Adenoids and Diseased Tonsils: Their Effect on General Intelligence

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

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

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.

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

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