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(n squared-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-r squared)) / [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] D squared)/(n(n squared-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