·74     51·16  2·42    ·08
    M                     2·7                        2·3     ·5
    75%ile                3·15                       2·85    ·85
    25%ile                1·6                        1·75    ·92
    Q                      ·775                       ·65    ·885
    P. E. (distribution)   ·66                        ·78    ·82
    P. E. (average)       ±·18                       ±·22   ±·28

                                                       Av.=·29 P. E.
                                                       M.=1·79 P. E.

In weight, then, the mean gain of the test group over and above the
control continues to increase through the second period of six months.
The variability, however, increases enormously, which fact is due
possibly to varying conditions which may enter in during the longer
period to affect the health and thus lessen the gain of some of the
children.

In order to determine whether the slight inequalities in interval length
have any considerable effect on the results, we have calculated the
relation between the length of interval and amount of improvement. The
coefficient of correlation by the method of rank differences is equal to
·03. The small number of cases renders the unreliability of correlation
very great, but we can at least say that there is no consistent
relationship between improvement and time interval, within the narrow
limits here set. We are probably justified in taking twelve months as
the interval, since such was the case in eight out of the fifteen test
cases, while the greatest variation above this made was four months, and
below it, one month.

The gains in height after twelve months are shown in Table XVI. The
average gain of test group in excess of control, is only ·08 inches, and
the median ·5 inches. Variability is about the same as at the end of six
months, P. E. ± ·28. The average is only ·29 P. E., but the median is a
little larger, 1·79 P. E. If these measures are compared with the
results after the first period, we have:

                                                    6 months 12 months

  Average of gains of test group in excess of control  ·16       ·08
  Median of gains of test group in excess of control   ·2        ·5
  P. E. of difference                                  ·16       ·28
  Average in terms of P. E.                           1·00       ·29
  Median in terms of P. E.                            1·25      1·79

There seems to be little gain in height after the first period. Test
cases 1 and 11 each show a gain of 3·7 inches after fifteen and twelve
months respectively, compared with gains after six months of 1·6, and
1·9 inches. But case 2 in the control group, makes still greater
comparative gain, +1·8 inches after six months and 4·6 inches after
seventeen months. In this case there are almost six additional months
for the child to grow, which may account for the larger gain. Control
case 1, however, may be compared with his partner, mentioned above,
since the interval between tests was the same for both. This boy grew
1·4 inches in six months, and 3·3 inches after 15 months. This is
practically equal growth with test case 1. Control case 11 also shows
relatively great growth during 12 months, +3·2 inches, whereas the
growth in six months was only 1·3 inches. Out of the test group, 7 cases
gained more in the first period of six months, than in the second, while
only 6 gained more in the second than in the first. Of the control
group, 7 cases made more than half of their total gain during the second
six months of the total twelve months' period. Since this is true, it
seems likely that whatever increase in growth we find during the second
half of the twelve months' interval, may be explained by incidental
causes, and that so far as actual gain in height is considered, there is
no further effect from the operations, after six months.

As was mentioned in the previous chapter, height and weight are of less
significance when considered alone, than when taken in relation to each
other and to the age of the individual. The gain in this
weight-height-age relationship following upon operation for adenoids and
tonsils, will be considered in the same manner as were weight and height
gains. We have, then:

                          TABLE XVII

  Height-Weight Relationship, Second Retests, 13 Pairs Showing changes
       in per cent over or underweight after 12 months' interval

    N[16]        Test Group (A)           Control Group (B)

            Test 1  Test 3  Change    Test 1  Test 2 Change  A-B

    8       - 1     + 7      + 8       -13      0     +13    - 5
    16      -16     -17      - 1       -13    - 9     + 4    - 5
    11      - 3     - 6      - 3       - 9    -10     - 1    - 2
    14      -13     - 6      + 7       - 5    + 4     + 9    - 2
    19      + 6     +10      + 4       + 1    + 7     + 6    - 2
    28      - 7     - 4      + 3         0    + 5     + 5    - 2
    10      - 1       0      + 1       - 6    - 6       0    + 1
    7       - 8     - 8        0       - 7    - 9     - 2    + 2
    2       - 8     - 4      + 4       + 9    +10     + 1    + 3
    4       - 7     - 4      + 3       -15    -15       0    + 3
    1         0     + 6      + 6       + 8    + 5     - 3    + 9
    13      -13     + 6      +19       -11    -12     - 1    +20
    3       + 6     +13      + 7       - 5    -20     -15    +22

    Av.     - 5     -  ·54     4·46    - 5·08   3·85    1·23   3·23
    M                          4                      - 2      6
    75%ile                     6·75                     2·75   3
    25%ile                   - 2·50                     2·75  -2
    Q                          4·625                    2·75   2·50
    P. E. (distribution)       2·54                     3·23   5·23
    P. E. (average)          ±  ·71                   ±  ·90  ±1·15
                                                      Av.=2·81 P. E.
                                                      M. =5·22 P. E.

                                                    6 months  12 months

  Average of gains of test group in excess of control  1·83     3·23
  Median of gains of test group in excess of control   4·00     6
  P. E. of difference                                   ·91     1·15
  Average in terms of P. E.                            2·02     2·81
  Median in terms of P. E.                             4·40     5·22

The mean of the actual gains in the second period exceeds that of the
first. Again the second group of results is more variable, decreasing
the reliability. There seems, however, to be a definite increase in the
net gain of the test group during a second six months' period. Some
individual cases may be cited. The greatest gain after six months is 8
units in the test case, matched by an equal gain of 8 units in the
control group. After twelve months, the test group shows one gain of 19
units, the highest gain in the control group being 13. Six cases in the
test group, and 13 in the control had lost at the end of six months, but
after twelve months, all but 2 of the test cases showed a gain, and all
but 5 of the controls. In 10 test cases out of the total 13, more than
half of the gain occurred during the second six months. In the control
group, six of the cases made more than half of their gain during the
second six months, and the second interval gains of the other 7 cases
exceeded the 50 per cent mark by so little that they may be accounted
for by chance.

These results seem to indicate a slight but actual increase in the net
gain of the test group during the second six months of the experiment,
and an accompanying growth in the variability of these gains.

It will be remembered that the results described in the previous chapter
show no gain in strength of grip as a result of operation. Comparison of
the 13 cases tested after the second interval, with the 16 cases at the
end of the first, gives results as follows:

    TABLE XVIII

    Gain in Grip, Second Retest, 13 Pairs

    N[16]       Test Group (A)                 Control Group (B)

          Test 1   Test 2    Gain        Test 1   Test 2   Gain   A-B

    7       7        6        -1            9       14       5    -6
    19     22       20        -2           15       18       3    -5
    2       9       10         1           10       15       5    -4
    27      9        6        -3            8        9       1    -4
    13     26·5     28·5       2           22       27       5    -3
    10     12·5     12        -·5          10       12       2    -2·5
    16     19       18·5      -·5          10       10       0    - ·5
    3       12·5      13      ·5          14      14·5     ·5     0
    14      16        17     1            22      22·5     ·5      ·5
    21      16·5      15    -1·5          19      17     -2        ·5
    1       13        18     5            11      15      4       1
    23      11·5      15     3·5          14·5    16      1·5     2
    11      11        11     0            11·5     7·5   -4       4

    Av.     14·27     14·61   ·34         13·54   15·19   1·65   -1·31
    M                        0                            1·5    -1·5
    75%ile                   1·25                         3·75     ·62
    25%ile                  -1·38                          ·12    -·4
    Q                        1·31                         1·81     ·51
    P. E. (distribution)     1·34                         1·65    2·31
    P. E. (average)          ±·37                         ±·46    ±·59
                                                       Av.=-2·22 P. E.
                                                        M.=-2·54 P. E.

                                                          6     12
                                                        months months
    Average of gains of test group in excess of control   -·24  -1·31
    Median of gains of test group in excess of control   -1·00  -1·50
    P. E. of difference                                   ±·48   ±·59
    Average in terms of P. E.                             -·50  -2·22
    Median in terms of P. E.                             -2·08  -2·54

The greatest gain in the test group after twelve months is 5 Kg. (Case
1). During the first six months this case lost 1 Kg. There are two gains
of 5 Kg. in the control group. Of these two (cases 7 and 13) had gained
1 Kg. during the first interval and another (case 2) 2 Kg. The greatest
loss in the test group after the twelve months' period was 3 Kg., by
case 27, which had already lost this amount at the end of six months.
The greatest loss in the control group was suffered by case 11, a loss
of 4 Kg., all in the second period. After the first period, 9 out of 16
cases in the test group gained in strength of grip, and 13 in the
control group. After the second period, the test cases showing gain
numbered only 7 out of 13, while all of the control cases had gained
except 2. Of the test group 8 cases in the second period either gained
less than half of the amount they had improved in the first period, or
dropped from the scores they had made at that time. The corresponding
numbers for the control group are 6 and 7.

There is evidently no improvement in strength of grip twelve months
after operation. The unreliability of the results is very great.
However, there is certainly no tendency toward improvement. Why this
should be is a question. It may be that the change in examiners is
partly responsible, for performance in this test is influenced to a
surprising extent by the manner in which it is presented.

                       TABLE XIX

            Tapping--Second Retest, 15 Pairs

    N[16]   Test Group (A)      Control Group (B)

        Test 1  Test 3  Gain   Test 1  Test 3  Gain  A-B

    21    152     154     2     149     174    34    -32
    13    160     176    16     150     188    38    -22
     1    135     142     7     106     134    28    -21
    18    133     126   - 7     100     108     8    -15
    23    150     157     7     122     141    19    -12
    10     68     145    77      70     148    78    - 1
     3    136     144     8     135     135     0      8
    20    105     122    17     150     154     4     13
    15    172     192    20     140     145     5     15
    27    108     114     6     115     101   -14     20
     8    113     128    15     131     121   -10     25
    28    150     176    26     178     172   - 6     32
     2    105     135    30     152     139   -13     43
    11    125     120   - 5     155     102   -53     48
    14    190     228    38     175     165   -10     48

    Av.   133·47  150·6  17·13  134·6   141·8   7·2   9·93
    M                    15                     4     11
    75%ile               21·5                  21·5   26·75
    25%ile                5                   -10·75 -16·5
    Q                     8·25                 16·12  21·62
    P. E. (distribution) 10·13                 17·2   22·07
    P. E. (average)     ± 2·67                ± 4·53 ± 5·26
                                              Av.=1·89 P. E.
                                              M. =2·09 P. E.

There were 15 pairs of cases who performed the tapping test at the end
of twelve months. Comparison with the 21 pairs after six months yields
the following results:

                                                    6 months  12 months

  Average of gains of test group in excess of control  - ·09     9·93
  Median of gains of test group in excess of control    0       11
  P. E. of difference                                  ±3·10   ± 5·26
  Average in terms of P. E.                              ·03     1·89
  Median in terms of P. E.                              0        2·09

The gain in the second interval is greater for the tapping test than for
any of the tests yet described. After the first six months there is no
gain. At the end of ten months the average gain is 9·93, and the median
11 taps per half minute. After six months' interval, 11 of 21 test group
cases had lost. At the end of twelve months, only 2 out of 15 had lost.
The control group, on the other hand, lost in 11 out of 21 cases after
six months, and in 6 out of 15 at the end of twelve months. All but one
of the test group cases made more than half of their gain in the second
period. Of the control group only 7 cases did this. The variability of
gains after 12 months is about equal to the variability at the end of
six months.

Strangely enough, decrease in fatigueability as described in the
previous chapter does not show itself after 12 months. In fact, the
negligible loss in ability noticeable after six months has increased
after a period of twelve months. In only 4 out of 11 test group cases,
is the gain in the second period equal to that of the first, a similar
result to that found in the control group, where 5 out of the 11 cases
made half their total gain in the second interval. The results are
compared below.

                                                     6 months 12 months

  Average of gains of test group in excess of control   -·020    - ·06
  Median of gains of test group in excess of control    -·015    - ·09
  P. E. of difference                                   ±·04     ± ·036
  Average in terms of P. E.                             -·50     -1·66
  Median in terms of P. E.                              -·38     -2·50

                       TABLE XX

      Tapping for Fatigue, Second Retests, 11 Pairs

    N[16]  Test Group (A)        Control Group (B)

       Test 1  Test 3   Gain   Test 1  Test 3   Gain   A-B

    20  -·10     ·03    -·13     ·20      ·0     ·20   -·33
    27   ·15     ·17    -·02     ·09     -·17    ·26   -·28
    10  -·09     ·27    -·36     ·06      ·16   -·10   -·26
    14   ·09     ·05     ·04     ·13     -·13    ·26   -·22
    13  -·03    -·06     ·03     ·27      ·07    ·20   -·17
    28   ·01     ·05    -·04     ·17      ·10    ·07   -·11
    15   ·03     ·03     ·0      ·18      ·08    ·10   -·10
    23   ·11     ·0      ·11     ·06      ·0     ·06    ·05
    21   ·27    -·01     ·28     ·29      ·14    ·15    ·13
    11   ·28    -·04     ·32     ·11     -·01    ·12    ·20
    18   ·14    -·15     ·29     ·01      ·15   -·14    ·43
    Av.  ·078    ·031    ·047    ·143     ·035   ·107  -·06
    M                    ·03                     ·12   -·09
    75%ile               ·153                    ·20    ·07
    25%ile              -·062                    ·02   -·275
    Q                    ·107                    ·09    ·172
    P. E. (distribution) ·087                    ·093   ·19
    P. E. (average)     ±·02                    ±·03   ±·036
                                                Av.=-1·66 P. E.
                                                 M.=-2·50 P. E.

The point of greatest interest in the present study is, as has been
said, improvement in intelligence. Does operation for adenoids and
tonsils result in improvement in intelligence, as measured by I.Q.? If
such improvement does not manifest itself after six months, can it be
found after a second period of the same length? The latter question is
answered by observation of Table XXI and attention to the following
facts, gathered from the 21 pairs of cases who were given intelligence
tests after the twelve months' interval.

                                                          6       12
                                                        months  months
    Average of gains of test group in excess of control  -1·035 -3·14
    Median of gains of test group in excess of control   -1     -3
    P. E. of difference                                  ±1·10  ±1·84
    Average in terms of P. E.                            - ·94  -1·71
    Median in terms of P. E.                             - ·99  -1·63

The result after twelve months remains the same as that after the six
months' interval. A gain or loss of two or three points in I.Q. is
negligible, so that the mean gain of the test group in excess of the
control is practically zero at the end of each period. Variability
increases with the length of the interval. One case in the test group
(case 4) gained nothing in six months, but showed a gain of 15 points
after 13 months. However, there is a control case to match this,--case
15, who gained 1 point in the first six months and 20 points after 10
months. Case 20 in the test group lost 4 points in the first six months,
but gained back these and 10 additional in the second period. But
control No. 1 gained 5 points in the second interval after having lost 4
in the first.

On the other hand several cases lost in the second period, as compared
with the first. Test group case 7, for example, gained 8 points in the
first six months, and lost 6 of them in the second. Case 3 in the same
group lost 3 points in the first period, and failed to regain any of
them. Case 12 lost 3 points in six months and 9 more before the end of
12 months. In the control group, case 23 gained 15 pounds in the first
six months and lost eight of them in the second. Summing up gains and
losses in the second period, for both groups:

                        TABLE XXI

               I.Q., Second Retests, 21 Pairs

   N[16]   Test Group (A)         Control Group (B)

       Test 1  Test 3   Gain   Test 1  Test 3   Gain   A-B

    27   110     112      2       72      98     26    -24
    15    97      97      0       78      98     20    -20
    3     94      91     -3       82      96     14    -17
    7     91      93      2       95     112     17    -15
    20   106     116     10      118     140     22    -12
    23    85      80     -5       81      88      7    -12
    8     91      92      1       98     111     13    -12
    12    98      86    -12       98      91     -7     -5
    21    64      66      2       86      93      7     -5
    4     96     111     15       83     102     19     -4
    13    70      61     -9       66      60     -6     -3
    18    98     101      3       90      92      2      1
    16    65      74      9       74      81      7      2
    10   110     116      6      104     107      3      3
    28    81      83      2       95      94     -1      3
    11   103     102     -1      101      95     -6      5
    1     82      93     11       80      85      5      6
    14    96     102      6      140     138     -2      8
    19    96      97      1       98      90     -8      9
    2    107     113      6       91      86     -5     11
    9     83     102     19       87      91      4     15
    Av.   91·5    94·6    3·0     91·2   97·5     6·2   -3·1
    M                     2                       5     -3
    75%ile                6                      13·75   4·5
    25%ile               -·75                    -4·25 -12
    Q                    3·37                     9·00   8·25
    P. E. (distribution) 2·09                     8·24   8·86
    P. E. (average)      ±·45                    ±1·79  ±1·84
                                                 Av.=-1·71 P. E.
                                                  M.=-1·63 P. E.

                Lost in 2nd   Gained in 2nd   No    Gained equally
                  period         period     change   with gain in
                                                      1st period
    Test group       9            11           1          9
    Control group   10            11                      8

The average gain of the test group was 3·09 points after 12 months,
compared with 2·25 after six. The control group, however, made an
average gain of 6·24 after 12 months, the gain after six months being
3·29. These numbers are insignificant as gains, but they at least show
no improvement in the test group which the control group does not reveal
as well. On the basis of the results, we may say that there has been no
improvement in I.Q. as a result of operation, either after six months or
after twelve.

There remains to be considered only the result of the Healy Picture
Completion Test. We have scores in this test for 18 pairs of cases. When
these scores are compared with those in the former tests, the results
stand as follows:

    Average of gains of test group in excess of control -5·85   -3·36
    Median of gains of test group in excess of control  -7·75    1
    P. E. of difference                                 ±3·05   ±3·38
    Average in terms of P. E.                           -1·92    -·87
    Median in terms of P. E.                            -2·54     ·26

The figures given above show no gain in the Healy test as a result of
operation. Both after six months, and after twelve, we find that the
test group has gained no more than the control group. As before there
are individual cases showing considerable gain in the second period, but
these are matched by control cases which reveal equal or even greater
gains. In the test group, 5 cases lost in the second period in
comparison with the first, 18 gained, and 7 gained as much in the second
period as in the first. The control group lost in the second period in 5
cases, gained in 18, and gained as much as in the first period in 7
cases. The two groups, then, are practically equal, both showing a gain
in the second period, but this gain cannot be due to the operations,
since the control group did not undergo operation.

                     TABLE XXII

               Healy A, Second Retests, 18 Pairs

    N[16]  Test Group (A)        Control Group (B)

       Test 1  Test 3   Gain   Test 1  Test 3   Gain   A-B

    12    20       1    -19      -10    41·5    51·5  -70·5
    23    49·5    62·5   13        4    64      60    -47
    15     7      19     12        1    54·5    53·5  -41·5
    1    -22      11     36      -50    11      61    -25
    2     28·5    24·5   -4        3    19·5    16·5  -20·5
    3     21·5    15·5   -6       17    25·5     8·5  -14·5
    19    57·5    60·5    3      -22   -15       7     -4
    13    43      62·5   19·5     -1·5  21·5    23     -3·5
    21    20      38     18       70·5  88      17·5     ·5
    10   -12      11     23       27    48·5    21·5    1·5
    14    12·5    77     64·5     -5    48·5    53·5   11
    27   -25      25·5   50·5      2    39·5    37·5   13
    11    -8      15·5   23·5    -29   -20       9     14·5
    16    49      79     30       30    45·5    15·5   14·5
    7     -6      16     22       45    11       6·5   15·5
    28    29·5    77·5   48       64·5  83·5    19     29
    18   -13·5    13·5   27      -32   -35      -3     30
    20     0      55     55       30    48·5    18·5   36·5
    Av.   13·81   36·92  23·11     5·77 32·25   26·47  -3·36
    M                    22·5                   18·75   1
    75%ile               33                     44     14·5
    25%ile                7·5                    8·75 -22·25
    Q                    12·75                  17·62  18·37
    P. E. (distribution) 11·5                   17·72  17·86
    P. E. (average)      ±2·7                   ±4·22  ±3·88
                                               Av.=-·87 P. E.
                                                M.=+·26 P. E.

                            TABLE XXIII

             Weight in        Height in   Height-weight    Grip in
    Gains     pounds           inches       percents         Kg.

             lb.   P. E.    in.   P. E.     %    P. E.    Kg.   P. E.
    Av. 1   1·37    2·85    ·16    1·     1·83   2·02   - ·24   - ·50
    Av. 2   1·90    1·30    ·08     ·29   3·23   2·81   -1·31   -2·22
    M.  1   1·20    2·80    ·20    1·25   4·00   4·40   -1·00   -2·08
    M.  2   2·20    1·51    ·50    1·79   6·00   5·22   -1·50   -2·54
    P. E. 1    ± ·48           ±·16           ±·91            ±·48
    P. E. 2    ±1·46           ±·28          ±1·15            ±·59

    Gains     Taps in        Tapping in
              1/2 min.     fatigue ratios       I.Q.      Healy Score
             taps  P. E.  ratio    P. E.    Pts.   P. E.   Pts.   P. E.

    Av. 1     ·09   ·03    -·02   - ·50   -1·035   - ·94   -5·85   - ·92
    Av. 2    9·93  1·89    -·065  -1·66   -3·14    -1·71   -3·36   - ·87
    M. 1     0·    0·      -·015  - ·38   -1·      - ·99   -7·75   -2·54
    M. 2    11·    2·09    -·09   -2·50   -3·      -1·63    1        ·26
    P. E. 1    ±3·10           ±·04           ±1·10            ±3·05
    P. E. 2    ±5·26           ±·036          ±1·84            ±3·88

In Table XXIII are collected the results discussed in the foregoing
chapter. The mean results are expressed in terms of P. E. and as gross
values, so that the various tests may be compared.




CHAPTER V.

SUMMARY.


The results obtained from the experiment may be summarized as follows:

1. Six months after operation for adenoids and tonsils, there seems to
be a slight but not very reliable gain in weight as the result of the
operation. After twelve months this has increased; indeed, it has very
nearly doubled.

2. Gain in height, resulting from operation, is so slight as to be
unreliable. This gain does not increase during a second period of six
months.

3. The height-weight-age relationship is an excellent measure of the
physical well-being of the child. The figures expressing this
relationship show no very reliable gain in the first six months, but
improvement increases considerably during the second period.

4. The test group shows no gain over the control group in strength of
grip. There seems on the other hand to be a slight loss; which does not
decrease in amount during the second period.

5. Speed of tapping did not increase during the first period, any more
for the test group than for the control. During the second period,
however, there is a marked improvement.

6. Operation for adenoids and tonsils does not lessen fatigueability as
shown by the tapping test. The probability is, however, that the test is
at fault.

7. No rise in I.Q., as a result of operation, makes itself evident after
six months or after twelve months.

8. There is no improvement in the performance of the Healy test either
after six months or after twelve.

9. In every test except grip and tapping, there is a marked increase in
the variability of the gains after the second period. This is possibly
due simply to the fact that the longer interval permits the
intervention of more extraneous factors which may influence the scores
in one direction or the other.

10. A group of 236 children with diseased tonsils showed equal
distribution of I.Q. with a group of 294 children who were normal in
this respect.


CONCLUSIONS

The article by MacPhail, which has been reviewed in a former chapter,
showed pretty conclusively that the removal of adenoids and tonsils was
followed by improvement in school work. That such improvement was not
due to a rise in general intelligence can be concluded from the present
experiment. That efficiency in school work does not rest wholly upon
intelligence has been demonstrated more than once. The tendency here
noted to improve in general physical tone may, perhaps, serve as a sign
of the factor upon which such improvement depends. Improved health means
better attention, better emotional response, greater resistance to
fatigue, and probably increased efficiency.

Interesting investigations of such improvement in efficiency might be
made by administering educational tests to groups similar to those of
the present study. The results of such an experiment would be
exceedingly instructive, and would be more significant than conclusions
drawn from school marks. By this means also we might determine along
what special line efficiency is most affected.

Since there was no recuperation in intelligence resulting from operation
for adenoids and tonsils, it is reasonable to expect that there had been
no retardation from which to recuperate. This supposition is borne out
by results of the statistical study, wherein we found that a group of
children suffering from diseased tonsils possessed equal intelligence
with a group which was free from such defect.

We can say to physicians, then, with fair amount of assurance, that
removal of adenoids and tonsils will probably not raise to any great
degree the intelligence level of the mentally defective child who is
brought to him. We can say to students of the constancy of the I.Q.,
that it is not greatly lowered by adenoids and diseased tonsils and we
may say to the clinical psychologist that these defects have no
demonstrable effect upon general intelligence, whatever effects they may
have on volitional and emotional normality,--the two elements which,
along with intelligence are necessary for the maintenance of the
individual as an instrument of social efficiency.