Adenoids and Diseased Tonsils_ Their Effect on General Intelligence Margaret Cobb Rogers 357 downloads.pdf

The Project Gutenberg eBook of Adenoids and Diseased
Tonsils: Their Effect on General Intelligence
This eBook is for the use of anyone anywhere in the United States and most
other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms of
the Project Gutenberg License included with this eBook or online at
www.gutenberg.org. If you are not located in the United States, you will
have to check the laws of the country where you are located before using
this eBook.

Title: Adenoids and Diseased Tonsils: Their Effect on General Intelligence

Author: Margaret Cobb Rogers

Release date: January 26, 2012 [eBook #38676]
Most recently updated: January 25, 2021

Language: English

Other information and formats: www.gutenberg.org/ebooks/38676

Credits: 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.)

*** START OF THE PROJECT GUTENBERG EBOOK ADENOIDS
AND DISEASED TONSILS: THEIR EFFECT ON GENERAL
INTELLIGENCE ***

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]
"... 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]
"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]
"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."
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]
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]
"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.
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 Adenoids Deaf
Defective & Tonsils
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 70·8

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
50 39 32 29
children
Normal 36 32 20 13
Defective 14 7 12 16
Percentage of
72 82 62·5 44·8
normal

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:

Non-
Exempt Children Children
exempt
Normal Defective Defective
Normal
9th St.
56 28 39 38
Primary
Rutledge
87 35 75 34
School
Allison
128 65 81 49
School
Camac School 183 71 103 75
Claghorn
193 61 127 66
School
647 260 425 262
Percentage
28·8 38·1
Defective

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,
6 4 9 9
number defective
Tonsils 3 4 3 3
Adenoids 2 1 5 6
Deaf 2 5 1
Catarrh 2 3
Percentage of children, nose
12 10·2 28·1 31
and throat defects

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.
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."
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:

46 24
Causes children 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
9 6
defects

Irregular attendance 2 3
Adenoids only 2 0

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

151 children 19 children
Causes
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]

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 23·0
Malnutrition 8,303 2·9 557 36·1
Defective vision 21,078 9·3 536 34·7
Defective hearing 1,206 0·5 47 3·0
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:

Exempt Children Non-exempt Children
Defect No. Examined % No. Examined %
Defective vision 37110·0 171 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 91826·0 423 30·0
Miscellaneous 214 6·0 128 9·0
Total 1,77449·0 930 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.

"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 65·0 100

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 Period Period
1 2 3
A—Per cent of 31 cases (operated upon) 32·2
Per cent of 100 children at random 42
B—Per cent of 18 children— 20 months
33·3 66·6
(operated upon)
Per cent of 100 children at random 42 41
C—Per cent of 11 cases for 30 months (operated
36·3 63·5 100
upon)
Per cent of 100 children at random 42 41 41

"... 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."
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]
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 Cases Per cent of Cases No. of Cases Per cent of 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
σ 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 σ 14·4 in the tonsil group, while in the
normal Q is 8·27 and σ 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 Tonsil Group Per Cent of 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

Weight Height Grip, Kg.
N Age
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 -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 4746·7 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 6749·6 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

Tapping, 1/2 min.
N 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 95101 -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 98104 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 104100 27 65
11 125+ 90 98+ 87 103100 - 8 6
11C 155+125 101+107 101102 -29 -3·5
12 98+69 98 95 20 21
12C 102 84 98101 -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 96107 12·5 48·5

14C 175+152 175+164 140137 - 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 96101 57·5 49
19C 100+115 118+ 92 98 98 -22 -11
20 105+115 110+ 93 106102 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 91100 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 131124 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 145137 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 3·80 1·9 1·2
75%ile 5·80 4·6 3·1
25%ile 2·00 ·9 0·1
Q 1·90 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.

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 50·62 1·36 ·16
M 1·4 1·3 ·2
75%ile 1·9 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 BA-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 - 3·50 + 4·00
75%ile +2 0.00 + 6·50

25%ile -2 - 4·50 - 2.00
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
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 -2·50
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
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 19·50
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
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 -0·015
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.= -·50 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 ρ = 1 - ((6ΣD_n) /( n(n²-1))) where f = 2 sin
(Π/6)ρ. The resulting value of r was -·10 with unreliability of ·226,
calculated by the formula σt.r - obt.r = (1·05(1-r²)) / √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
27 110 109 -1 72 96 24 -25
20106 102 -4 118 131 13 -17
8 91 86 -5 98 104 6 -11
24131 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
2107 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 -1 -0·015
75%ile 7 +·04 5
25%ile -3 -·16 -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
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 - 7·75 -0·015
75%ile 18 +·04 3
25%ile -5 -·16 -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 ·36 226 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((Π/6)ρ)) when ρ = 1 -
((6ΣD²)/(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.
P.R. P.R. gain 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 41 168 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 33 175 8 2·7
18C 40 49 60 9 247 18 3
19 59 69 41 10 67 16 3·2
19C 67 67 33 287 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 -3 134 53 8·8
26 21 15 79 -6 226
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.

Height- Grip Tapping I.Q.
WeightHeight Tapping 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 0.00 -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.
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 46·0 49·7 13·0 18·0
1C 15 53·5 62·8 46·4 49·7 11·0 15·0
2 15 40·9 47·9 42·6 45·9 9·0 10·0
2C 17 52·3 65·5 45·2 49·8 10·0 15·0
3 16 55·0 67·5 47·0 50·2 12·8 13·0
3C 14 61·5 57·8 51·7 54·0 14·0 14·5
4 13 51·1 60·2 47·5 50·5 9·0
4C 13 49·4 54·2 48·9 50·8 9·5
7 14 39·9 45·8 42·9 45·6 7·0 6·0
7C 12 38·4 42·1 41·9 43·7 9·0 14·0
8 11 60·8 69·2 50·8 52·3 10·0
8C 11 45·4 57·9 36·8 48·7 15·0
10 11 48·9 56·7 46·1 48·6 12·5 12·0
10C 11 47·1 51·8 45·6 48·1 10·0 12·0
11 12 47·8 55·0 45·8 49·5 11·0 11·0
11C 12 41·6 47·0 43·6 46·8 11·5 7·5
12 12 48·0 66·5 44·8 14·0
12C 11 41·0 69·6 41·5 6·0
13 12 90·0 112·0 61·3 61·8 26·5 28·5
13C 12 74·7 88·0 56·8 60·0 22·0 27·0
14 12 56·0 66·0 51·0 53·3 16·0 17·0
14C 12 81·9 98·0 57·9 59·5 22·0 22·5
15 12 57·5 51·1 15·5
15C 10 67·2 50·1 15·0
16 12 56·0 60·3 51·6 53·5 19·0 18·5
16C 11 51·2 55·0 48·7 50·1 10·0 10·0
18 12 58·2 47·3 18·0
18C 11 45·3 46·7 8·0
19 12 90·0 108·0 57·7 60·5 22·0 20·0
19C 11 52·4 59·0 46·7 48·0 15·0 18·0

20 12 44·2 47·2 11·0
20C 11 61·3 49·6 15·0
21 12 70·7 85·5 54·1 16·5 15.0
21C 10 62·4 69·2 49·6 19·0 17·0
23 12 51·7 47·8 11·5 15·0
23C 11 64·1 51·4 14·5 16·0
27 12 43·7 45·4 9·0 6·0
27C 11 41·0 44·6 0 9·0
28 12 71·3 78·5 54·9 56·3 23·5
28C 11 74·2 85·8 53·4 55·9 21·0

N[16] Tapping I.Q. Healy
Test 1 Test 3 (1) (3) (1) (3)
1 135 142 82 93·0 -25·0 11·0
1C 106 134 80 85·0 -50·0 11·0
2 105 135 107 113·0 28·5 24·5
2C 152 139 91 86·0 3·0 19·5
3 136 144 94 91·0 21·5 15·5
3C 135 135 82 96·0 17·0 25·5
4 103 96 111 8·5
4C 109 83102 33·0
7 125 91 93 - 6·0 16·0
7C 105 95 112 4·5 11·0
8 113 128 91 92·0 32·5
8C 131 121 98 111·0 4·0
10 68+ 74 145+106 110 116·0 -12·0 11·0
10C 70+ 74 148+124 104 107·0 27·0 48·5
11 125+ 90 120+125 103 102·0 - 8·0 15·5
11C 155+125 102+112 101 95·0 -29·0 -20·0
12 98+ 69 86 20·0 1·0
12C 102 98 90 -10·0 41·5
13 160+165 176+187 70 61·0 43·0 62·5
13C 150+109 188+174 66 60·0 -1·5 21·5
14 190+172 228+215 96 102·0 12·5 77·0

14C 175+152 165+186 140 138·0 - 5·0 48·5
15 172+167 192+186 97 97·0 7·0 19·0
15C 140+115 145+133 78 98·0 1·0 54·5
16 145+131 65 74 49·0 79·0
16C 145+ 99 74 81 30·0 45·5
18 133+115 126+145 98 101·0 -13·5 13·5
18C 100+ 99 108+ 92 90 92·0 -32·0 -35·0
19 168+136 96 97 57·5 60·5
19C 100+115 98 90 -22·0 -15·0
20 105+115 122+118 106 116·0 55·0
20C 150+120 154+154 118 140·0 30·0 48·5
21 152+111 154+155 64 66·0 20·0 38·0
21C 140+136 174+150 86 93·0 70·5 88·0
23 150+119 157+157 85 80·0 49·5 62·5
23C 122+115 141+141 81 88·0 4·0 64·0
27 108+ 92 114+ 95 110 112·0 -25·0 25·5
27C 115+105 101+118 72 98·0 2·0 39·5
28 150+148 176+168 81 83·0 29·5 77·5
28C 178+148 172+157 95 94·0 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
1248 66·5 18·5 69·6 28·6 -10·1
2 40·9 47·9 7 52·3 65·5 13·2 -6·2
1456 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
1656 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
1390 112 22 74·7 88 13·3 8·7
1990 108 18 52·4 59 6·6 11·4
355 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 1·90
Median 1·20 2·20
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 60·0 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 46·0 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 51·0 53·3 2·3 57·9 59·5 1·6 ·7
3 47·0 50·2 3·2 51·7 54·0 2·3 ·9
7 42·9 45·6 2·7 41·9 43·7 1·8 ·9
4 47·5 50·5 3·0 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 ·20 ·50
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 6·00

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 - ·5
3 12·5 13 ·5 14 14·5 ·5
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 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 months 12 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 0·00 11·00
P. E. of difference ±3·10 ± 5·26
Average in terms of P. E. ·03 1·89
Median in terms of P. E. 0·00 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 - ·060
Median of gains of test group in excess of control -·015 - ·090
P. E. of difference ±·040 ± ·036
Average in terms of P. E. -·500 -1·660
Median in terms of P. E. -·380 -2·500

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 months 12 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 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.

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

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 1·00
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

Gains Weight in Height in Height-weight Grip in
pounds inches percents Kg.
lb. P. E. in. P. E % P. E. Kg. P. E.
Av. 1 1·37 2·85 ·16 1·00 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

TABLE XXIII (Continued)

Tapping in
Gains Taps in 1/2 min. I.Q. Healy Score
fatigue ratios
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 -3·140 -1·71 -3·36 - ·87
M. 1 0·00 0·00 -·015 - ·38 -1·000 - ·99 -7·75 -2·54
M. 2 11·00 2·09 -·09 -2·50 -3·000 -1·63 1·00 ·26
P. E. 1 ±3·10 ±·040 ±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.

Footnotes
[1] F. Hooper, M. D., quoting from a paper by B. Frankel.
[2] Adenoid Growths of the Naso-pharynx. Read before the Homeopathic
Medical Society of New York, February, 1895.
[3] H. Addington Bruce, Psychology and Parenthood, 1916.

[4] H. Addington Bruce in the Century Magazine, 1916—The Mind of the Child.
[5] The italics are mine.
[6] Psych. Clinic, 1916, 10, 45-48. Anna Johnson. The Teacher in the Retarded
School.
[7] Psych. Clinic, 1909, 3, 71-77. The Effect of Physical Defect on School
Progress.
[8] Cornell, Psychological Clinic, 2, 1909.
[9] H. R. Burpitt. Relative Degrees of Dullness and Backwardness in School
Children and their Causation. Journal of Mental Science, 1916.
[10] Transactions of the International Congress on School
[11] Ayres: "Laggards in Our Schools." 1909.
[12] Wallin: "Mental Health of the School Child." 1914.
[13] Wallin: "Mental Health of the School Child." 1914.
[14] In a few cases where the operation was postponed after just previous to the
operation. Since both cases were retested, practice effect is of no great
importance.
[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.
[16] Numbers refer to cases as listed on Table II.

*** END OF THE PROJECT GUTENBERG EBOOK ADENOIDS AND
DISEASED TONSILS: THEIR EFFECT ON GENERAL INTELLIGENCE
***

Updated editions will replace the previous one—the old editions will be
renamed.

Creating the works from print editions not protected by U.S. copyright law
means that no one owns a United States copyright in these works, so the
Foundation (and you!) can copy and distribute it in the United States
without permission and without paying copyright royalties. Special rules,
set forth in the General Terms of Use part of this license, apply to copying
and distributing Project Gutenberg™ electronic works to protect the
PROJECT GUTENBERG™ concept and trademark. Project Gutenberg is a
registered trademark, and may not be used if you charge for an eBook,
except by following the terms of the trademark license, including paying
royalties for use of the Project Gutenberg trademark. If you do not charge
anything for copies of this eBook, complying with the trademark license is
very easy. You may use this eBook for nearly any purpose such as creation
of derivative works, reports, performances and research. Project Gutenberg
eBooks may be modified and printed and given away—you may do
practically ANYTHING in the United States with eBooks not protected by
U.S. copyright law. Redistribution is subject to the trademark license,
especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG™ LICENSE
PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free
distribution of electronic works, by using or distributing this work (or any
other work associated in any way with the phrase “Project Gutenberg”), you
agree to comply with all the terms of the Full Project Gutenberg License
available with this file or online at www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing
Project Gutenberg electronic works

1.A. By reading or using any part of this Project Gutenberg electronic work,
you indicate that you have read, understand, agree to and accept all the
terms of this license and intellectual property (trademark/copyright)
agreement. If you do not agree to abide by all the terms of this agreement,
you must cease using and return or destroy all copies of Project Gutenberg
electronic works in your possession. If you paid a fee for obtaining a copy
of or access to a Project Gutenberg electronic work and you do not agree to
be bound by the terms of this agreement, you may obtain a refund from the
person or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be used on
or associated in any way with an electronic work by people who agree to be
bound by the terms of this agreement. There are a few things that you can
do with most Project Gutenberg electronic works even without complying
with the full terms of this agreement. See paragraph 1.C below. There are a
lot of things you can do with Project Gutenberg electronic works if you
follow the terms of this agreement and help preserve free future access to
Project Gutenberg electronic works. See paragraph 1.E below.

1.C. The Project Gutenberg Literary Archive Foundation (“the Foundation”
or PGLAF), owns a compilation copyright in the collection of Project
Gutenberg electronic works. Nearly all the individual works in the
collection are in the public domain in the United States. If an individual
work is unprotected by copyright law in the United States and you are

located in the United States, we do not claim a right to prevent you from
copying, distributing, performing, displaying or creating derivative works
based on the work as long as all references to Project Gutenberg are
removed. Of course, we hope that you will support the Project Gutenberg
mission of promoting free access to electronic works by freely sharing
Project Gutenberg works in compliance with the terms of this agreement for
keeping the Project Gutenberg name associated with the work. You can
easily comply with the terms of this agreement by keeping this work in the
same format with its attached full Project Gutenberg License when you
share it without charge with others.

1.D. The copyright laws of the place where you are located also govern
what you can do with this work. Copyright laws in most countries are in a
constant state of change. If you are outside the United States, check the
laws of your country in addition to the terms of this agreement before
downloading, copying, displaying, performing, distributing or creating
derivative works based on this work or any other Project Gutenberg work.
The Foundation makes no representations concerning the copyright status
of any work in any country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other immediate
access to, the full Project Gutenberg License must appear prominently
whenever any copy of a Project Gutenberg work (any work on which the
phrase “Project Gutenberg” appears, or with which the phrase “Project
Gutenberg” is associated) is accessed, displayed, performed, viewed, copied
or distributed:

This eBook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it
away or re-use it under the terms of the Project Gutenberg™
License included with this eBook or online at
www.gutenberg.org. If you are not located in the United
States, you will have to check the laws of the country where
you are located before using this eBook.

1.E.2. If an individual Project Gutenberg electronic work is derived from
texts not protected by U.S. copyright law (does not contain a notice
indicating that it is posted with permission of the copyright holder), the
work can be copied and distributed to anyone in the United States without
paying any fees or charges. If you are redistributing or providing access to a
work with the phrase “Project Gutenberg” associated with or appearing on
the work, you must comply either with the requirements of paragraphs
1.E.1 through 1.E.7 or obtain permission for the use of the work and the
Project Gutenberg trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg electronic work is posted with the
permission of the copyright holder, your use and distribution must comply
with both paragraphs 1.E.1 through 1.E.7 and any additional terms imposed
by the copyright holder. Additional terms will be linked to the Project
Gutenberg License for all works posted with the permission of the
copyright holder found at the beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project Gutenberg License
terms from this work, or any files containing a part of this work or any
other work associated with Project Gutenberg.

1.E.5. Do not copy, display, perform, distribute or redistribute this
electronic work, or any part of this electronic work, without prominently
displaying the sentence set forth in paragraph 1.E.1 with active links or
immediate access to the full terms of the Project Gutenberg License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form, including any
word processing or hypertext form. However, if you provide access to or
distribute copies of a Project Gutenberg work in a format other than “Plain
Vanilla ASCII” or other format used in the official version posted on the
official Project Gutenberg website (www.gutenberg.org), you must, at no
additional cost, fee or expense to the user, provide a copy, a means of
exporting a copy, or a means of obtaining a copy upon request, of the work
in its original “Plain Vanilla ASCII” or other form. Any alternate format
must include the full Project Gutenberg License as specified in paragraph
1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying, performing,
copying or distributing any Project Gutenberg works unless you comply
with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing access to
or distributing Project Gutenberg electronic works provided that:

• You pay a royalty fee of 20% of the gross profits you derive from the
use of Project Gutenberg works calculated using the method you
already use to calculate your applicable taxes. The fee is owed to the
owner of the Project Gutenberg trademark, but he has agreed to donate
royalties under this paragraph to the Project Gutenberg Literary
Archive Foundation. Royalty payments must be paid within 60 days
following each date on which you prepare (or are legally required to
prepare) your periodic tax returns. Royalty payments should be clearly
marked as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information about
donations to the Project Gutenberg Literary Archive Foundation.”

• You provide a full refund of any money paid by a user who notifies
you in writing (or by e-mail) within 30 days of receipt that s/he does
not agree to the terms of the full Project Gutenberg™ License. You
must require such a user to return or destroy all copies of the works
possessed in a physical medium and discontinue all use of and all
access to other copies of Project Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of any
money paid for a work or a replacement copy, if a defect in the
electronic work is discovered and reported to you within 90 days of
receipt of the work.

• You comply with all other terms of this agreement for free distribution
of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™
electronic work or group of works on different terms than are set forth in
this agreement, you must obtain permission in writing from the Project
Gutenberg Literary Archive Foundation, the manager of the Project

Gutenberg™ trademark. Contact the Foundation as set forth in Section 3
below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend considerable
effort to identify, do copyright research on, transcribe and proofread works
not protected by U.S. copyright law in creating the Project Gutenberg™
collection. Despite these efforts, Project Gutenberg™ electronic works, and
the medium on which they may be stored, may contain “Defects,” such as,
but not limited to, incomplete, inaccurate or corrupt data, transcription
errors, a copyright or other intellectual property infringement, a defective or
damaged disk or other medium, a computer virus, or computer codes that
damage or cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except
for the “Right of Replacement or Refund” described in paragraph 1.F.3, the
Project Gutenberg Literary Archive Foundation, the owner of the Project
Gutenberg™ trademark, and any other party distributing a Project
Gutenberg™ electronic work under this agreement, disclaim all liability to
you for damages, costs and expenses, including legal fees. YOU AGREE
THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT
LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT
EXCEPT THOSE PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE
THAT THE FOUNDATION, THE TRADEMARK OWNER, AND ANY
DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE
TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL,
PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE
NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you
discover a defect in this electronic work within 90 days of receiving it, you
can receive a refund of the money (if any) you paid for it by sending a
written explanation to the person you received the work from. If you
received the work on a physical medium, you must return the medium with
your written explanation. The person or entity that provided you with the
defective work may elect to provide a replacement copy in lieu of a refund.
If you received the work electronically, the person or entity providing it to

you may choose to give you a second opportunity to receive the work
electronically in lieu of a refund. If the second copy is also defective, you
may demand a refund in writing without further opportunities to fix the
problem.

1.F.4. Except for the limited right of replacement or refund set forth in
paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO OTHER
WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING
BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied warranties or
the exclusion or limitation of certain types of damages. If any disclaimer or
limitation set forth in this agreement violates the law of the state applicable
to this agreement, the agreement shall be interpreted to make the maximum
disclaimer or limitation permitted by the applicable state law. The invalidity
or unenforceability of any provision of this agreement shall not void the
remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the
trademark owner, any agent or employee of the Foundation, anyone
providing copies of Project Gutenberg™ electronic works in accordance
with this agreement, and any volunteers associated with the production,
promotion and distribution of Project Gutenberg™ electronic works,
harmless from all liability, costs and expenses, including legal fees, that
arise directly or indirectly from any of the following which you do or cause
to occur: (a) distribution of this or any Project Gutenberg work, (b)
alteration, modification, or additions or deletions to any Project Gutenberg
work, and (c) any Defect you cause.

Section 2. Information about the Mission of Project
Gutenberg

Project Gutenberg is synonymous with the free distribution of electronic
works in formats readable by the widest variety of computers including
obsolete, old, middle-aged and new computers. It exists because of the

efforts of hundreds of volunteers and donations from people in all walks of
life.

Volunteers and financial support to provide volunteers with the assistance
they need are critical to reaching Project Gutenberg’s goals and ensuring
that the Project Gutenberg collection will remain freely available for
generations to come. In 2001, the Project Gutenberg Literary Archive
Foundation was created to provide a secure and permanent future for
Project Gutenberg and future generations. To learn more about the Project
Gutenberg Literary Archive Foundation and how your efforts and donations
can help, see Sections 3 and 4 and the Foundation information page at
www.gutenberg.org.

Section 3. Information about the Project Gutenberg
Literary Archive Foundation

The Project Gutenberg Literary Archive Foundation is a non-profit 501(c)
(3) educational corporation organized under the laws of the state of
Mississippi and granted tax exempt status by the Internal Revenue Service.
The Foundation’s EIN or federal tax identification number is 64-6221541.
Contributions to the Project Gutenberg Literary Archive Foundation are tax
deductible to the full extent permitted by U.S. federal laws and your state’s
laws.

The Foundation’s business office is located at 41 Watchung Plaza #516,
Montclair NJ 07042, USA, +1 (862) 621-9288. Email contact links and up
to date contact information can be found at the Foundation’s website and
official page at www.gutenberg.org/contact

Section 4. Information about Donations to the Project
Gutenberg Literary Archive Foundation

Project Gutenberg™ depends upon and cannot survive without widespread
public support and donations to carry out its mission of increasing the
number of public domain and licensed works that can be freely distributed
in machine-readable form accessible by the widest array of equipment

including outdated equipment. Many small donations ($1 to $5,000) are
particularly important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws regulating
charities and charitable donations in all 50 states of the United States.
Compliance requirements are not uniform and it takes a considerable effort,
much paperwork and many fees to meet and keep up with these
requirements. We do not solicit donations in locations where we have not
received written confirmation of compliance. To SEND DONATIONS or
determine the status of compliance for any particular state visit
www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where we have
not met the solicitation requirements, we know of no prohibition against
accepting unsolicited donations from donors in such states who approach us
with offers to donate.

International donations are gratefully accepted, but we cannot make any
statements concerning tax treatment of donations received from outside the
United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation methods
and addresses. Donations are accepted in a number of other ways including
checks, online payments and credit card donations. To donate, please visit:
www.gutenberg.org/donate.

Section 5. General Information About Project Gutenberg
electronic works

Professor Michael S. Hart was the originator of the Project Gutenberg
concept of a library of electronic works that could be freely shared with
anyone. For forty years, he produced and distributed Project Gutenberg
eBooks with only a loose network of volunteer support.

Project Gutenberg eBooks are often created from several printed editions,
all of which are confirmed as not protected by copyright in the U.S. unless a

copyright notice is included. Thus, we do not necessarily keep eBooks in
compliance with any particular paper edition.

Most people start at our website which has the main PG search facility:
www.gutenberg.org.

This website includes information about Project Gutenberg, including how
to make donations to the Project Gutenberg Literary Archive Foundation,
how to help produce our new eBooks, and how to subscribe to our email
newsletter to hear about new eBooks.