CHAPTER II.. Method and Procedure

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.

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

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

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

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

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