CHAPTER III.. Discussion of the Results

DISCUSSION OF THE RESULTS

Statistical Study

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

TABLE I

Tonsil Group Normal Group

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

40- 50 2 .8 0 0 50- 60 1 .4 2 .7 60- 70 7 2.9 4 1.4 70- 80 21 8.9 29 9.8 80- 90 45 19.0 52 17.7 90-100 80 33.9 107 36.4 100-110 55 23.3 67 22.8 110-120 17 7.2 24 8.1 120-130 6 2.5 9 3.0 130-140 2 .8 0 0 140-150 1 .4 0 0

Average 94.9 95.4 Median 95.3 95.6 Q 8.705 8.27 [Sigma] 14.4 12.2

From these it is evident that the two groups are practically equal in intelligence. The average I.Q. for the normal group is 95.4, as compared with 94.9 for the tonsil group. The medians are equally close,--95.6 in the normal group and 95.3 with the tonsil cases. The difference in variability is negligible, Q being 8.705 and [Sigma] 14.4 in the tonsil group, while in the normal Q is 8.27 and [Sigma] 12.2. The two cases with the lowest I.Q.'s were tonsil cases, but the three highest I.Q.'s also belong in this group.

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

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

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

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

Below 70 4.1 2.1 Below 90 32.0 29.6 Above 110 10.9 11.1 Above 120 3.7 3.0 Above 130 1.2 0

In other words, in the percentage of cases below normal intelligence, the tonsil group exceeds by 2.4 per cent. The percentage of defective cases is also slightly greater in the tonsil group--the difference here being 2 per cent. The normal group has a negligible predominance of bright cases,--only two-tenths of one per cent difference, while with the very superior cases, the tonsil group again exceeds,--by 1.2 per cent. The per cent of the tonsil group which reaches or exceeds the median of the normal is 49 per cent.

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

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

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

STUDY OF IMPROVEMENT AFTER OPERATION

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

Let us consider first the improvement of the children in general health, as shown by height and weight. In Tables III and IV we have tabulated the results, in such shape as to permit of comparison. An inspection of these tables will establish the fact that after a six months' interval, the test group shows, in respect to height and weight, a very slight gain over the control group. In weight, the average of the amounts by which the test group gains exceed the control group gains is 1.37 lbs., and in height, only .16 inches. The medians of these amounts are 1.2 lbs. and .2 inches respectively. Comparing the improvements for the two groups, we find that in the case of the weights, the smallest gain (a loss of 1.2 lbs.) occurs in the control group, while the largest gain (10.7 lbs.) is in the test group.

TABLE II. RESULTS OF TESTS

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

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

1 2 1 2 1 2 1 2

1 7- 7 8- 1 50.4 54.2 46 47.6 13 12 1C 8- 1 8- 7 53.5 57.2 46.4 47.8 11 13

2 6- 9 7- 3 40.9 42.9 42.6 41.1 9 9 2C 7- 1 7- 7 52.3 57.4 45.2 47 10 12

3 8- 8- 6 55 59.5 47 48.4 12.8 14.5 3C 9- 9 10- 3 61.5 62.9 51.7 52.9 14 15

4 8-10 9- 4 51.1 54.2 47.5 49.2 9 4C 9-10 10- 4 49.4 51 48.9 52 9.5

5 6- 1 6- 7 45 47 44.9 45.2 11 5C 8- 2 8- 8 56.2 57 46.6 48.1 12

6 5- 2 5- 8 43.8 44.5 43.1 43.9 8 6C 7- 1 7- 7 50.6 52.5 45.4 47.3 10.5

7 6- 7 7- 1 39.9 41 42.9 44.8 7 6.5 7C 6- 7 7- 1 38.4 38.7 41.9 43.2 9 10

8 8- 6 9- 60.8 63.3 50.8 51.8 10 8C 8- 5 8-11 45.4 52.1 46.8 47.6 15 16

9 9- 4 9-10 50.6 53.2 48.1 49.4 10.5 13 9C 9- 6 10- 59.8 61.4 51.9 55.2 16.5 21

10 6- 7 7-1 48.9 51.4 46.1 47.7 12.5 11 10C 7- 7-6 47.1 47.5 45.6 47.2 10 15

11 6- 7 7- 47.8 47.5 45.8 47.7 11 15 11C 6- 8 7-1 41.6 42.5 43.6 44.9 11.5 11.5

12 7- 8 8-2 48 52.5 44.8 14 12C 7- 1 7-8 41 44.5 41.5 43.3 6 4.5

13 13- 3 13-10 90 98 61.5 65 26.5 28.5 13C 14- 6 15- 74.7 76.8 56.8 57.8 22 23

14 11- 9 12-4 56 62 51 51.6 16 15 14C 11-10 12-4 81.9 86 57.9 58.3 22 24

15 10- 3 10-10 57.5 51.1 15.5 15C 10- 1 10-7 67.2 70.3 50.1 51 15 15.5

16 10- 9 11-3 56 57 51.6 52.3 19 17.5 16C 10- 9 11-3 51.2 50 48.7 49.5 10 10

17 8- 1 8-7 57 48.7 14 17C 7-10 8-4 45.3 44.8 10 8.5

18 7- 2 7-8 58.2 47.3 11 18C 6-11 7-5 45.3 47 46.7 47.1 8 6.5

19 11- 4 11-10 90 96.3 57.7 59 22 21 19C 7-11 8-5 52.4 54.4 46.7 47.2 15 12

20 7- 1 7- 7 44.2 47.2 11. 20C 7- 3 7-10 61.3 66 49.6 55 15 12.5

21 11- 11- 6 70.7 76.5 54.1 16.5 16.5 21C 10- 1 10- 7 62.4 67 49.6 50.4 19 15

22 10- 9 11- 3 73.3 53 56.4 18 22.5 22C 11- 7 12- 1 70.7 80.5 56.8 58.1 19.5 21.5

23 8- 7 9- 1 51.7 47.8 11.5 15.5 23C 8-11 9- 4 64.1 66.5 51.4 53.1 14.5 14

24 9- 8 10- 2 58.5 62.5 51 19 20 24C 10- 2 10- 8 60 61 50.1 51.5 15 15

25 10- 1 10- 7 55.5 59.5 50 50.8 14 25C 10-10 11- 4 63.3 63.8 50.2 50.9 12.5 21.5

26 9- 8 10- 2 63.8 74.5 51.6 54.3 14 26C 10- 4 10- 9 64.2 67 51.4 52.3 20 16.5

27 6- 7 7- 1 43.7 45.4 9 6 27C 6- 3 6- 9 41 44 44.6 45.4 8 9

28 12-11 13- 5 71.3 75.5 54.9 55.8 23.5 21 28C 13- 8 14- 2 74.2 79.8 53.4 54.5 21

TABLE II. RESULTS (Continued)

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

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

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

2 105 112 107 114 28.5 30 2C 152 114 91 96 3 -11

3 136 139 94 91 21.5 22.5 3C 135 129 82 85 17 19

4 103 96 96 8.5 4C 109 83 85 33

5 110 95 99 -25 5C 156 114 117 40.5

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

7 125 113 91 99 6 -28 7C 105 95 99 4.5 27.5

8 113 110 91 86 32.5 8C 131 101 98 104 4 23

9 149 135 83 93 3.5 10.5 9C 144 150 87 90 34 55

10 68+ 74 88+ 82 110 109 -12 6.5 10C 70+ 54 135+109 104 100 27 65

11 125+ 90 98+ 87 103 100 - 8 6 11C 155+125 101+107 101 102 -29 -3.5

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

13 160+165 142+134 70 78 43 42 13C 150+109 122+ 94 66 64 - 1.5 30.5

14 190+172 138+130 96 107 12.5 48.5 14C 175+152 175+164 140 137 - 5 25.5

15 172+167 170+156 97 94 7 25 15C 140+115 137+115 78 79 1 42.5

16 145+131 65 73 49 47.5 16C 145+99 135+135 74 82 30 37

17 90+89 150+100 71 77 29.5 12 17C 125+116 121+ 97 96 99 1.5 15

18 133+115 135+111 98 98 -13.5 -12 18C 100+ 99 84+ 74 90 94 -32 -28

19 168+136 96 101 57.5 49 19C 100+115 118+ 92 98 98 -22 -11

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

21 152+111 132+125 64 67 20 32 21C 140+136 138+110 86 97 70.5 58.5

22 164+148 183+141 91 100 48.5 43.5 22C 120+116 157+127 63 62 34.5 33.5

23 150+119 141+136 85 94 49.5 68 23C 122+115 140+110 81 96 4 25

24 157+136 142+126 131 124 54.5 63 24C 155+135 155+100 89 92 31.5 59.5

25 140+127 150+119 77 76 8 25 25C 148+134 151+135 145 137 29.5 29

26 137+113 138+117 80 76 22.5 7 26C 125+105 125+ 79 90 88 56 61.5

27 108+ 92 97+ 92 110 109 -25 15 27C 115+105 112+109 72 96 2 27.5

28 150+148 162+143 81 84 29.5 73.5 28C 178+148 170+163 95 98 64.5 51.5

We have therefore:

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

Again, in only five pairs does the gain of the control exceed that of the test case, while in the remaining sixteen pairs the gains of the test cases are greater than those of their respective controls. The greatest loss of test as compared to control is 4.2 lbs., while the largest gain is 7.9. It would seem then, that after a six months' interval a child who has been operated on for adenoids and tonsils will tend to show a slightly greater increase in weight than a child who continues to suffer from the defects. The very small group renders this conclusion far from assured. Since it doubtless takes some little time to recover from the effects of the operation, and since there is comparatively little gain in weight in a six months' interval, it would be well to extend the experiment over another year. For the greater reliability of results, some degree of after-care should be given the operative cases, the control cases of course receiving the same treatment. While this was impracticable in the present study, it happened that three pairs of cases were members of a nutrition class, and therefore underwent some hygienic treatment. In one pair, (no. 11) the test case lost .3 of a pound, while the control gained .9. The test cases of pairs 7 and 10 gained .8 lb. and 2.1 lbs. respectively, over and above their controls. However, these three cases alone are of little significance.

A study of increase in height suffers even more than one of weight gains from the short interval which elapsed between measurements. Normally, there is very little growth in six months. There are only nineteen pairs of cases in this portion of the study, a fact which renders it of even less value. However, results are offered for what they are worth. The smallest increase in height (.3 in.) is in the test group, while the greatest growth (3.5 in.) is also in the test group. There is, however, a gain of 3.3 inches in the control group as well as one of only .4 inches. There are seven pairs in which the test group growth is less than that of the controls, one in which the two are equal, and in the remaining eleven the growth of the test cases exceeds that of the controls. The variability

TABLE III

Gain in weight, 6 months, 21 pairs

N Test Group (A) Control Group (B) Lbs.

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

8 60.8 63.3 2.5 45.4 52.1 6.7 -4.2 2 40.9 42.9 2.0 52.3 57.4 5.1 -3.1 28 71.3 75.5 4.2 74.2 79.8 5.6 -1.4 6 43.8 44.5 .7 50.6 52.5 1.9 -1.2 11 47.8 47.5 -.3 41.6 42.5 .9 -1.2 1 50.4 54.2 3.8 53.5 57.2 3.7 .1 7 39.9 41.0 1.1 38.4 38.7 .3 .8 9 50.6 53.2 2.6 59.8 61.4 1.6 1.0 12 48.0 52.5 4.5 41.0 44.5 3.5 1.0 14 56.0 62.0 6.0 81.9 86.0 4.9 1.1 5 45.0 47.0 2.0 56.2 57.0 .8 1.2 21 70.7 76.5 5.8 62.4 67.0 4.6 1.2 4 51.1 54.2 3.1 49.4 51.0 1.6 1.5 10 48.9 51.4 2.5 47.1 47.5 .4 2.1 16 56.0 57.0 1.0 51.2 50.0 -1.2 2.2 24 58.5 62.5 4.0 60.0 61.0 1.0 3.0 3 55.0 59.5 4.5 61.5 62.9 1.4 3.1 25 55.5 59.5 4.0 63.3 63.8 .5 3.5 19 90.0 96.3 6.3 52.4 54.4 2.0 4.3 13 90.0 98.0 8.0 74.7 76.8 2.1 5.9 26 63.8 74.5 10.7 64.2 67.0 2.8 7.9

Av. 56.86 60.61 3.76 56.24 58.60 2.39 1.37

M 3.8 1.9 1.2 75%ile 5.8 4.6 3.1 25%ile 2.0 .9 .1 Q 1.9 1.85 1.5 P. E. (distribution) 1.76 1.39 1.63 P. E. (average) +-.38 +-.30 +-.48 ---------------- Av. =2.85 P. E. M. =2.80 P. E.

: Numbers refer to cases as listed on Table II.

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

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

There was an average loss of .28 per cent in the weight-height-age relationship for the test group, and of 2.11 per cent for the control group. The average improvement of the test group in excess of the control group is, then, 1.83 per cent. The median improvement of test group over and above control is 4.00 per cent. The test group is more variable than the control in improvement. The greatest improvement, 8 per cent, is found in both groups.

TABLE IV

Gain in Height--6 Months, 19 Pairs

N Test Group (A) Control Group (B) Inches

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

9 48.1 49.4 1.3 51.9 55.2 3.3 -2.0 4 47.5 49.2 1.7 48.9 52.0 3.1 -1.4 5 44.9 45.2 .3 46.6 48.1 1.5 -1.2 6 43.1 43.9 .8 45.4 47.3 1.9 -1.1 2 42.5 44.1 1.6 45.2 47.0 1.8 -.2 28 54.9 55.8 .9 53.4 54.5 1.1 -.2 16 51.6 52.3 .7 48.7 49.5 .8 -.1 10 46.1 47.7 1.6 45.6 47.2 1.6 0 25 50.0 50.8 .8 50.2 50.9 .7 .1 1 46.0 47.6 1.6 46.4 47.8 1.4 .2 3 47.0 48.4 1.4 51.7 52.9 1.2 .2 8 50.8 51.8 1.0 46.8 47.6 .8 .2 14 51.0 51.6 .6 57.9 58.3 .4 .2 7 42.9 44.8 1.9 41.9 43.2 1.3 .6 11 45.8 47.7 1.9 43.6 44.9 1.3 .6 19 57.7 59.0 1.3 46.7 47.2 .5 .8 26 51.6 54.3 2.7 51.4 52.3 .9 1.8 22 53.0 56.4 3.4 56.8 58.1 1.3 2.1 13 61.5 65.0 3.5 56.8 57.8 1.0 2.5 Av. 49.26 50.79 1.53 49.20 50.62 1.36 .16 M 1.4 1.3 .2 75%ile 1.90 1.75 .65 25%ile .78 .8 -.43 Q .56 .48 .54 P. E. (distribution) .53 .44 .44 P. E. (average) +-.12 +-.10 +-.16 Av.=1 P. E. M=1.25 P. E.

The greatest loss, 10 per cent, is in the control group. Eight cases show a loss in comparison to their controls, and nine reveal a gain. On the whole, there is some significance in the small net improvement manifested by the test group. The average is 2.02 P. E.'s, and the median 4.40 P. E.'s.

The dynamometer results show no gain in strength of grip six months after operation. Indeed the average of the gains of the operative cases is slightly less than the average gain of the controls. Comparing the test group with the control, we find the average of the differences to be -.24. But the variability is so high (P. E. = +-.48) as to render this figure unreliable. The greatest loss in strength of grip is found in the control group, but the greatest gain is also in this group. Seven cases in the test group show a loss, as compared with only three control cases. In eight, or one-half of the sixteen cases, the control member of a pair gained more than the test member. Considering the three pairs of nutrition cases, we find that in pair number 7 the test case loses 1.5 Kg. when compared with the control; and in pair number 10, 6.5 Kg., while the test case in pair 11 gains 4 Kg. The conclusion from the data would seem to be that, within the space of six months at any rate, operation for adenoids and tonsils brings about no increase in strength of grip.

TABLE V

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

A B A-B

N 1 2 3 4 5 6 7

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

Av. - 4.67 - 4.94 - .28 - 3.06 - 5.17 - 2.11 + 1.83 M + .5 - 3.5 + 4.00 75%ile +2 0 6.5 25%ile -2 - 4.5 - 2 Q 2 2.25 4.25 P. E. (distribution) 3 2.39 1.33 P. E. (average) +-.71 +- 57 +- 91

Av.=2.02 P. E. M.=4.40 P. E.

Is there, after operation, an improvement in motor control and attention, and a lessening of fatiguability as these may be demonstrated in the tapping test? Table VI gives the number of taps in the first half minute of tapping for both groups before and after the six months interval. The test group suffers an average loss of 2.24 taps, and a median loss of 2. The average loss of the control group is 2.33, and the median 2.

TABLE VI

Gain in Grip--6 Months--16 Pairs

N Test Group (A) Control Group (B)

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

10 12.5 11 -1.5 10 15 5 -6.5 27 9 6 -3 8 9 1 -4 1 13 12 -1 11 13 2 -3 14 16 15 -1 22 24 2 -3 2 9 9 0 10 12 2 -2 9 10.5 13 2.5 16.5 21 4.5 -2 7 7 6.5 - .5 9 10 1 -1.5 16 19 17.5 -1.5 10 10 0 -1.5 3 12.8 14.5 1.7 14 15 1 .7 13 26.5 28.5 2 22 23 1 1 24 19 20 1 15 15 0 1 19 22 21 -1 15 12 -3 2 22 18 22.5 4.5 19.5 21.5 2 2.5 11 11 15 4 11.5 11.5 0 4 21 16.5 16.5 0 19 15 -4 4 23 11.5 15.5 4 14.5 14 - .5 4.5 Av. 14.58 15.22 .62 14.19 15.06 .875 - .24 M 0 1 -1.0 75%ile 3 2 2.25 25%ile -1 0 -2.5 Q 2 1 2.38 P. E. (distribution) 1.58 1.02 2.49 P. E. (average) +-.40 +-.26 +-.48

Av.= -.50 P. E. M.= -2.08 P. E.

There is practically no change then in the tapping ability of either group. The high unreliability of the difference (P. E. = +- 3.10) is noteworthy. It would seem that incidental causes have a much greater effect upon tapping ability than can be demonstrated as resulting from the removal of adenoids and tonsils.

Use of the tapping test as a measure of the decrease in tendency to fatigue similarly brings out no indication of any improvement in the operative group of cases. The measure of fatigue was taken as a ratio; namely, the number of taps in the first, minus the number in the second half minute over the number of taps in the first half minute. Then, if there is a greater number of taps in the second, the ratio will be minus, indicating that fatigue effect is so small as to be overcome by practice effect. This was a fact in only four cases. Since what we are measuring is improvement, the ratio for test 2 is subtracted from the ratio for test 1 to find the gain in overcoming fatigue. Table VIII shows the average gain for group one to be -.0196, and the median -.045. That is, there is an average increase in fatiguability of .0196 units and a median increase of .045 with a P. E. of +- .02. This increase in fatiguability occurs also in the control group, average 0, and median .03 with P. E. of +- .03. The average gain of test group over control group is -.02 and the median gain is -.015. Again variability is relatively large, P. E. being 1.04, so that the median and average gains are -.50 P. E. and -.38 P. E. respectively.

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

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

We find that the test group shows an average gain in I.Q. of 2.25 points. The median gain is 2 points, the total range 18 points and P. E. of the average is +- .99. The control group shows an average gain very slightly higher, 3.25 points, the median gain being 3. The range in this case is 32 points, but P. E. is only +- .47. The average of the compared gains of separate pairs is -1.035. These numbers are so small as to be insignificant. Actually, we may say that the operative group as a whole showed no gain over the control group. If we examine individual cases we find that the greatest loss in I.Q. was in the control group, (8 points) but the greatest gain (24 points) also appears in this group. In the test group 11 cases

TABLE VII

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

N Test Group (A) Control Group (B)

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

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

Av. 135.19 132.95 - 2.24 136.47 134.14 - 2.33 .09

M - 2 - 2 0 75%ile 6.5 4.5 16.0 25%ile -15 -14 19.5 Q 10.75 9.25 17.75 P. E. (distribution) 12.24 7.33 18.09 P. E. (average) +-2.66 +-1.59 +-3.10

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

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

The results of the Healy tests are similar. There is a slightly higher average gain in the control group. The test group contains eight cases which made a poorer score at the end of the interval, the control group six. The range of gains is from -22 to +44, or 66 points, in the test group, while in the control group the gains range from -14 to +41.5 or 55.5

TABLE VIII

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

N Test Group (A) Control Group (B)

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

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

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

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

points. Seventeen of the operative cases showed a smaller gain than their respective controls. The three pairs of cases from the nutrition class show the following gains:--pair 7; the test case loses 22 points, the control gains 23 points; pair 10, test case gains 18.5, but control gains 38 points; pair 11, test case gains 14 points, and control gains 25.5 points. From this test then, we can find no general tendency for cases operated on to improve in intelligence in excess of improvement in a control group which was not so treated.

This question presents itself:--is there any relationship between improvement in physical well-being as revealed in weight, and improvement in intelligence? If, as has been supposed, adenoids and diseased tonsils cause mental retardation indirectly through physical deprivation, it would seem as though greater improvement in intelligence after operation should accompany greater improvement in weight, and smaller intelligence gain should accompany slighter gain in weight. In order to determine whether this was true for our cases, improvement in I.Q. was correlated with gain in weight, for the test group. The order of merit method was used, and the formula = 1 - ((6 D_n) /( n(n squared-1))) where f = 2 sin (/6). The resulting value of r was -.10 with unreliability of .226, calculated by the formula [Sigma]t.r - obt.r = (1.05(1-r squared)) / n. There is therefore no correlation between improvement in intelligence and gain in weight.

TABLE IX

Improvement in I.Q., 28 Pairs

N Test Group (A) Control Group (B)

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

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

Av. 91.53 93.78 2.25 92.93 96.21 3.285 -1.035 M 2 3 -1 75%ile 7 4 5 25%ile -3 -1 -6 Q 5 2.5 5.5 P. E. (distribution) 5.25 2.5 5 P. E. (average) +-.99 +-.47 +-1.10 Av. = -.94 P. E. M. = -.99 P. E.

TABLE X

Improvement in Performance of Healy Test, 24 Pairs

N Test Group (A) Control Group (B)

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

7 - 6 -28 -22 4.5 27.5 23 -45 13 43 42 - 1 - 1.5 30.5 -32 -33 17 29.5 12 -17.5 1.5 15 13.5 -31 15 7 25 18 1 42.5 41.5 -23.5 26 22.5 7 -15.5 56 61.5 5.5 -21.5 10 -12 6.5 18.5 27 65 38 -19.5 19 57.5 49 - 8.5 -22 -11 11 -19.5 24 54.5 63 8.5 31.5 59.5 28 -19.5 20 0 -11 -11 30 35 5 -16 9 3.5 10.5 7 34 55 21 -14 11 -8 6 14 -29 -3.5 25.5 -11.5 16 49 47.5 - 1.5 30 37 7 - 8.5 1 -25 2 27 -50 -16 34 - 7 22 48.5 43.5 - 5 34.5 33.5 - 1 - 4 18 -13.5 -12 1.5 -32 -28 4 - 2.5 23 49.5 68 18.5 4 25 21 - 2.5 3 21.5 22.5 1 17 19 2 - 1 12 20 21 1 -10 -12 - 2 3 14 12.5 48.5 36 - 5 25.5 30.5 6.5 27 -25 15 40 2 27.5 25.5 14.5 2 28.5 30 1.5 3 -11 -14 15.5 25 8 25 17 29.5 29 - .5 17.5 21 20 32 12 70.5 58.5 -12 24 28 29.5 73.5 44 64.5 51.5 -13 57 Av. 17.29 24.94 7.64 12.12 25.69 13.56 - 5.85 M 4.25 12.25 - 7.75 75%ile 18 25.5 3 25%ile - 5 - .5 -19.5 Q 11.5 13 11.25 P. E. (distribution) 10.6 10.56 13.65 P. E. (average) +-2.16 +- 2.16 +- 3.05

Av. = -1.92 P. E. M. = -2.54 P. E.

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

TABLE XI

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

Weight Height Grip Tapping

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

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

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

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

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

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

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

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

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

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

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

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

13 .95 1.00 .99 1.00 .99 1.00 .90 .66 13C .87 .89 .93 .96 .94 .96 .78 .36

14 .49 .66 .67 .74 .72 .67 1.00 .57 14C .92 .93 .96 .98 .93 .98 .97 .97

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TABLE XI (Continued)

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

N I.Q. Healy Total Possible Average Gain

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

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

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

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

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

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

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

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

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

10 .88 .86 .15 .35 .34 400 .056 10C .81 .73 .57 .97 1.39 392 .218

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

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

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

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

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

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

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

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

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

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

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

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

23 .32 .49 .86 .98 .65 168 .163 23C .23 .59 .33 .50 1.26 253 .21

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

25 .17 .15 .37 .55 .49 280 .098 25C 1.00 .97 .63 .60 .53 134 .088

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

27 .88 .86 .10 .43 .05 268 .013 27C .11 .59 .29 .59 1.49 320 .25

28 .23 .29 .63 1.00 .59 153 .097 28C .53 .67 .96 .87 .24 83 .048

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

TABLE XII

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

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

1 25 27 75 2 415 30 5 1C 21 15 79 -6 462 53 8.9

2 84 89 16 5 416 38 6.3 2C 45 51 55 6 358 - 7 -1.1

3 49 44 51 -5 328 40 6.6 3C 25 32 75 7 287 30 5

4 59 59 41 0 168 22 7.3 4C 27 32 73 5 195 42 14

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

6 53 77 47 24 229 55 18.3 6C 37 38 63 1 210 27 9

7 45 71 55 26 478 37 6.2 7C 53 71 47 18 393 74 14.8

8 45 34 55 -11 203 -50 -12.5 8C 67 81 33 14 241 10 2.5

9 27 46 73 19 375 71 11.8 9C 35 40 65 5 217 72 12

10 88 86 12 -2 400 34 5.6 10C 81 73 19 -8 392 139 21.8

11 79 73 21 -6 379 21 3.5 11C 77 79 23 2 379 -44 -7.3

12 67 53 33 - 6 161 - 11 - 3.6 12C 67 77 33 10 208 19 3.2

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

14 59 84 41 25 212 69 11.5 14C 97 96 3 - 1 104 41 6.8

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

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

17 9 17 81 8 223 66 22 17C 59 71 41 12 174 21 5.3

18 67 67 33 0 175 8 2.7 18C 40 49 60 9 247 18 3

19 59 69 41 10 67 16 3.2 19C 67 67 33 0 287 16 2.7

20 82 79 18 - 3 177 - 6 - 2 20C 91 94 9 3 65 20 6.6

21 5 7 95 2 209 - 16 - 3.2 21C 34 62 66 28 157 46 7.7

22 45 73 55 28 120 87 17.4 22C 3 2 97 - 1 275 74 12.3

23 32 49 68 17 168 65 16.3 23C 23 59 77 36 253 126 21

24 94 92 6 - 2 89 - 6 - 1.2 24C 38 46 62 8 179 54 9

25 17 15 83 - 2 280 49 9.8 25C 100 97 0 - 3 134 53 8.8

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

27 88 86 12 - 2 268 5 1.3 27C 11 59 89 48 320 148 25

28 23 29 77 6 153 59 9.7 28C 53 67 47 14 83 24 4.8

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

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

TABLE XIII

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

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

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

Average 2.85 1.00 2.02 -.50 .03 -.50 -.94 -1.92 Median 2.80 1.25 .55 -.83 .32 -.50 0 -2.54