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