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+Project Gutenberg's Adenoids and Diseased Tonsils, by Margaret Cobb Rogers
+
+This eBook is for the use of anyone anywhere 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
+
+
+Title: Adenoids and Diseased Tonsils
+ Their Effect on General Intelligence
+
+Author: Margaret Cobb Rogers
+
+Release Date: January 26, 2012 [EBook #38676]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK ADENOIDS AND DISEASED TONSILS ***
+
+
+
+
+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.)
+
+
+
+
+
+
+
+
+
+ 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]
+
+ [1]: F. Hooper, M. D., quoting from a paper by B. Frankel.
+
+"... 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]
+
+ [2]: Adenoid Growths of the Naso-pharynx. Read before the
+ Homeopathic Medical Society of New York, February, 1895.
+
+"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]
+
+ [3]: H. Addington Bruce, Psychology and Parenthood, 1916.
+
+"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."
+
+ [4]: H. Addington Bruce in the Century Magazine, 1916--The
+ Mind of the Child.
+
+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]
+
+ [5]: The italics are mine.
+
+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]
+
+ [6]: Psych. Clinic, 1916, 10, 45-48. Anna Johnson. The
+ Teacher in the Retarded School.
+
+"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.
+
+ [7]: Psych. Clinic, 1909, 3, 71-77. The Effect of Physical
+ Defect on School Progress.
+
+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 Defective and Tonsils Adenoids Deaf
+
+ 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 0·8
+
+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 children 50 39 32 29
+ Normal 36 32 20 13
+ Defective 14 7 12 16
+
+ Percentage of normal 72 82 62·5 44·8
+
+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:
+
+ Exempt Children Non-exempt Children
+ Normal Defective Normal Defective
+
+ 9th St. Primary 56 28 39 38
+ Rutledge School 87 35 75 34
+ Allison School 128 65 81 49
+ Camac School 183 71 103 75
+ Claghorn School 193 61 127 66
+ --- --- --- ---
+ 647 260 425 262
+
+ Percentage Defective 28·8 38·1
+
+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,
+ number defective 6 4 9 9
+ _Tonsils_ _3_ _4_ _3_ _3_
+ _Adenoids_ _2_ _1_ _5_ _6_
+ Deaf 2 5 1
+ Catarrh 2 3
+
+ Percentage of children,
+ nose and throat defects 12 10·2 28·1 31
+
+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.
+
+ [8]: Cornell, Psychological Clinic, 2, 1909.
+
+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."
+
+ [9]: H. R. Burpitt. Relative Degrees of Dullness and
+ Backwardness in School Children and their Causation. Journal of
+ Mental Science, 1916.
+
+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:
+
+ Causes 46 children 24 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 defects 9 6
+ Irregular attendance 2 3
+ _Adenoids only_ _2_ _0_
+
+Turning to what the author calls single causes,--present in 170 cases out
+of the 400,--
+
+ Causes 151 children 19 children
+ 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]
+
+ [10]: Transactions of the International Congress on School
+ Hygiene, 1913, The Physical Condition of Retarded School Children.
+
+ 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
+ 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
+ _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:
+
+ [11]: Ayres: "Laggards in Our Schools." 1909.
+
+ Exempt Children Non-exempt Children
+
+ Defect No. Examined % No. Examined %
+ Defective vision 371 10·0 171 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 918 26·0 423 30·0
+ Miscellaneous 214 6·0 128 9·0
+ Total 1,774 49·0 930 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.
+
+ [12]: Wallin: "Mental Health of the School Child." 1914.
+
+"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· 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 1 Period 2 Period 3
+ A--Per cent of 31 cases 32·2
+ (operated upon)
+ Per cent of 100 children 42
+ at random
+
+ B--Per cent of 18 children--20 33·3 66·6
+ months (operated upon)
+ Per cent of 100 children at 42 41
+ random
+
+ C--Per cent of 11 cases for 30 36·3 63·5 100
+ months (operated upon)
+ Per cent of 100 children at 42 41 41
+ random
+
+"... 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."
+
+ [13]: Wallin: "Mental Health of the School Child." 1914.
+
+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]
+
+ [14]: 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
+
+
+
+
+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 Per cent of No. of Per cent of
+ Cases Cases Cases Cases
+
+ 40- 50 2 ·8 0 0
+ 50- 60 1 ·4 2 ·7
+ 60- 70 7 2·9 4 1·4
+ 70- 80 21 8·9 29 9·8
+ 80- 90 45 19·0 52 17·7
+ 90-100 80 33·9 107 36·4
+ 100-110 55 23·3 67 22·8
+ 110-120 17 7·2 24 8·1
+ 120-130 6 2·5 9 3·0
+ 130-140 2 ·8 0 0
+ 140-150 1 ·4 0 0
+
+ Average 94·9 95·4
+ Median 95·3 95·6
+ Q 8·705 8·27
+ [Sigma] 14·4 12·2
+
+From these it is evident that the two groups are practically equal in
+intelligence. The average I.Q. for the normal group is 95·4, as compared
+with 94·9 for the tonsil group. The medians are equally close,--95·6 in
+the normal group and 95·3 with the tonsil cases. The difference in
+variability is negligible, Q being 8·705 and [Sigma] 14·4 in the
+tonsil group, while in the normal Q is 8·27 and [Sigma] 12·2. The
+two cases with the lowest I.Q.'s were tonsil cases, but the three
+highest I.Q.'s also belong in this group.
+
+ Fig. 1. Distribution of I.Q.'s. Number of cases.
+
+ Fig. 2. Distribution of I.Q.'s by percentage of total number of
+ cases in the group.
+
+If the frequencies are expressed in terms of per cent of the total
+number of cases in the group, the two may be compared further. The
+following details are noticeable.
+
+ I.Q. Per cent of Per Cent of
+ Tonsil Group Normal Group
+
+ Below 70 4·1 2·1
+ Below 90 32·0 29·6
+ Above 110 10·9 11·1
+ Above 120 3·7 3·0
+ Above 130 1·2 0
+
+In other words, in the percentage of cases below normal intelligence,
+the tonsil group exceeds by 2·4 per cent. The percentage of defective
+cases is also slightly greater in the tonsil group--the difference here
+being 2 per cent. The normal group has a negligible predominance of
+bright cases,--only two-tenths of one per cent difference, while with
+the very superior cases, the tonsil group again exceeds,--by 1·2 per
+cent. The per cent of the tonsil group which reaches or exceeds the
+median of the normal is 49 per cent.
+
+These figures seem to indicate remarkable similarity between the two
+groups considered. The two distributions are almost identical. While the
+slight predominance of cases below normal mentality in the tonsil group
+may indicate a very feeble tendency toward coincidence of tonsillar
+defect and mental dullness, it does not seem large enough to be at all
+significant. This is especially true when we consider that the tonsil
+group exceeds in superior children. If we allow the preceding contention
+of coincidence between dullness and tonsils, must we not argue here in
+the same manner for a tendency toward coincidence of superiority and
+tonsils?
+
+The chief source of error in this part of the study is the fact that the
+throat examinations were not conducted by the same person throughout the
+investigation. For this reason there must have been some slight
+disagreement as to what should constitute a reportable case. In the
+event, then, of a positive relationship between tonsil defect and
+lowering of the intelligence quotient, placement of normal tonsils in
+the "tonsil" group, and of diseased tonsils in the "normal" group would
+raise the first, and lower the second, thus tending to conceal the
+difference between the two. On the other hand, the cases where
+disagreement would occur would naturally be those of slighter defect, in
+which the intellectual retardation would be less likely to occur, so
+that the result would probably be merely an increased height at the
+overlapping portion of the curves, with no change at the ends.
+
+In any case, the two examiners had worked together previously, so that
+each must have been somewhat familiar with the opinions of the other.
+They were aware, also, that pronounced tonsillar defect was what we were
+attempting to detect. However this may be, there must always be some
+disagreement in diagnosis. When this is allowed for, the results of the
+investigation may be taken for what they are worth. Contrary to
+expectation, there seems to be very little difference in intelligence
+between a group of children whose throats are normal, and one in whom
+the tonsils are diseased or badly enlarged.
+
+
+STUDY OF IMPROVEMENT AFTER OPERATION
+
+The complete results of the tests and retests are collected in Table II,
+where each control case is listed immediately below its respective test
+case, and where age, height, weight, grip, tapping rate, I.Q., and score
+in Healy Picture Completion are shown. From these data the more detailed
+observations have been made. The improvement of each child in the
+various tests has been computed, and a comparison drawn between the two
+groups. As we have previously stated, any improvement shown by the test
+group in excess of that of the control group, may be looked upon as
+significant.
+
+Let us consider first the improvement of the children in general health,
+as shown by height and weight. In Tables III and IV we have tabulated
+the results, in such shape as to permit of comparison. An inspection of
+these tables will establish the fact that after a six months' interval,
+the test group shows, in respect to height and weight, a very slight
+gain over the control group. In weight, the average of the amounts by
+which the test group gains exceed the control group gains is 1·37 lbs.,
+and in height, only ·16 inches. The medians of these amounts are 1·2
+lbs. and ·2 inches respectively. Comparing the improvements for the two
+groups, we find that in the case of the weights, the smallest gain (a
+loss of 1·2 lbs.) occurs in the control group, while the largest gain
+(10·7 lbs.) is in the test group.
+
+ TABLE II. RESULTS OF TESTS
+
+ Blank spaces indicate where tests were omitted for one reason or another
+
+ N Age Weight Height Grip, Kg.
+ lbs. in. best hand
+
+ 1 2 1 2 1 2 1 2
+
+ 1 7- 7 8- 1 50·4 54·2 46 47·6 13 12
+ 1C 8- 1 8- 7 53·5 57·2 46·4 47·8 11 13
+
+ 2 6- 9 7- 3 40·9 42·9 42·6 41·1 9 9
+ 2C 7- 1 7- 7 52·3 57·4 45·2 47 10 12
+
+ 3 8- 8- 6 55 59·5 47 48·4 12·8 14·5
+ 3C 9- 9 10- 3 61·5 62·9 51·7 52·9 14 15
+
+ 4 8-10 9- 4 51·1 54·2 47·5 49·2 9
+ 4C 9-10 10- 4 49·4 51 48·9 52 9·5
+
+ 5 6- 1 6- 7 45 47 44·9 45·2 11
+ 5C 8- 2 8- 8 56·2 57 46·6 48·1 12
+
+ 6 5- 2 5- 8 43·8 44·5 43·1 43·9 8
+ 6C 7- 1 7- 7 50·6 52·5 45·4 47·3 10·5
+
+ 7 6- 7 7- 1 39·9 41 42·9 44·8 7 6·5
+ 7C 6- 7 7- 1 38·4 38·7 41·9 43·2 9 10
+
+ 8 8- 6 9- 60·8 63·3 50·8 51·8 10
+ 8C 8- 5 8-11 45·4 52·1 46·8 47·6 15 16
+
+ 9 9- 4 9-10 50·6 53·2 48·1 49·4 10·5 13
+ 9C 9- 6 10- 59·8 61·4 51·9 55·2 16·5 21
+
+ 10 6- 7 7-1 48·9 51·4 46·1 47·7 12·5 11
+ 10C 7- 7-6 47·1 47·5 45·6 47·2 10 15
+
+ 11 6- 7 7- 47·8 47·5 45·8 47·7 11 15
+ 11C 6- 8 7-1 41·6 42·5 43·6 44·9 11·5 11·5
+
+ 12 7- 8 8-2 48 52·5 44·8 14
+ 12C 7- 1 7-8 41 44·5 41·5 43·3 6 4·5
+
+ 13 13- 3 13-10 90 98 61·5 65 26·5 28·5
+ 13C 14- 6 15- 74·7 76·8 56·8 57·8 22 23
+
+ 14 11- 9 12-4 56 62 51 51·6 16 15
+ 14C 11-10 12-4 81·9 86 57·9 58·3 22 24
+
+ 15 10- 3 10-10 57·5 51·1 15·5
+ 15C 10- 1 10-7 67·2 70·3 50·1 51 15 15·5
+
+ 16 10- 9 11-3 56 57 51·6 52·3 19 17·5
+ 16C 10- 9 11-3 51·2 50 48·7 49·5 10 10
+
+ 17 8- 1 8-7 57 48·7 14
+ 17C 7-10 8-4 45·3 44·8 10 8·5
+
+ 18 7- 2 7-8 58·2 47·3 11
+ 18C 6-11 7-5 45·3 47 46·7 47·1 8 6·5
+
+ 19 11- 4 11-10 90 96·3 57·7 59 22 21
+ 19C 7-11 8-5 52·4 54·4 46·7 47·2 15 12
+
+ 20 7- 1 7- 7 44·2 47·2 11·
+ 20C 7- 3 7-10 61·3 66 49·6 55 15 12·5
+
+ 21 11- 11- 6 70·7 76·5 54·1 16·5 16·5
+ 21C 10- 1 10- 7 62·4 67 49·6 50·4 19 15
+
+ 22 10- 9 11- 3 73·3 53 56·4 18 22·5
+ 22C 11- 7 12- 1 70·7 80·5 56·8 58·1 19·5 21·5
+
+ 23 8- 7 9- 1 51·7 47·8 11·5 15·5
+ 23C 8-11 9- 4 64·1 66·5 51·4 53·1 14·5 14
+
+ 24 9- 8 10- 2 58·5 62·5 51 19 20
+ 24C 10- 2 10- 8 60 61 50·1 51·5 15 15
+
+ 25 10- 1 10- 7 55·5 59·5 50 50·8 14
+ 25C 10-10 11- 4 63·3 63·8 50·2 50·9 12·5 21·5
+
+ 26 9- 8 10- 2 63·8 74·5 51·6 54·3 14
+ 26C 10- 4 10- 9 64·2 67 51·4 52·3 20 16·5
+
+ 27 6- 7 7- 1 43·7 45·4 9 6
+ 27C 6- 3 6- 9 41 44 44·6 45·4 8 9
+
+ 28 12-11 13- 5 71·3 75·5 54·9 55·8 23·5 21
+ 28C 13- 8 14- 2 74·2 79·8 53·4 54·5 21
+
+
+ TABLE II. RESULTS (Continued)
+
+ Blank spaces indicate where tests were omitted for one reason or another
+
+ N Tapping, 1/2 min. I.Q. Healy, Score
+ best hand
+
+ 1 2 1 2 1 2
+ 1 135 120 82 83 -25 -2
+ 1C 106 115 80 76 -50 -16
+
+ 2 105 112 107 114 28·5 30
+ 2C 152 114 91 96 3 -11
+
+ 3 136 139 94 91 21·5 22·5
+ 3C 135 129 82 85 17 19
+
+ 4 103 96 96 8·5
+ 4C 109 83 85 33
+
+ 5 110 95 99 -25
+ 5C 156 114 117 40·5
+
+ 6 110 95 101 -33
+ 6C 126 88 89 -32
+
+ 7 125 113 91 99 6 -28
+ 7C 105 95 99 4·5 27·5
+
+ 8 113 110 91 86 32·5
+ 8C 131 101 98 104 4 23
+
+ 9 149 135 83 93 3·5 10·5
+ 9C 144 150 87 90 34 55
+
+ 10 68+ 74 88+ 82 110 109 -12 6·5
+ 10C 70+ 54 135+109 104 100 27 65
+
+ 11 125+ 90 98+ 87 103 100 - 8 6
+ 11C 155+125 101+107 101 102 -29 -3·5
+
+ 12 98+69 98 95 20 21
+ 12C 102 84 98 101 -10 -12
+
+ 13 160+165 142+134 70 78 43 42
+ 13C 150+109 122+ 94 66 64 - 1·5 30·5
+
+ 14 190+172 138+130 96 107 12·5 48·5
+ 14C 175+152 175+164 140 137 - 5 25·5
+
+ 15 172+167 170+156 97 94 7 25
+ 15C 140+115 137+115 78 79 1 42·5
+
+ 16 145+131 65 73 49 47·5
+ 16C 145+99 135+135 74 82 30 37
+
+ 17 90+89 150+100 71 77 29·5 12
+ 17C 125+116 121+ 97 96 99 1·5 15
+
+ 18 133+115 135+111 98 98 -13·5 -12
+ 18C 100+ 99 84+ 74 90 94 -32 -28
+
+ 19 168+136 96 101 57·5 49
+ 19C 100+115 118+ 92 98 98 -22 -11
+
+ 20 105+115 110+ 93 106 102 0 -11
+ 20C 150+120 155+149 118 131 30 35
+
+ 21 152+111 132+125 64 67 20 32
+ 21C 140+136 138+110 86 97 70·5 58·5
+
+ 22 164+148 183+141 91 100 48·5 43·5
+ 22C 120+116 157+127 63 62 34·5 33·5
+
+ 23 150+119 141+136 85 94 49·5 68
+ 23C 122+115 140+110 81 96 4 25
+
+ 24 157+136 142+126 131 124 54·5 63
+ 24C 155+135 155+100 89 92 31·5 59·5
+
+ 25 140+127 150+119 77 76 8 25
+ 25C 148+134 151+135 145 137 29·5 29
+
+ 26 137+113 138+117 80 76 22·5 7
+ 26C 125+105 125+ 79 90 88 56 61·5
+
+ 27 108+ 92 97+ 92 110 109 -25 15
+ 27C 115+105 112+109 72 96 2 27·5
+
+ 28 150+148 162+143 81 84 29·5 73·5
+ 28C 178+148 170+163 95 98 64·5 51·5
+
+ We have therefore:
+
+ 28 pairs of I.Q.'s to be compared
+ 21 pairs of weights
+ 19 pairs of heights
+ 16 pairs of grip measurements
+ 20 pairs of tapping speeds
+ 24 pairs of Healy Completion scores.
+
+Again, in only five pairs does the gain of the control exceed that of
+the test case, while in the remaining sixteen pairs the gains of the
+test cases are greater than those of their respective controls. The
+greatest loss of test as compared to control is 4·2 lbs., while the
+largest gain is 7·9. It would seem then, that after a six months'
+interval a child who has been operated on for adenoids and tonsils will
+tend to show a slightly greater increase in weight than a child who
+continues to suffer from the defects. The very small group renders this
+conclusion far from assured. Since it doubtless takes some little time
+to recover from the effects of the operation, and since there is
+comparatively little gain in weight in a six months' interval, it would
+be well to extend the experiment over another year. For the greater
+reliability of results, some degree of after-care should be given the
+operative cases, the control cases of course receiving the same
+treatment. While this was impracticable in the present study, it
+happened that three pairs of cases were members of a nutrition class,
+and therefore underwent some hygienic treatment. In one pair, (no. 11)
+the test case lost ·3 of a pound, while the control gained ·9. The test
+cases of pairs 7 and 10 gained ·8 lb. and 2·1 lbs. respectively, over
+and above their controls. However, these three cases alone are of little
+significance.
+
+A study of increase in height suffers even more than one of weight gains
+from the short interval which elapsed between measurements. Normally,
+there is very little growth in six months. There are only nineteen pairs
+of cases in this portion of the study, a fact which renders it of even
+less value. However, results are offered for what they are worth. The
+smallest increase in height (·3 in.) is in the test group, while the
+greatest growth (3·5 in.) is also in the test group. There is, however,
+a gain of 3·3 inches in the control group as well as one of only ·4
+inches. There are seven pairs in which the test group growth is less
+than that of the controls, one in which the two are equal, and in the
+remaining eleven the growth of the test cases exceeds that of the
+controls. The variability
+
+ TABLE III
+
+ Gain in weight, 6 months, 21 pairs
+
+
+ N[16] Test Group (A) Control Group (B) Lbs.
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 8 60·8 63·3 2·5 45·4 52·1 6·7 -4·2
+ 2 40·9 42·9 2·0 52·3 57·4 5·1 -3·1
+ 28 71·3 75·5 4·2 74·2 79·8 5·6 -1·4
+ 6 43·8 44·5 ·7 50·6 52·5 1·9 -1·2
+ 11 47·8 47·5 -·3 41·6 42·5 ·9 -1·2
+ 1 50·4 54·2 3·8 53·5 57·2 3·7 ·1
+ 7 39·9 41·0 1·1 38·4 38·7 ·3 ·8
+ 9 50·6 53·2 2·6 59·8 61·4 1·6 1·0
+ 12 48·0 52·5 4·5 41·0 44·5 3·5 1·0
+ 14 56·0 62·0 6·0 81·9 86·0 4·9 1·1
+ 5 45·0 47·0 2·0 56·2 57·0 ·8 1·2
+ 21 70·7 76·5 5·8 62·4 67·0 4·6 1·2
+ 4 51·1 54·2 3·1 49·4 51·0 1·6 1·5
+ 10 48·9 51·4 2·5 47·1 47·5 ·4 2·1
+ 16 56·0 57·0 1·0 51·2 50·0 -1·2 2·2
+ 24 58·5 62·5 4·0 60·0 61·0 1·0 3·0
+ 3 55·0 59·5 4·5 61·5 62·9 1·4 3·1
+ 25 55·5 59·5 4·0 63·3 63·8 ·5 3·5
+ 19 90·0 96·3 6·3 52·4 54·4 2·0 4·3
+ 13 90·0 98·0 8·0 74·7 76·8 2·1 5·9
+ 26 63·8 74·5 10·7 64·2 67·0 2·8 7·9
+
+ Av. 56·86 60·61 3·76 56·24 58·60 2·39 1·37
+
+ M 3·8 1·9 1·2
+ 75%ile 5·8 4·6 3·1
+ 25%ile 2·0 ·9 ·1
+ Q 1·9 1·85 1·5
+ P. E. (distribution) 1·76 1·39 1·63
+ P. E. (average) ±·38 ±·30 ±·48
+ ----------------
+ Av. =2·85 P. E.
+ M. =2·80 P. E.
+
+
+ [16]: Numbers refer to cases as listed on Table II.
+
+of the test group growth is greater than that of the control group. The
+three nutrition pairs show the following records of growth,--in number
+7, the test case shows a growth of·.6 in. more than his control. Number
+10 is the pair in which the growth is equal. In number 11 the test case
+again exceeds in growth by ·6 of an inch.
+
+More reliable than height and weight considered separately, as an index
+of physical welfare, is weight in relation to height and age. Table V
+shows the improvement in this relationship for the two groups. The
+numbers in columns 1, 2, 4 and 5 show the per cent under or over weight
+of the individual cases, in relation to their respective heights and
+ages. The authority upon which the figures are based, is the table
+published by the American Child Health Association, giving standard
+weights for height and age in boys.
+
+There was an average loss of ·28 per cent in the weight-height-age
+relationship for the test group, and of 2·11 per cent for the control
+group. The average improvement of the test group in excess of the
+control group is, then, 1·83 per cent. The median improvement of test
+group over and above control is 4·00 per cent. The test group is more
+variable than the control in improvement. The greatest improvement, 8
+per cent, is found in both groups.
+
+
+ TABLE IV
+
+ Gain in Height--6 Months, 19 Pairs
+
+ N[16] Test Group (A) Control Group (B) Inches
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 9 48·1 49·4 1·3 51·9 55·2 3·3 -2·0
+ 4 47·5 49·2 1·7 48·9 52·0 3·1 -1·4
+ 5 44·9 45·2 ·3 46·6 48·1 1·5 -1·2
+ 6 43·1 43·9 ·8 45·4 47·3 1·9 -1·1
+ 2 42·5 44·1 1·6 45·2 47·0 1·8 -·2
+ 28 54·9 55·8 ·9 53·4 54·5 1·1 -·2
+ 16 51·6 52·3 ·7 48·7 49·5 ·8 -·1
+ 10 46·1 47·7 1·6 45·6 47·2 1·6 0
+ 25 50·0 50·8 ·8 50·2 50·9 ·7 ·1
+ 1 46·0 47·6 1·6 46·4 47·8 1·4 ·2
+ 3 47·0 48·4 1·4 51·7 52·9 1·2 ·2
+ 8 50·8 51·8 1·0 46·8 47·6 ·8 ·2
+ 14 51·0 51·6 ·6 57·9 58·3 ·4 ·2
+ 7 42·9 44·8 1·9 41·9 43·2 1·3 ·6
+ 11 45·8 47·7 1·9 43·6 44·9 1·3 ·6
+ 19 57·7 59·0 1·3 46·7 47·2 ·5 ·8
+ 26 51·6 54·3 2·7 51·4 52·3 ·9 1·8
+ 22 53·0 56·4 3·4 56·8 58·1 1·3 2·1
+ 13 61·5 65·0 3·5 56·8 57·8 1·0 2·5
+ Av. 49·26 50·79 1·53 49·20 50·62 1·36 ·16
+ M 1·4 1·3 ·2
+ 75%ile 1·90 1·75 ·65
+ 25%ile ·78 ·8 -·43
+ Q ·56 ·48 ·54
+ P. E. (distribution) ·53 ·44 ·44
+ P. E. (average) ±·12 ±·10 ±·16
+ Av.=1 P. E.
+ M=1·25 P. E.
+
+The greatest loss, 10 per cent, is in the control group. Eight cases
+show a loss in comparison to their controls, and nine reveal a gain. On
+the whole, there is some significance in the small net improvement
+manifested by the test group. The average is 2·02 P. E.'s, and the
+median 4·40 P. E.'s.
+
+The dynamometer results show no gain in strength of grip six months
+after operation. Indeed the average of the gains of the operative cases
+is slightly less than the average gain of the controls. Comparing the
+test group with the control, we find the average of the differences to
+be -·24. But the variability is so high (P. E. = ±·48) as to render this
+figure unreliable. The greatest loss in strength of grip is found in the
+control group, but the greatest gain is also in this group. Seven cases
+in the test group show a loss, as compared with only three control
+cases. In eight, or one-half of the sixteen cases, the control member of
+a pair gained more than the test member. Considering the three pairs of
+nutrition cases, we find that in pair number 7 the test case loses 1·5
+Kg. when compared with the control; and in pair number 10, 6·5 Kg.,
+while the test case in pair 11 gains 4 Kg. The conclusion from the data
+would seem to be that, within the space of six months at any rate,
+operation for adenoids and tonsils brings about no increase in strength
+of grip.
+
+ TABLE V
+
+ Showing change in per cent over or underweight for height and age,
+ 18 pairs
+
+ A B A-B
+
+ N[16] 1 2 3 4 5 6 7
+
+ 8 - 1 - 1 0 -13 - 5 + 8 - 8
+ 11 - 3 -12 -9 - 9 -11 - 2 - 7
+ 10 - 1 - 5 -4 - 6 - 8 - 2 - 2
+ 28 - 7 - 7 0 0 + 2 + 2 - 2
+ 13 -13 -19 -6 -11 -15 - 4 - 2
+ 19 + 6 + 8 +2 + 1 + 5 + 4 - 2
+ 6 + 2 - 3 -5 + 5 + 1 - 4 - 1
+ 14 -13 - 9 +4 - 5 0 + 5 - 1
+ 7 - 8 -15 -7 - 7 -14 - 7 0
+ 2 - 8 - 6 +2 + 9 +10 + 1 + 1
+ 3 + 6 + 8 +2 - 5 - 8 - 3 + 5
+ 16 -16 -15 +1 -13 -17 - 4 + 5
+ 25 - 8 - 7 +1 + 4 - 1 - 5 + 6
+ 5 - 4 - 1 +3 + 8 + 4 - 4 + 7
+ 9 - 8 -11 -3 - 7 -17 -10 + 7
+ 26 - 1 + 5 +6 + 1 0 - 1 + 7
+ 4 - 7 - 7 0 -15 -23 - 8 + 8
+ 1 0 + 8 +8 + 8 + 4 - 4 +12
+
+ Av. - 4·67 - 4·94 - ·28 - 3·06 - 5·17 - 2·11 + 1·83
+ M + ·5 - 3·5 + 4·00
+ 75%ile +2 0 6·5
+ 25%ile -2 - 4·5 - 2
+ Q 2 2·25 4·25
+ P. E. (distribution) 3 2·39 1·33
+ P. E. (average) ±·71 ± 57 ± 91
+
+ Av.=2·02 P. E.
+ M.=4·40 P. E.
+
+Is there, after operation, an improvement in motor control and
+attention, and a lessening of fatiguability as these may be demonstrated
+in the tapping test? Table VI gives the number of taps in the first half
+minute of tapping for both groups before and after the six months
+interval. The test group suffers an average loss of 2·24 taps, and a
+median loss of 2. The average loss of the control group is 2·33, and the
+median 2.
+
+ TABLE VI
+
+ Gain in Grip--6 Months--16 Pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 10 12·5 11 -1·5 10 15 5 -6·5
+ 27 9 6 -3 8 9 1 -4
+ 1 13 12 -1 11 13 2 -3
+ 14 16 15 -1 22 24 2 -3
+ 2 9 9 0 10 12 2 -2
+ 9 10·5 13 2·5 16·5 21 4·5 -2
+ 7 7 6·5 - ·5 9 10 1 -1·5
+ 16 19 17·5 -1·5 10 10 0 -1·5
+ 3 12·8 14·5 1·7 14 15 1 ·7
+ 13 26·5 28·5 2 22 23 1 1
+ 24 19 20 1 15 15 0 1
+ 19 22 21 -1 15 12 -3 2
+ 22 18 22·5 4·5 19·5 21·5 2 2·5
+ 11 11 15 4 11·5 11·5 0 4
+ 21 16·5 16·5 0 19 15 -4 4
+ 23 11·5 15·5 4 14·5 14 - ·5 4·5
+ Av. 14·58 15·22 ·62 14·19 15·06 ·875 - ·24
+ M 0 1 -1·0
+ 75%ile 3 2 2·25
+ 25%ile -1 0 -2·5
+ Q 2 1 2·38
+ P. E. (distribution) 1·58 1·02 2·49
+ P. E. (average) ±·40 ±·26 ±·48
+
+ Av.= -·50 P. E.
+ M.= -2·08 P. E.
+
+There is practically no change then in the tapping ability of either
+group. The high unreliability of the difference (P. E. = ± 3·10) is
+noteworthy. It would seem that incidental causes have a much greater
+effect upon tapping ability than can be demonstrated as resulting from
+the removal of adenoids and tonsils.
+
+Use of the tapping test as a measure of the decrease in tendency to
+fatigue similarly brings out no indication of any improvement in the
+operative group of cases. The measure of fatigue was taken as a ratio;
+namely, the number of taps in the first, minus the number in the second
+half minute over the number of taps in the first half minute. Then, if
+there is a greater number of taps in the second, the ratio will be
+minus, indicating that fatigue effect is so small as to be overcome by
+practice effect. This was a fact in only four cases. Since what we are
+measuring is improvement, the ratio for test 2 is subtracted from the
+ratio for test 1 to find the gain in overcoming fatigue. Table VIII
+shows the average gain for group one to be -·0196, and the median -·045.
+That is, there is an average increase in fatiguability of ·0196 units
+and a median increase of ·045 with a P. E. of ± ·02. This increase in
+fatiguability occurs also in the control group, average 0, and median
+·03 with P. E. of ± ·03. The average gain of test group over control
+group is -·02 and the median gain is -·015. Again variability is
+relatively large, P. E. being 1·04, so that the median and average gains
+are -·50 P. E. and -·38 P. E. respectively.
+
+We may say, then, that the capacities brought out by the tapping test
+seem to undergo no improvement in six months after removal of adenoids
+and tonsils.
+
+The main line of interest in the present experiment lay with the
+relation of adenoid and tonsil defects to general intelligence. The
+results of the two tests dealing more specifically with this side of the
+problem are here set forth. Table IX shows the I.Q.'s. of the two groups
+before and after the six months' interval, together with changes plus or
+minus in I.Q., and a comparison of the separate pairs in respect to
+improvement.
+
+We find that the test group shows an average gain in I.Q. of 2·25
+points. The median gain is 2 points, the total range 18 points and P. E.
+of the average is ± ·99. The control group shows an average gain very
+slightly higher, 3·25 points, the median gain being 3. The range in this
+case is 32 points, but P. E. is only ± ·47. The average of the compared
+gains of separate pairs is -1·035. These numbers are so small as to be
+insignificant. Actually, we may say that the operative group as a whole
+showed no gain over the control group. If we examine individual cases we
+find that the greatest loss in I.Q. was in the control group, (8 points)
+but the greatest gain (24 points) also appears in this group. In the
+test group 11 cases
+
+ TABLE VII
+
+ Gain in number of taps in one-half minute, 21 pairs--right hand
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 14 190 138 -52 175 175 0 -52
+ 10 68 88 20 70 135 65 -45
+ 23 150 141 - 9 122 140 18 -27
+ 1 135 120 -15 106 115 9 -24
+ 9 149 135 -14 144 150 6 -20
+ 21 152 132 -20 140 138 - 2 -18
+ 22 164 183 19 120 157 37 -18
+ 24 157 142 -15 155 155 0 -15
+ 27 108 97 -11 115 112 - 3 - 8
+ 20 105 110 5 150 155 5 0
+ 15 172 170 - 2 140 137 - 3 1
+ 26 137 138 1 125 125 0 1
+ 25 140 150 10 148 151 3 7
+ 3 136 139 3 135 129 - 6 9
+ 13 160 142 -18 150 122 -28 10
+ 18 133 135 2 100 84 -16 18
+ 28 150 162 12 178 170 - 8 20
+ 8 113 110 - 3 131 101 -30 27
+ 11 125 98 -27 155 101 -54 27
+ 2 105 112 7 152 114 -38 45
+ 17 90 150 60 125 121 - 4 64
+
+ Av. 135·19 132·95 - 2·24 136·47 134·14 - 2·33 ·09
+
+ M - 2 - 2 0
+ 75%ile 6·5 4·5 16·0
+ 25%ile -15 -14 19·5
+ Q 10·75 9·25 17·75
+ P. E. (distribution) 12·24 7·33 18·09
+ P. E. (average) ±2·66 ±1·59 ±3·10
+
+ Av. = ·03 P. E.
+ M. = ·0 P. E.
+
+lost in I.Q., as compared with 7 in the control group. Thirteen test
+cases lost in comparison with their respective controls. Two gained
+equally with their controls, and the remaining thirteen showed a larger
+gain. In regard to the three pairs taken from the nutrition class,
+number 7 gained 8 points and his control, 4. Number 10 lost a point and
+his control lost 4, while number 11 lost 3 points with a gain of 1 point
+by his control. So that these cases, in spite of most favorable
+conditions, show no consistent gain in I.Q.
+
+The results of the Healy tests are similar. There is a slightly higher
+average gain in the control group. The test group contains eight cases
+which made a poorer score at the end of the interval, the control group
+six. The range of gains is from -22 to +44, or 66 points, in the test
+group, while in the control group the gains range from -14 to +41·5 or
+55·5
+
+ TABLE VIII
+
+ Decrease in fatigue in tapping--Difference in rates of second half
+ minute over first half minute. Sixteen pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 13 -·03 ·05 -·08 ·27 -·28 ·55 -·63
+ 28 ·01 ·11 -·10 ·17 ·04 ·13 -·23
+ 20 ·10 ·15 -·05 ·20 ·04 ·16 -·21
+ 10 -·09 ·07 -·16 ·23 ·19 ·04 -·20
+ 17 ·01 ·33 -·32 ·07 ·20 -·13 -·19
+ 25 ·09 ·21 -·12 ·09 ·11 -·02 -·10
+ 11 ·28 ·11 ·17 ·19 -·06 ·25 -·08
+ 15 ·03 ·08 -·05 ·18 ·16 ·02 -·07
+ 22 ·10 ·23 -·13 ·03 ·19 -·16 ·03
+ 27 ·15 ·05 ·10 ·09 ·03 ·06 ·04
+ 14 ·09 ·06 ·03 ·02 ·06 -·04 ·07
+ 18 ·14 ·18 -·04 ·01 ·12 -·11 ·07
+ 24 ·13 ·11 ·02 ·13 ·35 -·22 ·24
+ 26 ·18 ·15 ·03 ·16 ·37 -·21 ·24
+ 23 ·21 ·04 ·17 ·06 ·21 -·15 ·32
+ 21 ·27 ·05 ·22 ·03 ·20 -·17 ·39
+
+ Av. ·104 ·124 -·020 ·121 ·121 ·0 -·020
+ M -·045 -·03 -·015
+ 75%ile ·03 +·04 ·07
+ 25%ile -·12 -·16 -·20
+ Q ·075 ·10 ·135
+ P. E. (distribution) ·09 ·11 ·05
+ P. E. (average) ±·02 ±·03 ±·04
+
+ Av. = -·5 P. E.
+ M. = -·38 P. E.
+
+points. Seventeen of the operative cases showed a smaller gain than
+their respective controls. The three pairs of cases from the nutrition
+class show the following gains:--pair 7; the test case loses 22 points,
+the control gains 23 points; pair 10, test case gains 18·5, but control
+gains 38 points; pair 11, test case gains 14 points, and control gains
+25·5 points. From this test then, we can find no general tendency for
+cases operated on to improve in intelligence in excess of improvement in
+a control group which was not so treated.
+
+This question presents itself:--is there any relationship between
+improvement in physical well-being as revealed in weight, and
+improvement in intelligence? If, as has been supposed, adenoids and
+diseased tonsils cause mental retardation indirectly through physical
+deprivation, it would seem as though greater improvement in intelligence
+after operation should accompany greater improvement in weight, and
+smaller intelligence gain should accompany slighter gain in weight. In
+order to determine whether this was true for our cases, improvement in
+I.Q. was correlated with gain in weight, for the test group. The order
+of merit method was used, and the formula [Rho] = 1 - ((6 [Sum] D_n) /( n(n²-1)))
+where f = 2 sin ([Pi]/6)[Rho]. The resulting value of r was -·10 with
+unreliability of ·226, calculated by the formula [Sigma]t.r - obt.r =
+(1·05(1-r²)) / [sqrt]n. There is therefore no correlation between
+improvement in intelligence and gain in weight.
+
+ TABLE IX
+
+ Improvement in I.Q., 28 Pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 27 110 109 -1 72 96 24 -25
+ 20 106 102 -4 118 131 13 -17
+ 8 91 86 -5 98 104 6 -11
+ 24 131 124 -7 89 92 3 -10
+ 21 64 67 3 86 97 11 -8
+ 3 94 91 -3 82 85 3 -6
+ 12 98 95 -3 98 101 3 -6
+ 23 85 94 9 81 96 15 -6
+ 11 103 100 -3 101 102 1 -4
+ 15 97 94 -3 78 79 1 -4
+ 18 98 98 0 90 94 4 -4
+ 4 96 96 0 83 85 2 -2
+ 26 80 76 -4 90 88 -2 -2
+ 16 65 73 8 74 82 8 0
+ 28 81 84 3 95 98 3 0
+ 5 95 99 4 114 117 3 1
+ 2 107 114 7 91 96 5 2
+ 10 110 109 -1 104 100 -4 3
+ 17 71 77 6 96 99 3 3
+ 7 91 99 8 95 99 4 4
+ 1 82 83 1 80 76 -4 5
+ 6 95 101 6 88 89 1 5
+ 19 96 101 5 98 98 0 5
+ 9 83 93 10 87 90 3 7
+ 25 77 76 -1 145 137 -8 7
+ 13 70 78 8 66 64 -2 10
+ 22 91 100 9 63 62 -1 10
+ 14 96 107 11 140 137 3 14
+
+ Av. 91·53 93·78 2·25 92·93 96·21 3·285 -1·035
+ M 2 3 -1
+ 75%ile 7 4 5
+ 25%ile -3 -1 -6
+ Q 5 2·5 5·5
+ P. E. (distribution) 5·25 2·5 5
+ P. E. (average) ±·99 ±·47 ±1·10
+ Av. = -·94 P. E.
+ M. = -·99 P. E.
+
+ TABLE X
+
+ Improvement in Performance of Healy Test, 24 Pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 7 - 6 -28 -22 4·5 27·5 23 -45
+ 13 43 42 - 1 - 1·5 30·5 -32 -33
+ 17 29·5 12 -17·5 1·5 15 13·5 -31
+ 15 7 25 18 1 42·5 41·5 -23·5
+ 26 22·5 7 -15·5 56 61·5 5·5 -21·5
+ 10 -12 6·5 18·5 27 65 38 -19·5
+ 19 57·5 49 - 8·5 -22 -11 11 -19·5
+ 24 54·5 63 8·5 31·5 59·5 28 -19·5
+ 20 0 -11 -11 30 35 5 -16
+ 9 3·5 10·5 7 34 55 21 -14
+ 11 -8 6 14 -29 -3·5 25·5 -11·5
+ 16 49 47·5 - 1·5 30 37 7 - 8·5
+ 1 -25 2 27 -50 -16 34 - 7
+ 22 48·5 43·5 - 5 34·5 33·5 - 1 - 4
+ 18 -13·5 -12 1·5 -32 -28 4 - 2·5
+ 23 49·5 68 18·5 4 25 21 - 2·5
+ 3 21·5 22·5 1 17 19 2 - 1
+ 12 20 21 1 -10 -12 - 2 3
+ 14 12·5 48·5 36 - 5 25·5 30·5 6·5
+ 27 -25 15 40 2 27·5 25·5 14·5
+ 2 28·5 30 1·5 3 -11 -14 15·5
+ 25 8 25 17 29·5 29 - ·5 17·5
+ 21 20 32 12 70·5 58·5 -12 24
+ 28 29·5 73·5 44 64·5 51·5 -13 57
+ Av. 17·29 24·94 7·64 12·12 25·69 13·56 - 5·85
+ M 4·25 12·25 - 7·75
+ 75%ile 18 25·5 3
+ 25%ile - 5 - ·5 -19·5
+ Q 11·5 13 11·25
+ P. E. (distribution) 10·6 10·56 13·65
+ P. E. (average) ±2·16 ± 2·16 ± 3·05
+
+ Av. = -1·92 P. E.
+ M. = -2·54 P. E.
+
+Similarly, it might be thought that the children who had suffered from
+the defects for a comparatively short time, might reveal greater
+improvement in intelligence after six months than those who had been
+afflicted for a longer space of time. We had no way of knowing
+definitely how long the defects had been present in the cases studied.
+Roughly, though, we may say that in general the older boys have had
+defective tonsils and adenoids for a longer time than the younger ones,
+and that the older the boy, the older the defect. On this basis, if
+correlation of youth with gain in I.Q. should give a larger positive
+value for r, we might be justified in saying that the younger boys, who
+have been handicapped for a lesser period, show greater mental
+recuperation than their older companions. Such a correlation was
+attempted in the test group, correlating age at the first test with gain
+in I.Q. The same methods and formulae were used as in the weight and
+intelligence comparison, the greatest gain in I.Q. being given first
+position, and the lowest age. The resulting value for r was -·24, with
+an unreliability of ·186. The relationship would appear to be in the
+other direction but it is so small, with an unreliability measure so
+large as to be insignificant. Once more, then, we find in our results no
+correspondence between recency of defect and quick mental recovery.
+
+ TABLE XI
+
+ Showing percentile ratings of the members of the two groups at the
+ beginning and end of the six months' interval
+
+ Weight Height Grip Tapping
+
+ 1 ·29 ·44 ·25 ·40 ·47 ·40 ·51 ·33
+ 1C ·43 ·54 ·27 ·45 ·33 ·47 ·17 ·30
+
+ 2 ·04 ·10 ·04 ·11 ·16 ·16 ·16 ·25
+ 2C ·38 ·55 ·20 ·32 ·25 ·40 ·80 ·28
+
+ 3 ·46 ·59 ·32 ·49 ·44 ·56 ·52 ·58
+ 3C ·65 ·69 ·74 ·81 ·54 ·67 ·51 ·42
+
+ 4 ·33 ·44 ·39 ·52 ·16 ·13
+ 4C ·27 ·32 ·51 ·78 ·18 ·19
+
+ 5 ·16 ·20 ·18 ·20 ·33 ·23
+ 5C ·50 ·53 ·28 ·47 ·40 ·87
+
+ 6 ·12 ·15 ·06 ·10 ·10 ·23
+ 6C ·31 ·40 ·22 ·38 ·27 ·41
+
+ 7 ·03 ·07 ·05 ·15 ·07 ·06 ·40 ·27
+ 7C ·01 ·02 ·03 ·07 ·16 ·24 ·16
+
+ 8 ·62 ·71 ·63 ·75 ·24 ·27 ·23
+ 8C ·18 ·37 ·31 ·40 ·67 ·72 ·43 ·11
+
+ 9 ·31 ·41 ·47 ·53 ·26 ·47 ·71 ·51
+ 9C ·60 ·65 ·76 ·89 ·76 ·89 ·63 ·78
+
+ 10 ·26 ·35 ·26 ·43 ·44 ·33 ·01 ·04
+ 10C ·21 ·22 ·23 ·37 ·24 ·67 ·02 ·51
+
+ 11 ·24 ·23 ·25 ·43 ·33 ·67 ·40 ·08
+ 11C ·08 ·09 ·09 ·17 ·36 ·36 ·86 ·11
+
+ 12 ·25 ·40 ·15 ·53 ·08
+ 12C ·06 ·15 ·02 ·08 ·04 ·01 ·12 ·03
+
+ 13 ·95 1·00 ·99 1·00 ·99 1·00 ·90 ·66
+ 13C ·87 ·89 ·93 ·96 ·94 ·96 ·78 ·36
+
+ 14 ·49 ·66 ·67 ·74 ·72 ·67 1·00 ·57
+ 14C ·92 ·93 ·96 ·98 ·93 ·98 ·97 ·97
+
+ 15 ·56 ·68 ·70 ·95 ·94
+ 15C ·79 ·80 ·59 ·66 ·67 ·70 ·62 ·54
+
+ 16 ·49 ·53 ·74 ·79 ·81 ·77 ·69
+ 16C ·34 ·28 ·50 ·54 ·24 ·24 ·69 ·51
+
+ 17 ·53 ·50 ·53 ·05 ·78
+ 17C ·17 ·15 ·24 ·11 ·40 ·34
+
+ 18 ·57 ·38 ·33 ·45 ·51
+ 18C ·17 ·20 ·30 ·34 ·10 ·06 ·09 ·03
+
+ 19 ·95 ·99 ·94 ·98 ·94 ·88 ·93
+ 19 ·38 ·45 ·30 ·37 ·67 ·40 ·09 ·31
+
+ 20 ·13 ·37 ·33 ·16 ·23
+ 20C ·63 ·75 ·56 ·88 ·67 ·44 ·78 ·86
+
+ 21 ·83 ·89 ·84 ·76 ·76 ·80 ·44
+ 21C ·67 ·77 ·55 ·61 ·81 ·67 ·62 ·57
+
+ 22 ·85 ·81 ·91 ·78 ·95 ·92 ·99
+ 22C ·83 ·92 ·93 ·97 ·82 ·91 ·33 ·89
+
+ 23 ·36 ·45 ·36 ·70 ·78 ·63
+ 23C ·73 ·74 ·70 ·82 ·55 ·53 ·36 ·62
+
+ 24 ·59 ·69 ·67 ·81 ·85 ·89 ·66
+ 24C ·62 ·63 ·59 ·71 ·67 ·67 ·86 ·86
+
+ 25 ·47 ·60 ·57 ·63 ·53 ·62 ·78
+ 25C ·73 ·74 ·60 ·64 ·44 ·91 ·70 ·79
+
+ 26 ·74 ·89 ·74 ·85 ·53 ·54 ·57
+ 26C ·76 ·81 ·70 ·79 ·84 ·76 ·40 ·40
+
+ 27 ·11 ·23 ·16 ·04 ·18 ·06
+ 27C ·07 ·12 ·12 ·23 ·10 ·16 ·30 ·25
+
+ 28 ·86 ·90 ·87 ·90 ·97 ·88 ·78 ·91
+ 28C ·87 ·93 ·83 ·86 ·88 ·98 ·94
+
+TABLE XI (Continued)
+
+Showing percentile ratings of the two groups at the beginning and end of
+the six months' interval
+
+ N[16] I.Q. Healy Total Possible Average
+ Gain
+
+ 1 ·25 ·27 ·10 ·29 ·30 415 ·05
+ 1C ·21 ·15 ·01 ·12 ·53 462 ·089
+
+ 2 ·84 ·89 ·60 ·66 ·38 416 ·063
+ 2C ·45 ·51 ·29 ·18 -·07 358 -·011
+
+ 3 ·49 ·44 ·49 ·51 ·40 328 ·066
+ 3C ·25 ·32 ·44 ·45 ·30 287 ·05
+
+ 4 ·59 ·59 ·38 ·22 168 ·073
+ 4C ·27 ·32 ·71 ·42 195 ·14
+
+ 5 ·53 ·71 ·10 ·42 213 ·14
+ 5C ·89 ·90 ·77 ·24 133 ·08
+
+ 6 ·53 ·77 ·02 ·55 229 ·183
+ 6C ·37 ·38 ·04 ·27 210 ·09
+
+ 7 ·45 ·71 ·22 ·07 ·37 478 ·062
+ 7C ·53 ·71 ·34 ·59 ·74 393 ·148
+
+ 8 ·45 ·34 ·70 -·50 303 -·125
+ 8C ·67 ·81 ·33 ·52 ·10 241 ·025
+
+ 9 ·27 ·46 ·23 ·39 ·71 375 ·118
+ 9C ·35 ·40 ·73 ·89 ·72 217 ·12
+
+ 10 ·88 ·86 ·15 ·35 ·34 400 ·056
+ 10C ·81 ·73 ·57 ·97 1·39 392 ·218
+
+ 11 ·79 ·73 ·20 ·34 ·21 379 ·035
+ 11C ·77 ·79 ·05 ·23 -·44 379 -·073
+
+ 12 ·67 ·53 ·47 ·49 -·11 161 -·036
+ 12C ·67 ·77 ·19 ·15 ·19 208 ·032
+
+ 13 ·09 ·19 ·79 ·78 ·02 129 ·003
+ 13C ·06 ·05 ·24 ·67 ·06 178 ·01
+
+ 14 ·59 ·84 ·41 ·84 ·69 212 ·115
+ 14C ·97 ·96 ·21 ·56 ·41 104 ·068
+
+ 15 ·62 ·49 ·38 ·55 ·12 106 ·04
+ 15C ·19 ·20 ·26 ·79 ·66 193 ·11
+
+ 16 ·05 ·12 ·86 ·82 ·15 205 ·03
+ 16C ·13 ·25 ·66 ·76 ·24 313 ·04
+
+ 17 ·09 ·17 ·63 ·40 ·66 223 ·220
+ 17C ·59 ·71 ·27 ·43 ·21 174 ·053
+
+ 18 ·67 ·67 ·13 ·15 ·08 175 ·027
+ 18C ·40 ·49 ·04 ·07 ·18 247 ·03
+
+ 19 ·59 ·69 ·91 ·85 ·16 67 ·032
+ 19C ·67 ·67 ·11 ·18 ·16 287 ·027
+
+ 20 ·82 ·79 ·25 ·18 -·06 177 -·02
+ 20C ·91 ·94 ·66 ·75 ·20 65 ·066
+
+ 21 ·05 ·07 ·47 ·69 -·16 209 -·032
+ 21C ·34 ·62 ·99 ·92 ·46 157 ·077
+
+ 22 ·45 ·73 ·84 ·81 ·87 120 ·174
+ 22C ·03 ·02 ·74 ·72 ·74 275 ·123
+
+ 23 ·32 ·49 ·86 ·98 ·65 168 ·163
+ 23C ·23 ·59 ·33 ·50 1·26 253 ·21
+
+ 24 ·94 ·92 ·88 ·95 - ·06 89 -·012
+ 24C ·38 ·46 ·68 ·93 ·54 179 ·09
+
+ 25 ·17 ·15 ·37 ·55 ·49 280 ·098
+ 25C 1·00 ·97 ·63 ·60 ·53 134 ·088
+
+ 26 ·21 ·15 ·51 ·36 0 226 0
+ 26C ·40 ·37 ·90 ·94 ·04 184 ·007
+
+ 27 ·88 ·86 ·10 ·43 ·05 268 ·013
+ 27C ·11 ·59 ·29 ·59 1·49 320 ·25
+
+ 28 ·23 ·29 ·63 1·00 ·59 153 ·097
+ 28C ·53 ·67 ·96 ·87 ·24 83 ·048
+
+Table XI expresses the results of Table II, with the scores given in
+percentile values. In each test, the group was taken as composed of the
+two scores of every individual--the total number of scores in tests and
+retests, eliminating those scores where the other member of the pair was
+lacking, or where no retest was given. Thus case number 1 was just
+within the lowest 27% of the group in weight at the first weighing, but
+had advanced to the 44 percentile at the second. In height he gained
+from the 25 percentile to the 40 percentile. His total gain in all tests
+is 30 percentile out of a possible 415, and the average gain is·.05. The
+reader may see by scanning the table that the gains in the test group
+are practically equaled by those in the control group. There seems to be
+no consistent relationship between a low score in the first test and a
+large gain. This is true even though the method of calculation tends to
+minimize gains at the high end of the group, and losses at the low end.
+In table XII this may be seen more clearly in respect to I.Q. and the
+results for all the tests taken together with the I.Q. weighted by being
+counted twice. A large possible gain indicates that the score at the
+first testing was low, and vice versa. Considering I.Q. values, the
+largest possible gain in the test group was 95 per cent of the group.
+This occurred twice, in one case the actual gain being 7% of the group
+and in the other 2%. In the control group, the largest possible gain was
+97% of the group, but actually this case fell 1% of the group. If we
+correlate possible gain with actual gain for each group, using the
+formula r = 2sin(([Pi]/6)[Rho]) when [Rho] = 1 - ((6 [Sum] D²)/(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. 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
+
+
+
+
+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.
+
+ [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.
+
+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 49·7 13 18
+ 1C 15 53·5 62·8 46·4 49·7 11 15
+
+ 2 15 40·9 47·9 42·6 45·9 9 10
+ 2C 17 52·3 65·5 45·2 49·8 10 15
+
+ 3 16 55 67·5 47 50·2 12·8 13
+ 3C 14 61·5 57·8 51·7 54 14 14·5
+
+ 4 13 51·1 60·2 47·5 50·5 9
+ 4C 13 49·4 54·2 48·9 50·8 9·5
+
+ 7 14 39·9 45·8 42·9 45·6 7 6
+ 7C 12 38·4 42·1 41·9 43·7 9 14
+
+ 8 11 60·8 69·2 50·8 52·3 10
+ 8C 11 45·4 57·9 36·8 48·7 15
+
+ 10 11 48·9 56·7 46·1 48·6 12·5 12
+ 10C 11 47·1 51·8 45·6 48·1 10 12
+
+ 11 12 47·8 55 45·8 49·5 11 11
+ 11C 12 41·6 47 43·6 46·8 11·5 7·5
+
+ 12 12 48 66·5 44·8 14
+ 12C 11 41 69·6 41·5 6
+
+ 13 12 90 112 61·3 61·8 26·5 28·5
+ 13C 12 74·7 88 56·8 60·0 22 27
+
+ 14 12 56 66 51 53·3 16 17
+ 14C 12 81·9 98 57·9 59·5 22 22·5
+
+ 15 12 57·5 51·1 15·5
+ 15C 10 67·2 50·1 15
+
+ 16 12 56 60·3 51·6 53·5 19 18·5
+ 16C 11 51·2 55 48·7 50·1 10 10
+
+ 18 12 58·2 47·3 18
+ 18C 11 45·3 46·7 8
+
+ 19 12 90 108 57·7 60·5 22 20
+ 19C 11 52·4 59 46·7 48 15 18
+
+ 20 12 44·2 47·2 11
+ 20C 11 61·3 49·6 15
+
+ 21 12 70·7 85·5 54·1 16·5 15
+ 21C 10 62·4 69·2 49·6 19 17
+
+ 23 12 51·7 47·8 11·5 15
+ 23C 11 64·1 51·4 14·5 16
+
+ 27 12 43·7 45·4 9 6
+ 27C 11 41 44·6 8 9
+
+ 28 12 71·3 78·5 54·9 56·3 23·5
+ 28C 11 74·2 85·8 53·4 55·9 21
+
+
+ TABLE XIV (Continued)
+
+ N[16] Tapping I.Q. Healy
+
+ Test 1 Test 3 (1) (3) (1) (3)
+
+ 1 135 142 82 93 -25 11
+ 1C 106 134 80 85 -50 11
+
+ 2 105 135 107 113 28·5 24·5
+ 2C 152 139 91 86 3 19·5
+
+ 3 136 144 94 91 21·5 15·5
+ 3C 135 135 82 96 17 25·5
+
+ 4 103 96 111 8·5
+ 4C 109 83 102 33
+
+ 7 125 91 93 - 6 16
+ 7C 105 95 112 4·5 11
+
+ 8 113 128 91 92 32·5
+ 8C 131 121 98 111 4
+
+ 10 68+ 74 145+106 110 116 -12 11
+ 10C 70+ 74 148+124 104 107 27 48·5
+
+ 11 125+ 90 120+125 103 102 - 8 15·5
+ 11C 155+125 102+112 101 95 -29 -20
+
+ 12 98+ 69 98 86 20 1
+ 12C 102 98 90 -10 41·5
+
+ 13 160+165 176+187 70 61 43 62·5
+ 13C 150+109 188+174 66 60 -1·5 21·5
+
+ 14 190+172 228+215 96 102 12·5 77
+ 14C 175+152 165+186 140 138 - 5 48·5
+
+ 15 172+167 192+186 97 97 7 19
+ 15C 140+115 145+133 78 98 1 54·5
+
+ 16 145+131 65 74 49 79
+ 16C 145+ 99 74 81 30 45·5
+
+ 18 133+115 126+145 98 101 -13·5 13·5
+ 18C 100+ 99 108+ 92 90 92 -32 -35
+
+ 19 168+136 96 97 57·5 60·5
+ 19C 100+115 98 90 -22 -15
+
+ 20 105+115 122+118 106 116 0 55
+ 20C 150+120 154+154 118 140 30 48·5
+
+ 21 152+111 154+155 64 66 20 38
+ 21C 140+136 174+150 86 93 70·5 88
+
+ 23 150+119 157+157 85 80 49·5 62·5
+ 23C 122+115 141+141 81 88 4 64
+
+ 27 108+ 92 114+ 95 110 112 -25 25·5
+ 27C 115+105 101+118 72 98 2 39·5
+
+ 28 150+148 176+168 81 83 29·5 77·5
+ 28C 178+148 172+157 95 94 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
+
+ 12 48 66·5 18·5 41 69·6 28·6 -10·1
+ 2 40·9 47·9 7 52·3 65·5 13·2 -6·2
+ 14 56 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
+ 16 56 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
+ 13 90 112 22 74·7 88 13·3 8·7
+ 19 90 108 18 52·4 59 6·6 11·4
+ 3 55 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 1·9
+ Median 1·2 2·2
+ 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 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 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 53·3 2·3 57·9 59·5 1·6 ·7
+ 3 47 50·2 3·2 51·7 54 2·3 ·9
+ 7 42·9 45·6 2·7 41·9 43·7 1·8 ·9
+ 4 47·5 50·5 3 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 ·2 ·5
+ 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
+ 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 0 - ·5
+ 3 12·5 13 ·5 14 14·5 ·5 0
+ 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 0 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 12
+ months 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 11
+ P. E. of difference ±3·10 ± 5·26
+ Average in terms of P. E. ·03 1·89
+ Median in terms of P. E. 0 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 - ·06
+ Median of gains of test group in excess of control -·015 - ·09
+ P. E. of difference ±·04 ± ·036
+ Average in terms of P. E. -·50 -1·66
+ Median in terms of P. E. -·38 -2·50
+
+ 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 12
+ months 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 0 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.
+
+ Lost in 2nd Gained in 2nd No Gained equally
+ period period change with gain in
+ 1st period
+ Test group 9 11 1 9
+ Control group 10 11 8
+
+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
+ 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
+
+ Weight in Height in Height-weight Grip in
+ Gains pounds inches percents Kg.
+
+ lb. P. E. in. P. E. % P. E. Kg. P. E.
+ Av. 1 1·37 2·85 ·16 1· 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
+
+ Gains Taps in Tapping in
+ 1/2 min. fatigue ratios I.Q. Healy Score
+ 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 -3·14 -1·71 -3·36 - ·87
+ M. 1 0· 0· -·015 - ·38 -1· - ·99 -7·75 -2·54
+ M. 2 11· 2·09 -·09 -2·50 -3· -1·63 1 ·26
+ P. E. 1 ±3·10 ±·04 ±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.
+
+
+
+
+
+End of the Project Gutenberg EBook of Adenoids and Diseased Tonsils, by
+Margaret Cobb Rogers
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+Project Gutenberg's Adenoids and Diseased Tonsils, by Margaret Cobb Rogers
+
+This eBook is for the use of anyone anywhere 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
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+
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+Title: Adenoids and Diseased Tonsils
+ Their Effect on General Intelligence
+
+Author: Margaret Cobb Rogers
+
+Release Date: January 26, 2012 [EBook #38676]
+
+Language: English
+
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+
+
+
+<H1>ADENOIDS AND DISEASED<br> TONSILS</h1>
+
+<p class='center larger'>THEIR EFFECT ON GENERAL INTELLIGENCE</p>
+
+<p class='center smaller padtop'>BY</p>
+
+<p class='center larger'>MARGARET COBB ROGERS, Ph.D.</p>
+
+
+<p class='center larger padtop'>ARCHIVES OF PSYCHOLOGY</p>
+<p class='center smaller'><span class="smcap">Edited by R. S. WOODWORTH</span></p>
+
+<p class='center smaller'>No. 50</p>
+
+
+<p class='center smaller padtop'><span class="smcap">Columbia University Contributions to Philosophy and Psychology</span></p>
+
+
+<p class='center padtop'>NEW YORK</p>
+<p class='center'><span class="smcap">April, 1922</span></p>
+
+<p class='center smaller padtop'>AGENTS: G. E. STECHERT &amp; CO.: London: (2 Star Yard Carey St., W. C.);</p>
+<p class='center smaller'>Paris (16, Rue de Conde)</p>
+
+<br>
+
+<hr style="width: 65%;">
+<h2>CONTENTS</h2>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"> <span class="smcap">Introduction</span></td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp;Purpose of the Study.</td><td align="left"> <a href="#Page_5">5</a> </td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left" colspan="2"> <span class="smcap">Chapter I.</span></td><td align="left"> <a href="#Page_7">7</a> </td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp;Previous Literature Concerning the Relation of Nose and Throat Defects to Intelligence.</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left" colspan="2"> <span class="smcap">Chapter II.</span></td><td align="left"> <a href="#Page_24">24</a> </td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp;Method and Procedure.</td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp; &nbsp;1. A Statistical Study.</td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp; &nbsp;2. A Study of Improvement After Treatment.</td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp; &nbsp; &nbsp; &nbsp;Selection of Cases.</td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp; &nbsp; &nbsp; &nbsp;The Tests.</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left" colspan="2"> <span class="smcap">Chapter III.</span></td><td align="left"> <a href="#Page_29">29</a> </td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp;Discussion of the Results.</td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp; &nbsp;1. The Statistical Study.</td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp; &nbsp;2. The Study of Improvement after Operation.</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left" colspan="2"> <span class="smcap">Chapter IV.</span></td><td align="left"> <a href="#Page_53">53</a> </td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp;Measurement of Improvement after a Second Interval of Six Months.</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left" colspan="2"> <span class="smcap">Chapter V.</span></td><td align="left"><a href="#Page_68">68</a> </td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp;Summary.</td></tr>
+<tr><td align="left"></td><td align="left"> &nbsp;Conclusions.</td></tr>
+</table></div>
+<br>
+<hr style="width: 65%;">
+<p><span class="pagenum"><a name="Page_5" id="Page_5">[Pg 5]</a></span></p>
+
+<h2>INTRODUCTION&mdash;PURPOSE</h2>
+
+
+<p>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&mdash;adenoids and diseased tonsils,&mdash;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,&mdash;in a multitude of ways they
+have seemed to deserve the verdict,&mdash;"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.</p>
+
+<p>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?</p>
+
+<p>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<span class="pagenum">[Pg 6]</span>
+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.</p>
+
+<p>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.</p>
+
+<p>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.</p><br>
+
+
+<hr style="width: 65%;">
+<p><span class="pagenum"><a name="Page_7" id="Page_7">[Pg 7]</a></span></p>
+
+<h2>ADENOIDS AND DISEASED TONSILS:<br> THEIR EFFECT UPON GENERAL INTELLIGENCE</h2>
+
+<h2>CHAPTER I.</h2>
+
+<h3>PREVIOUS LITERATURE</h3>
+
+<h3>Concerning the Relation of Nose and Throat Defects to Intelligence</h3>
+
+
+<p>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.<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a></p>
+
+<p>"... 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."</p>
+
+<p>The following quotation from an article by Irving Townsend,
+M. D., is in the same vein:<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a></p>
+
+<p>"Aprosexia is the rather imposing term applied to the imperfect
+or arrested mental development attributed to this<span class="pagenum">[Pg 8]</span>
+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."</p>
+
+<p>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:<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a></p>
+
+<p>"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."</p>
+
+<p>And again:</p>
+
+<p>"The boy or girl suffering from adenoids<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a> 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."</p>
+
+<p>The following extracts are quoted from Burgerstein's
+"Handbuch der Schulhygiene":</p>
+
+<p>"Bresgen und Heymann machen endlich darauf aufmerksam,
+dass die Ursache der Kephalalgie haufig in der Behinderung<span class="pagenum">[Pg 9]</span>
+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."...</p>
+
+<p>"Viele Kinder erscheinen schwachbegabt, ohne os zu sein,
+da bei denselben entweder nach behebung von Ohrenkrankheiten,
+nach Herstellung der freien <i>atmung oder Gebrauch
+einer entsprechenden Brille die scheinbare Geistesschwache
+schwindet</i>."<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a></p>
+
+<p>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.<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a></p>
+
+<p>"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."</p>
+
+<p>The second is a quotation from Jelliffe and White, "Diseases
+of the Nervous System." Lee and Ferbiger, 1917, p. 903.</p>
+
+<p>"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."</p>
+
+<p>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.</p>
+
+<p>The statistical studies of physical defects in the schools
+reveal almost universally a positive relationship between<span class="pagenum">[Pg 10]</span>
+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.<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a> 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.</p>
+
+<p>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&mdash;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.</p>
+
+<p>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:</p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center"> Dull</td><td align="center"> Normal</td><td align="center">Bright</td></tr>
+<tr><td align="left"> Number of children examined</td><td align="right"> 407 &nbsp; &nbsp; &nbsp;</td><td align="right"> 2588 &nbsp; &nbsp; &nbsp;</td><td align="right"> 309 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Defects per child</td><td align="right"> 1·65</td><td align="right"> 1·30</td><td align="right"> 1·07</td></tr>
+<tr><td align="left"> Enlarged glands</td><td align="right"> 20 &nbsp; &nbsp; &nbsp;</td><td align="right"> 13 &nbsp; &nbsp; &nbsp;</td><td align="right"> 6 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Defective vision</td><td align="right"> 24 &nbsp; &nbsp; &nbsp;</td><td align="right"> 25 &nbsp; &nbsp; &nbsp;</td><td align="right"> 29 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Defective breathing</td><td align="right"> 15 &nbsp; &nbsp; &nbsp;</td><td align="right"> 11 &nbsp; &nbsp; &nbsp;</td><td align="right"> 9 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Defective teeth</td><td align="right"> 42 &nbsp; &nbsp; &nbsp;</td><td align="right"> 40 &nbsp; &nbsp; &nbsp;</td><td align="right"> 34 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> <i>Hypertrophied tonsils</i></td><td align="right"> <i>26</i> &nbsp; &nbsp; &nbsp;</td><td align="right"> <i>19</i> &nbsp; &nbsp; &nbsp;</td><td align="right"> <i>12</i> &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> <i>Adenoids</i></td><td align="right"> <i>15</i> &nbsp; &nbsp; &nbsp;</td><td align="right"> <i>10</i> &nbsp; &nbsp; &nbsp;</td><td align="right"> <i>6</i> &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Other Defects</td><td align="right"> 21 &nbsp; &nbsp; &nbsp;</td><td align="right"> 11 &nbsp; &nbsp; &nbsp;</td><td align="right"> 11 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td><td align="center"></td><td align="center"></td><td align="center"></td></tr>
+<tr><td align="left"> Defective</td><td align="right"> 75 &nbsp; &nbsp; &nbsp;</td><td align="right"> 73 &nbsp; &nbsp; &nbsp;</td><td align="right"> 68 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Not defective</td><td align="right"> 25 &nbsp; &nbsp; &nbsp;</td><td align="right"> 27 &nbsp; &nbsp; &nbsp;</td><td align="right"> 32 &nbsp; &nbsp; &nbsp;</td></tr>
+</table></div>
+
+<p>Average number of grades completed by pupils having no
+physical defects, compared with the number completed by
+those suffering from different defects:</p><p><span class="pagenum">[Pg 11]</span></p>
+
+<h3>3304 Children, 10-14 years, grades 1-8</h3>
+
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="right"> Average grades completed</td><td align="right"> % lost</td></tr>
+<tr><td align="left"> Children having no physical defects</td><td align="right"> 4·94</td></tr>
+<tr><td align="left"> Children having enlarged glands</td><td align="right"> 4·20</td><td align="right"> 14·9</td></tr>
+<tr><td align="left"> Children having defective vision</td><td align="right"> 4·94</td><td align="right"> 0 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Children having defective breathing</td><td align="right"> 4·58</td><td align="right"> 7·2</td></tr>
+<tr><td align="left"> Children having defective teeth</td><td align="right">4·65</td><td align="right"> 5·9</td></tr>
+<tr><td align="left"> <i>Children having hypertrophied tonsils</i></td><td align="right"> <i>4·50</i></td><td align="right"> <i>8·9</i></td></tr>
+<tr><td align="left"> <i>Children having adenoids</i></td><td align="right"> <i>4·24</i></td><td align="right"> <i>14·1</i></td></tr>
+<tr><td align="left"> Children having other defects</td><td align="right"> 4·52</td><td align="right"> 8·5</td></tr>
+<tr><td align="left"></</td></tr>
+</table></div>
+<p>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.</p>
+
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> No. of cases</td><td align="center"> Normal</td><td align="center">Average</td><td align="center"> General<br>Defective</td><td align="center"> Adenoids <br>&amp; Tonsils</td><td align="center"> Adenoids</td><td align="center"> Deaf</td></tr>
+<tr><td align="left"> Allison</td><td align="right"></td><td align="right"> 219 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 9th St.</td><td align="right"> 64 &nbsp; &nbsp;</td><td align="right"> 84 &nbsp; &nbsp;</td><td align="right"> 21 &nbsp; &nbsp;</td><td align="right"></td><td align="right"> 8 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Claghorn</td><td align="right"> 179 &nbsp; &nbsp;</td><td align="right"> 252 &nbsp; &nbsp;</td><td align="right"> 13 &nbsp; &nbsp;</td></tr>
+<tr><td align="left" colspan ="7"> Grade in language</td></tr>
+<tr><td align="left"> 9th St.</td><td align="right"> 72·9</td><td align="right"> 70·5</td><td align="right"> 63·3</td><td align="right"></td><td align="right"> 60 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Claghorn</td><td align="right"> 74·4</td><td align="right"> 72·7</td><td align="right"> 71·4</td></tr>
+<tr><td align="left" colspan ="7"> Grade in Arith.</td></tr>
+<tr><td align="left"> 9th St.</td><td align="right"> 75·5</td><td align="right"> 74 &nbsp; &nbsp;</td><td align="right"> 70 &nbsp; &nbsp;</td><td align="right"></td><td align="right"> 66·7</td></tr>
+<tr><td align="left"> Claghorn</td><td align="right"> 72 &nbsp; &nbsp;</td><td align="right"> 70 &nbsp; &nbsp;</td><td align="right"> 65·1</td></tr>
+<tr><td align="left" colspan ="7"> Grade in spelling</td></tr>
+<tr><td align="left"> 9th St.</td><td align="right"> 75·4</td><td align="right"> 72·8</td><td align="right"> 64·8</td><td align="right"></td><td align="right"> 65 &nbsp; &nbsp;</td></tr>
+<tr><td align="left" colspan ="7"> Grade in geography</td></tr>
+<tr><td align="left"> Claghorn</td><td align="right"> 76·6</td><td align="right"> 76·5</td><td align="right"> 76·2</td></tr>
+<tr><td align="left" colspan ="7"> Average of grades</td></tr>
+<tr><td align="left"> Allison</td><td align="right"> 75 &nbsp; &nbsp;</td><td align="right"> 74 &nbsp; &nbsp;</td><td align="right"> 72·6</td><td align="right"> 72 &nbsp; &nbsp;</td><td align="right"></td><td align="right"> 67 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 9th St.</td><td align="right"> 74·6</td><td align="right"> 72·4</td><td align="right"> 66 &nbsp; &nbsp;</td><td align="right"></td><td align="right"> 63·9</td></tr>
+<tr><td align="left"> Claghorn</td><td align="right"> 74·3</td><td align="right"> 73·1</td><td align="right"> 70·8</td></tr>
+</table></div>
+<p>An additional investigation of four classes in the same
+grammar grade of the Claghorn School gives the following
+results:</p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center"> Class 1 Bright</td><td align="center"> Class 15 Children</td><td align="center"> Class 9 Dull</td><td align="center"> Class 11 Dullest</td></tr>
+<tr><td align="left"> Number of children</td><td align="center"> 50</td><td align="center"> 39</td><td align="right"> 32 &nbsp; &nbsp;</td><td align="right"> 29 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> &nbsp; &nbsp;Normal</td><td align="center"> 36</td><td align="center"> 32</td><td align="right"> 20 &nbsp; &nbsp;</td><td align="right"> 13 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> &nbsp; &nbsp;Defective</td><td align="center"> 14</td><td align="center"> 7</td><td align="right"> 12 &nbsp; &nbsp;</td><td align="right"> 16 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Percentage of normal</td><td align="center"> 72</td><td align="center"> 82</td><td align="right"> 62·5</td><td align="right"> 44·8</td></tr>
+</table></div>
+<p>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<span class="pagenum">[Pg 12]</span>
+on account of high standing, with those not exempt. The results
+follow:</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center"> Exempt Normal</td><td align="right"></td><td align="center"> Children Defective</td><td align="center"> Non-exempt Normal</td><td align="right"></td><td align="center">Children Defective</td></tr>
+<tr><td align="left"> 9th St. Primary</td><td align="right"> 56</td><td align="right"></td><td align="right"> 28</td><td align="right"> 39</td><td align="right"></td><td align="right"> 38</td></tr>
+<tr><td align="left"> Rutledge School</td><td align="right"> 87</td><td align="right"></td><td align="right"> 35</td><td align="right"> 75</td><td align="right"></td><td align="right"> 34</td></tr>
+<tr><td align="left"> Allison School</td><td align="right"> 128</td><td align="right"></td><td align="right"> 65</td><td align="right"> 81</td><td align="right"></td><td align="right"> 49</td></tr>
+<tr><td align="left"> Camac School</td><td align="right"> 183</td><td align="right"></td><td align="right"> 71</td><td align="right"> 103</td><td align="right"></td><td align="right"> 75</td></tr>
+<tr><td align="left"> Claghorn School</td><td align="right"><u>193</u></td><td align="right"></td><td align="right"><u> &nbsp;61</u></td><td align="right"><u>127</u></td><td align="right"></td><td align="right"><u> &nbsp;66</u></td></tr>
+<tr><td align="left"></td><td align="right">647</td><td align="right"></td><td align="right">260</td><td align="right">425</td><td align="right"></td><td align="right">262</td></tr>
+<tr><td align="left"> Percentage Defective</td><td align="right"></td><td align="right"> 28·8</td><td align="right"></td><td align="right"></td><td align="right"> 38·1</td></tr>
+</table></div>
+<p>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.</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="left"> Class 1 Bright</td><td align="left"> Class 15 Children</td><td align="left"> Class 9 Dull</td><td align="left"> Class 11 Dullest</td></tr>
+<tr><td align="left"> Number of children</td><td align="left"> 50</td><td align="left"> 39</td><td align="left"> 32</td><td align="left"> 29</td></tr>
+<tr><td align="left"> Nose and throat conditions, number defective</td><td align="left"> &nbsp;6</td><td align="left"> &nbsp;4</td><td align="left"> &nbsp;9</td><td align="left"> &nbsp;9</td></tr>
+<tr><td align="left"> &nbsp; &nbsp;<i>Tonsils</i></td><td align="left"> <i>3</i></td><td align="left"> &nbsp;<i>4</i></td><td align="left"> &nbsp;<i>3</i></td><td align="left"> &nbsp;<i>3</i></td></tr>
+<tr><td align="left"> &nbsp; &nbsp;<i>Adenoids</i></td><td align="left"> <i>2</i></td><td align="left"> &nbsp;<i>1</i></td><td align="left"> &nbsp;<i>5</i></td><td align="left"> &nbsp;<i>6</i></td></tr>
+<tr><td align="left"> &nbsp; &nbsp;Deaf</td><td align="left"> 2</td><td align="left"></td><td align="left"> &nbsp;5</td><td align="left"> &nbsp;1</td></tr>
+<tr><td align="left"> &nbsp; &nbsp;Catarrh</td><td align="left"></td><td align="left"></td><td align="left"> &nbsp;2</td><td align="left"> &nbsp;3</td></tr>
+<tr><td align="left"> Percentage of children, nose and throat defects</td><td align="left"> 12</td><td align="left"> 10·2</td><td align="left"> 28·1</td><td align="left"> 31</td></tr>
+</table></div>
+<p>During the same year, another examination along the
+same lines was conducted in the William McKinley Primary
+School,<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a> where a large number of dull children had been
+grouped in special classes.</p>
+
+<p>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,&mdash;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.</p>
+
+<p>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<span class="pagenum">[Pg 13]</span>
+included adenoids and tonsil conditions will be reviewed here.
+Those by Ayres and Cornell have been described above.</p>
+
+<p>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."</p>
+
+<p>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:</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> Defects</td><td align="center" colspan="5"> Retardation</td></tr>
+<tr><td align="left"></td><td align="center"> 1 yr.</td><td align="left"> 2 yr.</td><td align="left"> 3 yr.</td><td align="left">4 yr.</td><td align="left"> 5 yr.</td></tr>
+<tr><td align="left"></td><td align="center" colspan="5"> Per Cent</td></tr>
+<tr><td align="left"> Health</td><td align="left"> 16·5</td><td align="left">21·3</td><td align="left">28·0</td><td align="left">19·0</td><td align="left">37·5</td></tr>
+<tr><td align="left"> Nutrition</td><td align="left"> 13·4</td><td align="left"> &nbsp; 8·9</td><td align="left">17·2</td><td align="left">20·2</td><td align="left">17·5</td></tr>
+<tr><td align="left"> <i>Adenoids</i></td><td align="left"> &nbsp; <i>6·2</i></td><td align="left"> &nbsp; <i>7·3</i></td><td align="left"> &nbsp; <i>8·1</i></td><td align="left"> &nbsp; <i>9·6</i></td><td align="left"> &nbsp; <i>7·5</i></td></tr>
+<tr><td align="left"> Speech</td><td align="left"> &nbsp; 5·2</td><td align="left"> &nbsp; 5·1</td><td align="left"> &nbsp;4·2</td><td align="left">10·5</td><td align="left"> 20·0</td></tr>
+<tr><td align="left"> Visual defects</td><td align="left"> 15·5</td><td align="left"> 15·9</td><td align="left"> 18·2</td><td align="left"> 22·8</td><td align="left"> 22·8</td></tr>
+<tr><td align="left"> Auditory</td><td align="left"> &nbsp; 8·2</td><td align="left"> &nbsp; 6·7</td><td align="left"> &nbsp; 4·9</td><td align="left"> &nbsp; 6·1</td><td align="left"> 10·0</td></tr>
+</table></div>
+<p>Burpitt<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a> 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."</p>
+
+<p>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.<span class="pagenum">[Pg 14]</span>
+These were divided into two groups,&mdash;3-9 to 4-9 and 4-9 to
+5-9. The results are given in the following table:</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"> Causes</td><td align="center"> 46 children<br>3-9 to 4-9</td><td align="center"> 24 children<br>4-9 to 5-9</td></tr>
+<tr><td align="left"></td><td align="left"></td><td align="left"></td></tr>
+<tr><td align="left"> Inherent dullness only</td><td align="center"> 8</td><td align="center"> 3</td></tr>
+<tr><td align="left"> Inherent dullness and one or more physical defects</td><td align="center"> 7</td><td align="center"> 2</td></tr>
+<tr><td align="left"> Irregular attendance with one or more physical defects</td><td align="center"> 9</td><td align="center"> 6</td></tr>
+<tr><td align="left"> Irregular attendance</td><td align="center"> 2</td><td align="center"> 3</td></tr>
+<tr><td align="left"> <i>Adenoids only</i></td><td align="center"> <i>2</i></td><td align="center"> <i>0</i></td></tr>
+</table></div>
+<p>Turning to what the author calls single causes,&mdash;present
+in 170 cases out of the 400,&mdash;</p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"> Causes</td><td align="center"> 151 children<br> 1-9 to 3-9</td><td align="center"> 19 children <Br> 3-9 to 6-9</td></tr>
+<tr><td align="left"></td><td align="left"></td><td align="left"></td></tr>
+<tr><td align="left"> Irregular attendance</td><td align="center"> 51</td><td align="center"> &nbsp;6</td></tr>
+<tr><td align="left"> <i>Adenoids</i></td><td align="center"> <i>24</i></td><td align="center"> &nbsp;<i>2</i></td></tr>
+<tr><td align="left"> Inherent dullness</td><td align="center"> 59</td><td align="center"> 11</td></tr>
+</table></div>
+<p>The term "cause" seems to be rather loosely used in this
+study. The author says concerning this,</p>
+
+<p>"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.</p>
+
+<p>The following table compares the physical condition of two
+groups, one comprised of children examined in the regular
+routine examinations during the year 1912,&mdash;the other a
+group of retarded school children, given a special examination:&mdash;<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a></p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="left"> Group I</td><td align="left"> Group II</td></tr>
+<tr><td align="left"> No. of children examined</td><td align="left"> 287,456</td><td align="left"> 1,541</td></tr>
+<tr><td align="left"> No. with physical defects</td><td align="left"> 206,720&mdash;71·9%</td><td align="left"> 1,383&mdash;89·8%</td></tr>
+<tr><td align="left"> No. of defects found</td><td align="left">226,639</td><td align="left"> 2,986</td></tr>
+</table></div><br>
+<p><span class="pagenum">[Pg 15]</span></p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> Defect</td><td align="center"> No.</td><td align="center"></td><td align="center"> %</td><td align="center"> &nbsp; &nbsp;</td><td align="center"> No.</td><td align="left"></td><td align="center"> %</td></tr>
+<tr><td align="left"> Anaemia</td><td align="left"></td><td align="left"></td><td align="left"></td><td align="center"> &nbsp; &nbsp;</td><td align="right"> 335</td><td align="left"></td><td align="right"> 23·0</td></tr>
+<tr><td align="left"> Malnutrition</td><td align="right"> 8,303</td><td align="left"></td><td align="right"> 2·9</td><td align="center"> &nbsp; &nbsp;</td><td align="right"> 557</td><td align="left"></td><td align="right"> 36·1</td></tr>
+<tr><td align="left"> Defective vision</td><td align="right"> 21,078</td><td align="left"></td><td align="right"> 9·3</td><td align="center"> &nbsp; &nbsp;</td><td align="right"> 536</td><td align="left"></td><td align="right"> 34·7</td></tr>
+<tr><td align="left"> Defective hearing</td><td align="right"> 1,206</td><td align="left"></td><td align="right"> 0·5</td><td align="center"> &nbsp; &nbsp;</td><td align="right"> 47</td><td align="left"></td><td align="right"> 3·0</td></tr>
+<tr><td align="left"> <i>Defective nasal breathing</i></td><td align="right"> <i>21,931</i></td><td align="left"></td><td align="right"> <i>7·6</i></td><td align="center"> &nbsp; &nbsp;</td><td align="right"> <i>316</i></td><td align="left"></td><td align="right"> <i>20·4</i></td></tr>
+<tr><td align="left"> <i>Hypertrophied tonsils</i></td><td align="right"><i>30,021</i></td><td align="left"></td><td align="right"> <i>10·4</i></td><td align="center"> &nbsp; &nbsp;</td><td align="right"> <i>297</i></td><td align="left"></td><td align="right"> <i>19·2</i></td></tr>
+<tr><td align="left"> Defective teeth</td><td align="right"> 142,168</td><td align="right"></td><td align="right"> 49·4</td><td align="center"> &nbsp; &nbsp;</td><td align="right"> 796</td><td align="left"></td><td align="right"> 51·6</td></tr>
+<tr><td align="left"> Pulmonary disease</td><td align="right"> 335</td><td align="left"></td><td align="right"> 0·1</td><td align="center"> &nbsp; &nbsp;</td><td align="right"> 47</td><td align="left"></td><td align="right"> 3·0</td></tr>
+<tr><td align="left"> Cardiac disease</td><td align="right"> 1,597</td><td align="left"></td><td align="right"> 0·5</td><td align="center"> &nbsp; &nbsp;</td><td align="right"> 35</td><td align="left"></td><td align="right"> 2·3</td></tr>
+<tr><td align="left" colspan="2"> &nbsp; &nbsp; Average No. of defects per child</td><td align="right"> 1·1</td><td align="left"></td><td align="center"> &nbsp; &nbsp;</td><td align="right"></td><td align="right"> 2·5</td></tr>
+</table></div>
+
+<p>In an investigation of 3,587 exempt and 1,418 non-exempt
+children in the Philadelphia schools,<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a> Dr. Newmayer found
+the following percentages of defect:</p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="left" colspan="2"> Exempt Children</td><td align="center" colspan="2"> Non-exempt Children</td></tr>
+<tr><td align="center"> Defect</td><td align="center"> No. Examined</td><td align="center"> %</td><td align="center"> No. Examined</td><td align="center"> %</td></tr>
+<tr><td align="left"> Defective vision</td><td align="right"> &nbsp; 371</td><td align="right">10·0</td><td align="right"> 171</td><td align="right"> 12·0</td></tr>
+<tr><td align="left"> Defective hearing</td><td align="right"> &nbsp; &nbsp;49</td><td align="right"> 1·4</td><td align="right"> 29</td><td align="right"> 2·0</td></tr>
+<tr><td align="left"> <i>Defects of nose</i></td><td align="right"> &nbsp; &nbsp;<i>54</i></td><td align="right"> <i>1·5</i></td><td align="right"> <i>21</i></td><td align="right"> <i>1·5</i></td></tr>
+<tr><td align="left"> <i>Defects of throat</i></td><td align="right"> &nbsp; <i>137</i></td><td align="right"> <i>3·8</i></td><td align="right"> <i>53</i></td><td align="right"> <i>3·7</i></td></tr>
+<tr><td align="left"> Orthopedic defects</td><td align="right"> &nbsp; &nbsp;25</td><td align="right"> ·7</td><td align="right"> 25</td><td align="right">1·8</td></tr>
+<tr><td align="left"> Mentally defective</td><td align="right"> &nbsp; &nbsp; &nbsp;6</td><td align="right"> ·1</td><td align="right"> 80</td><td align="right"> 5·6</td></tr>
+<tr><td align="left"> Skin diseases</td><td align="right"> &nbsp;918</td><td align="right"> 26·0</td><td align="right"> 423</td><td align="right"> 30·0</td></tr>
+<tr><td align="left"> Miscellaneous</td><td align="right"> 214</td><td align="right"> 6·0</td><td align="right"> 128</td><td align="right"> 9·0</td></tr>
+<tr><td align="left"> &nbsp; &nbsp; Total</td><td align="right"> 1,774</td><td align="right"> 49·0</td><td align="right">930</td><td align="right"> 65·0</td></tr>
+</table></div>
+<p>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.</p>
+
+<p>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,</p>
+
+<p>"It is a well-known fact that hypertrophy of the tonsils
+and presence of adenoids may produce more or less dullness<span class="pagenum">[Pg 16]</span>
+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."</p>
+
+<p>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:</p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center"> Number<br> before<br> Operation</td><td align="center" colspan="2"> Number<br> after<br> Operation</td></tr>
+<tr><td align="left"> Mouth breathing</td><td align="center"> 43</td><td align="right"> 31</td></tr>
+<tr><td align="left"> Eneuresis</td><td align="center"> 33</td><td align="right"> 32</td></tr>
+<tr><td align="left"> Sore throats</td><td align="center"> 70</td><td align="right"> 2</td></tr>
+<tr><td align="left"> Ear trouble</td><td align="center"> 19</td><td align="right"> 2</td></tr>
+<tr><td align="left"> Change in voice</td><td align="left"></td><td align="right"> 38</td><td align="left">improved</td></tr>
+<tr><td align="left"> Tonsillar tissue recurred in</td><td align="left"></td><td align="right"> 5</td></tr>
+<tr><td align="left"> General physical health</td><td align="left"></td><td align="right"> 90</td><td align="left">improved</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 6</td><td align="left">borderlines</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 33</td><td align="left">morons</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 42</td><td align="left">imbeciles</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 9</td><td align="left">idiots</td></tr>
+<tr><td align="left"> Mental improvement from observation</td><td align="left"></td><td align="right"> 27</td><td align="left">improved</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 4</td><td align="left">borderlines</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 15</td><td align="left">morons</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 7</td><td align="left">imbeciles</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"> 1</td><td align="left">idiot</td></tr>
+</table></div>
+
+<p>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.</p>
+
+<p>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.</p><p><span class="pagenum">[Pg 17]</span></p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>Quotation of the teachers' reports will be of interest.</p>
+
+<p>"'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.'"</p>
+
+<p>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.</p>
+
+<p>On the basis of these results, the author concludes:</p>
+
+<p>"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.</p>
+
+<p>Another investigation was made by Dr. Cornell in the Philadelphia<span class="pagenum">[Pg 18]</span>
+schools,<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a> where seventy more or less retarded pupils
+in grades one to four were operated on for adenoids. According
+to the teachers' reports&mdash;</p>
+
+<blockquote>
+ &nbsp; &nbsp;30 per cent improved considerably.<br>
+ &nbsp; &nbsp;40 per cent improved.<br>
+ &nbsp; &nbsp;25 per cent did not improve.<br>
+ &nbsp; &nbsp;1·6 per cent deteriorated.<br>
+ &nbsp; &nbsp;3·0 per cent deteriorated considerably.<br><br>
+
+ Of those who had two chances of promotion,<br>
+ &nbsp; &nbsp; 6·3 per cent were promoted twice.<br>
+ &nbsp; &nbsp;16·0 per cent failed twice.<br>
+ &nbsp; &nbsp;33·3 per cent were promoted once.<br>
+ &nbsp; &nbsp;33·3 per cent failed once.<br><br>
+
+ With one opportunity,<br>
+ &nbsp; &nbsp;11·0 per cent were promoted.<br>
+ &nbsp; &nbsp;31·7 per cent failed.<br>
+</blockquote>
+
+<p>"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."</p>
+
+<p>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."</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 19]</span>
+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.</p>
+
+<p>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.</p>
+
+<p>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."</p>
+
+<p>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.</p>
+
+<p>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."</p>
+
+<p>"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.</p>
+
+<p>"School records were looked up for the ten school months
+preceding operation, and for each school month subsequent&mdash;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.</p>
+
+<p>"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.</p><p><span class="pagenum">[Pg 20]</span></p>
+
+<p>"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 <i>all</i> 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."</p>
+
+<p>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.</p>
+
+
+<h3>TABLE A</h3>
+
+<h3>Table showing where improvement begins.</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="left" colspan="3"> <i>Per Cent of cases showing improvement</i></td></tr>
+<tr><td align="left"></td><td align="left"> Period 1</td><td align="left"> Period 2</td><td align="left"> Period 3</td></tr>
+<tr><td align="left"> Based on 31 cases</td><td align="center"> 32·2</td></tr>
+<tr><td align="left"> Based on 18 cases</td><td align="center"> 33·3</td><td align="center"> 66·6</td></tr>
+<tr><td align="left"> Based on 11 cases</td><td align="center"> 36·3</td><td align="center"> 63·5</td><td align="center"> 100</td></tr>
+<tr><td align="left"> Based on all groups</td><td align="center"> 33·9</td><td align="center"> 65·0</td><td align="center"> 100</td></tr>
+</table></div>
+<p>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.</p>
+
+
+<h3>TABLE B</h3>
+
+<h3>Table showing how time of improvement of "operated cases" compares
+with improvement among children at random.</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"></td><td align="center"> Period 1</td><td align="center"> Period 2</td><td align="center"> Period 3</td></tr>
+<tr><td align="left"> A&mdash;Per cent of 31 cases (operated upon)</td><td align="left"> 32·2</td></tr>
+<tr><td align="left"> &nbsp; &nbsp; Per cent of 100 children at random</td><td align="left"> 42</td></tr>
+<tr><td align="left"> B&mdash;Per cent of 18 children&mdash; 20 months (operated upon)</td><td align="left"> 33·3</td><td align="left"> 66·6</td></tr>
+<tr><td align="left"> &nbsp; &nbsp; Per cent of 100 children at random</td><td align="left"> 42</td><td align="left"> 41</td></tr>
+<tr><td align="left"> C&mdash;Per cent of 11 cases for 30 months (operated upon)</td><td align="left"> 36·3</td><td align="left"> 63·5</td><td align="right"> 100</td></tr>
+<tr><td align="left"> &nbsp; &nbsp; Per cent of 100 children at random</td><td align="left"> 42</td><td align="left"> 41</td><td align="right"> 41</td></tr>
+</table></div>
+
+<p>"... 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:<span class="pagenum">[Pg 21]</span></p>
+
+<p>"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."</p>
+
+<p>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.</p>
+
+<p>The first of these investigations is described by Wallin.<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a>
+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."</p>
+
+<p><span class="pagenum">[Pg 22]</span></p>
+
+<p>The results show the following influence of dental treatment
+upon the working efficiency of the pupils.</p>
+
+<p>1. The indices of improvement are about the same for boys
+and girls.</p>
+
+<p>2. Improvement was about the same for older and younger
+pupils.</p>
+
+<p>3. There were great individual differences in initial proficiency
+and in improvement.</p>
+
+<p>4. Improvement in one test does not presuppose improvement
+in another.</p>
+
+<p>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."</p>
+
+<p>6. The average gains in the tests were:</p>
+
+<p>
+<span style="margin-left: 1em;">Memory, 19 per cent with 8 losses and 19 gains.</span><br>
+<span style="margin-left: 1em;">Spontaneous association, 42 per cent with 2 losses and 25 gains,</span><br>
+<span style="margin-left: 1em;">Addition, 35 per cent with 1 loss and 26 gains.</span><br>
+<span style="margin-left: 1em;">Controlled association, 29 per cent with 0 losses.</span><br>
+<span style="margin-left: 1em;">Perception-attention, 69 per cent with 0 losses.</span><br>
+<span style="margin-left: 1em;">Average gain for all tests, 57 per cent.</span><br>
+</p>
+
+<p>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&mdash;and that is, I
+believe, a sufficiently liberal concession&mdash;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,<span class="pagenum">[Pg 23]</span>
+while six did thirty-eight weeks of work in twenty-four weeks,
+and one boy finished two years of work within the experimental
+year."</p>
+
+<p>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."</p>
+
+<p>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.</p>
+
+<p>The improvement of Group A&mdash;uninfected children&mdash;proved
+to be greatest, and was taken as 100 per cent. On this
+basis, Group B&mdash;infected children not treated&mdash;showed the
+least improvement,&mdash;only 34 per cent. Group C&mdash;children
+completely cured of infection&mdash;improved 60 per cent. Group
+D&mdash;severely infected children, treated but not completely cured&mdash;improved
+38 per cent, and Group Du&mdash;an older sub-group of
+D&mdash;improved 9 per cent as much as the normal children, and
+much less than the untreated younger children. Dr. Strong
+reaches the following conclusion:</p>
+
+<p>"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,&mdash;effects
+from which the individual may never recover."</p><br><p><span class="pagenum"><a name="Page_24" id="Page_24">[Pg 24]</a></span></p>
+
+
+
+<hr style="width: 65%;">
+<h2>CHAPTER II.</h2>
+
+<h3>METHOD AND PROCEDURE</h3>
+
+
+<p>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.</p>
+
+
+<h3>A Statistical Study</h3>
+
+<p>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.</p>
+
+<p>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.</p>
+
+
+<h3>A Study of Improvement After Treatment</h3>
+
+<p>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<span class="pagenum">[Pg 25]</span>
+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.</p>
+
+
+<h3>Selection of Cases</h3>
+
+<p>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.</p>
+
+<p>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,&mdash;to the number of
+fifty-six, and from them the control group was finally selected.</p>
+
+<p>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<span class="pagenum">[Pg 26]</span>
+children were included who were undergoing operation for
+both adenoids and tonsils.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+
+<h3>The Tests</h3>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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'<span class="pagenum">[Pg 27]</span>
+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.</p>
+
+<p>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.<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a></p>
+
+<p>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.</p>
+
+<p>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.</p><p><span class="pagenum">[Pg 28]</span></p>
+
+
+<div class='center smaller'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center" colspan="3"> Test Case</td><td align="center" colspan="3"> Original Control</td><td align="center" colspan="2"> Final Control</td></tr>
+<tr><td align="right"></td><td align="center"> Test I</td><td align="center"> Op.</td><td align="center"> Test II</td><td align="right"></td><td align="center"> Test I</td><td align="center"> Test II</td><td align="right"></td><td align="center"> Test I</td><td align="center"> Test II</td></tr>
+<tr><td align="right"> JB</td><td align="right"> 10-15-19</td><td align="right">10-20-19</td><td align="right"> lost</td><td align="right"> SS</td><td align="right"> 10-15-19</td><td align="right"> 4-15-20</td></tr>
+<tr><td align="right"> LL</td><td align="right">10-15-19</td><td align="right">10-20-19</td><td align="right"> 4-15-20</td><td align="right"> LJ</td><td align="right"> 10-15-19</td><td align="right"> lost</td><td align="right"> SS</td><td align="right"> 10-15-19</td><td align="right"> 4-15-20</td></tr>
+<tr><td align="right"> HK</td><td align="right"> 10-30-19</td><td align="right">11- 6-19</td><td align="right"> 4-30-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> MG</td><td align="right"> 10-21-19</td><td align="right"> 4-30-20</td></tr>
+<tr><td align="right"> MS</td><td align="right">11-11-19</td><td align="right">11-12-19</td><td align="right"> 5-17-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> AA</td><td align="right">11-20-19</td><td align="right"> 5-17-20</td></tr>
+<tr><td align="right"> GF</td><td align="right">12-11-19</td><td align="right">12-26-19</td><td align="right"> 6-11-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> SD</td><td align="right"> 12- 4-19</td><td align="right"> 6-11-20</td></tr>
+<tr><td align="right"> RJ</td><td align="right">12-16-19</td><td align="right">12-30-19</td><td align="right"> 6-16-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> NF</td><td align="right"> 12-10-19</td><td align="right"> 5-14-20</td></tr>
+<tr><td align="right"> JJ</td><td align="right">12-16-19</td><td align="right">12-30-19</td><td align="right"> 6-16-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> ML</td><td align="right"> 12- 5-19</td><td align="right"> 6- 9-20</td></tr>
+<tr><td align="right"> AG</td><td align="right">1-15-20</td><td align="right"> 1-16-20</td><td align="right"> 7-15-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> LP</td><td align="right"> 1-15-20</td><td align="right"> 7-15-20</td></tr>
+<tr><td align="right"> IK</td><td align="right">2-14-20</td><td align="right">2-16-20</td><td align="right"> 8-11-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> AL</td><td align="right"> 2-14-20</td><td align="right"> 8- 2-20</td></tr>
+<tr><td align="right"> HG</td><td align="right">2-10-20</td><td align="right"> 2-11-20</td><td align="right"> moved</td><td align="right"></td><td align="right" colspan="2"> control removed</td></tr>
+<tr><td align="right"> AC</td><td align="right">2-11-20</td><td align="right"> 2-12-20</td><td align="right"> 8- 2-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> JF</td><td align="right"> 2-11-20</td><td align="right"> 8- 3-20</td></tr>
+<tr><td align="right"> CL</td><td align="right">2-26-20</td><td align="right">3- 1-20</td><td align="right"> 8- 3-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> JF</td><td align="right"> 2-26-20</td><td align="right">8- 3-20</td></tr>
+<tr><td align="right"> MR</td><td align="right">2-26-20</td><td align="right"> 3- 1-20</td><td align="right"> moved</td><td align="right"></td><td align="right" colspan="2"> control removed</td></tr>
+<tr><td align="right"> SR</td><td align="right">2-26-20</td><td align="right"> 2-27-20</td><td align="right"> 8- 3-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> PG</td><td align="right"> 2-26-20</td><td align="right">8- 3-20</td></tr>
+<tr><td align="right"> IK</td><td align="right">3-17-20</td><td align="right">3-17-20</td><td align="right"> moved</td><td align="right"></td><td align="right" colspan="2"> control removed</td></tr>
+<tr><td align="right"> AO</td><td align="right">3- 8-20</td><td align="right"> 3- 8-20</td><td align="right"> 9-20-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> SK</td><td align="right"> 3- 9-20</td><td align="right"> 9-24-20</td></tr>
+<tr><td align="right"> RB</td><td align="right">3- 8-20</td><td align="right"> 3- 8-20</td><td align="right"> moved</td><td align="right"></td><td align="right" colspan="2"> control removed</td></tr>
+<tr><td align="right"> DT</td><td align="right">3- 8-20</td><td align="right">3- 8-20</td><td align="right"> mastoid</td><td align="right"></td><td align="right" colspan="2"> control removed</td></tr>
+<tr><td align="right"> AL</td><td align="right">3- 9-20</td><td align="right"> 3- 9-20</td><td align="right"> moved</td><td align="right"></td><td align="right" colspan="2"> control removed</td></tr>
+<tr><td align="right"> JD</td><td align="right">3- 9-20</td><td align="right"> 3- 9-20</td><td align="right"> 9-23-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> DD</td><td align="right"> 3-11-20</td><td align="right">9-16-20</td></tr>
+<tr><td align="right"> LS</td><td align="right">3- 9-20</td><td align="right">3- 9-20</td><td align="right"> 9-25-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> KS</td><td align="right"> 3-16-20</td><td align="right">9-24-20</td></tr>
+<tr><td align="right"> JB</td><td align="right">3-12-20</td><td align="right"> 3-12-20</td><td align="right"> moved</td><td align="right"></td><td align="right" colspan="2"> control removed</td></tr>
+<tr><td align="right"> HS</td><td align="right">3-13-20</td><td align="right"> 3-13-20</td><td align="right"> 9-21-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> MR</td><td align="right"> 3-15-20</td><td align="right"> 9-15-20</td></tr>
+<tr><td align="right"> AM</td><td align="right">3-13-20</td><td align="right">3-13-20</td><td align="right"> 9-20-20</td><td align="right"> JM</td><td align="right"> 3-13-20</td><td align="right"> lost</td><td align="right"> HH</td><td align="right"> 4- 6-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> SO</td><td align="right">3-18-20</td><td align="right"> 3-18-20</td><td align="right"> 9-22-20</td><td align="right"> SS</td><td align="right"> 3-22-20</td><td align="right"> wrong boy</td><td align="right"> MA</td><td align="right"> 3-23-20</td><td align="right">9-23-20</td></tr>
+<tr><td align="right"> IF</td><td align="right">3-18-20</td><td align="right"> 3-18-20</td><td align="right">9-23-20</td><td align="right"></td><td align="right"></td><td align="right">(adenoids</td><td align="right">PK</td><td align="right"> 3-22-20</td><td align="right">9-21-20</td></tr>
+<tr><td align="right"> AD</td><td align="right">3-19-20</td><td align="right">3-19-20</td><td align="right"> 9-20-20</td><td align="right">LC</td><td align="right">3-22-20</td><td align="right"> (removed</td><td align="right"> IB</td><td align="right"> 3-23-20</td><td align="right"> 9-24-20</td></tr>
+<tr><td align="right"> JR</td><td align="right">3-19-20</td><td align="right"> 3-19-20</td><td align="right"> moved</td><td align="right"> IB</td><td align="right">3-23-20</td><td align="right"> 9-24-20</td><td align="right"></td></tr>
+<tr><td align="right"> JN</td><td align="right">3-20-20</td><td align="right"> 3-20-20</td><td align="right"> moved</td><td align="right"> MA</td><td align="right"> 3-13-20</td><td align="right">9-23-20</td><td align="right"> LF</td><td align="right"> 3-20-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> HS</td><td align="right">3-20-20</td><td align="right">3-20-20</td><td align="right"> 9-21-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> SB</td><td align="right"> 3-25-20</td><td align="right"> 9-21-20</td></tr>
+<tr><td align="right"> II</td><td align="right">3-26-20</td><td align="right"> 3-26-20</td><td align="right"> 9-24-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> BF</td><td align="right"> 4- 5-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> UF</td><td align="right">3-27-20</td><td align="right"> 3-27-20</td><td align="right"> 9-29-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> LF</td><td align="right"> 4- 7-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> SM</td><td align="right">3-27-20</td><td align="right">3-27-20</td><td align="right"> 9-30-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> LG</td><td align="right"> 4- 6-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> AM</td><td align="right">3-29-20</td><td align="right"> 3-29-20</td><td align="right"> 9-29-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> BG</td><td align="right"> 4- 6-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> CK</td><td align="right">3-29-20</td><td align="right"> 3-29-20</td><td align="right"> 9-29-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> NF</td><td align="right"> 4- 7-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> FB</td><td align="right">3-30-20</td><td align="right">3-30-20</td><td align="right"> 9-29-20</td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> JF</td><td align="right"> 3-26-20</td><td align="right">10- 1-20</td></tr>
+<tr><td align="right"> AA</td><td align="right">3-30-20</td><td align="right"> 3-30-20</td><td align="right"> 9-23-20</td></tr>
+<tr><td align="right"> LS</td><td align="right">3-31-20</td><td align="right"> 3-31-20</td><td align="right"> moved</td><td align="right"></td><td align="right"> control</td><td align="right"> removed</td><td align="right"> MA</td><td align="right"> 4- 5-20</td><td align="right"> 9-30-20</td></tr>
+<tr><td align="right"> FT</td><td align="right">3-31-20</td><td align="right">3-31-20</td><td align="right"> 9-28-20</td></tr>
+<tr><td align="right"> LP</td><td align="right">4- 1-20</td><td align="right"> 4- 1-20</td><td align="right"> moved</td><td align="right"> HH</td><td align="right"> 4- 6-20</td><td align="right">10- 1-20</td></tr>
+</table></div><br>
+<hr style="width: 65%;">
+<p><span class="pagenum"><a name="Page_29" id="Page_29">[Pg 29]</a></span></p>
+
+
+<h2>CHAPTER III.</h2>
+
+<h3>DISCUSSION OF THE RESULTS</h3>
+
+
+<h3>Statistical Study</h3>
+
+<p>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.</p>
+
+
+<h3>TABLE I</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center" colspan="2"> Tonsil Group</td><td align="center" colspan="2"> Normal Group</td></tr>
+<tr><td align="center"> I.Q.</td><td align="center"> No. of Cases</td><td align="center"> Per cent of Cases</td><td align="center"> No. of Cases</td><td align="center">Per cent of Cases</td></tr>
+<tr><td align="right"> 40- 50</td><td align="right"> 2 &nbsp; </td><td align="right"> ·8</td><td align="right">0 &nbsp; </td><td align="right"> 0 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 50- 60</td><td align="right"> 1 &nbsp; </td><td align="right"> ·4</td><td align="right">2 &nbsp; </td><td align="right"> ·7</td></tr>
+<tr><td align="right"> 60- 70</td><td align="right"> 7 &nbsp; </td><td align="right"> 2·9</td><td align="right"> 4 &nbsp; </td><td align="right"> 1·4</td></tr>
+<tr><td align="right"> 70- 80</td><td align="right"> 21 &nbsp; </td><td align="right"> 8·9</td><td align="right"> 29 &nbsp; </td><td align="right"> 9·8</td></tr>
+<tr><td align="right"> 80- 90</td><td align="right"> 45 &nbsp; </td><td align="right"> 19·0</td><td align="right"> 52 &nbsp; </td><td align="right"> 17·7</td></tr>
+<tr><td align="right"> 90-100</td><td align="right"> 80 &nbsp; </td><td align="right"> 33·9</td><td align="right"> 107 &nbsp; </td><td align="right"> 36·4</td></tr>
+<tr><td align="right"> 100-110</td><td align="right"> 55 &nbsp; </td><td align="right">23·3</td><td align="right"> 67 &nbsp; </td><td align="right"> 22·8</td></tr>
+<tr><td align="right"> 110-120</td><td align="right"> 17 &nbsp; </td><td align="right">7·2</td><td align="right"> 24 &nbsp; </td><td align="right"> 8·1</td></tr>
+<tr><td align="right"> 120-130</td><td align="right"> 6 &nbsp; </td><td align="right"> 2·5</td><td align="right"> 9 &nbsp; </td><td align="right"> 3·0</td></tr>
+<tr><td align="right"> 130-140</td><td align="right"> 2 &nbsp; </td><td align="right"> ·8</td><td align="right"> 0 &nbsp; </td><td align="right"> 0 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 140-150</td><td align="right">1 &nbsp; </td><td align="right"> ·4</td><td align="right"> 0 &nbsp; </td><td align="right">0 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> </td></tr>
+<tr><td align="right"> Average</td><td align="right"> 94·9</td><td align="right"></td><td align="right"> 95·4</td></tr>
+<tr><td align="right"> Median</td><td align="right"> 95·3</td><td align="right"></td><td align="right"> 95·6</td></tr>
+<tr><td align="right"> Q</td><td align="right"> 8·705</td><td align="right"></td><td align="right"> 8·27</td></tr>
+<tr><td align="right"> σ</td><td align="right"> 14·4</td><td align="right"></td><td align="right"> 12·2</td></tr>
+</table></div>
+<p>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,&mdash;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.</p><p><span class="pagenum">[Pg 30]</span></p>
+
+<div class="figcenter" style="width: 480px;">
+<img src="images/fig_001.jpg" width="480" height="319" alt="" title="">
+<span class="caption">Fig. 1. Distribution of I.Q.'s. Number of cases.</span>
+</div>
+<br><br>
+<div class="figcenter" style="width: 495px;">
+<img src="images/fig_002.jpg" width="495" height="243" alt="" title="">
+<span class="caption">Fig. 2. Distribution of I.Q.'s by percentage of total
+number of cases in the group.</span>
+</div>
+
+<p><span class="pagenum">[Pg 31]</span></p>
+
+<p>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.</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> I.Q.</td><td align="center"> Per cent of Tonsil Group</td><td align="center"> Per Cent of Normal Group</td></tr>
+<tr><td align="left"> Below 70</td><td align="center"> &nbsp; 4·1</td><td align="center"> &nbsp; 2·1</td></tr>
+<tr><td align="left"> Below 90</td><td align="center"> 32·0</td><td align="center"> 29·6</td></tr>
+<tr><td align="left"> Above 110</td><td align="center"> 10·9</td><td align="center"> 11·1</td></tr>
+<tr><td align="left"> Above 120</td><td align="center"> &nbsp; 3·7</td><td align="center"> &nbsp; 3·0</td></tr>
+<tr><td align="left"> Above 130</td><td align="center"> &nbsp; 1·2</td><td align="center"> &nbsp; 0 &nbsp; &nbsp;</td></tr>
+</table></div>
+<p>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&mdash;the difference here being 2 per cent. The normal
+group has a negligible predominance of bright cases,&mdash;only
+two-tenths of one per cent difference, while with the very
+superior cases, the tonsil group again exceeds,&mdash;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.</p>
+
+<p>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?</p>
+
+<p>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<span class="pagenum">[Pg 32]</span>
+probably be merely an increased height at the overlapping
+portion of the curves, with no change at the ends.</p>
+
+<p>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.</p>
+
+
+<h3>STUDY OF IMPROVEMENT AFTER OPERATION</h3>
+
+<p>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.</p>
+
+<p>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.</p><p><span class="pagenum">[Pg 33]</span></p>
+
+<h3>TABLE II. RESULTS OF TESTS</h3>
+
+<p class='larger center'>Blank spaces indicate where tests were omitted for one reason or another</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N</td><td align="center" colspan="2"> Age</td><td align="center" colspan="2"> Weight<br>lbs.</td><td align="center" colspan="2"> Height<br> in.</td><td align="center" colspan="2"> Grip, Kg.<br> best hand</td></tr>
+<tr><td align="left"></td><td align="center"> 1</td><td align="center"> 2</td><td align="center"> 1</td><td align="center"> 2</td><td align="center"> 1</td><td align="center"> 2</td><td align="center"> 1</td><td align="center"> 2</td></tr>
+<tr><td align="left"> 1</td><td align="left"> &nbsp; 7- 7</td><td align="left"> &nbsp; 8- 1</td><td align="right"> 50·4</td><td align="right"> 54·2</td><td align="right"> 46&nbsp; &nbsp;</td><td align="right"> 47·6</td><td align="right"> 13&nbsp; &nbsp;</td><td align="right"> 12&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 1C</td><td align="left"> &nbsp; 8- 1</td><td align="left"> &nbsp; 8- 7</td><td align="right"> 53·5</td><td align="right"> 57·2</td><td align="right"> 46·4</td><td align="right"> 47·8</td><td align="right"> 11&nbsp; &nbsp;</td><td align="right">13&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 2</td><td align="left"> &nbsp; 6- 9</td><td align="left"> &nbsp; 7- 3</td><td align="right"> 40·9</td><td align="right"> 42·9</td><td align="right"> 42·6</td><td align="right"> 41·1</td><td align="right"> 9&nbsp; &nbsp;</td><td align="right"> 9&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 2C</td><td align="left"> &nbsp; 7- 1</td><td align="left"> &nbsp; 7- 7</td><td align="right"> 52·3</td><td align="right">57·4</td><td align="right"> 45·2</td><td align="right">47&nbsp; &nbsp;</td><td align="right"> 10&nbsp; &nbsp;</td><td align="right"> 12&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 3</td><td align="left"> &nbsp; 8-</td><td align="left"> &nbsp; 8- 6</td><td align="right"> 55&nbsp; &nbsp;</td><td align="right"> 59·5</td><td align="right"> 47&nbsp; &nbsp;</td><td align="right"> 48·4</td><td align="right"> 12·8</td><td align="right"> 14·5</td></tr>
+<tr><td align="left"> 3C</td><td align="left"> &nbsp; 9- 9</td><td align="left">10- 3</td><td align="right"> 61·5</td><td align="right">62·9</td><td align="right"> 51·7</td><td align="right"> 52·9</td><td align="right"> 14&nbsp; &nbsp;</td><td align="right"> 15&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 4</td><td align="left"> &nbsp; 8-10</td><td align="left"> &nbsp; 9- 4</td><td align="right"> 51·1</td><td align="right"> 54·2</td><td align="right"> 47·5</td><td align="right">49·2</td><td align="right"> 9&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 4C</td><td align="left"> &nbsp; 9-10</td><td align="left"> 10- 4</td><td align="right"> 49·4</td><td align="right">51&nbsp; &nbsp;</td><td align="right"> 48·9</td><td align="right"> 52&nbsp; &nbsp;</td><td align="right"> 9·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 5</td><td align="left"> &nbsp; 6- 1</td><td align="left"> &nbsp; 6- 7</td><td align="right"> 45&nbsp; &nbsp;</td><td align="right">47&nbsp; &nbsp;</td><td align="right"> 44·9</td><td align="right"> 45·2</td><td align="right"> 11&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 5C</td><td align="left"> &nbsp; 8- 2</td><td align="left"> &nbsp; 8- 8</td><td align="right"> 56·2</td><td align="right">57&nbsp; &nbsp;</td><td align="right"> 46·6</td><td align="right">48·1</td><td align="right"> 12&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 6</td><td align="left"> &nbsp; 5- 2</td><td align="left"> &nbsp; 5- 8</td><td align="right"> 43·8</td><td align="right"> 44·5</td><td align="right"> 43·1</td><td align="right">43·9</td><td align="right"> 8&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 6C</td><td align="left"> &nbsp; 7- 1</td><td align="left"> &nbsp; 7- 7</td><td align="right"> 50·6</td><td align="right"> 52·5</td><td align="right"> 45·4</td><td align="right">47·3</td><td align="right"> 10·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 7</td><td align="left"> &nbsp; 6- 7</td><td align="left"> &nbsp; 7- 1</td><td align="right">39·9</td><td align="right"> 41&nbsp; &nbsp;</td><td align="right"> 42·9</td><td align="right">44·8</td><td align="right"> 7&nbsp; &nbsp;</td><td align="right"> 6·5</td></tr>
+<tr><td align="left"> 7C</td><td align="left"> &nbsp; 6- 7</td><td align="left"> &nbsp; 7- 1</td><td align="right"> 38·4</td><td align="right"> 38·7</td><td align="right"> 41·9</td><td align="right">43·2</td><td align="right"> 9&nbsp; &nbsp;</td><td align="right"> 10&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 8</td><td align="left"> &nbsp; 8- 6</td><td align="left"> &nbsp; 9-</td><td align="right"> 60·8</td><td align="right"> 63·3</td><td align="right"> 50·8</td><td align="right"> 51·8</td><td align="right"> 10&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 8C</td><td align="left"> &nbsp; 8- 5</td><td align="left"> &nbsp; 8-11</td><td align="right"> 45·4</td><td align="right">52·1</td><td align="right"> 46·8</td><td align="right">47·6</td><td align="right"> 15&nbsp; &nbsp;</td><td align="right"> 16&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 9</td><td align="left"> &nbsp; 9- 4</td><td align="left"> &nbsp; 9-10</td><td align="right"> 50·6</td><td align="right"> 53·2</td><td align="right"> 48·1</td><td align="right"> 49·4</td><td align="right">10·5</td><td align="right"> 13&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 9C</td><td align="left"> &nbsp; 9- 6</td><td align="left">10-</td><td align="right"> 59·8</td><td align="right"> 61·4</td><td align="right"> 51·9</td><td align="right"> 55·2</td><td align="right"> 16·5</td><td align="right"> 21&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 10</td><td align="left"> &nbsp; 6- 7</td><td align="left"> &nbsp; 7-1</td><td align="right"> 48·9</td><td align="right"> 51·4</td><td align="right"> 46·1</td><td align="right">47·7</td><td align="right"> 12·5</td><td align="right"> 11&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 10C</td><td align="left"> &nbsp; 7-</td><td align="left"> &nbsp; 7-6</td><td align="right"> 47·1</td><td align="right"> 47·5</td><td align="right"> 45·6</td><td align="right">47·2</td><td align="right"> 10&nbsp; &nbsp;</td><td align="right"> 15&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 11</td><td align="left"> &nbsp; 6- 7</td><td align="left"> &nbsp; 7-</td><td align="right"> 47·8</td><td align="right"> 47·5</td><td align="right"> 45·8</td><td align="right"> 47·7</td><td align="right"> 11&nbsp; &nbsp;</td><td align="right"> 15&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 11C</td><td align="left"> &nbsp; 6- 8</td><td align="left"> &nbsp; 7-1</td><td align="right"> 41·6</td><td align="right"> 42·5</td><td align="right"> 43·6</td><td align="right">44·9</td><td align="right"> 11·5</td><td align="right"> 11·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 12</td><td align="left"> &nbsp; 7- 8</td><td align="left"> &nbsp; 8-2</td><td align="right"> 48&nbsp; &nbsp;</td><td align="right"> 52·5</td><td align="right"> 44·8</td><td align="right"></td><td align="right"> 14&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 12C</td><td align="left"> &nbsp; 7- 1</td><td align="left"> &nbsp; &nbsp; -8</td><td align="right"> 41&nbsp; &nbsp;</td><td align="right"> 44·5</td><td align="right"> 41·5</td><td align="right">43·3</td><td align="right"> 6&nbsp; &nbsp;</td><td align="right"> 4·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 13</td><td align="left">13- 3</td><td align="left">13-10</td><td align="right">90&nbsp; &nbsp;</td><td align="right"> 98&nbsp; &nbsp;</td><td align="right"> 61·5</td><td align="right"> 65</td><td align="right">26·5</td><td align="right"> 28·5</td></tr>
+<tr><td align="left"> 13C</td><td align="left">14- 6</td><td align="left">15-</td><td align="right"> 74·7</td><td align="right">76·8</td><td align="right"> 56·8</td><td align="right"> 57·8</td><td align="right">22&nbsp; &nbsp;</td><td align="right">23&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 14</td><td align="left"> 11- 9</td><td align="left"> 12-4</td><td align="right"> 56&nbsp; &nbsp;</td><td align="right"> 62&nbsp; &nbsp;</td><td align="right"> 51&nbsp; &nbsp;</td><td align="right"> 51·6</td><td align="right"> 16&nbsp; &nbsp;</td><td align="right"> 15&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 14C</td><td align="left"> 11-10</td><td align="left">12-4</td><td align="right"> 81·9</td><td align="right"> 86&nbsp; &nbsp;</td><td align="right"> 57·9</td><td align="right"> 58·3</td><td align="right"> 22&nbsp; &nbsp;</td><td align="right"> 24&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 15</td><td align="left"> 10- 3</td><td align="left"> 10-10</td><td align="right"> 57·5</td><td align="right"></td><td align="right"> 51·1</td><td align="right"></td><td align="right"></td><td align="right"> 15·5</td></tr>
+<tr><td align="left"> 15C</td><td align="left"> 10- 1</td><td align="left">10-7</td><td align="right"> 67·2</td><td align="right">70·3</td><td align="right"> 50·1</td><td align="right">51</td><td align="right"> 15&nbsp; &nbsp;</td><td align="right"> 15·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 16</td><td align="left"> 10- 9</td><td align="left"> 11-3</td><td align="right"> 56&nbsp; &nbsp;</td><td align="right"> 57&nbsp; &nbsp;</td><td align="right"> 51·6</td><td align="right"> 52·3</td><td align="right"> 19&nbsp; &nbsp;</td><td align="right"> 17·5</td></tr>
+<tr><td align="left"> 16C</td><td align="left"> 10- 9</td><td align="left">11-3</td><td align="right"> 51·2</td><td align="right"> 50&nbsp; &nbsp;</td><td align="right"> 48·7</td><td align="right">49·5</td><td align="right"> 10&nbsp; &nbsp;</td><td align="right"> 10&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 17</td><td align="left"> &nbsp; 8- 1</td><td align="left"> &nbsp; 8-7</td><td align="right"> 57&nbsp; &nbsp;</td><td align="right"></td><td align="right"> 48·7</td><td align="right"></td><td align="right"> 14&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 17C</td><td align="left"> &nbsp; 7-10</td><td align="left"> &nbsp; 8-4</td><td align="right"> 45·3</td><td align="right"></td><td align="right"> 44·8</td><td align="right"></td><td align="right"> 10&nbsp; &nbsp;</td><td align="right"> 8·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 18</td><td align="left"> &nbsp; 7- 2</td><td align="left"> &nbsp; 7-8</td><td align="right"> 58·2</td><td align="right"></td><td align="right"> 47·3</td><td align="right"></td><td align="right"> 11&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 18C</td><td align="left"> &nbsp; 6-11</td><td align="left"> &nbsp; 7-5</td><td align="right"> 45·3</td><td align="right">47</td><td align="right"> 46·7</td><td align="right"> 47·1</td><td align="right"> 8&nbsp; &nbsp;</td><td align="right"> 6·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 19</td><td align="left"> 11- 4</td><td align="left">11-10</td><td align="right">90&nbsp; &nbsp;</td><td align="right"> 96·3</td><td align="right"> 57·7</td><td align="right">59&nbsp; &nbsp;</td><td align="right"> 22&nbsp; &nbsp;</td><td align="right"> 21&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 19C</td><td align="left"> &nbsp; 7-11</td><td align="left"> &nbsp; 8-5</td><td align="right"> 52·4</td><td align="right"> 54·4</td><td align="right"> 46·7</td><td align="right">47·2</td><td align="right"> 15&nbsp; &nbsp;</td><td align="right"> 12&nbsp; &nbsp;<span class="pagenum">[Pg 34]</span></td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 20</td><td align="left"> &nbsp; 7- 1</td><td align="left"> &nbsp; 7- 7</td><td align="right"> 44·2</td><td align="right"></td><td align="right"> 47·2</td><td align="right"></td><td align="right"> 11&nbsp; &nbsp;</td><td align="right"></td></tr>
+<tr><td align="left"> 20C</td><td align="left"> &nbsp; 7- 3</td><td align="left"> &nbsp; 7-10</td><td align="right"> 61·3</td><td align="right"> 66&nbsp; &nbsp;</td><td align="right"> 49·6</td><td align="right"> 55&nbsp; &nbsp;</td><td align="right"> 15&nbsp; &nbsp;</td><td align="right"> 12·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 21</td><td align="left"> 11-</td><td align="left"> 11- 6</td><td align="right"> 70·7</td><td align="right"> 76·5</td><td align="right"> 54·1</td><td align="right"></td><td align="right"> 16·5</td><td align="right"> 16·5</td></tr>
+<tr><td align="left"> 21C</td><td align="left"> 10- 1</td><td align="left"> 10- 7</td><td align="right"> 62·4</td><td align="right"> 67</td><td align="right"> 49·6</td><td align="right"> 50·4</td><td align="right"> 19&nbsp; &nbsp;</td><td align="right"> 15&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 22</td><td align="left"> 10- 9</td><td align="left"> 11- 3</td><td align="right"> 73·3</td><td align="right"></td><td align="right"> 53&nbsp; &nbsp;</td><td align="right"> 56·4</td><td align="right"> 18&nbsp; &nbsp;</td><td align="right"> 22·5</td></tr>
+<tr><td align="left"> 22C</td><td align="left"> 11- 7</td><td align="left"> 12- 1</td><td align="right"> 70·7</td><td align="right"> 80·5</td><td align="right"> 56·8</td><td align="right"> 58·1</td><td align="right"> 19·5</td><td align="right"> 21·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 23</td><td align="left"> &nbsp; 8- 7</td><td align="left"> &nbsp; 9- 1</td><td align="right"> 51·7</td><td align="right"></td><td align="right"> 47·8</td><td align="right"></td><td align="right"> 11·5</td><td align="right"> 15·5</td></tr>
+<tr><td align="left"> 23C</td><td align="left"> &nbsp; 8-11</td><td align="left"> &nbsp; 9- 4</td><td align="right"> 64·1</td><td align="right"> 66·5</td><td align="right"> 51·4</td><td align="right"> 53·1</td><td align="right"> 14·5</td><td align="right"> 14&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 24</td><td align="left"> &nbsp; 9- 8</td><td align="left"> 10- 2</td><td align="right"> 58·5</td><td align="right"> 62·5</td><td align="right"> 51</td><td align="right"></td><td align="right"> 19&nbsp; &nbsp;</td><td align="right"> 20&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 24C</td><td align="left"> 10- 2</td><td align="left"> 10- 8</td><td align="right"> 60&nbsp; &nbsp;</td><td align="right"> 61&nbsp; &nbsp;</td><td align="right"> 50·1</td><td align="right"> 51·5</td><td align="right"> 15&nbsp; &nbsp;</td><td align="right"> 15&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 25</td><td align="left"> 10- 1</td><td align="left"> 10- 7</td><td align="right"> 55·5</td><td align="right"> 59·5</td><td align="right"> 50</td><td align="right"> 50·8</td><td align="right"> 14&nbsp; &nbsp;</td><td align="right"></td></tr>
+<tr><td align="left"> 25C</td><td align="left"> 10-10</td><td align="left"> 11- 4</td><td align="right"> 63·3</td><td align="right"> 63·8</td><td align="right"> 50·2</td><td align="right"> 50·9</td><td align="right"> 12·5</td><td align="right"> 21·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 26</td><td align="left"> &nbsp; 9- 8</td><td align="left"> 10- 2</td><td align="right"> 63·8</td><td align="right"> 74·5</td><td align="right"> 51·6</td><td align="right"> 54·3</td><td align="right"> 14&nbsp; &nbsp;</td><td align="right"></td></tr>
+<tr><td align="left"> 26C</td><td align="left"> 10- 4</td><td align="left"> 10- 9</td><td align="right"> 64·2</td><td align="right"> 67&nbsp; &nbsp;</td><td align="right"> 51·4</td><td align="right"> 52·3</td><td align="right"> 20&nbsp; &nbsp;</td><td align="right"> 16·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 27</td><td align="left"> &nbsp; 6- 7</td><td align="left"> &nbsp; 7- 1</td><td align="right"> 43·7</td><td align="right"></td><td align="right"> 45·4</td><td align="right"></td><td align="right"> 9&nbsp; &nbsp;</td><td align="right"> 6&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 27C</td><td align="left"> &nbsp; 6- 3</td><td align="left"> &nbsp; 6- 9</td><td align="right"> 41&nbsp; &nbsp;</td><td align="right"> 44&nbsp; &nbsp;</td><td align="right"> 44·6</td><td align="right"> 45·4</td><td align="right"> 8&nbsp; &nbsp;</td><td align="right"> 9&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 28</td><td align="left"> 12-11</td><td align="left"> 13- 5</td><td align="right"> 71·3</td><td align="right"> 75·5</td><td align="right"> 54·9</td><td align="right"> 55·8</td><td align="right"> 23·5</td><td align="right"> 21&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 28C</td><td align="left"> 13- 8</td><td align="left"> 14- 2</td><td align="right"> 74·2</td><td align="right"> 79·8</td><td align="right"> 53·4</td><td align="right"> 54·5</td><td align="right"> 21&nbsp; &nbsp;</td><td align="right"></td></tr>
+</table></div>
+
+<h3>TABLE II. RESULTS (Continued)</h3>
+
+<p class='larger center'>Blank spaces indicate where tests were omitted for one reason or another</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N</td><td align="center" colspan="2"> Tapping, 1/2 min.<br>best hand</td><td align="center" colspan="2"> I.Q.</td><td align="center" colspan="2"> Healy, Score</td></tr>
+<tr><td align="left"></td><td align="center"> 1</td><td align="center"> 2</td><td align="center"> 1</td><td align="center"> 2</td><td align="center"> 1&nbsp; &nbsp;</td><td align="center"> 2&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 1</td><td align="center"> 135</td><td align="center"> 120</td><td align="right"> 82</td><td align="right"> 83</td><td align="right"> -25&nbsp; &nbsp;</td><td align="right"> -2&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 1C</td><td align="center"> 106</td><td align="center"> 115</td><td align="right"> 80</td><td align="right"> 76</td><td align="right"> -50&nbsp; &nbsp;</td><td align="right"> -16&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 2</td><td align="center"> 105</td><td align="center"> 112</td><td align="right"> 107</td><td align="right"> 114</td><td align="right"> 28·5</td><td align="right"> 30&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 2C</td><td align="center"> 152</td><td align="center"> 114</td><td align="right"> 91</td><td align="right"> 96</td><td align="right"> 3&nbsp; &nbsp;</td><td align="right"> -11&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 3</td><td align="center"> 136</td><td align="center"> 139</td><td align="right"> 94</td><td align="right"> 91</td><td align="right"> 21·5</td><td align="right"> 22·5</td></tr>
+<tr><td align="left"> 3C</td><td align="center"> 135</td><td align="center"> 129</td><td align="right"> 82</td><td align="right"> 85</td><td align="right"> 17&nbsp; &nbsp;</td><td align="right"> 19&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 4</td><td align="center"> 103</td><td align="center"></td><td align="right"> 96</td><td align="right"> 96</td><td align="right"> 8·5</td><td align="right"></td></tr>
+<tr><td align="left"> 4C</td><td align="center"> 109</td><td align="center"></td><td align="right"> 83</td><td align="right"> 85</td><td align="right"> 33&nbsp; &nbsp;</td><td align="right"></td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 5</td><td align="center"> 110</td><td align="center"></td><td align="right"> 95</td><td align="right"> 99</td><td align="right"> -25&nbsp; &nbsp;</td><td align="right"></td></tr>
+<tr><td align="left"> 5C</td><td align="center"> 156</td><td align="center"></td><td align="right"> 114</td><td align="right"> 117</td><td align="right"> 40·5</td><td align="right"></td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 6</td><td align="center"> 110</td><td align="center"></td><td align="right"> 95</td><td align="right"> 101</td><td align="right"> -33&nbsp; &nbsp;</td><td align="right"></td></tr>
+<tr><td align="left"> 6C</td><td align="center"> 126</td><td align="center"></td><td align="right"> 88</td><td align="right"> 89</td><td align="right"> -32&nbsp; &nbsp;</td><td align="right"></td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 7</td><td align="center"> 125</td><td align="center"> 113</td><td align="right"> 91</td><td align="right"> 99</td><td align="right"> 6&nbsp; &nbsp;</td><td align="right"> -28&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 7C</td><td align="center"> 105</td><td align="center"></td><td align="right"> 95</td><td align="right"> 99</td><td align="right"> 4·5</td><td align="right"> 27·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 8</td><td align="center"> 113</td><td align="center"> 110</td><td align="right"> 91</td><td align="right"> 86</td><td align="right"> 32·5</td><td align="right"></td></tr>
+<tr><td align="left"> 8C</td><td align="center"> 131</td><td align="center"> 101</td><td align="right"> 98</td><td align="right"> 104</td><td align="right"> 4&nbsp; &nbsp;</td><td align="right"> 23&nbsp; &nbsp; <span class="pagenum">[Pg 35]</span></td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 9</td><td align="center"> 149</td><td align="center"> 135</td><td align="right"> 83</td><td align="right"> 93</td><td align="right"> 3·5</td><td align="right"> 10·5</td></tr>
+<tr><td align="left"> 9C</td><td align="center"> 144</td><td align="center"> 150</td><td align="right"> 87</td><td align="right"> 90</td><td align="right"> 34&nbsp; &nbsp;</td><td align="right"> 55</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 10</td><td align="center"> 68+ 74</td><td align="center"> 88+ 82</td><td align="right"> 110</td><td align="right"> 109</td><td align="right"> -12&nbsp; &nbsp;</td><td align="right"> 6·5</td></tr>
+<tr><td align="left"> 10C</td><td align="center"> 70+ 54</td><td align="center"> 135+109</td><td align="right"> 104</td><td align="right"> 100</td><td align="right"> 27&nbsp; &nbsp;</td><td align="right"> 65&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 11</td><td align="center"> 125+ 90</td><td align="center"> 98+ 87</td><td align="right"> 103</td><td align="right"> 100</td><td align="right"> - 8&nbsp; &nbsp;</td><td align="right"> 6&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 11C</td><td align="center"> 155+125</td><td align="center"> 101+107</td><td align="right"> 101</td><td align="right"> 102</td><td align="right"> -29&nbsp; &nbsp;</td><td align="right"> -3·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 12</td><td align="center"> 98+69</td><td align="center"></td><td align="right"> 98</td><td align="right"> 95</td><td align="right"> 20&nbsp; &nbsp;</td><td align="right"> 21&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 12C</td><td align="center"> 102</td><td align="center"> 84</td><td align="right"> 98</td><td align="right"> 101</td><td align="right"> -10&nbsp; &nbsp;</td><td align="right"> -12&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 13</td><td align="center"> 160+165</td><td align="center"> 142+134</td><td align="right"> 70</td><td align="right"> 78</td><td align="right"> 43&nbsp; &nbsp;</td><td align="right"> 42&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 13C</td><td align="center"> 150+109</td><td align="center"> 122+ 94</td><td align="right"> 66</td><td align="right"> 64</td><td align="right"> - 1·5</td><td align="right"> 30·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 14</td><td align="center"> 190+172</td><td align="center"> 138+130</td><td align="right"> 96</td><td align="right"> 107</td><td align="right"> 12·5</td><td align="right"> 48·5</td></tr>
+<tr><td align="left"> 14C</td><td align="center"> 175+152</td><td align="center"> 175+164</td><td align="right"> 140</td><td align="right"> 137</td><td align="right"> - 5&nbsp; &nbsp;</td><td align="right"> 25·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 15</td><td align="center"> 172+167</td><td align="center"> 170+156</td><td align="right"> 97</td><td align="right"> 94</td><td align="right"> 7&nbsp; &nbsp;</td><td align="right"> 25&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 15C</td><td align="center"> 140+115</td><td align="center"> 137+115</td><td align="right"> 78</td><td align="right"> 79</td><td align="right"> 1&nbsp; &nbsp;</td><td align="right"> 42·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 16</td><td align="center"> 145+131</td><td align="center"></td><td align="right"> 65</td><td align="right"> 73</td><td align="right"> 49&nbsp; &nbsp;</td><td align="right"> 47·5</td></tr>
+<tr><td align="left"> 16C</td><td align="center"> 145+99</td><td align="center"> 135+135</td><td align="right"> 74</td><td align="right"> 82</td><td align="right"> 30&nbsp; &nbsp;</td><td align="right"> 37&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 17</td><td align="center"> 90+89</td><td align="center"> 150+100</td><td align="right"> 71</td><td align="right"> 77</td><td align="right"> 29·5</td><td align="right"> 12&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 17C</td><td align="center"> 125+116</td><td align="center"> 121+ 97</td><td align="right"> 96</td><td align="right"> 99</td><td align="right"> 1·5</td><td align="right"> 15&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 18</td><td align="center"> 133+115</td><td align="center"> 135+111</td><td align="right"> 98</td><td align="right"> 98</td><td align="right"> -13·5</td><td align="right"> -12&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 18C</td><td align="center"> 100+ 99</td><td align="center"> 84+ 74</td><td align="right"> 90</td><td align="right"> 94</td><td align="right"> -32</td><td align="right"> -28&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 19</td><td align="center"> 168+136</td><td align="center"></td><td align="right"> 96</td><td align="right"> 101</td><td align="right"> 57·5</td><td align="right"> 49&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 19C</td><td align="center"> 100+115</td><td align="center"> 118+ 92</td><td align="right"> 98</td><td align="right"> 98</td><td align="right"> -22&nbsp; &nbsp;</td><td align="right"> -11&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 20</td><td align="center"> 105+115</td><td align="center"> 110+ 93</td><td align="right"> 106</td><td align="right"> 102</td><td align="right"> 0&nbsp; &nbsp;</td><td align="right"> -11&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 20C</td><td align="center"> 150+120</td><td align="center"> 155+149</td><td align="right"> 118</td><td align="right"> 131</td><td align="right"> 30&nbsp; &nbsp;</td><td align="right"> 35&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 21</td><td align="center"> 152+111</td><td align="center"> 132+125</td><td align="right"> 64</td><td align="right"> 67</td><td align="right"> 20&nbsp; &nbsp;</td><td align="right"> 32&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 21C</td><td align="center"> 140+136</td><td align="center"> 138+110</td><td align="right"> 86</td><td align="right"> 97</td><td align="right"> 70·5</td><td align="right"> 58·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 22</td><td align="center"> 164+148</td><td align="center"> 183+141</td><td align="right"> 91</td><td align="right"> 100</td><td align="right"> 48·5</td><td align="right"> 43·5</td></tr>
+<tr><td align="left"> 22C</td><td align="center"> 120+116</td><td align="center"> 157+127</td><td align="right"> 63</td><td align="right"> 62</td><td align="right"> 34·5</td><td align="right"> 33·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 23</td><td align="center"> 150+119</td><td align="center"> 141+136</td><td align="right"> 85</td><td align="right"> 94</td><td align="right"> 49·5</td><td align="right"> 68&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 23C</td><td align="center"> 122+115</td><td align="center"> 140+110</td><td align="right"> 81</td><td align="right"> 96</td><td align="right"> 4&nbsp; &nbsp;</td><td align="right"> 25&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 24</td><td align="center"> 157+136</td><td align="center"> 142+126</td><td align="right"> 131</td><td align="right"> 124</td><td align="right"> 54·5</td><td align="right"> 63&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 24C</td><td align="center"> 155+135</td><td align="center"> 155+100</td><td align="right"> 89</td><td align="right"> 92</td><td align="right"> 31·5</td><td align="right"> 59·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 25</td><td align="center"> 140+127</td><td align="center"> 150+119</td><td align="right"> 77</td><td align="right"> 76</td><td align="right"> 8&nbsp; &nbsp;</td><td align="right"> 25&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 25C</td><td align="center"> 148+134</td><td align="center"> 151+135</td><td align="right"> 145</td><td align="right"> 137</td><td align="right"> 29·5</td><td align="right"> 29&nbsp; &nbsp;</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 26</td><td align="center"> 137+113</td><td align="center"> 138+117</td><td align="right"> 80</td><td align="right"> 76</td><td align="right"> 22·5</td><td align="right"> 7&nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 26C</td><td align="center"> 125+105</td><td align="center"> 125+ 79</td><td align="right"> 90</td><td align="right"> 88</td><td align="right"> 56&nbsp; &nbsp;</td><td align="right"> 61·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 27</td><td align="center"> 108+ 92</td><td align="center"> 97+ 92</td><td align="right"> 110</td><td align="right"> 109</td><td align="right"> -25&nbsp; &nbsp;</td><td align="right"> 15</td></tr>
+<tr><td align="left"> 27C</td><td align="center"> 115+105</td><td align="center"> 112+109</td><td align="right"> 72</td><td align="right"> 96</td><td align="right"> 2&nbsp; &nbsp;</td><td align="right"> 27·5</td></tr>
+<tr><td align="left"></td></tr>
+<tr><td align="left"> 28</td><td align="center"> 150+148</td><td align="center"> 162+143</td><td align="right"> 81</td><td align="right"> 84</td><td align="right"> 29·5</td><td align="right"> 73·5</td></tr>
+<tr><td align="left"> 28C</td><td align="center"> 178+148</td><td align="center"> 170+163</td><td align="right"> 95</td><td align="right"> 98</td><td align="right"> 64·5</td><td align="right"> 51·5</td></tr>
+</table></div> <p><span class="pagenum">[Pg 36]</span></p>
+
+<blockquote>
+<p>We have therefore:</p>
+<p style="margin-left: 2em;">28 pairs of I.Q's to be compared<br>
+ 21 pairs of weights<br>
+ 19 pairs of heights<br>
+ 16 pairs of grip measurements<br>
+ 20 pairs of tapping speeds<br>
+ 24 pairs of Healy Completion scores.</p>
+</blockquote>
+
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 37]</span></p>
+
+<h3>TABLE III</h3>
+
+<h3>Gain in weight, 6 months, 21 pairs</h3>
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right">N<a href="#Footnote_16_16" class="fnanchor">[16]</a></td><td align="right" colspan="3">Test Group (A) </td><td align="right" colspan="3">Control Group (B)</td><td align="right">Lbs.</td></tr>
+<tr><td align="right"></td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right">A-B</td></tr>
+<tr><td align="right">8</td><td align="right">60·8 &nbsp; </td><td align="right">63·3 &nbsp; </td><td align="right">2·5 &nbsp; </td><td align="right">45·4 &nbsp; </td><td align="right">52·1 &nbsp; </td><td align="right">6·7 &nbsp; </td><td align="right">-4·2 &nbsp; </td></tr>
+<tr><td align="right">2</td><td align="right">40·9 &nbsp; </td><td align="right">42·9 &nbsp; </td><td align="right">2·0 &nbsp; </td><td align="right">52·3 &nbsp; </td><td align="right">57·4 &nbsp; </td><td align="right">5·1 &nbsp; </td><td align="right">-3·1 &nbsp; </td></tr>
+<tr><td align="right">28</td><td align="right">71·3 &nbsp; </td><td align="right">75·5 &nbsp; </td><td align="right">4·2 &nbsp; </td><td align="right">74·2 &nbsp; </td><td align="right">79·8 &nbsp; </td><td align="right">5·6 &nbsp; </td><td align="right">-1·4 &nbsp; </td></tr>
+<tr><td align="right">6</td><td align="right">43·8 &nbsp; </td><td align="right">44·5 &nbsp; </td><td align="right">·7 &nbsp; </td><td align="right">50·6 &nbsp; </td><td align="right">52·5 &nbsp; </td><td align="right">1·9 &nbsp; </td><td align="right">-1·2 &nbsp; </td></tr>
+<tr><td align="right">11</td><td align="right">47·8 &nbsp; </td><td align="right">47·5 &nbsp; </td><td align="right">-·3 &nbsp; </td><td align="right">41·6 &nbsp; </td><td align="right">42·5 &nbsp; </td><td align="right">·9 &nbsp; </td><td align="right">-1·2 &nbsp; </td></tr>
+<tr><td align="right">1</td><td align="right">50·4 &nbsp; </td><td align="right">54·2 &nbsp; </td><td align="right">3·8 &nbsp; </td><td align="right">53·5 &nbsp; </td><td align="right">57·2 &nbsp; </td><td align="right">3·7 &nbsp; </td><td align="right">·1 &nbsp; </td></tr>
+<tr><td align="right">7</td><td align="right">39·9 &nbsp; </td><td align="right">41·0 &nbsp; </td><td align="right">1·1 &nbsp; </td><td align="right">38·4 &nbsp; </td><td align="right">38·7 &nbsp; </td><td align="right">·3 &nbsp; </td><td align="right">·8 &nbsp; </td></tr>
+<tr><td align="right">9</td><td align="right">50·6 &nbsp; </td><td align="right">53·2 &nbsp; </td><td align="right">2·6 &nbsp; </td><td align="right">59·8 &nbsp; </td><td align="right">61·4 &nbsp; </td><td align="right">1·6 &nbsp; </td><td align="right">1·0 &nbsp; </td></tr>
+<tr><td align="right">12</td><td align="right">48·0 &nbsp; </td><td align="right">52·5 &nbsp; </td><td align="right">4·5 &nbsp; </td><td align="right">41·0 &nbsp; </td><td align="right">44·5 &nbsp; </td><td align="right">3·5 &nbsp; </td><td align="right">1·0 &nbsp; </td></tr>
+<tr><td align="right">14</td><td align="right">56·0 &nbsp; </td><td align="right">62·0 &nbsp; </td><td align="right">6·0 &nbsp; </td><td align="right">81·9 &nbsp; </td><td align="right">86·0 &nbsp; </td><td align="right">4·9 &nbsp; </td><td align="right">1·1 &nbsp; </td></tr>
+<tr><td align="right">5</td><td align="right">45·0 &nbsp; </td><td align="right">47·0 &nbsp; </td><td align="right">2·0 &nbsp; </td><td align="right">56·2 &nbsp; </td><td align="right">57·0 &nbsp; </td><td align="right">·8 &nbsp; </td><td align="right">1·2 &nbsp; </td></tr>
+<tr><td align="right">21</td><td align="right">70·7 &nbsp; </td><td align="right">76·5 &nbsp; </td><td align="right">5·8 &nbsp; </td><td align="right">62·4 &nbsp; </td><td align="right">67·0 &nbsp; </td><td align="right">4·6 &nbsp; </td><td align="right">1·2 &nbsp; </td></tr>
+<tr><td align="right">4</td><td align="right">51·1 &nbsp; </td><td align="right">54·2 &nbsp; </td><td align="right">3·1 &nbsp; </td><td align="right">49·4 &nbsp; </td><td align="right">51·0 &nbsp; </td><td align="right">1·6 &nbsp; </td><td align="right">1·5 &nbsp; </td></tr>
+<tr><td align="right">10</td><td align="right">48·9 &nbsp; </td><td align="right">51·4 &nbsp; </td><td align="right">2·5 &nbsp; </td><td align="right">47·1 &nbsp; </td><td align="right">47·5 &nbsp; </td><td align="right">·4 &nbsp; </td><td align="right">2·1 &nbsp; </td></tr>
+<tr><td align="right">16</td><td align="right">56·0 &nbsp; </td><td align="right">57·0 &nbsp; </td><td align="right">1·0 &nbsp; </td><td align="right">51·2 &nbsp; </td><td align="right">50·0 &nbsp; </td><td align="right">-1·2 &nbsp; </td><td align="right">2·2 &nbsp; </td></tr>
+<tr><td align="right">24</td><td align="right">58·5 &nbsp; </td><td align="right">62·5 &nbsp; </td><td align="right">4·0 &nbsp; </td><td align="right">60·0 &nbsp; </td><td align="right">61·0 &nbsp; </td><td align="right">1·0 &nbsp; </td><td align="right">3·0 &nbsp; </td></tr>
+<tr><td align="right">3</td><td align="right">55·0 &nbsp; </td><td align="right">59·5 &nbsp; </td><td align="right">4·5 &nbsp; </td><td align="right">61·5 &nbsp; </td><td align="right">62·9 &nbsp; </td><td align="right">1·4 &nbsp; </td><td align="right">3·1 &nbsp; </td></tr>
+<tr><td align="right">25</td><td align="right">55·5 &nbsp; </td><td align="right">59·5 &nbsp; </td><td align="right">4·0 &nbsp; </td><td align="right">63·3 &nbsp; </td><td align="right">63·8 &nbsp; </td><td align="right">·5 &nbsp; </td><td align="right">3·5 &nbsp; </td></tr>
+<tr><td align="right">19</td><td align="right">90·0 &nbsp; </td><td align="right">96·3 &nbsp; </td><td align="right">6·3 &nbsp; </td><td align="right">52·4 &nbsp; </td><td align="right">54·4 &nbsp; </td><td align="right">2·0 &nbsp; </td><td align="right">4·3 &nbsp; </td></tr>
+<tr><td align="right">13</td><td align="right">90·0 &nbsp; </td><td align="right">98·0 &nbsp; </td><td align="right">8·0 &nbsp; </td><td align="right">74·7 &nbsp; </td><td align="right">76·8 &nbsp; </td><td align="right">2·1 &nbsp; </td><td align="right">5·9 &nbsp; </td></tr>
+<tr><td align="right">26</td><td align="right">63·8 &nbsp; </td><td align="right">74·5 &nbsp; </td><td align="right">10·7 &nbsp; </td><td align="right">64·2 &nbsp; </td><td align="right">67·0 &nbsp; </td><td align="right">2·8 &nbsp; </td><td align="right">7·9 &nbsp; </td></tr>
+<tr><td align="right">Av·</td><td align="right">56·86</td><td align="right">60·61</td><td align="right">3·76</td><td align="right">56·24</td><td align="right">58·60</td><td align="right">2·39</td><td align="right">1·37</td></tr>
+<tr><td align="right">M</td><td align="right"></td><td align="right"></td><td align="right">3·80</td><td align="right"></td><td align="right"></td><td align="right">1·9 &nbsp; </td><td align="right">1·2 &nbsp; </td></tr>
+<tr><td align="right">75%ile</td><td align="right"></td><td align="right"></td><td align="right">5·80</td><td align="right"></td><td align="right"></td><td align="right">4·6 &nbsp; </td><td align="right">3·1 &nbsp; </td></tr>
+<tr><td align="right">25%ile</td><td align="right"></td><td align="right"></td><td align="right">2·00</td><td align="right"></td><td align="right"></td><td align="right">·9 &nbsp; </td><td align="right">0·1 &nbsp; </td></tr>
+<tr><td align="right">Q </td><td align="right"></td><td align="right"></td><td align="right">1·90</td><td align="right"></td><td align="right"></td><td align="right">1·85</td><td align="right">1·5 &nbsp; </td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">1·76</td><td align="right"></td><td align="right"></td><td align="right">1·39</td><td align="right">1·63</td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">±·38</td><td align="right"></td><td align="right"></td><td align="right">±·30</td><td align="right">±·48</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">Av. =2·85 P. E.</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">M. =2·80 P. E.</td></tr>
+</table></div>
+<p>of the test group growth is greater than that of the control
+group. The three nutrition pairs show the following records
+of growth,&mdash;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.</p>
+
+<p>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.<span class="pagenum">[Pg 38]</span></p>
+
+<p>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.</p>
+
+
+<h3>TABLE IV</h3>
+
+<h3>Gain in Height&mdash;6 Months, 19 Pairs</h3>
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center">N<a href="#Footnote_16_16" class="fnanchor">[16]</a></td><td align="center" colspan="3">Test Group (A) </td><td align="center" colspan="3">Control Group (B)</td><td align="right">Inches</td></tr>
+<tr><td align="center">Test 1</td><td align="center">Test 2</td><td align="center">Gain</td><td align="center">Test 1</td><td align="center">Test 2</td><td align="center">Gain</td><td align="center">A-B</td></tr>
+<tr><td align="right">9</td><td align="right">48·1 &nbsp; <td align="right">49·4 &nbsp; <td align="right">1·3 &nbsp; <td align="right">51·9 &nbsp; <td align="right">55·2 &nbsp; <td align="right">3·3 &nbsp; <td align="right">-2·0 &nbsp; </td></tr>
+<tr><td align="right">4</td><td align="right">47·5 &nbsp; <td align="right">49·2 &nbsp; <td align="right">1·7 &nbsp; <td align="right">48·9 &nbsp; <td align="right">52·0 &nbsp; <td align="right">3·1 &nbsp; <td align="right">-1·4 &nbsp; </td></tr>
+<tr><td align="right">5</td><td align="right">44·9 &nbsp; <td align="right">45·2 &nbsp; <td align="right">·3 &nbsp; <td align="right">46·6 &nbsp; <td align="right">48·1 &nbsp; <td align="right">1·5 &nbsp; <td align="right">-1·2 &nbsp; </td></tr>
+<tr><td align="right">6</td><td align="right">43·1 &nbsp; <td align="right">43·9 &nbsp; <td align="right">·8 &nbsp; <td align="right">45·4 &nbsp; <td align="right">47·3 &nbsp; <td align="right">1·9 &nbsp; <td align="right">-1·1 &nbsp; </td></tr>
+<tr><td align="right">2</td><td align="right">42·5 &nbsp; <td align="right">44·1 &nbsp; <td align="right">1·6 &nbsp; <td align="right">45·2 &nbsp; <td align="right">47·0 &nbsp; <td align="right">1·8 &nbsp; <td align="right">-·2 &nbsp; </td></tr>
+<tr><td align="right">28</td><td align="right">54·9 &nbsp; <td align="right">55·8 &nbsp; <td align="right">·9 &nbsp; <td align="right">53·4 &nbsp; <td align="right">54·5 &nbsp; <td align="right">1·1 &nbsp; <td align="right">-·2 &nbsp; </td></tr>
+<tr><td align="right">16</td><td align="right">51·6 &nbsp; <td align="right">52·3 &nbsp; <td align="right">·7 &nbsp; <td align="right">48·7 &nbsp; <td align="right">49·5 &nbsp; <td align="right">·8 &nbsp; <td align="right">-·1 &nbsp; </td></tr>
+<tr><td align="right">10</td><td align="right">46·1 &nbsp; <td align="right">47·7 &nbsp; <td align="right">1·6 &nbsp; <td align="right">45·6 &nbsp; <td align="right">47·2 &nbsp; <td align="right">1·6 &nbsp; <td align="right">0 &nbsp; </td></tr>
+<tr><td align="right">25</td><td align="right">50·0 &nbsp; <td align="right">50·8 &nbsp; <td align="right">·8 &nbsp; <td align="right">50·2 &nbsp; <td align="right">50·9 &nbsp; <td align="right">·7 &nbsp; <td align="right">·1 &nbsp; </td></tr>
+<tr><td align="right">1</td><td align="right">46·0 &nbsp; <td align="right">47·6 &nbsp; <td align="right">1·6 &nbsp; <td align="right">46·4 &nbsp; <td align="right">47·8 &nbsp; <td align="right">1·4 &nbsp; <td align="right">·2 &nbsp; </td></tr>
+<tr><td align="right">3</td><td align="right">47·0 &nbsp; <td align="right">48·4 &nbsp; <td align="right">1·4 &nbsp; <td align="right">51·7 &nbsp; <td align="right">52·9 &nbsp; <td align="right">1·2 &nbsp; <td align="right">·2 &nbsp; </td></tr>
+<tr><td align="right">8</td><td align="right">50·8 &nbsp; <td align="right">51·8 &nbsp; <td align="right">1·0 &nbsp; <td align="right">46·8 &nbsp; <td align="right">47·6 &nbsp; <td align="right">·8 &nbsp; <td align="right">·2 &nbsp; </td></tr>
+<tr><td align="right">14</td><td align="right">51·0 &nbsp; <td align="right">51·6 &nbsp; <td align="right">·6 &nbsp; <td align="right">57·9 &nbsp; <td align="right">58·3 &nbsp; <td align="right">·4 &nbsp; <td align="right">·2 &nbsp; </td></tr>
+<tr><td align="right">7</td><td align="right">42·9 &nbsp; <td align="right">44·8 &nbsp; <td align="right">1·9 &nbsp; <td align="right">41·9 &nbsp; <td align="right">43·2 &nbsp; <td align="right">1·3 &nbsp; <td align="right">·6 &nbsp; </td></tr>
+<tr><td align="right">11</td><td align="right">45·8 &nbsp; <td align="right">47·7 &nbsp; <td align="right">1·9 &nbsp; <td align="right">43·6 &nbsp; <td align="right">44·9 &nbsp; <td align="right">1·3 &nbsp; <td align="right">·6 &nbsp; </td></tr>
+<tr><td align="right">19</td><td align="right">57·7 &nbsp; <td align="right">59·0 &nbsp; <td align="right">1·3 &nbsp; <td align="right">46·7 &nbsp; <td align="right">47·2 &nbsp; <td align="right">·5 &nbsp; <td align="right">·8 &nbsp; </td></tr>
+<tr><td align="right">26</td><td align="right">51·6 &nbsp; <td align="right">54·3 &nbsp; <td align="right">2·7 &nbsp; <td align="right">51·4 &nbsp; <td align="right">52·3 &nbsp; <td align="right">·9 &nbsp; <td align="right">1·8 &nbsp; </td></tr>
+<tr><td align="right">22</td><td align="right">53·0 &nbsp; <td align="right">56·4 &nbsp; <td align="right">3·4 &nbsp; <td align="right">56·8 &nbsp; <td align="right">58·1 &nbsp; <td align="right">1·3 &nbsp; <td align="right">2·1 &nbsp; </td></tr>
+<tr><td align="right">13</td><td align="right">61·5 &nbsp; <td align="right">65·0 &nbsp; <td align="right">3·5 &nbsp; <td align="right">56·8 &nbsp; <td align="right">57·8 &nbsp; <td align="right">1·0 &nbsp; <td align="right">2·5 &nbsp; </td></tr>
+<tr><td align="left">Av.</td><td align="right">49·26</td><td align="right">50·79</td><td align="right">1·53</td><td align="right"></td><td align="right">50·62</td><td align="right">1·36</td><td align="right">·16</td></tr>
+<tr><td align="left">M</td><td align="right"></td><td align="right"></td><td align="right">1·4 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">1·3 &nbsp; <td align="right">·2 &nbsp; </td></tr>
+<tr><td align="left">75%ile</td><td align="right"></td><td align="right"></td><td align="right">1·9 &nbsp; <td align="right"></td><td align="right"></td><td align="right">1·75</td><td align="right">·65</td></tr>
+<tr><td align="left">25%ile</td><td align="right"></td><td align="right"></td><td align="right">·78</td><td align="right"></td><td align="right"></td><td align="right">·8 &nbsp; <td align="right">-·43</td></tr>
+<tr><td align="left">Q</td><td align="right"></td><td align="right"></td><td align="right">·56</td><td align="right"></td><td align="right"></td><td align="right">·48</td><td align="right">·54</td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">·53</td><td align="right"></td><td align="right"></td><td align="right">·44</td><td align="right">·44</td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">±·12</td><td align="right"></td><td align="right"></td><td align="right">±·10<td align="right">±·16</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">Av.=1 &nbsp; &nbsp; &nbsp; P. E.</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">M=1·25 P. E.</td></tr>
+</table></div>
+
+<p>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.</p>
+
+<p>The dynamometer results show no gain in strength of grip
+six months after operation. Indeed the average of the gains<span class="pagenum">[Pg 39]</span>
+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.</p>
+
+<h3>TABLE V</h3>
+
+<h3>Showing change in per cent over or underweight for height and age, 18 pairs.</h3>
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right">A</td><td align="right"></td><td align="right"></td><td align="right">B</td><td align="right">A-B</td></tr>
+<tr><td align="right">N<a href="#Footnote_16_16">[16]</a></td><td align="right">1</td><td align="right">2</td><td align="right">3</td><td align="right">4</td><td align="right">5</td><td align="right">6</td><td align="right">7</td></tr>
+<tr><td align="right">8</td><td align="right">- 1 &nbsp; &nbsp; &nbsp; <td align="right">- 1 &nbsp; &nbsp; &nbsp; <td align="right">0 &nbsp; &nbsp; &nbsp; <td align="right">-13 &nbsp; &nbsp; &nbsp; <td align="right">- 5 &nbsp; &nbsp; &nbsp; <td align="right">+ 8 &nbsp; &nbsp; &nbsp; <td align="right">- 8 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">11</td><td align="right">- 3 &nbsp; &nbsp; &nbsp; <td align="right">-12 &nbsp; &nbsp; &nbsp; <td align="right">-9 &nbsp; &nbsp; &nbsp; <td align="right">- 9 &nbsp; &nbsp; &nbsp; <td align="right">-11 &nbsp; &nbsp; &nbsp; <td align="right">- 2 &nbsp; &nbsp; &nbsp; <td align="right">- 7 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">10</td><td align="right">- 1 &nbsp; &nbsp; &nbsp; <td align="right">- 5 &nbsp; &nbsp; &nbsp; <td align="right">-4 &nbsp; &nbsp; &nbsp; <td align="right">- 6 &nbsp; &nbsp; &nbsp; <td align="right">- 8 &nbsp; &nbsp; &nbsp; <td align="right">- 2 &nbsp; &nbsp; &nbsp; <td align="right">- 2 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">28</td><td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">0 &nbsp; &nbsp; &nbsp; <td align="right">0 &nbsp; &nbsp; &nbsp; <td align="right">+ 2 &nbsp; &nbsp; &nbsp; <td align="right">+ 2 &nbsp; &nbsp; &nbsp; <td align="right">- 2 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">13</td><td align="right">-13 &nbsp; &nbsp; &nbsp; <td align="right">-19 &nbsp; &nbsp; &nbsp; <td align="right">-6 &nbsp; &nbsp; &nbsp; <td align="right">-11 &nbsp; &nbsp; &nbsp; <td align="right">-15 &nbsp; &nbsp; &nbsp; <td align="right">- 4 &nbsp; &nbsp; &nbsp; <td align="right">- 2 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">19</td><td align="right">+ 6 &nbsp; &nbsp; &nbsp; <td align="right">+ 8 &nbsp; &nbsp; &nbsp; <td align="right">+2 &nbsp; &nbsp; &nbsp; <td align="right">+ 1 &nbsp; &nbsp; &nbsp; <td align="right">+ 5 &nbsp; &nbsp; &nbsp; <td align="right">+ 4 &nbsp; &nbsp; &nbsp; <td align="right">- 2 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">6</td><td align="right">+ 2 &nbsp; &nbsp; &nbsp; <td align="right">- 3 &nbsp; &nbsp; &nbsp; <td align="right">-5 &nbsp; &nbsp; &nbsp; <td align="right">+ 5 &nbsp; &nbsp; &nbsp; <td align="right">+ 1 &nbsp; &nbsp; &nbsp; <td align="right">- 4 &nbsp; &nbsp; &nbsp; <td align="right">- 1 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">14</td><td align="right">-13 &nbsp; &nbsp; &nbsp; </td><td align="right">- 9 &nbsp; &nbsp; &nbsp; </td><td align="right">+4 &nbsp; &nbsp; &nbsp; <td align="right">- 5 &nbsp; &nbsp; &nbsp; <td align="right">0 &nbsp; &nbsp; &nbsp; <td align="right">+ 5 &nbsp; &nbsp; &nbsp; <td align="right">- 1 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">7</td><td align="right">- 8 &nbsp; &nbsp; &nbsp; <td align="right">-15 &nbsp; &nbsp; &nbsp; <td align="right">-7 &nbsp; &nbsp; &nbsp; <td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">-14 &nbsp; &nbsp; &nbsp; <td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">0 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">2</td><td align="right">- 8 &nbsp; &nbsp; &nbsp; <td align="right">- 6 &nbsp; &nbsp; &nbsp; <td align="right">+2 &nbsp; &nbsp; &nbsp; <td align="right">+ 9 &nbsp; &nbsp; &nbsp; <td align="right">+10 &nbsp; &nbsp; &nbsp; <td align="right">+ 1 &nbsp; &nbsp; &nbsp; <td align="right">+ 1 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">3</td><td align="right">+ 6 &nbsp; &nbsp; &nbsp; <td align="right">+ 8 &nbsp; &nbsp; &nbsp; <td align="right">+2 &nbsp; &nbsp; &nbsp; <td align="right">- 5 &nbsp; &nbsp; &nbsp; <td align="right">- 8 &nbsp; &nbsp; &nbsp; <td align="right">- 3 &nbsp; &nbsp; &nbsp; <td align="right">+ 5 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">16</td><td align="right">-16 &nbsp; &nbsp; &nbsp; <td align="right">-15 &nbsp; &nbsp; &nbsp; <td align="right">+1 &nbsp; &nbsp; &nbsp; <td align="right">-13 &nbsp; &nbsp; &nbsp; <td align="right">-17 &nbsp; &nbsp; &nbsp; <td align="right">- 4 &nbsp; &nbsp; &nbsp; <td align="right">+ 5 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">25</td><td align="right">- 8 &nbsp; &nbsp; &nbsp; <td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">+1 &nbsp; &nbsp; &nbsp; <td align="right">+ 4 &nbsp; &nbsp; &nbsp; <td align="right">- 1 &nbsp; &nbsp; &nbsp; <td align="right">- 5 &nbsp; &nbsp; &nbsp; <td align="right">+ 6 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">5</td><td align="right">- 4 &nbsp; &nbsp; &nbsp; <td align="right">- 1 &nbsp; &nbsp; &nbsp; <td align="right">+3 &nbsp; &nbsp; &nbsp; <td align="right">+ 8 &nbsp; &nbsp; &nbsp; <td align="right">+ 4 &nbsp; &nbsp; &nbsp; <td align="right">- 4 &nbsp; &nbsp; &nbsp; <td align="right">+ 7 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">9</td><td align="right">- 8 &nbsp; &nbsp; &nbsp; <td align="right">-11 &nbsp; &nbsp; &nbsp; <td align="right">-3 &nbsp; &nbsp; &nbsp; <td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">-17 &nbsp; &nbsp; &nbsp; <td align="right">-10 &nbsp; &nbsp; &nbsp; <td align="right">+ 7 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">26</td><td align="right">- 1 &nbsp; &nbsp; &nbsp; <td align="right">+ 5 &nbsp; &nbsp; &nbsp; <td align="right">+6 &nbsp; &nbsp; &nbsp; <td align="right">+ 1 &nbsp; &nbsp; &nbsp; <td align="right">0 &nbsp; &nbsp; &nbsp; <td align="right">- 1 &nbsp; &nbsp; &nbsp; <td align="right">+ 7 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">4</td><td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">- 7 &nbsp; &nbsp; &nbsp; <td align="right">0 &nbsp; &nbsp; &nbsp; <td align="right">-15 &nbsp; &nbsp; &nbsp; <td align="right">-23 &nbsp; &nbsp; &nbsp; <td align="right">- 8 &nbsp; &nbsp; &nbsp; <td align="right">+ 8 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">1</td><td align="right">0 &nbsp; &nbsp; &nbsp; <td align="right">+ 8 &nbsp; &nbsp; &nbsp; <td align="right">+8 &nbsp; &nbsp; &nbsp; <td align="right">+ 8 &nbsp; &nbsp; &nbsp; <td align="right">+ 4 &nbsp; &nbsp; &nbsp; <td align="right">- 4 &nbsp; &nbsp; &nbsp; <td align="right">+12 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="left">Av.</td><td align="right">- 4·67</td><td align="right">- 4·94</td><td align="right">- ·28</td><td align="right">- 3·06</td><td align="right">- 5·17</td><td align="right">- 2·11</td><td align="right">+ 1·83</td></tr>
+<tr><td align="left">M</td><td align="right"></td><td align="right"></td><td align="right">+ ·5 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">- 3·50</td><td align="right">+ 4·00</td></tr>
+<tr><td align="left">75%ile </td><td align="right"></td><td align="right"></td><td align="right">+2 &nbsp; &nbsp; &nbsp; <td align="right"></td><td align="right"></td><td align="right">0.00</td><td align="right">+ 6·50</td></tr>
+<tr><td align="left">25%ile</td><td align="right"></td><td align="right"></td><td align="right">-2 &nbsp; &nbsp; &nbsp; <td align="right"></td><td align="right"></td><td align="right">- 4·50</td><td align="right">- 2.00</td></tr>
+<tr><td align="left">Q</td><td align="right"></td><td align="right"></td><td align="right">2 &nbsp; &nbsp; &nbsp; <td align="right"></td><td align="right"></td><td align="right">2·25</td><td align="right">+ 4·25</td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">3 &nbsp; &nbsp; &nbsp; <td align="right"></td><td align="right"></td><td align="right">2.39</td><td align="right">+ 1·33</td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">± ·71</td><td align="right"></td><td align="right"></td><td align="right">± ·57</td><td align="right">± ·91</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av.=2·02 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M.=4·40 P. E.</td></tr>
+</table></div>
+
+<p><span class="pagenum">[Pg 40]</span></p><p>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·</p>
+
+<h3>TABLE VI</h3>
+
+<h3>Gain in Grip&mdash;6 Months&mdash; 16 Pairs</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"> N<a href="#Footnote_16_16">[16]</a></td><td align="right" colspan="3"> Test Group (A)</td><td align="right" colspan="3"> Control Group (B)</td><td align="right"></td></tr>
+<tr><td align="right"></td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right"></td></tr>
+<tr><td align="right">10</td><td align="right">12·5 &nbsp; </td><td align="right">11 &nbsp; &nbsp; &nbsp; </td><td align="right">-1·5 &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-6·5 &nbsp;</td></tr>
+<tr><td align="right">27</td><td align="right">9 &nbsp; &nbsp; &nbsp; </td><td align="right">6 &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td><td align="right">8 &nbsp; &nbsp; &nbsp; </td><td align="right">9 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">1</td><td align="right">13 &nbsp; &nbsp; &nbsp; </td><td align="right">12 &nbsp; &nbsp; &nbsp; </td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right">11 &nbsp; &nbsp; &nbsp; </td><td align="right">13 &nbsp; &nbsp; &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">14</td><td align="right">16 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right">22 &nbsp; &nbsp; &nbsp; </td><td align="right">24 &nbsp; &nbsp; &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">2</td><td align="right">9 &nbsp; &nbsp; &nbsp; </td><td align="right">9 &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; </td><td align="right">12 &nbsp; &nbsp; &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-2 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">9</td><td align="right">10·5 &nbsp; </td><td align="right">13 &nbsp; &nbsp; &nbsp; </td><td align="right">2·5 &nbsp; </td><td align="right">16·5 &nbsp; </td><td align="right">21 &nbsp; &nbsp; &nbsp; </td><td align="right">4·5 &nbsp; &nbsp; </td><td align="right">-2 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">7</td><td align="right">7 &nbsp; &nbsp; &nbsp; </td><td align="right">6·5 &nbsp; </td><td align="right">- ·5 &nbsp; </td><td align="right">9 &nbsp; &nbsp; &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-1·5 &nbsp; </td></tr>
+<tr><td align="right">16</td><td align="right">19 &nbsp; &nbsp; &nbsp; </td><td align="right">17·5 &nbsp; </td><td align="right">-1·5 &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-1·5 &nbsp; </td></tr>
+<tr><td align="right">3</td><td align="right">12·8 &nbsp; </td><td align="right">14·5 &nbsp; </td><td align="right">1·7 &nbsp; </td><td align="right">14 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">·7 &nbsp; </td></tr>
+<tr><td align="right">13</td><td align="right">26·5 &nbsp; </td><td align="right">28·5 &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; </td><td align="right">22 &nbsp; &nbsp; &nbsp; </td><td align="right">23 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">24</td><td align="right">19 &nbsp; &nbsp; &nbsp; </td><td align="right">20 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">19</td><td align="right">22 &nbsp; &nbsp; &nbsp; </td><td align="right">21 &nbsp; &nbsp; &nbsp; </td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">12 &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">22</td><td align="right">18 &nbsp; &nbsp; &nbsp; </td><td align="right">22·5 &nbsp; </td><td align="right">4·5 &nbsp; </td><td align="right">19·5 &nbsp; </td><td align="right">21·5 &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">2·5 &nbsp; </td></tr>
+<tr><td align="right">11</td><td align="right">11 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; </td><td align="right">11·5 &nbsp; </td><td align="right">11·5 &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">21</td><td align="right">16·5 &nbsp; </td><td align="right">16·5 &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; </td><td align="right">19 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">23</td><td align="right">11·5 &nbsp; </td><td align="right">15·5 &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; </td><td align="right">14·5 &nbsp; </td><td align="right">14 &nbsp; &nbsp; &nbsp; </td><td align="right">- ·5 &nbsp; &nbsp; </td><td align="right">4·5 &nbsp; </td></tr>
+<tr><td align="left">Av.</td><td align="right">14·58</td><td align="right">15·22</td><td align="right">·62</td><td align="right">14·19</td><td align="right">15·06</td><td align="right">·875</td><td align="right">- ·24</td></tr>
+<tr><td align="left">M </td><td align="right"></td><td align="right"></td><td align="right">0 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">1 &nbsp; &nbsp; &nbsp; </td><td align="right">-1·0 &nbsp; </td></tr>
+<tr><td align="left">75%ile</td><td align="right"></td><td align="right"></td><td align="right">3 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">2 &nbsp; &nbsp; &nbsp; </td><td align="right">-2·25</td></tr>
+<tr><td align="left">25%ile</td><td align="right"></td><td align="right"></td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">0 &nbsp; &nbsp; &nbsp; </td><td align="right">-2·50</td></tr>
+<tr><td align="left">Q</td><td align="right"></td><td align="right"></td><td align="right">2 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">1 &nbsp; &nbsp; &nbsp; </td><td align="right">-2·38</td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">1·58</td><td align="right"></td><td align="right"></td><td align="right">1·02</td><td align="right">-2·49</td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">±·40</td><td align="right"></td><td align="right"></td><td align="right">±·26</td><td align="right">± ·48</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">Av.= -·50 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">M.= -2·08 P. E.</td></tr>
+</table></div>
+
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 41]</span>
+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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 42]</span></p>
+
+<h3>TABLE VII</h3>
+
+<h3>Gain in number of taps in one-half minute, 21 pairs&mdash;right hand</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"> N<a href="#Footnote_16_16">[16]</a></td><td align="right" colspan="3"> Test Group (A)</td><td align="right" colspan="3"> Control Group (B)</td><td align="right"></td></tr>
+<tr><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right"></td></tr>
+<tr><td align="right">14</td><td align="right">190 &nbsp; &nbsp; &nbsp;</td><td align="right">138 &nbsp; &nbsp; &nbsp;</td><td align="right">-52 &nbsp; &nbsp; &nbsp;</td><td align="right">175 &nbsp; &nbsp; &nbsp;</td><td align="right">175 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">-52 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">10</td><td align="right">68 &nbsp; &nbsp; &nbsp;</td><td align="right">88 &nbsp; &nbsp; &nbsp;</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td><td align="right">70 &nbsp; &nbsp; &nbsp;</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">65 &nbsp; &nbsp; &nbsp;</td><td align="right">-45 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">23</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">141 &nbsp; &nbsp; &nbsp;</td><td align="right">- 9 &nbsp; &nbsp; &nbsp;</td><td align="right">122 &nbsp; &nbsp; &nbsp;</td><td align="right">140 &nbsp; &nbsp; &nbsp;</td><td align="right">18 &nbsp; &nbsp; &nbsp;</td><td align="right">-27 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">1</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">120 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td><td align="right">106 &nbsp; &nbsp; &nbsp;</td><td align="right">115 &nbsp; &nbsp; &nbsp;</td><td align="right">9 &nbsp; &nbsp; &nbsp;</td><td align="right">-24 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">9</td><td align="right">149 &nbsp; &nbsp; &nbsp;</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">-14 &nbsp; &nbsp; &nbsp;</td><td align="right">144 &nbsp; &nbsp; &nbsp;</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">6 &nbsp; &nbsp; &nbsp;</td><td align="right">-20 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">21</td><td align="right">152 &nbsp; &nbsp; &nbsp;</td><td align="right">132 &nbsp; &nbsp; &nbsp;</td><td align="right">-20 &nbsp; &nbsp; &nbsp;</td><td align="right">140 &nbsp; &nbsp; &nbsp;</td><td align="right">138 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td><td align="right">-18 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">22</td><td align="right">164 &nbsp; &nbsp; &nbsp;</td><td align="right">183 &nbsp; &nbsp; &nbsp;</td><td align="right">19 &nbsp; &nbsp; &nbsp;</td><td align="right">120 &nbsp; &nbsp; &nbsp;</td><td align="right">157 &nbsp; &nbsp; &nbsp;</td><td align="right">37 &nbsp; &nbsp; &nbsp;</td><td align="right">-18 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">24</td><td align="right">157 &nbsp; &nbsp; &nbsp;</td><td align="right">142 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td><td align="right">155 &nbsp; &nbsp; &nbsp;</td><td align="right">155 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">27</td><td align="right">108 &nbsp; &nbsp; &nbsp;</td><td align="right">97 &nbsp; &nbsp; &nbsp;</td><td align="right">-11 &nbsp; &nbsp; &nbsp;</td><td align="right">115 &nbsp; &nbsp; &nbsp;</td><td align="right">112 &nbsp; &nbsp; &nbsp;</td><td align="right">- 3 &nbsp; &nbsp; &nbsp;</td><td align="right">- 8 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">20</td><td align="right">105 &nbsp; &nbsp; &nbsp;</td><td align="right">110 &nbsp; &nbsp; &nbsp;</td><td align="right">5 &nbsp; &nbsp; &nbsp;</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">155 &nbsp; &nbsp; &nbsp;</td><td align="right">5 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">15</td><td align="right">172 &nbsp; &nbsp; &nbsp;</td><td align="right">170 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td><td align="right">140 &nbsp; &nbsp; &nbsp;</td><td align="right">137 &nbsp; &nbsp; &nbsp;</td><td align="right">- 3 &nbsp; &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">26</td><td align="right">137 &nbsp; &nbsp; &nbsp;</td><td align="right">138 &nbsp; &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td><td align="right">125 &nbsp; &nbsp; &nbsp;</td><td align="right">125 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">25</td><td align="right">140 &nbsp; &nbsp; &nbsp;</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">10 &nbsp; &nbsp; &nbsp;</td><td align="right">148 &nbsp; &nbsp; &nbsp;</td><td align="right">151 &nbsp; &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">3</td><td align="right">136 &nbsp; &nbsp; &nbsp;</td><td align="right">139 &nbsp; &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp; &nbsp;</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">129 &nbsp; &nbsp; &nbsp;</td><td align="right">- 6 &nbsp; &nbsp; &nbsp;</td><td align="right">9 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">13</td><td align="right">160 &nbsp; &nbsp; &nbsp;</td><td align="right">142 &nbsp; &nbsp; &nbsp;</td><td align="right">-18 &nbsp; &nbsp; &nbsp;</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">122 &nbsp; &nbsp; &nbsp;</td><td align="right">-28 &nbsp; &nbsp; &nbsp;</td><td align="right">10 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">18</td><td align="right">133 &nbsp; &nbsp; &nbsp;</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp; &nbsp;</td><td align="right">100 &nbsp; &nbsp; &nbsp;</td><td align="right">84 &nbsp; &nbsp; &nbsp;</td><td align="right">-16 &nbsp; &nbsp; &nbsp;</td><td align="right">18 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">28</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">162 &nbsp; &nbsp; &nbsp;</td><td align="right">12 &nbsp; &nbsp; &nbsp;</td><td align="right">178 &nbsp; &nbsp; &nbsp;</td><td align="right">170 &nbsp; &nbsp; &nbsp;</td><td align="right">- 8 &nbsp; &nbsp; &nbsp;</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">8</td><td align="right">113 &nbsp; &nbsp; &nbsp;</td><td align="right">110 &nbsp; &nbsp; &nbsp;</td><td align="right">- 3 &nbsp; &nbsp; &nbsp;</td><td align="right">131 &nbsp; &nbsp; &nbsp;</td><td align="right">101 &nbsp; &nbsp; &nbsp;</td><td align="right">-30 &nbsp; &nbsp; &nbsp;</td><td align="right">27 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">11</td><td align="right">125 &nbsp; &nbsp; &nbsp;</td><td align="right">98 &nbsp; &nbsp; &nbsp;</td><td align="right">-27 &nbsp; &nbsp; &nbsp;</td><td align="right">155 &nbsp; &nbsp; &nbsp;</td><td align="right">101 &nbsp; &nbsp; &nbsp;</td><td align="right">-54 &nbsp; &nbsp; &nbsp;</td><td align="right">27 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">2</td><td align="right">105 &nbsp; &nbsp; &nbsp;</td><td align="right">112 &nbsp; &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">152 &nbsp; &nbsp; &nbsp;</td><td align="right">114 &nbsp; &nbsp; &nbsp;</td><td align="right">-38 &nbsp; &nbsp; &nbsp;</td><td align="right">45 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">17</td><td align="right">90 &nbsp; &nbsp; &nbsp;</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">60 &nbsp; &nbsp; &nbsp;</td><td align="right">125 &nbsp; &nbsp; &nbsp;</td><td align="right">121 &nbsp; &nbsp; &nbsp;</td><td align="right">- 4 &nbsp; &nbsp; &nbsp;</td><td align="right">64 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left">Av.</td><td align="right">135·19</td><td align="right">132·95</td><td align="right">- 2·24</td><td align="right">136·47</td><td align="right">134·14</td><td align="right">- 2·33</td><td align="right">·09</td></tr>
+<tr><td align="left">M </td><td align="right"></td><td align="right"></td><td align="right">-2 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right">-2 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left" colspan="3">75%ile</td><td align="right">6·5 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right">4·5 &nbsp; </td><td align="right">16·0 &nbsp; </td></tr>
+<tr><td align="left" colspan="3">25%ile</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"> &nbsp; &nbsp; &nbsp;</td><td align="right">-14 &nbsp; &nbsp; &nbsp;</td><td align="right">19·50</td></tr>
+<tr><td align="left">Q &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right">10·75</td><td align="right"></td><td align="right"></td><td align="right">9·25</td><td align="right">17·75</td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">12·24</td><td align="right"></td><td align="right"></td><td align="right">7·33</td><td align="right">18·09</td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">2·66</td><td align="right"></td><td align="right"></td><td align="right">±1·59</td><td align="right">±3·10</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">Av.= &nbsp; ·03 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">M.= 0 &nbsp; &nbsp; &nbsp; P. E.</td></tr>
+</table></div>
+
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 43]</span></p>
+
+<h3>TABLE VIII</h3>
+
+<h3>Decrease in fatigue in tapping&mdash;Difference in rates of second half
+minute over first half minute. Sixteen pairs</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"> N<a href="#Footnote_16_16">[16]</a>]</td><td align="right" colspan="3"> Test Group (A)</td><td align="right" colspan="3"> Control Group (B)</td><td align="right"></td></tr>
+<tr><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right"></td></tr>
+<tr><td align="right">13</td><td align="right">-·03 &nbsp; </td><td align="right">·05 &nbsp; </td><td align="right">-·08 &nbsp; </td><td align="right">·27 &nbsp; </td><td align="right">-·28 &nbsp; </td><td align="right">·55 &nbsp; </td><td align="right">-·63 &nbsp; </td></tr>
+<tr><td align="right">28</td><td align="right">·01 &nbsp; </td><td align="right">·11 &nbsp; </td><td align="right">-·10 &nbsp; </td><td align="right">·17 &nbsp; </td><td align="right">·04 &nbsp; </td><td align="right">·13 &nbsp; </td><td align="right">-·23 &nbsp; </td></tr>
+<tr><td align="right">20</td><td align="right">·10 &nbsp; </td><td align="right">·15 &nbsp; </td><td align="right">-·05 &nbsp; </td><td align="right">·20 &nbsp; </td><td align="right">·04 &nbsp; </td><td align="right">·16 &nbsp; </td><td align="right">-·21 &nbsp; </td></tr>
+<tr><td align="right">10</td><td align="right">-·09 &nbsp; </td><td align="right">·07 &nbsp; </td><td align="right">-·16 &nbsp; </td><td align="right">·23 &nbsp; </td><td align="right">·19 &nbsp; </td><td align="right">·04 &nbsp; </td><td align="right">-·20 &nbsp; </td></tr>
+<tr><td align="right">17</td><td align="right">·01 &nbsp; </td><td align="right">·33 &nbsp; </td><td align="right">-·32 &nbsp; </td><td align="right">·07 &nbsp; </td><td align="right">·20 &nbsp; </td><td align="right">-·13 &nbsp; </td><td align="right">-·19 &nbsp; </td></tr>
+<tr><td align="right">25</td><td align="right">·09 &nbsp; </td><td align="right">·21 &nbsp; </td><td align="right">-·12 &nbsp; </td><td align="right">·09 &nbsp; </td><td align="right">·11 &nbsp; </td><td align="right">-·02 &nbsp; </td><td align="right">-·10 &nbsp; </td></tr>
+<tr><td align="right">11</td><td align="right">·28 &nbsp; </td><td align="right">·11 &nbsp; </td><td align="right">·17 &nbsp; </td><td align="right">·19 &nbsp; </td><td align="right">-·06 &nbsp; </td><td align="right">·25 &nbsp; </td><td align="right">-·08 &nbsp; </td></tr>
+<tr><td align="right">15</td><td align="right">·03 &nbsp; </td><td align="right">·08 &nbsp; </td><td align="right">-·05 &nbsp; </td><td align="right">·18 &nbsp; </td><td align="right">·16 &nbsp; </td><td align="right">·02 &nbsp; </td><td align="right">-·07 &nbsp; </td></tr>
+<tr><td align="right">22</td><td align="right">·10 &nbsp; </td><td align="right">·23 &nbsp; </td><td align="right">-·13 &nbsp; </td><td align="right">·03 &nbsp; </td><td align="right">·19 &nbsp; </td><td align="right">-·16 &nbsp; </td><td align="right">·03 &nbsp; </td></tr>
+<tr><td align="right">27</td><td align="right">·15 &nbsp; </td><td align="right">·05 &nbsp; </td><td align="right">·10 &nbsp; </td><td align="right">·09 &nbsp; </td><td align="right">·03 &nbsp; </td><td align="right">·06 &nbsp; </td><td align="right">·04 &nbsp; </td></tr>
+<tr><td align="right">14</td><td align="right">·09 &nbsp; </td><td align="right">·06 &nbsp; </td><td align="right">·03 &nbsp; </td><td align="right">·02 &nbsp; </td><td align="right">·06 &nbsp; </td><td align="right">-·04 &nbsp; </td><td align="right">·07 &nbsp; </td></tr>
+<tr><td align="right">18</td><td align="right">·14 &nbsp; </td><td align="right">·18 &nbsp; </td><td align="right">-·04 &nbsp; </td><td align="right">·01 &nbsp; </td><td align="right">·12 &nbsp; </td><td align="right">-·11 &nbsp; </td><td align="right">·07 &nbsp; </td></tr>
+<tr><td align="right">24</td><td align="right">·13 &nbsp; </td><td align="right">·11 &nbsp; </td><td align="right">·02 &nbsp; </td><td align="right">·13 &nbsp; </td><td align="right">·35 &nbsp; </td><td align="right">-·22 &nbsp; </td><td align="right">·24 &nbsp; </td></tr>
+<tr><td align="right">26</td><td align="right">·18 &nbsp; </td><td align="right">·15 &nbsp; </td><td align="right">·03 &nbsp; </td><td align="right">·16 &nbsp; </td><td align="right">·37 &nbsp; </td><td align="right">-·21 &nbsp; </td><td align="right">·24 &nbsp; </td></tr>
+<tr><td align="right">23</td><td align="right">·21 &nbsp; </td><td align="right">·04 &nbsp; </td><td align="right">·17 &nbsp; </td><td align="right">·06 &nbsp; </td><td align="right">·21 &nbsp; </td><td align="right">-·15 &nbsp; </td><td align="right">·32 &nbsp; </td></tr>
+<tr><td align="right">21</td><td align="right">·27 &nbsp; </td><td align="right">·05 &nbsp; </td><td align="right">·22 &nbsp; </td><td align="right">·03 &nbsp; </td><td align="right">·20 &nbsp; </td><td align="right">-·17 &nbsp; </td><td align="right">·39 &nbsp; </td></tr>
+<tr><td align="left">Av.</td><td align="right">·104</td><td align="right">·124</td><td align="right">-·020</td><td align="right">·121</td><td align="right">·121</td><td align="right">·0 &nbsp; &nbsp; </td><td align="right">-·020</td></tr>
+<tr><td align="left">M </td><td align="right"></td><td align="right"></td><td align="right">·045</td><td align="right"></td><td align="right"></td><td align="right">-·03 &nbsp; </td><td align="right">-0·015</td></tr>
+<tr><td align="left" colspan="3">75%ile</td><td align="right">+·03 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">+·04 &nbsp; </td><td align="right">·07 &nbsp; </td></tr>
+<tr><td align="left" colspan="3">25%ile</td><td align="right">-·12 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">-·16 &nbsp; </td><td align="right">-·20 &nbsp; </td></tr>
+<tr><td align="left">Q</td><td align="right"></td><td align="right"></td><td align="right">·075</td><td align="right"></td><td align="right"></td><td align="right">·10 &nbsp; </td><td align="right">·135</td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">·09 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">·11 &nbsp; </td><td align="right">·05 &nbsp; </td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">±·02 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">±·03 &nbsp; </td><td align="right">±·04 &nbsp; </td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">Av.= -·50 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">M.= -·38 P. E.</td></tr>
+</table></div>
+
+<p>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:&mdash;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.</p>
+
+<p>This question presents itself:&mdash;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.<span class="pagenum">[Pg 44]</span>
+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 Ï = 1 - ((6ΣD_n) /( n(n²-1))) where f = 2 sin (Π/6)Ï. 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.</p>
+
+<h3>TABLE IX</h3>
+
+<h3>Improvement in I.Q., 28 Pairs</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"> N<a href="#Footnote_16_16">[16]</a></td><td align="right" colspan="3"> Test Group (A)</td><td align="right" colspan="3"> Control Group (B)</td><td align="right"></td></tr>
+<tr><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right"></td></tr>
+<tr><td align="right">27</td><td align="right">110 &nbsp; &nbsp; &nbsp; </td><td align="right">109 &nbsp; &nbsp; &nbsp; </td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right">72 &nbsp; &nbsp; &nbsp; </td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">24 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-25 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">20</td><td align="right">106 &nbsp; &nbsp; &nbsp; </td><td align="right">102 &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; </td><td align="right">118 &nbsp; &nbsp; &nbsp; </td><td align="right">131 &nbsp; &nbsp; &nbsp; </td><td align="right">13 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-17 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">8</td><td align="right">91 &nbsp; &nbsp; &nbsp; </td><td align="right">86 &nbsp; &nbsp; &nbsp; </td><td align="right">-5 &nbsp; &nbsp; &nbsp; </td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">104 &nbsp; &nbsp; &nbsp; </td><td align="right">6 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-11 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">24</td><td align="right">131 &nbsp; &nbsp; &nbsp; </td><td align="right">124 &nbsp; &nbsp; &nbsp; </td><td align="right">-7 &nbsp; &nbsp; &nbsp; </td><td align="right">89 &nbsp; &nbsp; &nbsp; </td><td align="right">92 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-10 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">21</td><td align="right">64 &nbsp; &nbsp; &nbsp; </td><td align="right">67 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; </td><td align="right">86 &nbsp; &nbsp; &nbsp; </td><td align="right">97 &nbsp; &nbsp; &nbsp; </td><td align="right">11 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-8 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">3</td><td align="right">94 &nbsp; &nbsp; &nbsp; </td><td align="right">91 &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td><td align="right">82 &nbsp; &nbsp; &nbsp; </td><td align="right">85 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-6 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">12</td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">95 &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">101 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-6 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">23</td><td align="right">85 &nbsp; &nbsp; &nbsp; </td><td align="right">94 &nbsp; &nbsp; &nbsp; </td><td align="right">9 &nbsp; &nbsp; &nbsp; </td><td align="right">81 &nbsp; &nbsp; &nbsp; </td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-6 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">11</td><td align="right">103 &nbsp; &nbsp; &nbsp; </td><td align="right">100 &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td><td align="right">101 &nbsp; &nbsp; &nbsp; </td><td align="right">102 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">15</td><td align="right">97 &nbsp; &nbsp; &nbsp; </td><td align="right">94 &nbsp; &nbsp; &nbsp; </td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td><td align="right">78 &nbsp; &nbsp; &nbsp; </td><td align="right">79 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">18</td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; </td><td align="right">90 &nbsp; &nbsp; &nbsp; </td><td align="right">94 &nbsp; &nbsp; &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">4</td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; </td><td align="right">83 &nbsp; &nbsp; &nbsp; </td><td align="right">85 &nbsp; &nbsp; &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-2 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">26</td><td align="right">80 &nbsp; &nbsp; &nbsp; </td><td align="right">76 &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; </td><td align="right">90 &nbsp; &nbsp; &nbsp; </td><td align="right">88 &nbsp; &nbsp; &nbsp; </td><td align="right">-2 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">-2 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">16</td><td align="right">65 &nbsp; &nbsp; &nbsp; </td><td align="right">73 &nbsp; &nbsp; &nbsp; </td><td align="right">8 &nbsp; &nbsp; &nbsp; </td><td align="right">74 &nbsp; &nbsp; &nbsp; </td><td align="right">82 &nbsp; &nbsp; &nbsp; </td><td align="right">8 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">28</td><td align="right">81 &nbsp; &nbsp; &nbsp; </td><td align="right">84 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; </td><td align="right">95 &nbsp; &nbsp; &nbsp; </td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">5</td><td align="right">95 &nbsp; &nbsp; &nbsp; </td><td align="right">99 &nbsp; &nbsp; &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; </td><td align="right">114 &nbsp; &nbsp; &nbsp; </td><td align="right">117 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">2</td><td align="right">107 &nbsp; &nbsp; &nbsp; </td><td align="right">114 &nbsp; &nbsp; &nbsp; </td><td align="right">7 &nbsp; &nbsp; &nbsp; </td><td align="right">91 &nbsp; &nbsp; &nbsp; </td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">2 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">10</td><td align="right">110 &nbsp; &nbsp; &nbsp; </td><td align="right">109 &nbsp; &nbsp; &nbsp; </td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right">104 &nbsp; &nbsp; &nbsp; </td><td align="right">100 &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">17</td><td align="right">71 &nbsp; &nbsp; &nbsp; </td><td align="right">77 &nbsp; &nbsp; &nbsp; </td><td align="right">6 &nbsp; &nbsp; &nbsp; </td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">99 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">7</td><td align="right">91 &nbsp; &nbsp; &nbsp; </td><td align="right">99 &nbsp; &nbsp; &nbsp; </td><td align="right">8 &nbsp; &nbsp; &nbsp; </td><td align="right">95 &nbsp; &nbsp; &nbsp; </td><td align="right">99 &nbsp; &nbsp; &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">1</td><td align="right">82 &nbsp; &nbsp; &nbsp; </td><td align="right">83 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; </td><td align="right">80 &nbsp; &nbsp; &nbsp; </td><td align="right">76 &nbsp; &nbsp; &nbsp; </td><td align="right">-4 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">6</td><td align="right">95 &nbsp; &nbsp; &nbsp; </td><td align="right">101 &nbsp; &nbsp; &nbsp; </td><td align="right">6 &nbsp; &nbsp; &nbsp; </td><td align="right">88 &nbsp; &nbsp; &nbsp; </td><td align="right">89 &nbsp; &nbsp; &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">19</td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">101 &nbsp; &nbsp; &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; </td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">98 &nbsp; &nbsp; &nbsp; </td><td align="right">0 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">9</td><td align="right">83 &nbsp; &nbsp; &nbsp; </td><td align="right">93 &nbsp; &nbsp; &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; </td><td align="right">87 &nbsp; &nbsp; &nbsp; </td><td align="right">90 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">7 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">25</td><td align="right">77 &nbsp; &nbsp; &nbsp; </td><td align="right">76 &nbsp; &nbsp; &nbsp; </td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right">145 &nbsp; &nbsp; &nbsp; </td><td align="right">137 &nbsp; &nbsp; &nbsp; </td><td align="right">-8 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">7 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">13</td><td align="right">70 &nbsp; &nbsp; &nbsp; </td><td align="right">78 &nbsp; &nbsp; &nbsp; </td><td align="right">8 &nbsp; &nbsp; &nbsp; </td><td align="right">66 &nbsp; &nbsp; &nbsp; </td><td align="right">64 &nbsp; &nbsp; &nbsp; </td><td align="right">-2 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">22</td><td align="right">91 &nbsp; &nbsp; &nbsp; </td><td align="right">100 &nbsp; &nbsp; &nbsp; </td><td align="right">9 &nbsp; &nbsp; &nbsp; </td><td align="right">63 &nbsp; &nbsp; &nbsp; </td><td align="right">62 &nbsp; &nbsp; &nbsp; </td><td align="right">-1 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">10 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">14</td><td align="right">96 &nbsp; &nbsp; &nbsp; </td><td align="right">107 &nbsp; &nbsp; &nbsp; </td><td align="right">11 &nbsp; &nbsp; &nbsp; </td><td align="right">140 &nbsp; &nbsp; &nbsp; </td><td align="right">137 &nbsp; &nbsp; &nbsp; </td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td><td align="right">14 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="left">Av.</td><td align="right">91·53</td><td align="right">93·78</td><td align="right">2·25</td><td align="right">92·93</td><td align="right">96·21</td><td align="right">3·285</td><td align="right">-1·035</td></tr>
+<tr><td align="left">M </td><td align="right"></td><td align="right"></td><td align="right">2 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">-1 &nbsp; &nbsp; &nbsp; </td><td align="right">-0·015</td></tr>
+<tr><td align="left" colspan="3">75%ile</td><td align="right">7 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">+·04 &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="left" colspan="3">25%ile</td><td align="right">-3 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">-·16 &nbsp; </td><td align="right">-6 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="left">Q</td><td align="right"></td><td align="right"></td><td align="right">5 &nbsp; &nbsp; &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">2·5 &nbsp; &nbsp;</td><td align="right">5·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">5·25</td><td align="right"></td><td align="right"></td><td align="right">2·5 &nbsp; &nbsp; </td><td align="right">5 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">±·99</td><td align="right"></td><td align="right"></td><td align="right">±·47&nbsp; </td><td align="right">±1·10&nbsp; </td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">Av.= -·94 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">M.= -·99 P. E.</td></tr>
+</table></div>
+
+<p><span class="pagenum">[Pg 45]</span></p>
+<h3>TABLE X</h3>
+
+<h3>Improvement in Performance of Healy Test, 24 Pairs</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"> N<a href="#Footnote_16_16">[16]</a></td><td align="right" colspan="3"> Test Group (A)</td><td align="right" colspan="3"> Control Group (B)</td><td align="right"></td></tr>
+<tr><td align="right"></td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right">Test 1</td><td align="right">Test 2</td><td align="right">Gain</td><td align="right"></td></tr>
+<tr><td align="right">7</td><td align="right">- 6 &nbsp; &nbsp; &nbsp;</td><td align="right">-28 &nbsp; &nbsp; &nbsp;</td><td align="right">-22 &nbsp; &nbsp; &nbsp;</td><td align="right">4·5 &nbsp; &nbsp; &nbsp;</td><td align="right">27·5 &nbsp; </td><td align="right">23 &nbsp; &nbsp; &nbsp;</td><td align="right">-45 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">13</td><td align="right">43 &nbsp; &nbsp; &nbsp;</td><td align="right">42 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1·5 &nbsp; </td><td align="right">30·5 &nbsp;</td><td align="right">-32 &nbsp; &nbsp; &nbsp;</td><td align="right">-33 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">17</td><td align="right">29·5 &nbsp; </td><td align="right">12 &nbsp; &nbsp; &nbsp;</td><td align="right">17·5 &nbsp; </td><td align="right">1·5 &nbsp; </td><td align="right">15 &nbsp; &nbsp; &nbsp;</td><td align="right">- 13·5 &nbsp; </td><td align="right">-31 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">15</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">25 &nbsp; &nbsp; &nbsp;</td><td align="right">18 &nbsp; &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td><td align="right">42·5 &nbsp; </td><td align="right">41·5 &nbsp; </td><td align="right">23·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right">26</td><td align="right">22·5 &nbsp;</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">-15·5 &nbsp; </td><td align="right">56 &nbsp; &nbsp; &nbsp;</td><td align="right">61·5 &nbsp; </td><td align="right">5·5 &nbsp; </td><td align="right">-21·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right">10</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td><td align="right">6·5 &nbsp; </td><td align="right">18·5 &nbsp; </td><td align="right">27 &nbsp; &nbsp; &nbsp;</td><td align="right">65 &nbsp; &nbsp; &nbsp;</td><td align="right">38 &nbsp; &nbsp; &nbsp;</td><td align="right">-19·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right">19</td><td align="right">57·5 &nbsp; </td><td align="right">49 &nbsp; &nbsp; &nbsp;</td><td align="right">- 8·5 &nbsp; </td><td align="right">-22 &nbsp; &nbsp; &nbsp;</td><td align="right">-11 &nbsp; &nbsp; &nbsp;</td><td align="right">11 &nbsp; &nbsp; &nbsp;</td><td align="right">-19·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right">24</td><td align="right">54·5 &nbsp; </td><td align="right">63 &nbsp; &nbsp; &nbsp;</td><td align="right">8·5 &nbsp; </td><td align="right">31·5 &nbsp; </td><td align="right">59·5 &nbsp; </td><td align="right">28 &nbsp; &nbsp; &nbsp;</td><td align="right">-19·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right">20</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">-11 &nbsp; &nbsp; &nbsp;</td><td align="right">-11 &nbsp; &nbsp; &nbsp;</td><td align="right">30 &nbsp; &nbsp; &nbsp;</td><td align="right">35 &nbsp; &nbsp; &nbsp;</td><td align="right">5 &nbsp; &nbsp; &nbsp;</td><td align="right">-16 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">9</td><td align="right">3·5 &nbsp; </td><td align="right">10·5 &nbsp; </td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">34 &nbsp; &nbsp; &nbsp;</td><td align="right">55 &nbsp; &nbsp; &nbsp;</td><td align="right">21 &nbsp; &nbsp; &nbsp;</td><td align="right">-14 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">11</td><td align="right">-8 &nbsp; &nbsp; &nbsp;</td><td align="right">6 &nbsp; &nbsp; &nbsp;</td><td align="right">14 &nbsp; &nbsp; &nbsp;</td><td align="right">-29 &nbsp; &nbsp; &nbsp;</td><td align="right">-3·5 &nbsp; </td><td align="right">25·5 &nbsp; </td><td align="right">-11·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right">16</td><td align="right">49 &nbsp; &nbsp; &nbsp;</td><td align="right">47·5 &nbsp; </td><td align="right">- 1·5 &nbsp; </td><td align="right">30 &nbsp; &nbsp; &nbsp;</td><td align="right">37 &nbsp; &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">- 8·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right">1</td><td align="right">-25 &nbsp; &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp; &nbsp;</td><td align="right">27 &nbsp; &nbsp; &nbsp;</td><td align="right">-50 &nbsp; &nbsp; &nbsp;</td><td align="right">-16 &nbsp; &nbsp; &nbsp;</td><td align="right">34 &nbsp; &nbsp; &nbsp;</td><td align="right">- 7 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">22</td><td align="right">48·5 &nbsp; </td><td align="right">43·5 &nbsp; </td><td align="right">- 5</td><td align="right">34·5 &nbsp; </td><td align="right">33·5 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1 &nbsp; &nbsp; &nbsp;</td><td align="right">- 4 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="right">18</td><td align="right">-13·5 &nbsp; </td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td><td align="right">1·5 &nbsp; </td><td align="right">-32 &nbsp; &nbsp; &nbsp;</td><td align="right">-28 &nbsp; &nbsp; &nbsp;</td><td align="right">4 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="right">23</td><td align="right">49·5 &nbsp; </td><td align="right">68 &nbsp; &nbsp; &nbsp;</td><td align="right">18·5 &nbsp; </td><td align="right">4 &nbsp; &nbsp; &nbsp;</td><td align="right">25 &nbsp; &nbsp; &nbsp;</td><td align="right">21 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="right">3</td><td align="right">21·5 &nbsp; </td><td align="right">22·5 &nbsp; </td><td align="right">1 &nbsp; &nbsp; &nbsp;</td><td align="right">17 &nbsp; &nbsp; &nbsp;</td><td align="right">19 &nbsp; &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">12</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td><td align="right">21 &nbsp; &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td><td align="right">-10 &nbsp; &nbsp; &nbsp;</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">14</td><td align="right">12·5 &nbsp; </td><td align="right">48·5 &nbsp; </td><td align="right">36 &nbsp; &nbsp; &nbsp;</td><td align="right">- 5 &nbsp; &nbsp; &nbsp;</td><td align="right">25·5 &nbsp; </td><td align="right">30·5 &nbsp; </td><td align="right">6·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="right">27</td><td align="right">-25 &nbsp; &nbsp; &nbsp;</td><td align="right">15 &nbsp; &nbsp; &nbsp;</td><td align="right">40 &nbsp; &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp; &nbsp;</td><td align="right">27·5 &nbsp; </td><td align="right">25·5 &nbsp; </td><td align="right">14·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="right">2</td><td align="right">28·5 &nbsp; </td><td align="right">30 &nbsp; &nbsp; &nbsp;</td><td align="right">1·5 &nbsp; </td><td align="right">3</td><td align="right">-11 &nbsp; &nbsp; &nbsp;</td><td align="right">-14 &nbsp; &nbsp; &nbsp;</td><td align="right">15·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="right">25</td><td align="right">8 &nbsp; &nbsp; &nbsp;</td><td align="right">25 &nbsp; &nbsp; &nbsp;</td><td align="right">17 &nbsp; &nbsp; &nbsp;</td><td align="right">29·5 &nbsp; </td><td align="right">29 &nbsp; &nbsp; &nbsp;</td><td align="right">-·5 &nbsp; </td><td align="right">17·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="right">21</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td><td align="right">32 &nbsp; &nbsp; &nbsp;</td><td align="right">12 &nbsp; &nbsp; &nbsp;</td><td align="right">70·5 &nbsp; </td><td align="right">58·5 &nbsp; </td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td><td align="right">24 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right">28</td><td align="right">29·5 &nbsp; </td><td align="right">73·5 &nbsp; </td><td align="right">44 &nbsp; &nbsp; &nbsp;</td><td align="right">64·5 &nbsp; </td><td align="right">51·5 &nbsp; </td><td align="right">-13 &nbsp; &nbsp; &nbsp;</td><td align="right">57 &nbsp; &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left">Av.</td><td align="right">17·29</td><td align="right">24·94</td><td align="right">7·64</td><td align="right">12·12</td><td align="right">25·69</td><td align="right">13·56</td><td align="right">- 5·85 &nbsp; </td></tr>
+<tr><td align="left">M </td><td align="right"></td><td align="right"></td><td align="right">4.25</td><td align="right"></td><td align="right"></td><td align="right">- 7·75</td><td align="right">-0·015</td></tr>
+<tr><td align="left" colspan="3">75%ile</td><td align="right">18 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right">+·04</td><td align="right">3 &nbsp; &nbsp; &nbsp; &nbsp; </td></tr>
+<tr><td align="left" colspan="3">25%ile</td><td align="right">-5 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right">-·16</td><td align="right">-19·5 &nbsp; &nbsp; </td></tr>
+<tr><td align="left">Q</td><td align="right"></td><td align="right"></td><td align="right">11·5 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">13 &nbsp; &nbsp; &nbsp; &nbsp;</td><td align="right">11·25</td></tr>
+<tr><td align="left" colspan="3">P. E. (distribution)</td><td align="right">10·6 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right">10·56</td><td align="right">13·65 &nbsp; </td></tr>
+<tr><td align="left" colspan="3">P. E. (average)</td><td align="right">±2·16</td><td align="right"></td><td align="right"></td><td align="right">± 2·16</td><td align="right">± 3·05 &nbsp; </td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">Av.= -1·92 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2">M.= -2·54 P. E.</td></tr>
+</table></div>
+
+<p>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<span class="pagenum">[Pg 46]</span>
+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.</p>
+
+<h3>TABLE XI</h3>
+
+<h3>Showing percentile ratings of the members of the two groups at the
+beginning and end of the six months' interval</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center" colspan="2">Weight</td><td align="center" colspan="2"> Height</td><td align="center" colspan="2"> Grip</td><td align="center" colspan="2"> Tapping</td></tr>
+<tr><td align="left"> 1</td><td align="right">·29</td><td align="right"> ·44</td><td align="right"> ·25</td><td align="right"> ·40</td><td align="right"> ·47</td><td align="right"> ·40</td><td align="right"> ·51</td><td align="right"> ·33</td></tr>
+<tr><td align="left"> 1C</td><td align="right">·43</td><td align="right">·54</td><td align="right"> ·27</td><td align="right">·45</td><td align="right"> ·33</td><td align="right"> ·47</td><td align="right">·17</td><td align="right">·30</td></tr>
+<tr><td align="left"> 2</td><td align="right">·04</td><td align="right"> ·10</td><td align="right"> ·04</td><td align="right"> ·11</td><td align="right"> ·16</td><td align="right">·16</td><td align="right"> ·16</td><td align="right"> ·25</td></tr>
+<tr><td align="left"> 2C</td><td align="right">·38</td><td align="right"> ·55</td><td align="right"> ·20</td><td align="right"> ·32</td><td align="right">·25</td><td align="right"> ·40</td><td align="right"> ·80</td><td align="right"> ·28</td></tr>
+<tr><td align="left"> 3</td><td align="right">·46</td><td align="right">·59</td><td align="right">·32</td><td align="right">·49</td><td align="right"> ·44</td><td align="right"> ·56</td><td align="right"> ·52</td><td align="right">·58</td></tr>
+<tr><td align="left"> 3C</td><td align="right">·65</td><td align="right"> ·69</td><td align="right"> ·74</td><td align="right"> ·81</td><td align="right"> ·54</td><td align="right">·67</td><td align="right">·51</td><td align="right"> ·42</td></tr>
+<tr><td align="left"> 4</td><td align="right">·33</td><td align="right"> ·44</td><td align="right"> ·39</td><td align="right"> ·52</td><td align="right"> ·16</td><td align="right"></td><td align="right"> ·13</td><td align="right"></td></tr>
+<tr><td align="left"> 4C</td><td align="right">·27</td><td align="right">·32</td><td align="right"> ·51</td><td align="right">·78</td><td align="right">·18</td><td align="right"></td><td align="right"> ·19</td><td align="right"></td></tr>
+<tr><td align="left"> 5</td><td align="right">·16</td><td align="right"> ·20</td><td align="right">·18</td><td align="right"> ·20</td><td align="right"> ·33</td><td align="right"></td><td align="right"> ·23</td></tr>
+<tr><td align="left"> 5C</td><td align="right">·50</td><td align="right"> ·53</td><td align="right"> ·28</td><td align="right"> ·47</td><td align="right"> ·40</td><td align="right"></td><td align="right"> ·87</td></tr>
+<tr><td align="left"> 6</td><td align="right">·12</td><td align="right">·15</td><td align="right"> ·06</td><td align="right">·10</td><td align="right"> ·10</td><td align="right"></td><td align="right"> ·23</td></tr>
+<tr><td align="left"> 6C</td><td align="right">·31</td><td align="right"> ·40</td><td align="right"> ·22</td><td align="right"> ·38</td><td align="right">·27</td><td align="right"></td><td align="right"> ·41</td></tr>
+<tr><td align="left"> 7</td><td align="right">·03</td><td align="right"> ·07</td><td align="right">·05</td><td align="right"> ·15</td><td align="right"> ·07</td><td align="right"> ·06</td><td align="right"> ·40</td><td align="right"> ·27</td></tr>
+<tr><td align="left"> 7C</td><td align="right">·01</td><td align="right">·02</td><td align="right"> ·03</td><td align="right">·07</td><td align="right"> ·16</td><td align="right"> ·24</td><td align="right"> ·16</td><td align="right"></td></tr>
+<tr><td align="left"> 8</td><td align="right">·62</td><td align="right"> ·71</td><td align="right"> ·63</td><td align="right"> ·75</td><td align="right"> ·24</td><td align="right"></td><td align="right"> ·27</td><td align="right">·23</td></tr>
+<tr><td align="left"> 8C</td><td align="right">·18</td><td align="right"> ·37</td><td align="right"> ·31</td><td align="right"> ·40</td><td align="right">·67</td><td align="right"> ·72</td><td align="right"> ·43</td><td align="right"> ·11</td></tr>
+<tr><td align="left"> 9</td><td align="right">·31</td><td align="right">·41</td><td align="right">·47</td><td align="right">·53</td><td align="right"> ·26</td><td align="right"> ·47</td><td align="right">·71</td><td align="right"> ·51</td></tr>
+<tr><td align="left"> 9C</td><td align="right">·60</td><td align="right"> ·65</td><td align="right"> ·76</td><td align="right"> ·89</td><td align="right"> ·76</td><td align="right">·89</td><td align="right"> ·63</td><td align="right">·78</td></tr>
+<tr><td align="left"> 10</td><td align="right">·26</td><td align="right"> ·35</td><td align="right"> ·26</td><td align="right"> ·43</td><td align="right"> ·44</td><td align="right"> ·33</td><td align="right"> ·01</td><td align="right"> ·04</td></tr>
+<tr><td align="left"> 10C</td><td align="right">·21</td><td align="right">·22</td><td align="right"> ·23</td><td align="right">·37</td><td align="right">·24</td><td align="right"> ·67</td><td align="right"> ·02</td><td align="right"> ·51</td></tr>
+<tr><td align="left"> 11</td><td align="right">·24</td><td align="right"> ·23</td><td align="right">·25</td><td align="right"> ·43</td><td align="right"> ·33</td><td align="right">·67</td><td align="right">·40</td><td align="right">·08</td></tr>
+<tr><td align="left"> 11C</td><td align="right">·08</td><td align="right"> ·09</td><td align="right"> ·09</td><td align="right"> ·17</td><td align="right"> ·36</td><td align="right"> ·36</td><td align="right"> ·86</td><td align="right"> ·11</td></tr>
+<tr><td align="left"> 12</td><td align="right">·25</td><td align="right">·40</td><td align="right"> ·15</td><td align="right"></td><td align="right"> ·53</td><td align="right"></td><td align="right"> ·08</td><td align="right"></td></tr>
+<tr><td align="left"> 12C</td><td align="right">·06</td><td align="right"> ·15</td><td align="right"> ·02</td><td align="right"> ·08</td><td align="right"> ·04</td><td align="right"> ·01</td><td align="right"> ·12</td><td align="right">·03</td></tr>
+<tr><td align="left"> 13</td><td align="right">·95</td><td align="right">1·00</td><td align="right">·99</td><td align="right">1·00</td><td align="right">·99</td><td align="right">1·00</td><td align="right"> ·90</td><td align="right"> ·66</td></tr>
+<tr><td align="left"> 13C</td><td align="right">·87</td><td align="right">·89</td><td align="right">·93</td><td align="right">·96</td><td align="right"> ·94</td><td align="right">·96</td><td align="right">·78</td><td align="right"> ·36<span class="pagenum">[Pg 47]</span></td></tr>
+<tr><td align="left"> 14</td><td align="right">·49</td><td align="right">·66</td><td align="right">·67</td><td align="right">·74</td><td align="right"> ·72</td><td align="right">·67</td><td align="right"> 1·00</td><td align="right"> ·57</td></tr>
+<tr><td align="left"> 14C</td><td align="right">·92</td><td align="right"> ·93</td><td align="right"> ·96</td><td align="right"> ·98</td><td align="right"> ·93</td><td align="right"> ·98</td><td align="right"> ·97</td><td align="right">·97</td></tr>
+<tr><td align="left"> 15</td><td align="right">·56</td><td align="right"></td><td align="right"> ·68</td><td align="right"></td><td align="right"> ·70</td><td align="right"></td><td align="right"> ·95</td><td align="right"> ·94</td></tr>
+<tr><td align="left"> 15C</td><td align="right">·79</td><td align="right">·80</td><td align="right"> ·59</td><td align="right"> ·66</td><td align="right">·67</td><td align="right"> ·70</td><td align="right"> ·62</td><td align="right"> ·54</td></tr>
+<tr><td align="left"> 16</td><td align="right">·49</td><td align="right">·53</td><td align="right"> ·74</td><td align="right"> ·79</td><td align="right"> ·81</td><td align="right"> ·77</td><td align="right">·69</td></tr>
+<tr><td align="left"> 16C</td><td align="right">·34</td><td align="right">·28</td><td align="right">·50</td><td align="right">·54</td><td align="right"> ·24</td><td align="right">·24</td><td align="right"> ·69</td><td align="right"> ·51</td></tr>
+<tr><td align="left"> 17</td><td align="right">·53</td><td align="right"></td><td align="right"> ·50</td><td align="right"></td><td align="right"> ·53</td><td align="right"></td><td align="right"> ·05</td><td align="right"> ·78</td></tr>
+<tr><td align="left"> 17C</td><td align="right">·17</td><td align="right"></td><td align="right"> ·15</td><td align="right"></td><td align="right"> ·24</td><td align="right"> ·11</td><td align="right"> ·40</td><td align="right">·34</td></tr>
+<tr><td align="left"> 18</td><td align="right">·57</td><td align="right"></td><td align="right"> ·38</td><td align="right"></td><td align="right"> ·33</td><td align="right"></td><td align="right"> ·45</td><td align="right"> ·51</td></tr>
+<tr><td align="left"> 18C</td><td align="right">·17</td><td align="right">·20</td><td align="right">·30</td><td align="right">·34</td><td align="right"> ·10</td><td align="right"> ·06</td><td align="right"> ·09</td><td align="right"> ·03</td></tr>
+<tr><td align="left"> 19</td><td align="right">·95</td><td align="right"> ·99</td><td align="right"> ·94</td><td align="right"> ·98</td><td align="right">·94</td><td align="right"> ·88</td><td align="right">·93</td><td align="right"></td></tr>
+<tr><td align="left"> 19</td><td align="right">·38</td><td align="right"> ·45</td><td align="right"> ·30</td><td align="right"> ·37</td><td align="right"> ·67</td><td align="right">·40</td><td align="right"> ·09</td><td align="right"> ·31</td></tr>
+<tr><td align="left"> 20</td><td align="right">·13</td><td align="right"></td><td align="right"> ·37</td><td align="right"></td><td align="right"> ·33</td><td align="right"></td><td align="right"> ·16</td><td align="right"> ·23</td></tr>
+<tr><td align="left"> 20C</td><td align="right">·63</td><td align="right"> ·75</td><td align="right"> ·56</td><td align="right"> ·88</td><td align="right"> ·67</td><td align="right"> ·44</td><td align="right"> ·78</td><td align="right">·86</td></tr>
+<tr><td align="left"> 21</td><td align="right">·83</td><td align="right"> ·89</td><td align="right">·84</td><td align="right"></td><td align="right"> ·76</td><td align="right"> ·76</td><td align="right"> ·80</td><td align="right"> ·44</td></tr>
+<tr><td align="left"> 21C</td><td align="right">·67</td><td align="right">·77</td><td align="right"> ·55</td><td align="right"> ·61</td><td align="right"> ·81</td><td align="right">·67</td><td align="right">·62</td><td align="right"> ·57</td></tr>
+<tr><td align="left"> 22</td><td align="right">·85</td><td align="right"></td><td align="right"> ·81</td><td align="right"> ·91</td><td align="right">·78</td><td align="right"> ·95</td><td align="right"> ·92</td><td align="right">·99</td></tr>
+<tr><td align="left"> 22C</td><td align="right">·83</td><td align="right"> ·92</td><td align="right"> ·93</td><td align="right">·97</td><td align="right"> ·82</td><td align="right"> ·91</td><td align="right"> ·33</td><td align="right"> ·89</td></tr>
+<tr><td align="left"> 23</td><td align="right">·36</td><td align="right"></td><td align="right"> ·45</td><td align="right"></td><td align="right"> ·36</td><td align="right">·70</td><td align="right"> ·78</td><td align="right"> ·63</td></tr>
+<tr><td align="left"> 23C</td><td align="right">·73</td><td align="right"> ·74</td><td align="right"> ·70</td><td align="right"> ·82</td><td align="right"> ·55</td><td align="right"> ·53</td><td align="right">·36</td><td align="right">·62</td></tr>
+<tr><td align="left"> 24</td><td align="right">·59</td><td align="right"> ·69</td><td align="right">·67</td><td align="right"></td><td align="right"> ·81</td><td align="right"> ·85</td><td align="right"> ·89</td><td align="right"> ·66</td></tr>
+<tr><td align="left"> 24C</td><td align="right">·62</td><td align="right">·63</td><td align="right"> ·59</td><td align="right"> ·71</td><td align="right"> ·67</td><td align="right">·67</td><td align="right"> ·86</td><td align="right"> ·86</td></tr>
+<tr><td align="left"> 25</td><td align="right">·47</td><td align="right"> ·60</td><td align="right"> ·57</td><td align="right">·63</td><td align="right"> ·53</td><td align="right"></td><td align="right"> ·62</td><td align="right">·78</td></tr>
+<tr><td align="left"> 25C</td><td align="right">·73</td><td align="right"> ·74</td><td align="right"> ·60</td><td align="right">·64</td><td align="right"> ·44</td><td align="right"> ·91</td><td align="right"> ·70</td><td align="right"> ·79</td></tr>
+<tr><td align="left"> 26</td><td align="right">·74</td><td align="right">·89</td><td align="right">·74</td><td align="right">·85</td><td align="right"> ·53</td><td align="right"></td><td align="right"> ·54</td><td align="right"> ·57</td></tr>
+<tr><td align="left"> 26C</td><td align="right">·76</td><td align="right"> ·81</td><td align="right"> ·70</td><td align="right">·79</td><td align="right"> ·84</td><td align="right"> ·76</td><td align="right">·40</td><td align="right">·40</td></tr>
+<tr><td align="left"> 27</td><td align="right">·11</td><td align="right"></td><td align="right"> ·23</td><td align="right"></td><td align="right"> ·16</td><td align="right"> ·04</td><td align="right"> ·18</td><td align="right"> ·06</td></tr>
+<tr><td align="left"> 27C</td><td align="right">·07</td><td align="right"> ·12</td><td align="right"> ·12</td><td align="right">·23</td><td align="right"> ·10</td><td align="right">·16</td><td align="right"> ·30</td><td align="right"> ·25</td></tr>
+<tr><td align="left"> 28</td><td align="right">·86</td><td align="right"> ·90</td><td align="right"> ·87</td><td align="right">·90</td><td align="right">·97</td><td align="right"> ·88</td><td align="right"> ·78</td><td align="right">·91</td></tr>
+<tr><td align="left"> 28C</td><td align="right">·87</td><td align="right">·93</td><td align="right">·83</td><td align="right">·86</td><td align="right">·88</td><td align="right"></td><td align="right"> ·98</td><td align="right"> ·94</td></tr>
+</table></div>
+
+<p><span class="pagenum">[Pg 48]</span></p>
+
+<H3>TABLE XI (Continued)</H3>
+
+<H3>Showing percentile ratings of the two groups at the beginning and end of the
+six months' interval</H3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a></td><td align="center" colspan="2">I.Q.</td><td align="center" colspan="2"> Healy</td><td align="center"> Total</td><td align="center"> Possible</td><td align="center"> Average</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"> Gain</td></tr>
+<tr><td align="left"> 1</td><td align="right">·25</td><td align="right">·27</td><td align="right">·10</td><td align="right">·29</td><td align="right">·30</td><td align="right">415</td><td align="right">·05 &nbsp; </td></tr>
+<tr><td align="left"> 1C</td><td align="right">·21</td><td align="right">·15</td><td align="right">·01</td><td align="right">·12</td><td align="right">·53</td><td align="right">462</td><td align="right">·089</td></tr>
+<tr><td align="left"> 2</td><td align="right">·84</td><td align="right">·89</td><td align="right">·60</td><td align="right">·66</td><td align="right">·38</td><td align="right">416</td><td align="right">·063</td></tr>
+<tr><td align="left"> 2C</td><td align="right">·45</td><td align="right">·51</td><td align="right">·29</td><td align="right">·18</td><td align="right">-·07</td><td align="right">358</td><td align="right"> -·011</td></tr>
+<tr><td align="left"> 3</td><td align="right">·49</td><td align="right">·44</td><td align="right">·49</td><td align="right">·51</td><td align="right">·40</td><td align="right">328</td><td align="right">·066</td></tr>
+<tr><td align="left"> 3C</td><td align="right">·25</td><td align="right">·32</td><td align="right">·44</td><td align="right">·45</td><td align="right">·30</td><td align="right">287</td><td align="right">·05 &nbsp; </td></tr>
+<tr><td align="left"> 4</td><td align="right">·59</td><td align="right">·59</td><td align="right">·38</td><td align="right"></td><td align="right">·22</td><td align="right">168</td><td align="right">·073</td></tr>
+<tr><td align="left"> 4C</td><td align="right">·27</td><td align="right">·32</td><td align="right">·71</td><td align="right"></td><td align="right">·42</td><td align="right">195</td><td align="right">·14 &nbsp; </td></tr>
+<tr><td align="left"> 5</td><td align="right">·53</td><td align="right">·71</td><td align="right">·10</td><td align="right"></td><td align="right">·42</td><td align="right">213</td><td align="right">·14 &nbsp; </td></tr>
+<tr><td align="left"> 5C</td><td align="right">·89</td><td align="right">·90</td><td align="right">·77</td><td align="right"></td><td align="right">·24</td><td align="right">133</td><td align="right">·08 &nbsp; </td></tr>
+<tr><td align="left"> 6</td><td align="right">·53</td><td align="right">·77</td><td align="right">·02</td><td align="right"></td><td align="right">·55</td><td align="right">229</td><td align="right">·183</td></tr>
+<tr><td align="left"> 6C</td><td align="right">·37</td><td align="right">·38</td><td align="right">·04</td><td align="right"></td><td align="right">·27</td><td align="right">210</td><td align="right">·09 &nbsp; </td></tr>
+<tr><td align="left"> 7</td><td align="right">·45</td><td align="right">·71</td><td align="right">·22</td><td align="right">·07</td><td align="right">·37</td><td align="right">478</td><td align="right">·062</td></tr>
+<tr><td align="left"> 7C</td><td align="right">·53</td><td align="right">·71</td><td align="right">·34</td><td align="right">·59</td><td align="right">·74</td><td align="right">393</td><td align="right">·148</td></tr>
+<tr><td align="left"> 8</td><td align="right">·45</td><td align="right">·34</td><td align="right">·70</td><td align="right"><td align="right">-·50</td><td align="right">303</td><td align="right"> -·125</td><td align="right"></td></tr>
+<tr><td align="left"> 8C</td><td align="right">·67</td><td align="right">·81</td><td align="right">·33</td><td align="right">·52</td><td align="right">·10</td><td align="right">241</td><td align="right">·025</td></tr>
+<tr><td align="left"> 9</td><td align="right">·27</td><td align="right">·46</td><td align="right">·23</td><td align="right">·39</td><td align="right">·71</td><td align="right">375</td><td align="right">·118</td></tr>
+<tr><td align="left"> 9C</td><td align="right">·35</td><td align="right">·40</td><td align="right">·73</td><td align="right">·89</td><td align="right">·72</td><td align="right">217</td><td align="right">·12 &nbsp; </td></tr>
+<tr><td align="left"> 10</td><td align="right">·88</td><td align="right">·86</td><td align="right">·15</td><td align="right">·35</td><td align="right">·34</td><td align="right">400</td><td align="right">·056</td></tr>
+<tr><td align="left"> 10C</td><td align="right">·81</td><td align="right">·73</td><td align="right">·57</td><td align="right">·97</td><td align="right">1·39</td><td align="right">392</td><td align="right">·218</td></tr>
+<tr><td align="left"> 11</td><td align="right">·79</td><td align="right">·73</td><td align="right">·20</td><td align="right">·34</td><td align="right">·21</td><td align="right">379</td><td align="right">·035</td></tr>
+<tr><td align="left"> 11C</td><td align="right">·77</td><td align="right">·79</td><td align="right">·05</td><td align="right">·23</td><td align="right">-·44</td><td align="right">379</td><td align="right"> -·073</td></tr>
+<tr><td align="left"> 12</td><td align="right">·67</td><td align="right">·53</td><td align="right">·47</td><td align="right">·49</td><td align="right">-·11</td><td align="right">161</td><td align="right"> -·036</td></tr>
+<tr><td align="left"> 12C</td><td align="right">·67</td><td align="right">·77</td><td align="right">·19</td><td align="right">·15</td><td align="right">·19</td><td align="right">208</td><td align="right">·032</td></tr>
+<tr><td align="left"> 13</td><td align="right">·09</td><td align="right">·19</td><td align="right">·79</td><td align="right">·78</td><td align="right">·02</td><td align="right">129</td><td align="right">·003</td></tr>
+<tr><td align="left"> 13C</td><td align="right">·06</td><td align="right">·05</td><td align="right">·24</td><td align="right">·67</td><td align="right">·06</td><td align="right">178</td><td align="right">·01 &nbsp; </td></tr>
+<tr><td align="left"> 14</td><td align="right">·59</td><td align="right">·84</td><td align="right">·41</td><td align="right">·84</td><td align="right">·69</td><td align="right">212</td><td align="right">·115</td></tr>
+<tr><td align="left"> 14C</td><td align="right">·97</td><td align="right">·96</td><td align="right">·21</td><td align="right">·56</td><td align="right">·41</td><td align="right">104</td><td align="right">·068</td></tr>
+<tr><td align="left"> 15</td><td align="right">·62</td><td align="right">·49</td><td align="right">·38</td><td align="right">·55</td><td align="right">·12</td><td align="right">106</td><td align="right">·04 &nbsp; </td></tr>
+<tr><td align="left"> 15C</td><td align="right">·19</td><td align="right">·20</td><td align="right">·26</td><td align="right">·79</td><td align="right">·66</td><td align="right">193</td><td align="right">·11 &nbsp; </td></tr>
+<tr><td align="left"> 16</td><td align="right">·05</td><td align="right">·12</td><td align="right">·86</td><td align="right">·82</td><td align="right">·15</td><td align="right">205</td><td align="right">·03 &nbsp; </td></tr>
+<tr><td align="left"> 16C</td><td align="right">·13</td><td align="right">·25</td><td align="right">·66</td><td align="right">·76</td><td align="right">·24</td><td align="right">313</td><td align="right">·04 &nbsp; </td></tr>
+<tr><td align="left"> 17</td><td align="right">·09</td><td align="right">·17</td><td align="right">·63</td><td align="right">·40</td><td align="right">·66</td><td align="right">223</td><td align="right">·220</td></tr>
+<tr><td align="left"> 17C</td><td align="right">·59</td><td align="right">·71</td><td align="right">·27</td><td align="right">·43</td><td align="right">·21</td><td align="right">174</td><td align="right">·053</td></tr>
+<tr><td align="left"> 18</td><td align="right">·67</td><td align="right">·67</td><td align="right">·13</td><td align="right">·15</td><td align="right">·08</td><td align="right">175</td><td align="right">·027</td></tr>
+<tr><td align="left"> 18C</td><td align="right">·40</td><td align="right">·49</td><td align="right">·04</td><td align="right">·07</td><td align="right">·18</td><td align="right">247</td><td align="right">·03 &nbsp; </td></tr>
+<tr><td align="left"> 19</td><td align="right">·59</td><td align="right">·69</td><td align="right">·91</td><td align="right">·85</td><td align="right">·16</td><td align="right">67</td><td align="right">·032</td></tr>
+<tr><td align="left"> 19C</td><td align="right">·67</td><td align="right">·67</td><td align="right">·11</td><td align="right">·18</td><td align="right">·16</td><td align="right">287</td><td align="right">·027</td></tr>
+<tr><td align="left"> 20</td><td align="right">·82</td><td align="right">·79</td><td align="right">·25</td><td align="right">·18</td><td align="right">-·06</td><td align="right">177</td><td align="right"> -·02 &nbsp; </td></tr>
+<tr><td align="left"> 20C</td><td align="right">·91</td><td align="right">·94</td><td align="right">·66</td><td align="right">·75</td><td align="right">·20</td><td align="right">65</td><td align="right">·066</td></tr>
+<tr><td align="left"> 21</td><td align="right">·05</td><td align="right">·07</td><td align="right">·47</td><td align="right">·69</td><td align="right">-·16</td><td align="right">209</td><td align="right"> -·032</td></tr>
+<tr><td align="left"> 21C</td><td align="right">·34</td><td align="right">·62</td><td align="right">·99</td><td align="right">·92</td><td align="right">·46</td><td align="right">157</td><td align="right">·077</td></tr>
+<tr><td align="left"> 22</td><td align="right">·45</td><td align="right">·73</td><td align="right">·84</td><td align="right">·81</td><td align="right">·87</td><td align="right">120</td><td align="right">·174</td></tr>
+<tr><td align="left"> 22C</td><td align="right">·03</td><td align="right">·02</td><td align="right">·74</td><td align="right">·72</td><td align="right">·74</td><td align="right">275</td><td align="right">·123</td></tr>
+<tr><td align="left"> 23</td><td align="right">·32</td><td align="right">·49</td><td align="right">·86</td><td align="right">·98</td><td align="right">·65</td><td align="right">168</td><td align="right">·163</td></tr>
+<tr><td align="left"> 23C</td><td align="right">·23</td><td align="right">·59</td><td align="right">·33</td><td align="right">·50</td><td align="right">1·26</td><td align="right">253</td><td align="right">·21 &nbsp; </td></tr>
+<tr><td align="left"> 24</td><td align="right">·94</td><td align="right">·92</td><td align="right">·88</td><td align="right">·95</td><td align="right">- ·06</td><td align="right">89</td><td align="right"> -·012</td></tr>
+<tr><td align="left"> 24C</td><td align="right">·38</td><td align="right">·46</td><td align="right">·68</td><td align="right">·93</td><td align="right">·54</td><td align="right">179</td><td align="right">·09 &nbsp; </td></tr>
+<tr><td align="left"> 25</td><td align="right">·17</td><td align="right">·15</td><td align="right">·37</td><td align="right">·55</td><td align="right">·49</td><td align="right">280</td><td align="right">·098</td></tr>
+<tr><td align="left"> 25C</td><td align="right">1·00</td><td align="right">·97</td><td align="right">·63</td><td align="right">·60</td><td align="right">·53</td><td align="right">134</td><td align="right">·088</td></tr>
+<tr><td align="left"> 26</td><td align="right">·21</td><td align="right">·15</td><td align="right">·51</td><td align="right">·36</td><td align="right"></td><td align="right">226 0</td><td align="right"></td></tr>
+<tr><td align="left"> 26C</td><td align="right">·40</td><td align="right">·37</td><td align="right">·90</td><td align="right">·94</td><td align="right">·04</td><td align="right">184</td><td align="right">·007</td></tr>
+<tr><td align="left"> 27</td><td align="right">·88</td><td align="right">·86</td><td align="right">·10</td><td align="right">·43</td><td align="right">·05</td><td align="right">268</td><td align="right">·013</td></tr>
+<tr><td align="left"> 27C</td><td align="right">·11</td><td align="right">·59</td><td align="right">·29</td><td align="right">·59</td><td align="right">1·49</td><td align="right">320</td><td align="right">·25 &nbsp; </td></tr>
+<tr><td align="left"> 28</td><td align="right">·23</td><td align="right">·29</td><td align="right">·63</td><td align="right"> 1·00</td><td align="right">·59</td><td align="right">153</td><td align="right">·097</td></tr>
+<tr><td align="left"> 28C</td><td align="right">·53</td><td align="right">·67</td><td align="right">·96</td><td align="right">·87</td><td align="right">·24</td><td align="right">83</td><td align="right">·048</td></tr>
+</table></div>
+
+
+<p>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&mdash;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<span class="pagenum">[Pg 50]</span>
+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)Ï)) when Ï = 1 - ((6ΣD²)/(n(n²-1)))
+we get a coefficient of correlation ·36 in the test group, and ·19</p>
+
+<h3>TABLE XII</h3>
+
+<h3>Showing gains in percentile rating for I.Q., and for a total of all the
+tests with I.Q. weighted by being counted twice.</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center" colspan="2"> I.Q.</td><td align="right"></td><td align="right"></td><td align="center"> Total</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="center"> A</td><td align="center"> B</td></tr>
+<tr><td align="left"></td><td align="center"> 1st P.R.</td><td align="center"> 2d P.R.</td><td align="center">possible gain</td><td align="center">actual gain</td><td align="center">possible gain</td><td align="center">actual gain</td><td align="center"> Av. Gain</td></tr>
+<tr><td align="left"> 1</td><td align="right">25</td><td align="right">27</td><td align="right">75</td><td align="right">2</td><td align="right">415</td><td align="right">30</td><td align="right">5 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 1C</td><td align="right">21</td><td align="right">15</td><td align="right">79</td><td align="right">-6</td><td align="right">462</td><td align="right">53</td><td align="right">8·9</td></tr>
+<tr><td align="left"> 2</td><td align="right">84</td><td align="right">89</td><td align="right">16</td><td align="right">5</td><td align="right">416</td><td align="right">38</td><td align="right">6·3</td></tr>
+<tr><td align="left"> 2C</td><td align="right">45</td><td align="right">51</td><td align="right">55</td><td align="right">6</td><td align="right">358</td><td align="right">- 7</td><td align="right">-1·1</td></tr>
+<tr><td align="left"> 3</td><td align="right">49</td><td align="right">44</td><td align="right">51</td><td align="right">-5</td><td align="right">328</td><td align="right">40</td><td align="right">6·6</td></tr>
+<tr><td align="left"> 3C</td><td align="right">25</td><td align="right">32</td><td align="right">75</td><td align="right">7</td><td align="right">287</td><td align="right">30</td><td align="right">5 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 4</td><td align="right">59</td><td align="right">59</td><td align="right">41</td><td align="right"></td><td align="right">168</td><td align="right">22</td><td align="right">7·3</td></tr>
+<tr><td align="left"> 4C</td><td align="right">27</td><td align="right">32</td><td align="right">73</td><td align="right">5</td><td align="right">195</td><td align="right">42</td><td align="right">14 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 5</td><td align="right">53</td><td align="right">71</td><td align="right">47</td><td align="right">18</td><td align="right">213</td><td align="right">42</td><td align="right">14 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 5C</td><td align="right">89</td><td align="right">90</td><td align="right">11</td><td align="right">1</td><td align="right">133</td><td align="right">24</td><td align="right">8 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 6</td><td align="right">53</td><td align="right">77</td><td align="right">47</td><td align="right">24</td><td align="right">229</td><td align="right">55</td><td align="right">18·3</td></tr>
+<tr><td align="left"> 6C</td><td align="right">37</td><td align="right">38</td><td align="right">63</td><td align="right">1</td><td align="right">210</td><td align="right">27</td><td align="right">9 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 7</td><td align="right">45</td><td align="right">71</td><td align="right">55</td><td align="right">26</td><td align="right">478</td><td align="right">37</td><td align="right">6·2</td></tr>
+<tr><td align="left"> 7C</td><td align="right">53</td><td align="right">71</td><td align="right">47</td><td align="right">18</td><td align="right">393</td><td align="right">74</td><td align="right">14·8</td></tr>
+<tr><td align="left"> 8</td><td align="right">45</td><td align="right">34</td><td align="right">55</td><td align="right">-11</td><td align="right">203</td><td align="right">-50</td><td align="right">-12·5</td></tr>
+<tr><td align="left"> 8C</td><td align="right">67</td><td align="right">81</td><td align="right">33</td><td align="right">14</td><td align="right">241</td><td align="right">10</td><td align="right">2·5</td></tr>
+<tr><td align="left"> 9</td><td align="right">27</td><td align="right">46</td><td align="right">73</td><td align="right">19</td><td align="right">375</td><td align="right">71</td><td align="right">11·8</td></tr>
+<tr><td align="left"> 9C</td><td align="right">35</td><td align="right">40</td><td align="right">65</td><td align="right">5</td><td align="right">217</td><td align="right">72</td><td align="right">12 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 10</td><td align="right">88</td><td align="right">86</td><td align="right">12</td><td align="right">-2</td><td align="right">400</td><td align="right">34</td><td align="right">5·6</td></tr>
+<tr><td align="left"> 10C</td><td align="right">81</td><td align="right">73</td><td align="right">19</td><td align="right">-8</td><td align="right">392</td><td align="right">139</td><td align="right">21·8</td></tr>
+<tr><td align="left"> 11</td><td align="right">79</td><td align="right">73</td><td align="right">21</td><td align="right">-6</td><td align="right">379</td><td align="right">21</td><td align="right">3·5</td></tr>
+<tr><td align="left"> 11C</td><td align="right">77</td><td align="right">79</td><td align="right">23</td><td align="right">2</td><td align="right">379</td><td align="right">-44</td><td align="right">-7·3<span class="pagenum">[Pg 51]</span></td></tr>
+<tr><td align="left"> 12</td><td align="right">67</td><td align="right">53</td><td align="right">33</td><td align="right">- 6</td><td align="right">161</td><td align="right">- 11</td><td align="right">- 3·6</td></tr>
+<tr><td align="left"> 12C</td><td align="right">67</td><td align="right">77</td><td align="right">33</td><td align="right">10</td><td align="right">208</td><td align="right">19</td><td align="right">3·2</td></tr>
+<tr><td align="left"> 13</td><td align="right">9</td><td align="right">19</td><td align="right">91</td><td align="right">10</td><td align="right">129</td><td align="right">2</td><td align="right">·3</td></tr>
+<tr><td align="left"> 13C</td><td align="right">6</td><td align="right">5</td><td align="right">94</td><td align="right">- 1</td><td align="right">178</td><td align="right">6</td><td align="right">1 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 14</td><td align="right">59</td><td align="right">84</td><td align="right">41</td><td align="right">25</td><td align="right">212</td><td align="right">69</td><td align="right">11·5</td></tr>
+<tr><td align="left"> 14C</td><td align="right">97</td><td align="right">96</td><td align="right">3</td><td align="right">- 1</td><td align="right">104</td><td align="right">41</td><td align="right">6·8</td></tr>
+<tr><td align="left"> 15</td><td align="right">62</td><td align="right">49</td><td align="right">38</td><td align="right">-13</td><td align="right">106</td><td align="right">12</td><td align="right">4 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 15C</td><td align="right">19</td><td align="right">20</td><td align="right">81</td><td align="right">1</td><td align="right">193</td><td align="right">66</td><td align="right">11 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 16</td><td align="right">5</td><td align="right">12</td><td align="right">95</td><td align="right">7</td><td align="right">205</td><td align="right">15</td><td align="right">3 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 16C</td><td align="right">13</td><td align="right">25</td><td align="right">87</td><td align="right">12</td><td align="right">213</td><td align="right">24</td><td align="right">4 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 17</td><td align="right">9</td><td align="right">17</td><td align="right">81</td><td align="right">8</td><td align="right">223</td><td align="right">66</td><td align="right">22 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 17C</td><td align="right">59</td><td align="right">71</td><td align="right">41</td><td align="right">12</td><td align="right">174</td><td align="right">21</td><td align="right">5·3</td></tr>
+<tr><td align="left"> 18</td><td align="right">67</td><td align="right">67</td><td align="right">33</td><td align="right"></td><td align="right">175</td><td align="right">8</td><td align="right">2·7</td></tr>
+<tr><td align="left"> 18C</td><td align="right">40</td><td align="right">49</td><td align="right">60</td><td align="right">9</td><td align="right">247</td><td align="right">18</td><td align="right">3 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 19</td><td align="right">59</td><td align="right">69</td><td align="right">41</td><td align="right">10</td><td align="right">67</td><td align="right">16</td><td align="right">3·2</td></tr>
+<tr><td align="left"> 19C</td><td align="right">67</td><td align="right">67</td><td align="right">33</td><td align="right"></td><td align="right">287</td><td align="right">16</td><td align="right">2·7</td></tr>
+<tr><td align="left"> 20</td><td align="right">82</td><td align="right">79</td><td align="right">18</td><td align="right">- 3</td><td align="right">177</td><td align="right">-6</td><td align="right">- 2 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 20C</td><td align="right">91</td><td align="right">94</td><td align="right">9</td><td align="right">3</td><td align="right">65</td><td align="right">20</td><td align="right">6·6</td></tr>
+<tr><td align="left"> 21</td><td align="right">5</td><td align="right">7</td><td align="right">95</td><td align="right">2</td><td align="right">209</td><td align="right">- 16</td><td align="right">- 3·2</td></tr>
+<tr><td align="left"> 21C</td><td align="right">34</td><td align="right">62</td><td align="right">66</td><td align="right">28</td><td align="right">157</td><td align="right">46</td><td align="right">7·7</td></tr>
+<tr><td align="left"> 22</td><td align="right">45</td><td align="right">73</td><td align="right">55</td><td align="right">28</td><td align="right">120</td><td align="right">87</td><td align="right">17·4</td></tr>
+<tr><td align="left"> 22C</td><td align="right">3</td><td align="right">2</td><td align="right">97</td><td align="right">- 1</td><td align="right">275</td><td align="right">74</td><td align="right">12·3</td></tr>
+<tr><td align="left"> 23</td><td align="right">32</td><td align="right">49</td><td align="right">68</td><td align="right">17</td><td align="right">168</td><td align="right">65</td><td align="right">16·3</td></tr>
+<tr><td align="left"> 23C</td><td align="right">23</td><td align="right">59</td><td align="right">77</td><td align="right">36</td><td align="right">253</td><td align="right">126</td><td align="right">21 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 24</td><td align="right">94</td><td align="right">92</td><td align="right">6</td><td align="right">- 2</td><td align="right">89</td><td align="right">-6</td><td align="right">- 1·2</td></tr>
+<tr><td align="left"> 24C</td><td align="right">38</td><td align="right">46</td><td align="right">62</td><td align="right">8</td><td align="right">179</td><td align="right">54</td><td align="right">9 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 25</td><td align="right">17</td><td align="right">15</td><td align="right">83</td><td align="right">- 2</td><td align="right">280</td><td align="right">49</td><td align="right">9·8</td></tr>
+<tr><td align="left"> 25C</td><td align="right">100</td><td align="right">97</td><td align="right"></td><td align="right">- 3</td><td align="right">134</td><td align="right">53</td><td align="right">8·8</td></tr>
+<tr><td align="left"> 26</td><td align="right">21</td><td align="right">15</td><td align="right">79</td><td align="right">- 6</td><td align="right">226</td><td align="right"></td></tr>
+<tr><td align="left"> 26C</td><td align="right">40</td><td align="right">37</td><td align="right">60</td><td align="right">- 3</td><td align="right">184</td><td align="right">4</td><td align="right">·7</td></tr>
+<tr><td align="left"> 27</td><td align="right">88</td><td align="right">86</td><td align="right">12</td><td align="right">- 2</td><td align="right">268</td><td align="right">5</td><td align="right">1·3</td></tr>
+<tr><td align="left"> 27C</td><td align="right">11</td><td align="right">59</td><td align="right">89</td><td align="right">48</td><td align="right">320</td><td align="right">148</td><td align="right">25 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 28</td><td align="right">23</td><td align="right">29</td><td align="right">77</td><td align="right">6</td><td align="right">153</td><td align="right">59</td><td align="right">9·7</td></tr>
+<tr><td align="left"> 28C</td><td align="right">53</td><td align="right">67</td><td align="right">47</td><td align="right">14</td><td align="right">83</td><td align="right">24</td><td align="right">4·8</td></tr>
+</table></div>
+<p><span class="pagenum">[Pg 52]</span></p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<h3>TABLE XIII</h3>
+
+<h3>Showing improvement in various tests of operative group over and
+above such improvement in control group. Expressed in Terms of P. E.</h3>
+
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center"> Weight</td><td align="center"> Height</td><td align="center"> Height-Weight</td><td align="center"> &nbsp;Grip &nbsp;</td><td align="center"> Tapping</td><td align="center"> Tapping fatigue</td><td align="center"> &nbsp;I.Q. &nbsp;</td><td align="center"> Healy</td></tr>
+<tr><td align="right"></td><td align="center"> P. E.</td><td align="center"> P. E.</td><td align="center"> P. E.</td><td align="center"> P. E.</td><td align="center"> P. E.</td><td align="center"> P. E.</td><td align="center"> P. E.</td><td align="center"> P. E.</td></tr>
+<tr><td align="right"> Average</td><td align="right">2·85</td><td align="right"> 1·00</td><td align="right"> 2·02</td><td align="right"> -·50</td><td align="right"> ·03</td><td align="right"> -·50</td><td align="right"> -·94</td><td align="right"> -1·92</td></tr>
+<tr><td align="right"> Median</td><td align="right">2·80</td><td align="right"> 1·25</td><td align="right"> ·55</td><td align="right"> -·83</td><td align="right"> ·32</td><td align="right"> -·50</td><td align="right"> 0.00</td><td align="right"> -2·54</td></tr>
+</table></div><br><p><span class="pagenum"><a name="Page_53" id="Page_53">[Pg 53]</a></span></p>
+
+
+
+<hr style="width: 65%;">
+<h2>CHAPTER IV</h2>
+
+<h3>MEASUREMENT OF IMPROVEMENT AFTER A SECOND INTERVAL OF SIX MONTHS</h3>
+
+
+<p>In view of the fact that one of the experimenters<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a> 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.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 54]</span></p>
+
+<h3>TABLE XIV</h3>
+
+<h3>Results of the Tests after an Interval of from 10 to 17 Months</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center"> Mos.</td><td align="center" colspan="2"> Weight</td><td align="center" colspan="2"> Height</td><td align="center" colspan="2"> Grip</td></tr>
+<tr><td align="center"></td><td align="center"></td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Test 1</td><td align="center"> Test 3</td></tr>
+<tr><td align="left"> 1</td><td align="right">15</td><td align="right">50·4</td><td align="right">63·5</td><td align="right">46·0</td><td align="right">49·7</td><td align="right">13·0</td><td align="right">18·0</td></tr>
+<tr><td align="left"> 1C</td><td align="right">15</td><td align="right">53·5</td><td align="right">62·8</td><td align="right">46·4</td><td align="right">49·7</td><td align="right">11·0</td><td align="right">15·0</td></tr>
+<tr><td align="left"> 2</td><td align="right">15</td><td align="right">40·9</td><td align="right">47·9</td><td align="right">42·6</td><td align="right">45·9</td><td align="right">9·0</td><td align="right">10·0</td></tr>
+<tr><td align="left"> 2C</td><td align="right">17</td><td align="right">52·3</td><td align="right">65·5</td><td align="right">45·2</td><td align="right">49·8</td><td align="right">10·0</td><td align="right">15·0</td></tr>
+<tr><td align="left"> 3</td><td align="right">16</td><td align="right">55·0</td><td align="right">67·5</td><td align="right">47·0</td><td align="right">50·2</td><td align="right">12·8</td><td align="right">13·0</td></tr>
+<tr><td align="left"> 3C</td><td align="right">14</td><td align="right">61·5</td><td align="right">57·8</td><td align="right">51·7</td><td align="right">54·0</td><td align="right">14·0</td><td align="right">14·5</td></tr>
+<tr><td align="left"> 4</td><td align="right">13</td><td align="right">51·1</td><td align="right">60·2</td><td align="right">47·5</td><td align="right">50·5</td><td align="right">9·0</td><td align="right"></td></tr>
+<tr><td align="left"> 4C</td><td align="right">13</td><td align="right">49·4</td><td align="right">54·2</td><td align="right">48·9</td><td align="right">50·8</td><td align="right">9·5</td><td align="right"></td></tr>
+<tr><td align="left"> 7</td><td align="right">14</td><td align="right">39·9</td><td align="right">45·8</td><td align="right">42·9</td><td align="right">45·6</td><td align="right">7·0</td><td align="right">6·0</td></tr>
+<tr><td align="left"> 7C</td><td align="right">12</td><td align="right">38·4</td><td align="right">42·1</td><td align="right">41·9</td><td align="right">43·7</td><td align="right">9·0</td><td align="right">14·0</td></tr>
+<tr><td align="left"> 8</td><td align="right">11</td><td align="right">60·8</td><td align="right">69·2</td><td align="right">50·8</td><td align="right">52·3</td><td align="right">10·0</td><td align="right"></td></tr>
+<tr><td align="left"> 8C</td><td align="right">11</td><td align="right">45·4</td><td align="right">57·9</td><td align="right">36·8</td><td align="right">48·7</td><td align="right">15·0</td><td align="right"></td></tr>
+<tr><td align="left"> 10</td><td align="right">11</td><td align="right">48·9</td><td align="right">56·7</td><td align="right">46·1</td><td align="right">48·6</td><td align="right">12·5</td><td align="right">12·0</td></tr>
+<tr><td align="left"> 10C</td><td align="right">11</td><td align="right">47·1</td><td align="right">51·8</td><td align="right">45·6</td><td align="right">48·1</td><td align="right">10·0</td><td align="right">12·0</td></tr>
+<tr><td align="left"> 11</td><td align="right">12</td><td align="right">47·8</td><td align="right">55·0</td><td align="right">45·8</td><td align="right">49·5</td><td align="right">11·0</td><td align="right">11·0</td></tr>
+<tr><td align="left"> 11C</td><td align="right">12</td><td align="right">41·6</td><td align="right">47·0</td><td align="right">43·6</td><td align="right">46·8</td><td align="right">11·5</td><td align="right">7·5</td></tr>
+<tr><td align="left"> 12</td><td align="right">12</td><td align="right">48·0</td><td align="right">66·5</td><td align="right">44·8</td><td align="right"></td><td align="right">14·0</td><td align="right"></td></tr>
+<tr><td align="left"> 12C</td><td align="right">11</td><td align="right">41·0</td><td align="right">69·6</td><td align="right">41·5</td><td align="right"></td><td align="right">6·0</td><td align="right"></td></tr>
+<tr><td align="left"> 13</td><td align="right">12</td><td align="right">90·0</td><td align="right">112·0</td><td align="right">61·3</td><td align="right">61·8</td><td align="right">26·5</td><td align="right">28·5</td></tr>
+<tr><td align="left"> 13C</td><td align="right">12</td><td align="right">74·7</td><td align="right">88·0</td><td align="right">56·8</td><td align="right">60·0</td><td align="right">22·0</td><td align="right">27·0</td></tr>
+<tr><td align="left"> 14</td><td align="right">12</td><td align="right">56·0</td><td align="right">66·0</td><td align="right">51·0</td><td align="right">53·3</td><td align="right">16·0</td><td align="right">17·0</td></tr>
+<tr><td align="left"> 14C</td><td align="right">12</td><td align="right">81·9</td><td align="right">98·0</td><td align="right">57·9</td><td align="right">59·5</td><td align="right">22·0</td><td align="right">22·5</td></tr>
+<tr><td align="left"> 15</td><td align="right">12</td><td align="right">57·5</td><td align="right"></td><td align="right">51·1</td><td align="right"><td align="right">15·5</td><td align="right"></td><td align="right"></td></tr>
+<tr><td align="left"> 15C</td><td align="right">10</td><td align="right">67·2</td><td align="right"></td><td align="right">50·1</td><td align="right"><td align="right">15·0</td><td align="right"></td><td align="right"></td></tr>
+<tr><td align="left"> 16</td><td align="right">12</td><td align="right">56·0</td><td align="right">60·3</td><td align="right">51·6</td><td align="right">53·5</td><td align="right">19·0</td><td align="right">18·5</td></tr>
+<tr><td align="left"> 16C</td><td align="right">11</td><td align="right">51·2</td><td align="right">55·0</td><td align="right">48·7</td><td align="right">50·1</td><td align="right">10·0</td><td align="right">10·0</td></tr>
+<tr><td align="left"> 18</td><td align="right">12</td><td align="right">58·2</td><td align="right"></td><td align="right">47·3</td><td align="right"></td><td align="right">18·0</td><td align="right"></td><td align="right"></td></tr>
+<tr><td align="left"> 18C</td><td align="right">11</td><td align="right">45·3</td><td align="right"></td><td align="right">46·7</td><td align="right"></td><td align="right">8·0</td><td align="right"></td><td align="right"></td></tr>
+<tr><td align="left"> 19</td><td align="right">12</td><td align="right">90·0</td><td align="right">108·0</td><td align="right">57·7</td><td align="right">60·5</td><td align="right">22·0</td><td align="right">20·0</td></tr>
+<tr><td align="left"> 19C</td><td align="right">11</td><td align="right">52·4</td><td align="right">59·0</td><td align="right">46·7</td><td align="right">48·0</td><td align="right">15·0</td><td align="right">18·0</td></tr>
+<tr><td align="left"> 20</td><td align="right">12</td><td align="right">44·2</td><td align="right"></td><td align="right">47·2</td><td align="right"></td><td align="right">11·0</td><td align="right"></td><td align="right"></td></tr>
+<tr><td align="left"> 20C</td><td align="right">11</td><td align="right">61·3</td><td align="right"></td><td align="right">49·6</td><td align="right"></td><td align="right">15·0</td><td align="right"></td><td align="right"></td></tr>
+<tr><td align="left"> 21</td><td align="right">12</td><td align="right">70·7</td><td align="right">85·5</td><td align="right">54·1</td><td align="right"></td><td align="right">16·5</td><td align="right">15.0</td><td align="right"></td></tr>
+<tr><td align="left"> 21C</td><td align="right">10</td><td align="right">62·4</td><td align="right">69·2</td><td align="right">49·6</td><td align="right"></td><td align="right">19·0</td><td align="right">17·0</td><td align="right"></td></tr>
+<tr><td align="left"> 23</td><td align="right">12</td><td align="right">51·7</td><td align="right"></td><td align="right">47·8</td><td align="right"></td><td align="right">11·5</td><td align="right">15·0</td><td align="right"></td></tr>
+<tr><td align="left"> 23C</td><td align="right">11</td><td align="right">64·1</td><td align="right"></td><td align="right">51·4</td><td align="right"></td><td align="right">14·5</td><td align="right">16·0</td><td align="right"></td></tr>
+<tr><td align="left"> 27</td><td align="right">12</td><td align="right">43·7</td><td align="right"></td><td align="right">45·4</td><td align="right"></td><td align="right">9·0</td><td align="right">6·0</td><td align="right"></td></tr>
+<tr><td align="left"> 27C</td><td align="right">11</td><td align="right">41·0</td><td align="right"></td><td align="right">44·6</td><td align="right"></td><td align="right">0</td><td align="right">9·0</td><td align="right"></td></tr>
+<tr><td align="left"> 28</td><td align="right">12</td><td align="right">71·3</td><td align="right">78·5</td><td align="right">54·9</td><td align="right">56·3</td><td align="right">23·5</td><td align="right"></td></tr>
+<tr><td align="left"> 28C</td><td align="right">11</td><td align="right">74·2</td><td align="right">85·8</td><td align="right">53·4</td><td align="right">55·9</td><td align="right">21·0</td><td align="right"></td></tr>
+</table></div>
+<p><span class="pagenum">[Pg 55]</span></p>
+
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center" colspan="2"> Tapping</td><td align="center" colspan="2"> I.Q.</td><td align="center" colspan="2"> Healy</td></tr>
+<tr><td align="center"></td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> (1)</td><td align="center"> (3)</td><td align="center"> (1)</td><td align="center"> (3)</td></tr>
+<tr><td align="left"> 1</td><td align="left">135</td><td align="left">142</td><td align="right">82</td><td align="right">93·0</td><td align="right">-25·0</td><td align="right">11·0</td></tr>
+<tr><td align="left"> 1C</td><td align="left">106</td><td align="left">134</td><td align="right">80</td><td align="right">85·0</td><td align="right">-50·0</td><td align="right">11·0</td></tr>
+<tr><td align="left"> 2</td><td align="left">105</td><td align="left">135</td><td align="right">107</td><td align="right">113·0</td><td align="right">28·5</td><td align="right">24·5</td></tr>
+<tr><td align="left"> 2C</td><td align="left">152</td><td align="left">139</td><td align="right">91</td><td align="right">86·0</td><td align="right">3·0</td><td align="right">19·5</td></tr>
+<tr><td align="left"> 3</td><td align="left">136</td><td align="left">144</td><td align="right">94</td><td align="right">91·0</td><td align="right">21·5</td><td align="right">15·5</td></tr>
+<tr><td align="left"> 3C</td><td align="left">135</td><td align="left">135</td><td align="right">82</td><td align="right">96·0</td><td align="right">17·0</td><td align="right">25·5</td></tr>
+<tr><td align="left"> 4</td><td align="left">103</td><td align="left"></td><td align="right">96</td><td align="right">111 &nbsp; &nbsp;</td><td align="right">8·5</td><td align="right"></td></tr>
+<tr><td align="left"> 4C</td><td align="left">109</td><td align="left"></td><td align="right">83</td><td align="right">102 &nbsp; &nbsp;</td><td align="right">33·0</td><td align="right"></td></tr>
+<tr><td align="left"> 7</td><td align="left">125</td><td align="left"></td><td align="right">91</td><td align="right">93 &nbsp; &nbsp;</td><td align="right">- 6·0</td><td align="right">16·0</td></tr>
+<tr><td align="left"> 7C</td><td align="left">105</td><td align="left"> </td><td align="right">95</td><td align="right">112 &nbsp; &nbsp;</td><td align="right">4·5</td><td align="right">11·0</td></tr>
+<tr><td align="left"> 8</td><td align="left">113</td><td align="left">128</td><td align="right">91</td><td align="right">92·0</td><td align="right">32·5</td><td align="right"></td></tr>
+<tr><td align="left"> 8C</td><td align="left">131</td><td align="left">121</td><td align="right">98</td><td align="right">111·0</td><td align="right">4·0</td><td align="right"></td></tr>
+<tr><td align="left"> 10</td><td align="left"> &nbsp;68+ 74</td><td align="left">145+106</td><td align="right">110</td><td align="right">116·0</td><td align="right">-12·0</td><td align="right">11·0</td></tr>
+<tr><td align="left"> 10C</td><td align="left"> &nbsp;70+ 74</td><td align="left">148+124</td><td align="right">104</td><td align="right">107·0</td><td align="right">27·0</td><td align="right">48·5</td></tr>
+<tr><td align="left"> 11</td><td align="left">125+ 90</td><td align="left">120+125</td><td align="right">103</td><td align="right">102·0</td><td align="right">- 8·0</td><td align="right">15·5</td></tr>
+<tr><td align="left"> 11C</td><td align="left">155+125</td><td align="left">102+112</td><td align="right">101</td><td align="right">95·0</td><td align="right">-29·0</td><td align="right">-20·0</td></tr>
+<tr><td align="left"> 12</td><td align="left"> &nbsp;98+ 69</td><td align="left"></td><td align="right"></td><td align="right">86 &nbsp; &nbsp;</td><td align="right">20·0</td><td align="right">1·0</td></tr>
+<tr><td align="left"> 12C</td><td align="left">102</td><td align="left"></td><td align="right">98</td><td align="right">90 &nbsp; &nbsp;</td><td align="right">-10·0</td><td align="right">41·5</td></tr>
+<tr><td align="left"> 13</td><td align="left">160+165</td><td align="left">176+187</td><td align="right">70</td><td align="right">61·0</td><td align="right">43·0</td><td align="right">62·5</td></tr>
+<tr><td align="left"> 13C</td><td align="left">150+109</td><td align="left">188+174</td><td align="right">66</td><td align="right">60·0</td><td align="right">-1·5</td><td align="right">21·5</td></tr>
+<tr><td align="left"> 14</td><td align="left">190+172</td><td align="left">228+215</td><td align="right">96</td><td align="right">102·0</td><td align="right">12·5</td><td align="right">77·0</td></tr>
+<tr><td align="left"> 14C</td><td align="left">175+152</td><td align="left">165+186</td><td align="right">140</td><td align="right">138·0</td><td align="right">- 5·0</td><td align="right">48·5</td></tr>
+<tr><td align="left"> 15</td><td align="left">172+167</td><td align="left">192+186</td><td align="right">97</td><td align="right">97·0</td><td align="right">7·0</td><td align="right">19·0</td></tr>
+<tr><td align="left"> 15C</td><td align="left">140+115</td><td align="left">145+133</td><td align="right">78</td><td align="right">98·0</td><td align="right">1·0</td><td align="right">54·5</td></tr>
+<tr><td align="left"> 16</td><td align="left">145+131</td><td align="left"></td><td align="right">65</td><td align="right">74 &nbsp; &nbsp;</td><td align="right">49·0</td><td align="right">79·0</td></tr>
+<tr><td align="left"> 16C</td><td align="left">145+ 99</td><td align="left"></td><td align="right">74</td><td align="right">81 &nbsp; &nbsp;</td><td align="right">30·0</td><td align="right">45·5</td></tr>
+<tr><td align="left"> 18</td><td align="left">133+115</td><td align="left">126+145</td><td align="right">98</td><td align="right">101·0</td><td align="right">-13·5</td><td align="right">13·5</td></tr>
+<tr><td align="left"> 18C</td><td align="left">100+ 99</td><td align="left">108+ 92</td><td align="right">90</td><td align="right">92·0</td><td align="right">-32·0</td><td align="right">-35·0</td></tr>
+<tr><td align="left"> 19</td><td align="left">168+136</td><td align="left"></td><td align="right">96</td><td align="right">97 &nbsp; &nbsp;</td><td align="right">57·5</td><td align="right">60·5</td></tr>
+<tr><td align="left"> 19C</td><td align="left">100+115</td><td align="left"></td><td align="right">98</td><td align="right">90 &nbsp; &nbsp;</td><td align="right">-22·0</td><td align="right">-15·0</td></tr>
+<tr><td align="left"> 20</td><td align="left">105+115</td><td align="left">122+118</td><td align="right">106</td><td align="right">116·0</td><td align="right"></td><td align="right">55·0</td></tr>
+<tr><td align="left"> 20C</td><td align="left">150+120</td><td align="left">154+154</td><td align="right">118</td><td align="right">140·0</td><td align="right">30·0</td><td align="right">48·5</td></tr>
+<tr><td align="left"> 21</td><td align="left">152+111</td><td align="left">154+155</td><td align="right">64</td><td align="right">66·0</td><td align="right">20·0</td><td align="right">38·0</td></tr>
+<tr><td align="left"> 21C</td><td align="left">140+136</td><td align="left">174+150</td><td align="right">86</td><td align="right">93·0</td><td align="right">70·5</td><td align="right">88·0</td></tr>
+<tr><td align="left"> 23</td><td align="left">150+119</td><td align="left">157+157</td><td align="right">85</td><td align="right">80·0</td><td align="right">49·5</td><td align="right">62·5</td></tr>
+<tr><td align="left"> 23C</td><td align="left">122+115</td><td align="left">141+141</td><td align="right">81</td><td align="right">88·0</td><td align="right">4·0</td><td align="right">64·0</td></tr>
+<tr><td align="left"> 27</td><td align="left">108+ 92</td><td align="left">114+ 95</td><td align="right">110</td><td align="right">112·0</td><td align="right">-25·0</td><td align="right">25·5</td></tr>
+<tr><td align="left"> 27C</td><td align="left">115+105</td><td align="left">101+118</td><td align="right">72</td><td align="right">98·0</td><td align="right">2·0</td><td align="right">39·5</td></tr>
+<tr><td align="left"> 28</td><td align="left">150+148</td><td align="left">176+168</td><td align="right">81</td><td align="right">83·0</td><td align="right">29·5</td><td align="right">77·5</td></tr>
+<tr><td align="left"> 28C</td><td align="left">178+148</td><td align="left">172+157</td><td align="right">95</td><td align="right">94·0</td><td align="right">64·5</td><td align="right">83·5</td></tr>
+</table></div><p><span class="pagenum">[Pg 56]</span></p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<h3>TABLE XV</h3>
+
+<h3>Weight, Second Retests, 15 Pairs</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center">N<a href="#Footnote_16_16">[16]</a></td><td align="right" colspan="3">Test Group (A)</td><td align="right" colspan="3">Control Group (B)</td></tr>
+<tr><td align="right"></td><td align="right"> Test 1</td><td align="right"> Test 3</td><td align="right">Gain</td><td align="right"> Test 1</td><td align="right"> Test 3</td><td align="right">Gain</td><td align="right"> A-B</td></tr>
+<tr><td align="right"> 12</td><td align="right">48 &nbsp; &nbsp; &nbsp;</td><td align="right">66·5 &nbsp; </td><td align="right">18·5 &nbsp; </td><td align="right">69·6 &nbsp; </td><td align="right">28·6 &nbsp; </td><td align="right">-10·1 &nbsp; </td></tr>
+<tr><td align="right"> 2</td><td align="right">40·9 &nbsp; </td><td align="right">47·9 &nbsp; </td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">52·3 &nbsp; </td><td align="right">65·5 &nbsp; </td><td align="right">13·2 &nbsp; </td><td align="right">-6·2 &nbsp; </td></tr>
+<tr><td align="right"> 14</td><td align="right">56 &nbsp; &nbsp; &nbsp;</td><td align="right">66 &nbsp; &nbsp; &nbsp;</td><td align="right">10 &nbsp; &nbsp; &nbsp;</td><td align="right">81·9 &nbsp; </td><td align="right">98 &nbsp; &nbsp; &nbsp;</td><td align="right">16·1 &nbsp; &nbsp; &nbsp;</td><td align="right">-6·1 &nbsp; </td></tr>
+<tr><td align="right"> 28</td><td align="right">71·3 &nbsp; </td><td align="right">78·5 &nbsp; </td><td align="right">7·2 &nbsp; </td><td align="right">74·2 &nbsp; </td><td align="right">85·8 &nbsp; </td><td align="right">11·6 &nbsp; </td><td align="right">-4·4 &nbsp; </td></tr>
+<tr><td align="right"> 8</td><td align="right">60·8 &nbsp; </td><td align="right">69·2 &nbsp; </td><td align="right">8·4 &nbsp; </td><td align="right">45·4 &nbsp; </td><td align="right">57·9 &nbsp; </td><td align="right">12·5 &nbsp; </td><td align="right">-4·1 &nbsp; </td></tr>
+<tr><td align="right"> 16</td><td align="right">56 &nbsp; &nbsp; &nbsp;</td><td align="right">60·3 &nbsp; </td><td align="right">3·7 &nbsp; </td><td align="right">51·2 &nbsp; </td><td align="right">55 &nbsp; &nbsp; &nbsp;</td><td align="right">3·8 &nbsp; </td><td align="right">-·1 &nbsp; </td></tr>
+<tr><td align="right"> 11</td><td align="right">47·8 &nbsp; </td><td align="right">55 &nbsp; &nbsp; &nbsp;</td><td align="right">7·2 &nbsp; </td><td align="right">41·6 &nbsp; </td><td align="right">47 &nbsp; &nbsp; &nbsp;</td><td align="right">5·4 &nbsp; </td><td align="right">1·8 &nbsp; </td></tr>
+<tr><td align="right"> 7</td><td align="right">39·9 &nbsp; </td><td align="right">45·8 &nbsp; </td><td align="right">5·9 &nbsp; </td><td align="right">38·4 &nbsp; </td><td align="right">42·1 &nbsp; </td><td align="right">3·7 &nbsp; </td><td align="right">2·2 &nbsp; </td></tr>
+<tr><td align="right"> 10</td><td align="right">48·9 &nbsp; </td><td align="right">56·7 &nbsp; </td><td align="right">7·8 &nbsp; </td><td align="right">47·1 &nbsp; </td><td align="right">51·8 &nbsp; </td><td align="right">4·7 &nbsp; </td><td align="right">3·1 &nbsp; </td></tr>
+<tr><td align="right"> 1</td><td align="right">50·4 &nbsp; </td><td align="right">63·5 &nbsp; </td><td align="right">13·1 &nbsp; </td><td align="right">53·5 &nbsp; </td><td align="right">62·8 &nbsp; </td><td align="right">9·3 &nbsp; </td><td align="right">3·8 &nbsp; </td></tr>
+<tr><td align="right"> 4</td><td align="right">51·1 &nbsp; </td><td align="right">60·2 &nbsp; </td><td align="right">9·1 &nbsp; </td><td align="right">49·4 &nbsp; </td><td align="right">54·2 &nbsp; </td><td align="right">4·8 &nbsp; </td><td align="right">4·3 &nbsp; </td></tr>
+<tr><td align="right"> 21</td><td align="right">70·7 &nbsp; </td><td align="right">85·5 &nbsp; </td><td align="right">14·8 &nbsp; </td><td align="right">62·4 &nbsp; </td><td align="right">69·2 &nbsp; </td><td align="right">6·8 &nbsp; </td><td align="right">8 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 13</td><td align="right">90 &nbsp; &nbsp; &nbsp;</td><td align="right">112 &nbsp; &nbsp; &nbsp;</td><td align="right">22 &nbsp; &nbsp; &nbsp;</td><td align="right">74·7 &nbsp; </td><td align="right">88 &nbsp; &nbsp; &nbsp;</td><td align="right">13·3 &nbsp; </td><td align="right">8·7 &nbsp; </td></tr>
+<tr><td align="right"> 19</td><td align="right">90 &nbsp; &nbsp; &nbsp;</td><td align="right">108 &nbsp; &nbsp; &nbsp;</td><td align="right">18 &nbsp; &nbsp; &nbsp;</td><td align="right">52·4 &nbsp; </td><td align="right">59 &nbsp; &nbsp; &nbsp;</td><td align="right">6·6 &nbsp; </td><td align="right">11·4 &nbsp; </td></tr>
+<tr><td align="right"> 3</td><td align="right">55 &nbsp; &nbsp; &nbsp;</td><td align="right">67·5 &nbsp; </td><td align="right">12·5 &nbsp; </td><td align="right">61·5 &nbsp; </td><td align="right">57·8 &nbsp; </td><td align="right">-3·7 &nbsp; </td><td align="right">16·2 &nbsp; </td></tr>
+<tr><td align="left"> Av.</td><td align="right">58·45</td><td align="right">69·50</td><td align="right">11·01</td><td align="right">55·13</td><td align="right">63·58</td><td align="right">9·11</td><td align="right">1·9 &nbsp; </td></tr>
+<tr><td align="left"> M</td><td align="right"></td><td align="right"></td><td align="right"> 9·1 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right"> 6·8 &nbsp; </td><td align="right"> 2·2 &nbsp; </td></tr>
+<tr><td align="left"> 75%ile</td><td align="right"></td><td align="right"></td><td align="right"> 13·52</td><td align="right"></td><td align="right"></td><td align="right"> 12·67</td><td align="right"> 5·22</td></tr>
+<tr><td align="left"> 25%ile</td><td align="right"></td><td align="right"></td><td align="right"> 7·15</td><td align="right"></td><td align="right"></td><td align="right"> 4·47</td><td align="right"> -4·07</td></tr>
+<tr><td align="left"> Q</td><td align="right"></td><td align="right"></td><td align="right"> 3·18</td><td align="right"></td><td align="right"></td><td align="right"> 4·1 &nbsp; </td><td align="right"> 4·65</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="right">3·81</td><td align="right"></td><td align="right"></td><td align="right"> 4·19</td><td align="right"> 6·1 &nbsp; </td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="right"> ±1·00</td><td align="right"></td><td align="right"></td><td align="right"> ±1·07</td><td align="right"> ±1·46</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av. = 1·30 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M. = 1·51 P. E.</td></tr>
+</table></div>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center">6 months</td><td align="center"> 12 months</td></tr>
+<tr><td align="left"> Average of gains in test group in excess of control</td><td align="right"> 1·37</td><td align="right"> 1·90</td></tr>
+<tr><td align="left"> Median</td><td align="right"> 1·20</td><td align="right"> 2·20</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="right"> ±·48</td><td align="right"> ±1·46</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="right"> 2·85</td><td align="right"> 1·30</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="right"> 2·80</td><td align="right"> 1·51</td></tr>
+</table></div>
+
+<p><span class="pagenum">[Pg 57]</span></p><p>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.</p>
+
+<p>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.</p>
+
+<h3>TABLE XVI</h3>
+
+<h3>Height, Second Retests, 13 Pairs</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center" colspan="3"> Test Group (A)</td><td align="center" colspan="3"> Control Group (B)</td></tr>
+<tr><td align="right"></td><td align="center"> Test 1</td><td align="center">Test 3</td><td align="center"> Gain</td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center"> A-B</td></tr>
+<tr><td align="right"> 13</td><td align="right">61·3 &nbsp;</td><td align="right">61·8 &nbsp;</td><td align="right">·5 &nbsp; &nbsp;</td><td align="right">56·8 &nbsp;</td><td align="right">60·0 &nbsp;</td><td align="right">3·2 &nbsp;</td><td align="right">-2·7 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 2</td><td align="right">42·6 &nbsp;</td><td align="right">45·9 &nbsp;</td><td align="right">3·3 &nbsp; &nbsp;</td><td align="right">45·2 &nbsp;</td><td align="right">49·8 &nbsp;</td><td align="right">4·6 &nbsp;</td><td align="right">-1·3 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 28</td><td align="right">54·9 &nbsp;</td><td align="right">56·3 &nbsp;</td><td align="right">1·4 &nbsp; &nbsp;</td><td align="right">53·4 &nbsp;</td><td align="right">55·9 &nbsp;</td><td align="right">2·5 &nbsp;</td><td align="right">-1·1 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 8</td><td align="right">50·8 &nbsp;</td><td align="right">52·3 &nbsp;</td><td align="right">1·5 &nbsp; &nbsp;</td><td align="right">46·8 &nbsp;</td><td align="right">48·7 &nbsp;</td><td align="right">1·9 &nbsp;</td><td align="right">- ·4 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 10</td><td align="right">46·1 &nbsp; </td><td align="right">48·6 &nbsp; </td><td align="right">2·5 &nbsp; &nbsp;</td><td align="right">45·6 &nbsp; </td><td align="right">48·1 &nbsp; </td><td align="right">2·5 &nbsp; </td><td align="right">·0 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 1</td><td align="right">46·0 &nbsp;</td><td align="right">49·7 &nbsp;</td><td align="right">3·7 &nbsp; &nbsp;</td><td align="right">46·4 &nbsp;</td><td align="right">49·7 &nbsp;</td><td align="right">3·3 &nbsp;</td><td align="right">·4 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 11</td><td align="right">45·8 &nbsp;</td><td align="right">49·5 &nbsp;</td><td align="right">3·7 &nbsp; &nbsp;</td><td align="right">43·6 &nbsp;</td><td align="right">46·8 &nbsp;</td><td align="right">3·2 &nbsp;</td><td align="right">·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 16</td><td align="right">51·6 &nbsp;</td><td align="right">53·5 &nbsp;</td><td align="right">1·9 &nbsp; &nbsp;</td><td align="right">48·7 &nbsp;</td><td align="right">50·1 &nbsp;</td><td align="right">1·4 &nbsp;</td><td align="right">·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 14</td><td align="right">51·0 &nbsp;</td><td align="right">53·3 &nbsp;</td><td align="right">2·3 &nbsp; &nbsp;</td><td align="right">57·9 &nbsp;</td><td align="right">59·5 &nbsp;</td><td align="right">1·6 &nbsp;</td><td align="right">·7 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 3</td><td align="right">47·0 &nbsp;</td><td align="right">50·2 &nbsp;</td><td align="right">3·2 &nbsp; &nbsp;</td><td align="right">51·7 &nbsp;</td><td align="right">54·0 &nbsp;</td><td align="right">2·3 &nbsp;</td><td align="right">·9 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 7</td><td align="right">42·9 &nbsp;</td><td align="right">45·6 &nbsp;</td><td align="right">2·7 &nbsp; &nbsp;</td><td align="right">41·9 &nbsp;</td><td align="right">43·7 &nbsp;</td><td align="right">1·8 &nbsp;</td><td align="right">·9 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 4</td><td align="right">47·5 &nbsp;</td><td align="right">50·5 &nbsp;</td><td align="right">3·0 &nbsp; &nbsp;</td><td align="right">48·9 &nbsp;</td><td align="right">50·8 &nbsp;</td><td align="right">1·9 &nbsp;</td><td align="right">1·1 &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 19</td><td align="right">57·7 &nbsp;</td><td align="right">60·5 &nbsp;</td><td align="right">2·8 &nbsp; &nbsp;</td><td align="right">46·7 &nbsp;</td><td align="right">4·8 &nbsp;</td><td align="right">1·3 &nbsp;</td><td align="right">1·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Av.</td><td align="right">49·63</td><td align="right">52·17</td><td align="right">2·5 &nbsp; &nbsp;</td><td align="right">48·74</td><td align="right">51·16</td><td align="right">2·42</td><td align="right">·08 &nbsp; </td></tr>
+<tr><td align="left"> M</td><td align="right"></td><td align="right"></td><td align="right"> 2·7 &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 2·3 &nbsp;</td><td align="right"> ·5 &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 75%ile</td><td align="right"></td><td align="right"></td><td align="right"> 3·15 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 2·85</td><td align="right">·85 &nbsp; </td></tr>
+<tr><td align="left"> 25%ile</td><td align="right"></td><td align="right"></td><td align="right"> 1·6 &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 1·75</td><td align="right"> ·92 &nbsp; </td></tr>
+<tr><td align="left"> Q</td><td align="right"></td><td align="right"></td><td align="right"> ·775</td><td align="right"></td><td align="right"></td><td align="right"> ·65</td><td align="right"> ·885</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="right"> ·66</td><td align="right"></td><td align="right"></td><td align="right"> ·78</td><td align="right"> ·82 &nbsp; </td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="right"> ±·18</td><td align="right"></td><td align="right"></td><td align="right"> ±·22</td><td align="right"> ±·28 &nbsp; </td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av.=·29 P. E.</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M.=1·79 P. E.</td></tr>
+</table></div>
+<p><span class="pagenum">[Pg 58]</span></p>
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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:</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center"> 6 months</td><td align="center"> 12 months</td></tr>
+<tr><td align="left"> Average of gains of test group in excess of control</td><td align="right"> ·16</td><td align="right"> ·08</td></tr>
+<tr><td align="left"> Median of gains of test group in excess of control</td><td align="right"> ·20</td><td align="right"> ·50</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="right"> ·16</td><td align="right"> ·28</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="right">1·00</td><td align="right"> ·29</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="right">1·25</td><td align="right"> 1·79</td></tr>
+</table></div>
+<p>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<span class="pagenum">[Pg 59]</span>
+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.</p>
+
+<p>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:</p>
+
+<h3>TABLE XVII</h3>
+
+<h3>Height-Weight Relationship, Second Retests, 13 Pairs
+Showing changes in per cent over or underweight after
+12 months' interval</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center"colspan="2"> Test Group (A)</td><td align="center" colspan="2"> Control Group (B)</td></tr>
+<tr><td align="right"></td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Change</td><td align="center"> Test 1</td><td align="center"> Test 2</td><td align="center">Change</td><td align="center"> A-B</td></tr>
+<tr><td align="right"> 8</td><td align="right">- 1</td><td align="right">+ 7 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 8 &nbsp; &nbsp; &nbsp;</td><td align="right">-13 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">+13 &nbsp; &nbsp; &nbsp;</td><td align="right">- 5</td><td align="right"></td></tr>
+<tr><td align="right"> 16</td><td align="right">-16</td><td align="right">-17 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1 &nbsp; &nbsp; &nbsp;</td><td align="right">-13 &nbsp; &nbsp; &nbsp;</td><td align="right">- 9 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 4 &nbsp; &nbsp; &nbsp;</td><td align="right">- 5 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 11</td><td align="right">- 3</td><td align="right">- 6 &nbsp; &nbsp; &nbsp;</td><td align="right">- 3 &nbsp; &nbsp; &nbsp;</td><td align="right">- 9 &nbsp; &nbsp; &nbsp;</td><td align="right">-10 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 14</td><td align="right">-13</td><td align="right">- 6 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 7 &nbsp; &nbsp; &nbsp;</td><td align="right">- 5 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 4 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 9 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 19</td><td align="right">+ 6</td><td align="right">+10 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 4 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 1 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 7 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 6 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 28</td><td align="right">- 7</td><td align="right">- 4 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 3 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 5 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 5 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 10</td><td align="right">- 1</td><td align="right"> 0 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 1 &nbsp; &nbsp; &nbsp;</td><td align="right">- 6 &nbsp; &nbsp; &nbsp;</td><td align="right">- 6 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 1 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 7</td><td align="right">- 8</td><td align="right">- 8 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">- 7 &nbsp; &nbsp; &nbsp;</td><td align="right">- 9 &nbsp; &nbsp; &nbsp;</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 2 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 2</td><td align="right">- 8</td><td align="right">- 4 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 4 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 9 &nbsp; &nbsp; &nbsp;</td><td align="right">+10 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 1 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 3 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 4</td><td align="right">- 7</td><td align="right">- 4 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 3 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 3 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 1</td><td align="right"> 0</td><td align="right">+ 6 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 6 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 8 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 5 &nbsp; &nbsp; &nbsp;</td><td align="right">- 3 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 9 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 13</td><td align="right">-13</td><td align="right">+ 6 &nbsp; &nbsp; &nbsp;</td><td align="right">+19 &nbsp; &nbsp; &nbsp;</td><td align="right">-11 &nbsp; &nbsp; &nbsp;</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1 &nbsp; &nbsp; &nbsp;</td><td align="right">+20 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 3</td><td align="right">+ 6</td><td align="right">+13 &nbsp; &nbsp; &nbsp;</td><td align="right">+ 7 &nbsp; &nbsp; &nbsp;</td><td align="right">- 5 &nbsp; &nbsp; &nbsp;</td><td align="right">-20 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td><td align="right">+22 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Av.</td><td align="right">- 5</td><td align="right">-·54</td><td align="right">4·46</td><td align="right">- 5·08</td><td align="right">3·85</td><td align="right">1·23</td><td align="right">3·23</td></tr>
+<tr><td align="left"> M</td><td align="right"></td><td align="right"></td><td align="right"> 4 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> - 2 &nbsp; &nbsp; &nbsp;</td><td align="right"> 6 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 75%ile</td><td align="right"></td><td align="right"></td><td align="right"> 6·75</td><td align="right"></td><td align="right"></td><td align="right"> 2·75</td><td align="right"> 3 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 25%ile</td><td align="right"></td><td align="right"></td><td align="right"> - 2·50</td><td align="right"></td><td align="right"></td><td align="right"> 2·75</td><td align="right">- 2 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Q</td><td align="right"></td><td align="right"></td><td align="right"> 4·625</td><td align="right"></td><td align="right"></td><td align="right"> 2·75</td><td align="right"> 2·50</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="right"> 2·54</td><td align="right"></td><td align="right"></td><td align="right"> 3·23</td><td align="right">5·23</td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="right">± ·71</td><td align="right"></td><td align="right"></td><td align="right"> ± ·90</td><td align="right"> ± 1·15</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av.=2·81 P. E.</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M. =5·22 P. E.</td></tr>
+</table></div>
+
+<p><span class="pagenum">[Pg 60]</span></p>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="right"> 6 months</td><td align="right"> 12 months</td></tr>
+<tr><td align="left"> Average of gains of test group in excess of control</td><td align="right"> 1·83</td><td align="right"> 3·23</td></tr>
+<tr><td align="left"> Median of gains of test group in excess of control</td><td align="right"> 4·00</td><td align="right"> 6·00</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="right"> ·91</td><td align="right"> 1·15</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="right"> 2·02</td><td align="right"> 2·81</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="right">4·40</td><td align="right"> 5·22</td></tr>
+</table></div>
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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:</p>
+
+<h3>TABLE XVIII</h3>
+
+<h3>Gain in Grip, Second Retest, 13 Pairs</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center" colspan="3"> Test Group (A)</td><td align="center" colspan="3"> Control Group (B)</td></tr>
+<tr><td align="center"></td><td align="center"> Test 1</td><td align="center"> Test 2</td><td align="center"> Gain</td><td align="center"> Test 1</td><td align="center"> Test 2</td><td align="center"> Gain</td><td align="center"> A-B</td></tr>
+<tr><td align="left"> &nbsp; 7</td><td align="left"> &nbsp; 7</td><td align="left"> &nbsp;6</td><td align="left"> &nbsp; -1</td><td align="left"> &nbsp;9</td><td align="left">14</td><td align="left"> &nbsp;5</td><td align="left">-6</td></tr>
+<tr><td align="left"> 19</td><td align="left">22</td><td align="left">20</td><td align="left"> &nbsp; -2</td><td align="left">15</td><td align="left">18</td><td align="left"> &nbsp;3</td><td align="left">-5</td></tr>
+<tr><td align="left"> &nbsp; 2</td><td align="left"> &nbsp; 9</td><td align="left">10</td><td align="left"> &nbsp; &nbsp;1</td><td align="left">10</td><td align="left">15</td><td align="left"> &nbsp;5</td><td align="left">-4</td></tr>
+<tr><td align="left"> 27</td><td align="left"> &nbsp; 9</td><td align="left"> &nbsp;6</td><td align="left"> &nbsp; -3</td><td align="left"> &nbsp;8</td><td align="left"> &nbsp;9</td><td align="left"> &nbsp;1</td><td align="left">-4</td></tr>
+<tr><td align="left"> 13</td><td align="left">26·5</td><td align="left">28·5</td><td align="left"> &nbsp; &nbsp;2</td><td align="left">22</td><td align="left">27</td><td align="left"> &nbsp;5</td><td align="left">-3</td></tr>
+<tr><td align="left"> 10</td><td align="left">12·5</td><td align="left">12</td><td align="left"> &nbsp; &nbsp;-·5</td><td align="left">10</td><td align="left">12</td><td align="left"> &nbsp;2</td><td align="left">-2·5</td></tr>
+<tr><td align="left"> 16</td><td align="left">19</td><td align="left">18·5</td><td align="left"> &nbsp; &nbsp;-·5</td><td align="left">10</td><td align="left">10</td><td align="left"></td><td align="left">- ·5<span class="pagenum">[Pg 61]</span></td></tr>
+<tr><td align="left"> &nbsp; 3</td><td align="left">12·5</td><td align="left">13</td><td align="left"> &nbsp; &nbsp; ·5</td><td align="left">14</td><td align="left">14·5</td><td align="left"> &nbsp;·5</td><td align="left"></td></tr>
+<tr><td align="left"> 14</td><td align="left">16</td><td align="left">17</td><td align="left"> &nbsp;1</td><td align="left">22</td><td align="left">22·5</td><td align="left"> &nbsp;·5</td><td align="left"> &nbsp;·5</td></tr>
+<tr><td align="left"> 21</td><td align="left">16·5</td><td align="left">15</td><td align="left">-1·5</td><td align="left">19</td><td align="left">17</td><td align="left">-2</td><td align="left"> &nbsp;·5</td></tr>
+<tr><td align="left"> &nbsp; 1</td><td align="left">13</td><td align="left">18</td><td align="left"> &nbsp;5</td><td align="left">11</td><td align="left">15</td><td align="left"> &nbsp;4</td><td align="left"> &nbsp;1</td></tr>
+<tr><td align="left"> 23</td><td align="left">11·5</td><td align="left">15</td><td align="left"> &nbsp;3·5</td><td align="left">14·5</td><td align="left">16</td><td align="left"> &nbsp;1·5</td><td align="left"> &nbsp;2</td></tr>
+<tr><td align="left"> 11</td><td align="left">11</td><td align="left">11</td><td align="left"></td><td align="left">11·5</td><td align="left"> &nbsp;7·5</td><td align="left">-4</td><td align="left"> &nbsp;4</td></tr>
+<tr><td align="left"> Av.</td><td align="left">14·27</td><td align="left">14·61</td><td align="left"> &nbsp; &nbsp;·34</td><td align="left">13·54</td><td align="left">15·19</td><td align="left"> &nbsp;1·65</td><td align="left">-1·31</td></tr>
+<tr><td align="left"> M</td><td align="left"></td><td align="left"></td><td align="left"> 0</td><td align="left"></td><td align="left"></td><td align="left"> 1·5</td><td align="left"> -1·5</td></tr>
+<tr><td align="left"> 75%ile</td><td align="left"></td><td align="left"></td><td align="left"> 1·25</td><td align="left"></td><td align="left"></td><td align="left"> 3·75</td><td align="left"> &nbsp; ·62</td></tr>
+<tr><td align="left"> 25%ile</td><td align="left"></td><td align="left"></td><td align="left"> -1·38</td><td align="left"></td><td align="left"></td><td align="left"> &nbsp; ·12</td><td align="left"> &nbsp; -·4</td></tr>
+<tr><td align="left"> Q</td><td align="left"></td><td align="left"></td><td align="left"> 1·31</td><td align="left"></td><td align="left"></td><td align="left"> 1·81</td><td align="left"> &nbsp; ·51</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="left"> 1·34</td><td align="left"></td><td align="left"></td><td align="left"> 1·65</td><td align="left"> 2·31</td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="left"> ± &nbsp;·37</td><td align="left"></td><td align="left"></td><td align="left"> ±·46</td><td align="left"> ±·59</td></tr>
+<tr><td align="left"></td><td align="left"></td><td align="left"></td><td align="left"></td><td align="left"></td><td align="left"></td><td align="left" colspan="2"> Av.=-2·22 P. E.</td></tr>
+<tr><td align="left"></td><td align="left"></td><td align="left"></td><td align="left"></td><td align="left"></td><td align="left"></td><td align="left" colspan="2"> M.=-2·54 P. E.</td></tr>
+</table></div>
+<br>
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center"> 6 months</td><td align="center"> 12 months</td></tr>
+<tr><td align="left"> Average of gains of test group in excess of control</td><td align="right"> -·24</td><td align="right"> -1·31</td></tr>
+<tr><td align="left"> Median of gains of test group in excess of control</td><td align="right"> -1·00</td><td align="right"> -1·50</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="right"> ±·48</td><td align="right"> ±·59</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="right"> -·50</td><td align="right"> -2·22</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="right"> -2·08</td><td align="right"> -2·54</td></tr>
+</table></div>
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 62]</span>
+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.</p>
+
+<h3>TABLE XIX</h3>
+
+<h3>Tapping&mdash;Second Retest, 15 Pairs</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center" colspan="3"> Test Group (A)</td><td align="center" colspan="3"> Control Group (B)</td></tr>
+<tr><td align="right"></td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center"> A-B</td></tr>
+<tr><td align="right"> 21</td><td align="right">152 &nbsp; &nbsp; &nbsp;</td><td align="right">154 &nbsp; &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp; &nbsp;</td><td align="right">149 &nbsp; &nbsp; &nbsp;</td><td align="right">174 &nbsp; &nbsp; &nbsp;</td><td align="right">34 &nbsp; &nbsp; &nbsp;</td><td align="right">-32 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 13</td><td align="right">160 &nbsp; &nbsp; &nbsp;</td><td align="right">176 &nbsp; &nbsp; &nbsp;</td><td align="right">16 &nbsp; &nbsp; &nbsp;</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">188 &nbsp; &nbsp; &nbsp;</td><td align="right">38 &nbsp; &nbsp; &nbsp;</td><td align="right">-22 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 1</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">142 &nbsp; &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">106 &nbsp; &nbsp; &nbsp;</td><td align="right">134 &nbsp; &nbsp; &nbsp;</td><td align="right">28 &nbsp; &nbsp; &nbsp;</td><td align="right">-21 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 18</td><td align="right">133 &nbsp; &nbsp; &nbsp;</td><td align="right">126 &nbsp; &nbsp; &nbsp;</td><td align="right">- 7 &nbsp; &nbsp; &nbsp;</td><td align="right">100 &nbsp; &nbsp; &nbsp;</td><td align="right">108 &nbsp; &nbsp; &nbsp;</td><td align="right">8 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 23</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">157 &nbsp; &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">122 &nbsp; &nbsp; &nbsp;</td><td align="right">141 &nbsp; &nbsp; &nbsp;</td><td align="right">19 &nbsp; &nbsp; &nbsp;</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 10</td><td align="right">68 &nbsp; &nbsp; &nbsp;</td><td align="right">145 &nbsp; &nbsp; &nbsp;</td><td align="right">77 &nbsp; &nbsp; &nbsp;</td><td align="right">70 &nbsp; &nbsp; &nbsp;</td><td align="right">148 &nbsp; &nbsp; &nbsp;</td><td align="right">78 &nbsp; &nbsp; &nbsp;</td><td align="right">- 1 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 3</td><td align="right">136 &nbsp; &nbsp; &nbsp;</td><td align="right">144 &nbsp; &nbsp; &nbsp;</td><td align="right">8 &nbsp; &nbsp; &nbsp;</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">8 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 20</td><td align="right">105 &nbsp; &nbsp; &nbsp;</td><td align="right">122 &nbsp; &nbsp; &nbsp;</td><td align="right">17 &nbsp; &nbsp; &nbsp;</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">154 &nbsp; &nbsp; &nbsp;</td><td align="right">4 &nbsp; &nbsp; &nbsp;</td><td align="right">13 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 15</td><td align="right">172 &nbsp; &nbsp; &nbsp;</td><td align="right">192 &nbsp; &nbsp; &nbsp;</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td><td align="right">140 &nbsp; &nbsp; &nbsp;</td><td align="right">145 &nbsp; &nbsp; &nbsp;</td><td align="right">5 &nbsp; &nbsp; &nbsp;</td><td align="right">15 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 27</td><td align="right">108 &nbsp; &nbsp; &nbsp;</td><td align="right">114 &nbsp; &nbsp; &nbsp;</td><td align="right">6 &nbsp; &nbsp; &nbsp;</td><td align="right">115 &nbsp; &nbsp; &nbsp;</td><td align="right">101 &nbsp; &nbsp; &nbsp;</td><td align="right">-14 &nbsp; &nbsp; &nbsp;</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 8</td><td align="right">113 &nbsp; &nbsp; &nbsp;</td><td align="right">128 &nbsp; &nbsp; &nbsp;</td><td align="right">15 &nbsp; &nbsp; &nbsp;</td><td align="right">131 &nbsp; &nbsp; &nbsp;</td><td align="right">121 &nbsp; &nbsp; &nbsp;</td><td align="right">-10 &nbsp; &nbsp; &nbsp;</td><td align="right">25 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 28</td><td align="right">150 &nbsp; &nbsp; &nbsp;</td><td align="right">176 &nbsp; &nbsp; &nbsp;</td><td align="right">26 &nbsp; &nbsp; &nbsp;</td><td align="right">178 &nbsp; &nbsp; &nbsp;</td><td align="right">172 &nbsp; &nbsp; &nbsp;</td><td align="right">- 6 &nbsp; &nbsp; &nbsp;</td><td align="right">32 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 2</td><td align="right">105 &nbsp; &nbsp; &nbsp;</td><td align="right">135 &nbsp; &nbsp; &nbsp;</td><td align="right">30 &nbsp; &nbsp; &nbsp;</td><td align="right">152 &nbsp; &nbsp; &nbsp;</td><td align="right">139 &nbsp; &nbsp; &nbsp;</td><td align="right">-13 &nbsp; &nbsp; &nbsp;</td><td align="right">43 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 11</td><td align="right">125 &nbsp; &nbsp; &nbsp;</td><td align="right">120 &nbsp; &nbsp; &nbsp;</td><td align="right">- 5 &nbsp; &nbsp; &nbsp;</td><td align="right">155 &nbsp; &nbsp; &nbsp;</td><td align="right">102 &nbsp; &nbsp; &nbsp;</td><td align="right">-53 &nbsp; &nbsp; &nbsp;</td><td align="right">48 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 14</td><td align="right">190 &nbsp; &nbsp; &nbsp;</td><td align="right">228 &nbsp; &nbsp; &nbsp;</td><td align="right">38 &nbsp; &nbsp; &nbsp;</td><td align="right">175 &nbsp; &nbsp; &nbsp;</td><td align="right">165 &nbsp; &nbsp; &nbsp;</td><td align="right">-10 &nbsp; &nbsp; &nbsp;</td><td align="right">48 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Av.</td><td align="right">133·47</td><td align="right">150·6</td><td align="right">17·13</td><td align="right">134·6 &nbsp; </td><td align="right">141·8 &nbsp; </td><td align="right">7·2 &nbsp; </td><td align="right">9·93</td></tr>
+<tr><td align="left"> M</td><td align="right"></td><td align="right"></td><td align="right"> 15 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 4 &nbsp; &nbsp; &nbsp;</td><td align="right"> 11</td></tr>
+<tr><td align="left"> 75%ile</td><td align="right"></td><td align="right"></td><td align="right"> 21·5 &nbsp; </td><td align="right"></td><td align="right"></td><td align="right"> 21·5 &nbsp; </td><td align="right"> 26·75</td></tr>
+<tr><td align="left"> 25%ile</td><td align="right"></td><td align="right"></td><td align="right"> 5 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> -10·75</td><td align="right">-16·5</td></tr>
+<tr><td align="left"> Q</td><td align="right"></td><td align="right"></td><td align="right"> 8·25</td><td align="right"></td><td align="right"></td><td align="right"> 16·12</td><td align="right">21·62</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="right"> 10·13</td><td align="right"></td><td align="right"></td><td align="right"> 17·2 &nbsp; </td><td align="right"> 22·07</td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="right"> ± 2·67</td><td align="right"></td><td align="right"></td><td align="right"> ± 4·53</td><td align="right">± 5·26</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av.=1·89 P. E.</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M. =2·09 P. E.</td></tr>
+</table></div>
+<p>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:</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center"> 6 months</td><td align="center"> 12 months</td></tr>
+<tr><td align="left"> Average of gains of test group in excess of control</td><td align="right"> - ·09</td><td align="right"> 9·93</td></tr>
+<tr><td align="left"> Median of gains of test group in excess of control</td><td align="right"> 0·00</td><td align="right"> 11·00</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="right"> ±3·10</td><td align="right"> ± 5·26</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="right"> ·03</td><td align="right"> 1·89</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="right"> 0·00</td><td align="right"> 2·09</td></tr>
+</table></div>
+<p>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<span class="pagenum">[Pg 63]</span>
+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.</p>
+
+<p>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.</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"></td><td align="center"> 6 months</td><td align="center">12 months</td></tr>
+<tr><td align="left"> Average of gains of test group in excess of control</td><td align="right"> -·020</td><td align="right"> - ·060</td></tr>
+<tr><td align="left"> Median of gains of test group in excess of control</td><td align="right"> -·015</td><td align="right"> - ·090</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="right">±·040</td><td align="right"> ± ·036</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="right"> -·500</td><td align="right"> -1·660</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="right"> -·380</td><td align="right"> -2·500</td></tr>
+</table></div>
+
+
+<h3>TABLE XX</h3>
+
+<h3>Tapping for Fatigue, Second Retests, 11 Pairs</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center" colspan="3"> Test Group (A)</td><td align="center" colspan="3"> Control Group (B)</td></tr>
+<tr><td align="right"></td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center"> A-B</td></tr>
+<tr><td align="right"> 20</td><td align="right">-·10 &nbsp;</td><td align="right">·03 &nbsp;</td><td align="right">-·13 &nbsp;</td><td align="right">·20 &nbsp;</td><td align="right">·0 &nbsp; &nbsp;</td><td align="right">·20 &nbsp;</td><td align="right">-·33 &nbsp;</td></tr>
+<tr><td align="right"> 27</td><td align="right">·15 &nbsp;</td><td align="right">·17 &nbsp;</td><td align="right">-·02 &nbsp;</td><td align="right">·09 &nbsp;</td><td align="right">-·17 &nbsp;</td><td align="right">·26 &nbsp;</td><td align="right">-·28 &nbsp;</td></tr>
+<tr><td align="right"> 10</td><td align="right">-·09 &nbsp;</td><td align="right">·27 &nbsp;</td><td align="right">-·36 &nbsp;</td><td align="right">·06 &nbsp;</td><td align="right">·16 &nbsp;</td><td align="right">-·10 &nbsp;</td><td align="right">-·26 &nbsp;</td></tr>
+<tr><td align="right"> 14</td><td align="right">·09 &nbsp;</td><td align="right">·05 &nbsp;</td><td align="right">·04 &nbsp;</td><td align="right">·13 &nbsp;</td><td align="right">-·13 &nbsp;</td><td align="right">·26 &nbsp;</td><td align="right">-·22 &nbsp;</td></tr>
+<tr><td align="right"> 13</td><td align="right">-·03 &nbsp;</td><td align="right">-·06 &nbsp;</td><td align="right">·03 &nbsp;</td><td align="right">·27 &nbsp;</td><td align="right">·07 &nbsp;</td><td align="right">·20 &nbsp;</td><td align="right">-·17 &nbsp;</td></tr>
+<tr><td align="right"> 28</td><td align="right">·01 &nbsp;</td><td align="right">·05 &nbsp;</td><td align="right">-·04 &nbsp;</td><td align="right">·17 &nbsp;</td><td align="right">·10 &nbsp;</td><td align="right">·07 &nbsp;</td><td align="right">-·11 &nbsp;</td></tr>
+<tr><td align="right"> 15</td><td align="right">·03 &nbsp;</td><td align="right">·03 &nbsp;</td><td align="right">·0 &nbsp; &nbsp;</td><td align="right">·18 &nbsp;</td><td align="right">·08 &nbsp;</td><td align="right">·10 &nbsp;</td><td align="right">-·10 &nbsp;</td></tr>
+<tr><td align="right"> 23</td><td align="right">·11 &nbsp;</td><td align="right">·0 &nbsp; &nbsp;</td><td align="right">·11 &nbsp;</td><td align="right">·06 &nbsp;</td><td align="right">·0 &nbsp; &nbsp;</td><td align="right">·06 &nbsp;</td><td align="right">·05 &nbsp;</td></tr>
+<tr><td align="right"> 21</td><td align="right">·27 &nbsp;</td><td align="right">-·01 &nbsp;</td><td align="right">·28 &nbsp;</td><td align="right">·29 &nbsp;</td><td align="right">·14 &nbsp;</td><td align="right">·15 &nbsp;</td><td align="right">·13 &nbsp;</td></tr>
+<tr><td align="right"> 11</td><td align="right">·28 &nbsp;</td><td align="right">-·04 &nbsp;</td><td align="right">·32 &nbsp;</td><td align="right">·11 &nbsp;</td><td align="right">-·01 &nbsp;</td><td align="right">·12 &nbsp;</td><td align="right">·20 &nbsp;</td></tr>
+<tr><td align="right"> 18</td><td align="right">·14 &nbsp;</td><td align="right">-·15 &nbsp;</td><td align="right">·29 &nbsp;</td><td align="right">·01 &nbsp;</td><td align="right">·15 &nbsp;</td><td align="right">-·14 &nbsp;</td><td align="right">·43 &nbsp;</td></tr>
+<tr><td align="left"> Av.</td><td align="right">·078</td><td align="right">·031</td><td align="right">·047</td><td align="right">·143</td><td align="right">·035</td><td align="right">·107</td><td align="right">-·06 &nbsp;</td></tr>
+<tr><td align="left"> M</td><td align="right"></td><td align="right"></td><td align="right"> ·03 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> ·12 &nbsp;</td><td align="right"> -·09 &nbsp;</td></tr>
+<tr><td align="left"> 75%ile</td><td align="right"></td><td align="right"></td><td align="right"> ·153</td><td align="right"></td><td align="right"></td><td align="right"> ·20 &nbsp;</td><td align="right"> ·07 &nbsp;</td></tr>
+<tr><td align="left"> 25%ile</td><td align="right"></td><td align="right"></td><td align="right"> -·062</td><td align="right"></td><td align="right"></td><td align="right"> ·02 &nbsp;</td><td align="right"> -·275</td></tr>
+<tr><td align="left"> Q</td><td align="right"></td><td align="right"></td><td align="right"> ·107</td><td align="right"></td><td align="right"></td><td align="right"> ·09 &nbsp;</td><td align="right"> ·172</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="right"> ·087</td><td align="right"></td><td align="right"></td><td align="right"> ·093</td><td align="right"> ·19 &nbsp;</td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="right">±·02 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> ±·03 &nbsp;</td><td align="right">±·036</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av.=-1·66 &nbsp; P. E.</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M.=-2·50 &nbsp; P. E.</td></tr>
+</table></div><p><span class="pagenum">[Pg 64]</span></p>
+
+<p>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.</p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center"> 6 months</td><td align="center">12 months</td></tr>
+<tr><td align="left"> Average of gains of test group in excess of control</td><td align="left">-1·035</td><td align="left">-3·14</td></tr>
+<tr><td align="left"> Median of gains of test group in excess of control</td><td align="left">-1</td><td align="left"> -3</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="left">±1·10</td><td align="left"> ±1·84</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="left"> &nbsp;- ·94</td><td align="left"> -1·71</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="left"> &nbsp;- ·99</td><td align="left"> -1·63</td></tr>
+</table></div>
+<p>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,&mdash;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.</p>
+
+<p>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:<span class="pagenum">[Pg 65]</span></p>
+
+<h3>TABLE XXI</h3>
+
+<h3>I.Q., Second Retests, 21 Pairs</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center" colspan="3"> Test Group (A)</td><td align="center" colspan="3"> Control Group (B)</td></tr>
+<tr><td align="right"></td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center">Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center">A-B</td></tr>
+<tr><td align="right"> 27</td><td align="right">110 &nbsp; &nbsp;</td><td align="right">112 &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp;</td><td align="right">72 &nbsp; &nbsp;</td><td align="right">98 &nbsp; &nbsp;</td><td align="right">26 &nbsp; &nbsp;</td><td align="right">-24 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 15</td><td align="right">97 &nbsp; &nbsp;</td><td align="right">97 &nbsp; &nbsp;</td><td align="right"></td><td align="right">78 &nbsp; &nbsp;</td><td align="right">98 &nbsp; &nbsp;</td><td align="right">20 &nbsp; &nbsp;</td><td align="right">-20 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 3</td><td align="right">94 &nbsp; &nbsp;</td><td align="right">91 &nbsp; &nbsp;</td><td align="right">-3 &nbsp; &nbsp;</td><td align="right">82 &nbsp; &nbsp;</td><td align="right">96 &nbsp; &nbsp;</td><td align="right">14 &nbsp; &nbsp;</td><td align="right">-17 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 7</td><td align="right">91 &nbsp; &nbsp;</td><td align="right">93 &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp;</td><td align="right">95 &nbsp; &nbsp;</td><td align="right">112 &nbsp; &nbsp;</td><td align="right">17 &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 20</td><td align="right">106 &nbsp; &nbsp;</td><td align="right">116 &nbsp; &nbsp;</td><td align="right">10 &nbsp; &nbsp;</td><td align="right">118 &nbsp; &nbsp;</td><td align="right">140 &nbsp; &nbsp;</td><td align="right">22 &nbsp; &nbsp;</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 23</td><td align="right">85 &nbsp; &nbsp;</td><td align="right">80 &nbsp; &nbsp;</td><td align="right">-5 &nbsp; &nbsp;</td><td align="right">81 &nbsp; &nbsp;</td><td align="right">88 &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp;</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 8</td><td align="right">91 &nbsp; &nbsp;</td><td align="right">92 &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp;</td><td align="right">98 &nbsp; &nbsp;</td><td align="right">111 &nbsp; &nbsp;</td><td align="right">13 &nbsp; &nbsp;</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 12</td><td align="right">98 &nbsp; &nbsp;</td><td align="right">86 &nbsp; &nbsp;</td><td align="right">-12 &nbsp; &nbsp;</td><td align="right">98 &nbsp; &nbsp;</td><td align="right">91 &nbsp; &nbsp;</td><td align="right">-7 &nbsp; &nbsp;</td><td align="right">-5 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 21</td><td align="right">64 &nbsp; &nbsp;</td><td align="right">66 &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp;</td><td align="right">86 &nbsp; &nbsp;</td><td align="right">93 &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp;</td><td align="right">-5 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 4</td><td align="right">96 &nbsp; &nbsp;</td><td align="right">111 &nbsp; &nbsp;</td><td align="right">15 &nbsp; &nbsp;</td><td align="right">83 &nbsp; &nbsp;</td><td align="right">102 &nbsp; &nbsp;</td><td align="right">19 &nbsp; &nbsp;</td><td align="right">-4 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 13</td><td align="right">70 &nbsp; &nbsp;</td><td align="right">61 &nbsp; &nbsp;</td><td align="right">-9 &nbsp; &nbsp;</td><td align="right">66 &nbsp; &nbsp;</td><td align="right">60 &nbsp; &nbsp;</td><td align="right">-6 &nbsp; &nbsp;</td><td align="right">-3 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 18</td><td align="right">98 &nbsp; &nbsp;</td><td align="right">101 &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp;</td><td align="right">90 &nbsp; &nbsp;</td><td align="right">92 &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 16</td><td align="right">65 &nbsp; &nbsp;</td><td align="right">74 &nbsp; &nbsp;</td><td align="right">9 &nbsp; &nbsp;</td><td align="right">74 &nbsp; &nbsp;</td><td align="right">81 &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 10</td><td align="right">110 &nbsp; &nbsp;</td><td align="right">116 &nbsp; &nbsp;</td><td align="right">6 &nbsp; &nbsp;</td><td align="right">104 &nbsp; &nbsp;</td><td align="right">107 &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 28</td><td align="right">81 &nbsp; &nbsp;</td><td align="right">83 &nbsp; &nbsp;</td><td align="right">2 &nbsp; &nbsp;</td><td align="right">95 &nbsp; &nbsp;</td><td align="right">94 &nbsp; &nbsp;</td><td align="right">-1 &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 11</td><td align="right">103 &nbsp; &nbsp;</td><td align="right">102 &nbsp; &nbsp;</td><td align="right">-1 &nbsp; &nbsp;</td><td align="right">101 &nbsp; &nbsp;</td><td align="right">95 &nbsp; &nbsp;</td><td align="right">-6 &nbsp; &nbsp;</td><td align="right">5 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 1</td><td align="right">82 &nbsp; &nbsp;</td><td align="right">93 &nbsp; &nbsp;</td><td align="right">11 &nbsp; &nbsp;</td><td align="right">80 &nbsp; &nbsp;</td><td align="right">85 &nbsp; &nbsp;</td><td align="right">5 &nbsp; &nbsp;</td><td align="right">6 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 14</td><td align="right">96 &nbsp; &nbsp;</td><td align="right">102 &nbsp; &nbsp;</td><td align="right">6 &nbsp; &nbsp;</td><td align="right">140 &nbsp; &nbsp;</td><td align="right">138 &nbsp; &nbsp;</td><td align="right">-2 &nbsp; &nbsp;</td><td align="right">8 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 19</td><td align="right">96 &nbsp; &nbsp;</td><td align="right">97 &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp;</td><td align="right">98 &nbsp; &nbsp;</td><td align="right">90 &nbsp; &nbsp;</td><td align="right">-8 &nbsp; &nbsp;</td><td align="right">9 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 2</td><td align="right">107 &nbsp; &nbsp;</td><td align="right">113 &nbsp; &nbsp;</td><td align="right">6 &nbsp; &nbsp;</td><td align="right">91 &nbsp; &nbsp;</td><td align="right">86 &nbsp; &nbsp;</td><td align="right">-5 &nbsp; &nbsp;</td><td align="right">11 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 9</td><td align="right">83 &nbsp; &nbsp;</td><td align="right">102 &nbsp; &nbsp;</td><td align="right">19 &nbsp; &nbsp;</td><td align="right">87 &nbsp; &nbsp;</td><td align="right">91 &nbsp; &nbsp;</td><td align="right">4 &nbsp; &nbsp;</td><td align="right">15 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Av.</td><td align="right">91·5</td><td align="right">94·6</td><td align="right">3·0</td><td align="right">91·2</td><td align="right">97·5</td><td align="right">6·2</td><td align="right">-3·1 &nbsp;</td></tr>
+<tr><td align="left"> M</td><td align="right"></td><td align="right"></td><td align="right"> 2 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 5 &nbsp; &nbsp; &nbsp;</td><td align="right"> -3 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 75%ile</td><td align="right"></td><td align="right"></td><td align="right"> 6 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 13·75</td><td align="right"> 4·5 &nbsp;</td></tr>
+<tr><td align="left"> 25%ile</td><td align="right"></td><td align="right"></td><td align="right"> -·75</td><td align="right"></td><td align="right"></td><td align="right"> -4·25</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> Q</td><td align="right"></td><td align="right"></td><td align="right"> 3·37</td><td align="right"></td><td align="right"></td><td align="right"> 9·00</td><td align="right"> 8·25</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="right">2·09</td><td align="right"></td><td align="right"></td><td align="right"> 8·24</td><td align="right"> 8·86</td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="right">±·45</td><td align="right"></td><td align="right"></td><td align="right"> ±1·79</td><td align="right"> ±1·84</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av.=-1·71 P. E.</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M.=-1·63 P. E.</td></tr>
+</table></div><br>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"></td><td align="center">Lost in 2nd period</td><td align="center">Gained in 2nd period</td><td align="center"> No change</td><td align="center"> Gained equally with<br> gain in 1st period</td></tr>
+<tr><td align="left"> Test group</td><td align="right"> 9</td><td align="center"> 11</td><td align="center"> 1</td><td align="center"> 9</td></tr>
+<tr><td align="left"> Control group</td><td align="right"> 10</td><td align="center"> 11</td><td align="left"></td><td align="center"> 8</td></tr>
+</table></div>
+<p>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.</p>
+
+<p>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:<span class="pagenum">[Pg 66]</span></p>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="left"> Average of gains of test group in excess of control</td><td align="right"> -5·85</td><td align="right"> -3·36</td></tr>
+<tr><td align="left"> Median of gains of test group in excess of control</td><td align="right"> -7·75</td><td align="right"> 1·00</td></tr>
+<tr><td align="left"> P. E. of difference</td><td align="right"> ±3·05</td><td align="right">±3·38</td></tr>
+<tr><td align="left"> Average in terms of P. E.</td><td align="right"> -1·92</td><td align="right"> -·87</td></tr>
+<tr><td align="left"> Median in terms of P. E.</td><td align="right"> -2·54</td><td align="right"> ·26</td></tr>
+</table></div>
+<p>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.</p>
+
+<h3>TABLE XXII</h3>
+
+<h3>Healy A, Second Retests, 18 Pairs</h3>
+
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> N<a href="#Footnote_16_16">[16]</a></td><td align="center" colspan="3"> Test Group (A)</td><td align="center" colspan="3"> Control Group (B)</td></tr>
+<tr><td align="right"></td><td align="center"> Test 1</td><td align="center"> Test 3</td><td align="center"> Gain</td><td align="center">Test 1</td><td align="center">Test 3</td><td align="center"> Gain</td><td align="center">A-B</td></tr>
+<tr><td align="right"> 12</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td><td align="right">-19 &nbsp; &nbsp; &nbsp;</td><td align="right">-10 &nbsp; &nbsp; &nbsp;</td><td align="right">41.5 &nbsp;</td><td align="right">51·5 &nbsp;</td><td align="right">-70·5 &nbsp;</td></tr>
+<tr><td align="right"> 23</td><td align="right">49·5 &nbsp;</td><td align="right">62·5 &nbsp;</td><td align="right">13 &nbsp; &nbsp; &nbsp;</td><td align="right">4 &nbsp; &nbsp; &nbsp;</td><td align="right">64 &nbsp; &nbsp; &nbsp;</td><td align="right">60 &nbsp; &nbsp; &nbsp;</td><td align="right">-47 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 15</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">19 &nbsp; &nbsp; &nbsp;</td><td align="right">12 &nbsp; &nbsp; &nbsp;</td><td align="right">1 &nbsp; &nbsp; &nbsp;</td><td align="right">54·5 &nbsp;</td><td align="right">53·5 &nbsp;</td><td align="right">-41·5 &nbsp;</td></tr>
+<tr><td align="right"> 1</td><td align="right">-22 &nbsp; &nbsp; &nbsp;</td><td align="right">11 &nbsp; &nbsp; &nbsp;</td><td align="right">36 &nbsp; &nbsp; &nbsp;</td><td align="right">-50 &nbsp; &nbsp; &nbsp;</td><td align="right">11 &nbsp; &nbsp; &nbsp;</td><td align="right">61 &nbsp; &nbsp; &nbsp;</td><td align="right">-25 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 2</td><td align="right">28·5 &nbsp;</td><td align="right">24·5 &nbsp;</td><td align="right">-4 &nbsp; &nbsp; &nbsp;</td><td align="right">3 &nbsp; &nbsp; &nbsp;</td><td align="right">19·5 &nbsp;</td><td align="right">16·5 &nbsp;</td><td align="right">-20·5 &nbsp;</td></tr>
+<tr><td align="right"> 3</td><td align="right">21·5 &nbsp;</td><td align="right">15·5 &nbsp;</td><td align="right">-6 &nbsp; &nbsp; &nbsp;</td><td align="right">17 &nbsp; &nbsp; &nbsp;</td><td align="right">25·5 &nbsp;</td><td align="right">8·5 &nbsp;</td><td align="right">-14·5 &nbsp;</td></tr>
+<tr><td align="right"> 19</td><td align="right">57·5 &nbsp;</td><td align="right">60·5 &nbsp;</td><td align="right">3 &nbsp; &nbsp; &nbsp;</td><td align="right">-22 &nbsp; &nbsp; &nbsp;</td><td align="right">-15 &nbsp; &nbsp; &nbsp;</td><td align="right">7 &nbsp; &nbsp; &nbsp;</td><td align="right">-4 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 13</td><td align="right">43 &nbsp; &nbsp; &nbsp;</td><td align="right">62·5 &nbsp;</td><td align="right">19·5 &nbsp;</td><td align="right">-1·5 &nbsp;</td><td align="right">21·5 &nbsp;</td><td align="right">23 &nbsp; &nbsp; &nbsp;</td><td align="right">-3·5 &nbsp;</td></tr>
+<tr><td align="right"> 21</td><td align="right">20 &nbsp; &nbsp; &nbsp;</td><td align="right">38 &nbsp; &nbsp; &nbsp;</td><td align="right">18 &nbsp; &nbsp; &nbsp;</td><td align="right">70·5 &nbsp;</td><td align="right">88 &nbsp; &nbsp; &nbsp;</td><td align="right">17·5 &nbsp;</td><td align="right">·5 &nbsp;</td></tr>
+<tr><td align="right"> 10</td><td align="right">-12 &nbsp; &nbsp; &nbsp;</td><td align="right">11 &nbsp; &nbsp; &nbsp;</td><td align="right">23 &nbsp; &nbsp; &nbsp;</td><td align="right">27 &nbsp; &nbsp; &nbsp;</td><td align="right">48·5 &nbsp;</td><td align="right">21·5 &nbsp;</td><td align="right">1·5 &nbsp;</td></tr>
+<tr><td align="right"> 14</td><td align="right">12·5 &nbsp;</td><td align="right">77 &nbsp; &nbsp; &nbsp;</td><td align="right">64·5 &nbsp;</td><td align="right">-5 &nbsp; &nbsp; &nbsp;</td><td align="right">48·5 &nbsp;</td><td align="right">53·5 &nbsp;</td><td align="right">11 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 27</td><td align="right">-25 &nbsp; &nbsp; &nbsp;</td><td align="right">25·5 &nbsp;</td><td align="right">50·5 &nbsp;</td><td align="right">2 &nbsp; &nbsp; &nbsp;</td><td align="right">39·5 &nbsp;</td><td align="right">37·5 &nbsp;</td><td align="right">13 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 11</td><td align="right">-8 &nbsp; &nbsp; &nbsp;</td><td align="right">15·5 &nbsp;</td><td align="right">23·5 &nbsp;</td><td align="right">-29 &nbsp; &nbsp; &nbsp;</td><td align="right">-20 &nbsp; &nbsp; &nbsp;</td><td align="right">9 &nbsp; &nbsp; &nbsp;</td><td align="right">14·5 &nbsp;</td></tr>
+<tr><td align="right"> 16</td><td align="right">49 &nbsp; &nbsp; &nbsp;</td><td align="right">79 &nbsp; &nbsp; &nbsp;</td><td align="right">30 &nbsp; &nbsp; &nbsp;</td><td align="right">30 &nbsp; &nbsp; &nbsp;</td><td align="right">45·5 &nbsp;</td><td align="right">15·5 &nbsp;</td><td align="right">14·5 &nbsp;</td></tr>
+<tr><td align="right"> 7</td><td align="right">-6 &nbsp; &nbsp; &nbsp;</td><td align="right">16 &nbsp; &nbsp; &nbsp;</td><td align="right">22 &nbsp; &nbsp; &nbsp;</td><td align="right">45 &nbsp; &nbsp; &nbsp;</td><td align="right">11 &nbsp; &nbsp; &nbsp;</td><td align="right">6·5 &nbsp;</td><td align="right">15·5 &nbsp;</td></tr>
+<tr><td align="right"> 28</td><td align="right">29·5 &nbsp;</td><td align="right">77·5 &nbsp;</td><td align="right">48 &nbsp; &nbsp; &nbsp;</td><td align="right">64·5 &nbsp;</td><td align="right">83·5 &nbsp;</td><td align="right">19 &nbsp; &nbsp; &nbsp;</td><td align="right">29 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 18</td><td align="right">-13·5 &nbsp;</td><td align="right">13·5 &nbsp;</td><td align="right">27 &nbsp; &nbsp; &nbsp;</td><td align="right">-32 &nbsp; &nbsp; &nbsp;</td><td align="right">-35 &nbsp; &nbsp; &nbsp;</td><td align="right">-3 &nbsp; &nbsp; &nbsp;</td><td align="right">30 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="right"> 20</td><td align="right">0 &nbsp; &nbsp; &nbsp;</td><td align="right">55 &nbsp; &nbsp; &nbsp;</td><td align="right">55 &nbsp; &nbsp; &nbsp;</td><td align="right">30 &nbsp; &nbsp; &nbsp;</td><td align="right">48·5 &nbsp;</td><td align="right">18·5 &nbsp;</td><td align="right">36·5 &nbsp;</td></tr>
+<tr><td align="left"> Av.</td><td align="right">13·81</td><td align="right">36·92</td><td align="right">23·11</td><td align="right">5·77</td><td align="right"> 32·25</td><td align="right">26·47</td><td align="right">-3·36</td><td align="right"></td></tr>
+<tr><td align="left"> M</td><td align="right"></td><td align="right"></td><td align="right"> 22·5 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 18·75</td><td align="right"> 1 &nbsp; &nbsp; &nbsp;</td></tr>
+<tr><td align="left"> 75%ile</td><td align="right"></td><td align="right"></td><td align="right"> 33 &nbsp; &nbsp; &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 44 &nbsp; &nbsp; &nbsp;</td><td align="right"> 14·5 &nbsp;</td></tr>
+<tr><td align="left"> 25%ile</td><td align="right"></td><td align="right"></td><td align="right"> 7·5 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 8·75</td><td align="right">-22·25</td></tr>
+<tr><td align="left"> Q</td><td align="right"></td><td align="right"></td><td align="right"> 12·75</td><td align="right"></td><td align="right"></td><td align="right"> 17·62</td><td align="right"> 18·37</td></tr>
+<tr><td align="left" colspan="3"> P. E. (distribution)</td><td align="right"> 11·5 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> 17·72</td><td align="right"> 17·86</td></tr>
+<tr><td align="left" colspan="3"> P. E. (average)</td><td align="right"> ±2·7 &nbsp;</td><td align="right"></td><td align="right"></td><td align="right"> ±4·22</td><td align="right"> ±3·88</td></tr>
+<tr><td align="left"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> Av.=-·87 P. E.</td></tr>
+<tr><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right"></td><td align="right" colspan="2"> M.=+·26 P. E.</td></tr>
+</table></div><p><span class="pagenum">[Pg 67]</span></p>
+
+<h3>TABLE XXIII</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="center"> &nbsp; Gains &nbsp; </td><td align="center" colspan="3"> Weight in pounds</td><td align="center" colspan="2"> Height in inches</td><td align="center" colspan="2"> Height-weight percents</td><td align="right" colspan="2">Grip in Kg.</td></tr>
+<tr><td align="right"></td><td align="right"> lb.</td><td align="right">P. E.</td><td align="right"> in.</td><td align="right">P. E</td><td align="right"> %</td><td align="right">P. E.</td><td align="right"> Kg.</td><td align="right"> P. E.</td></tr>
+<tr><td align="left"> Av. 1</td><td align="right">1·37</td><td align="right">2·85</td><td align="right">·16</td><td align="right">1·00</td><td align="right">1·83</td><td align="right">2·02</td><td align="right">- ·24</td><td align="right">- ·50</td><td align="right"></td></tr>
+<tr><td align="left"> Av. 2</td><td align="right">1·90</td><td align="right">1·30</td><td align="right">·08</td><td align="right">·29</td><td align="right">3·23</td><td align="right">2·81</td><td align="right">-1·31</td><td align="right">-2·22</td><td align="right"></td></tr>
+<tr><td align="left"> M. 1</td><td align="right">1·20</td><td align="right">2·80</td><td align="right">·20</td><td align="right">1·25</td><td align="right">4·00</td><td align="right">4·40</td><td align="right">-1·00</td><td align="right">-2·08</td></tr>
+<tr><td align="left"> M. 2</td><td align="right">2·20</td><td align="right">1·51</td><td align="right">·50</td><td align="right">1·79</td><td align="right">6·00</td><td align="right">5·22</td><td align="right">-1·50</td><td align="right">-2·54</td></tr>
+<tr><td align="left"> P. E. 1</td><td align="center" colspan="2"> ± ·48</td><td align="center" colspan="2"> ±·16</td><td align="center" colspan="2"> ±·91</td><td align="center" colspan="2"> ±·48</td></tr>
+<tr><td align="left"> P. E. 2</td><td align="center" colspan="2"> ±1·46</td><td align="center" colspan="2"> ±·28</td><td align="center" colspan="2"> ±1·15</td><td align="center" colspan="2"> ±·59</td></tr>
+</table></div><br>
+<h3>TABLE XXIII (Continued)</h3>
+
+<div class="center">
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align="right"> &nbsp; Gains &nbsp; </td><td align="center" colspan="2"> Taps in 1/2 min.</td><td align="center" colspan="2"> Tapping in<br> fatigue ratios</td><td align="center" colspan="2"> I.Q.</td><td align="center" colspan="2"> Healy Score</td></tr>
+<tr><td align="right"></td><td align="right"> taps</td><td align="right">P. E.</td><td align="right"> ratio</td><td align="right"> P. E.</td><td align="right"> Pts.</td><td align="right">P. E.</td><td align="right"> Pts</td><td align="right"> P. E.</td></tr>
+<tr><td align="left"> Av. 1</td><td align="right">·09</td><td align="right">·03</td><td align="right">-·02</td><td align="right">- ·50</td><td align="right">-1·035</td><td align="right">- ·94</td><td align="right">-5·85</td><td align="right">- ·92</td></tr>
+<tr><td align="left"> Av. 2</td><td align="right">9·93</td><td align="right">1·89</td><td align="right">-·065</td><td align="right">-1·66</td><td align="right">-3·140</td><td align="right">-1·71</td><td align="right">-3·36</td><td align="right">- ·87</td></tr>
+<tr><td align="left"> M. 1</td><td align="right">0·00</td><td align="right">0·00</td><td align="right">-·015</td><td align="right">- ·38</td><td align="right">-1·000</td><td align="right">- ·99</td><td align="right">-7·75</td><td align="right">-2·54</td></tr>
+<tr><td align="left"> M. 2</td><td align="right">11·00</td><td align="right">2·09</td><td align="right">-·09</td><td align="right">-2·50</td><td align="right">-3·000</td><td align="right">-1·63</td><td align="right">1·00</td><td align="right">·26</td></tr>
+<tr><td align="left"> P. E. 1</td><td align="center" colspan="2"> ±3·10</td><td align="center" colspan="2"> ±·040</td><td align="center" colspan="2"> ±1·10</td><td align="center" colspan="2"> ±3·05</td></tr>
+<tr><td align="left"> P. E. 2</td><td align="center" colspan="2"> ±5·26</td><td align="center" colspan="2"> ±·036</td><td align="center" colspan="2"> ±1·84</td><td align="center" colspan="2"> ±3·88</td></tr>
+</table></div>
+<p>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.<span class="pagenum"><a name="Page_68" id="Page_68">[Pg 68]</a></span></p>
+
+
+
+<hr style="width: 65%;">
+<h2>CHAPTER V.</h2>
+
+<h3>SUMMARY.</h3>
+
+
+<p>The results obtained from the experiment may be summarized
+as follows:</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>7. No rise in I.Q., as a result of operation, makes itself
+evident after six months or after twelve months.</p>
+
+<p>8. There is no improvement in the performance of the
+Healy test either after six months or after twelve.</p>
+
+<p>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<span class="pagenum">[Pg 69]</span>
+permits the intervention of more extraneous factors which
+may influence the scores in one direction or the other.</p>
+
+<p>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.</p>
+
+
+<h3>CONCLUSIONS</h3>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum">[Pg 70]</span>
+volitional and emotional normality,&mdash;the two elements which,
+along with intelligence are necessary for the maintenance
+of the individual as an instrument of social efficiency.</p>
+
+
+
+
+
+<h3>Footnotes</h3>
+
+
+<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> F. Hooper, M. D., quoting from a paper by B. Frankel.</p></div>
+
+<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> Adenoid Growths of the Naso-pharynx. Read before the
+Homeopathic Medical Society of New York, February, 1895.</p></div>
+
+<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> H. Addington Bruce, Psychology and Parenthood, 1916.</p></div><br>
+
+<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> H. Addington Bruce in the Century Magazine, 1916&mdash;The
+Mind of the Child.</p></div>
+
+<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> The italics are mine.</p></div>
+
+<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> Psych. Clinic, 1916, 10, 45-48. Anna Johnson. The
+Teacher in the Retarded School.</p></div>
+
+<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Psych. Clinic, 1909, 3, 71-77. The Effect of Physical
+Defect on School Progress.</p></div>
+
+<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> Cornell, Psychological Clinic, 2, 1909.</p></div>
+
+<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> H. R. Burpitt. Relative Degrees of Dullness and
+Backwardness in School Children and their Causation. Journal of
+Mental Science, 1916.</p></div>
+
+<div class="footnote"><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> Transactions of the International Congress on School</div>
+
+<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a>&nbsp; Ayres: "Laggards in Our Schools." 1909.</p></div>
+
+<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> Wallin: "Mental Health of the School Child." 1914.</p></div>
+
+<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Wallin: "Mental Health of the School Child." 1914.</p></div>
+
+<div class="footnote"><p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> Numbers refer to cases as listed on Table II.</p></div>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of Adenoids and Diseased Tonsils, by
+Margaret Cobb Rogers
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+Project Gutenberg's Adenoids and Diseased Tonsils, by Margaret Cobb Rogers
+
+This eBook is for the use of anyone anywhere 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
+
+
+Title: Adenoids and Diseased Tonsils
+ Their Effect on General Intelligence
+
+Author: Margaret Cobb Rogers
+
+Release Date: January 26, 2012 [EBook #38676]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK ADENOIDS AND DISEASED TONSILS ***
+
+
+
+
+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.)
+
+
+
+
+
+
+
+
+
+ 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]
+
+ [1]: F. Hooper, M. D., quoting from a paper by B. Frankel.
+
+"... 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]
+
+ [2]: Adenoid Growths of the Naso-pharynx. Read before the
+ Homeopathic Medical Society of New York, February, 1895.
+
+"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]
+
+ [3]: H. Addington Bruce, Psychology and Parenthood, 1916.
+
+"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."
+
+ [4]: H. Addington Bruce in the Century Magazine, 1916--The
+ Mind of the Child.
+
+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 Highmorshoehle,
+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]
+
+ [5]: The italics are mine.
+
+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]
+
+ [6]: Psych. Clinic, 1916, 10, 45-48. Anna Johnson. The
+ Teacher in the Retarded School.
+
+"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.
+
+ [7]: Psych. Clinic, 1909, 3, 71-77. The Effect of Physical
+ Defect on School Progress.
+
+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 Defective and Tonsils Adenoids Deaf
+
+ 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 0.8
+
+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 children 50 39 32 29
+ Normal 36 32 20 13
+ Defective 14 7 12 16
+
+ Percentage of normal 72 82 62.5 44.8
+
+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:
+
+ Exempt Children Non-exempt Children
+ Normal Defective Normal Defective
+
+ 9th St. Primary 56 28 39 38
+ Rutledge School 87 35 75 34
+ Allison School 128 65 81 49
+ Camac School 183 71 103 75
+ Claghorn School 193 61 127 66
+ --- --- --- ---
+ 647 260 425 262
+
+ Percentage Defective 28.8 38.1
+
+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,
+ number defective 6 4 9 9
+ _Tonsils_ _3_ _4_ _3_ _3_
+ _Adenoids_ _2_ _1_ _5_ _6_
+ Deaf 2 5 1
+ Catarrh 2 3
+
+ Percentage of children,
+ nose and throat defects 12 10.2 28.1 31
+
+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.
+
+ [8]: Cornell, Psychological Clinic, 2, 1909.
+
+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."
+
+ [9]: H. R. Burpitt. Relative Degrees of Dullness and
+ Backwardness in School Children and their Causation. Journal of
+ Mental Science, 1916.
+
+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:
+
+ Causes 46 children 24 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 defects 9 6
+ Irregular attendance 2 3
+ _Adenoids only_ _2_ _0_
+
+Turning to what the author calls single causes,--present in 170 cases out
+of the 400,--
+
+ Causes 151 children 19 children
+ 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]
+
+ [10]: Transactions of the International Congress on School
+ Hygiene, 1913, The Physical Condition of Retarded School Children.
+
+ 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
+ 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
+ _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:
+
+ [11]: Ayres: "Laggards in Our Schools." 1909.
+
+ Exempt Children Non-exempt Children
+
+ Defect No. Examined % No. Examined %
+ Defective vision 371 10.0 171 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 918 26.0 423 30.0
+ Miscellaneous 214 6.0 128 9.0
+ Total 1,774 49.0 930 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.
+
+ [12]: Wallin: "Mental Health of the School Child." 1914.
+
+"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. 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 1 Period 2 Period 3
+ A--Per cent of 31 cases 32.2
+ (operated upon)
+ Per cent of 100 children 42
+ at random
+
+ B--Per cent of 18 children--20 33.3 66.6
+ months (operated upon)
+ Per cent of 100 children at 42 41
+ random
+
+ C--Per cent of 11 cases for 30 36.3 63.5 100
+ months (operated upon)
+ Per cent of 100 children at 42 41 41
+ random
+
+"... 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."
+
+ [13]: Wallin: "Mental Health of the School Child." 1914.
+
+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]
+
+ [14]: 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
+
+
+
+
+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 Per cent of No. of Per cent of
+ Cases Cases Cases Cases
+
+ 40- 50 2 .8 0 0
+ 50- 60 1 .4 2 .7
+ 60- 70 7 2.9 4 1.4
+ 70- 80 21 8.9 29 9.8
+ 80- 90 45 19.0 52 17.7
+ 90-100 80 33.9 107 36.4
+ 100-110 55 23.3 67 22.8
+ 110-120 17 7.2 24 8.1
+ 120-130 6 2.5 9 3.0
+ 130-140 2 .8 0 0
+ 140-150 1 .4 0 0
+
+ Average 94.9 95.4
+ Median 95.3 95.6
+ Q 8.705 8.27
+ [Sigma] 14.4 12.2
+
+From these it is evident that the two groups are practically equal in
+intelligence. The average I.Q. for the normal group is 95.4, as compared
+with 94.9 for the tonsil group. The medians are equally close,--95.6 in
+the normal group and 95.3 with the tonsil cases. The difference in
+variability is negligible, Q being 8.705 and [Sigma] 14.4 in the
+tonsil group, while in the normal Q is 8.27 and [Sigma] 12.2. The
+two cases with the lowest I.Q.'s were tonsil cases, but the three
+highest I.Q.'s also belong in this group.
+
+ Fig. 1. Distribution of I.Q.'s. Number of cases.
+
+ Fig. 2. Distribution of I.Q.'s by percentage of total number of
+ cases in the group.
+
+If the frequencies are expressed in terms of per cent of the total
+number of cases in the group, the two may be compared further. The
+following details are noticeable.
+
+ I.Q. Per cent of Per Cent of
+ Tonsil Group Normal Group
+
+ Below 70 4.1 2.1
+ Below 90 32.0 29.6
+ Above 110 10.9 11.1
+ Above 120 3.7 3.0
+ Above 130 1.2 0
+
+In other words, in the percentage of cases below normal intelligence,
+the tonsil group exceeds by 2.4 per cent. The percentage of defective
+cases is also slightly greater in the tonsil group--the difference here
+being 2 per cent. The normal group has a negligible predominance of
+bright cases,--only two-tenths of one per cent difference, while with
+the very superior cases, the tonsil group again exceeds,--by 1.2 per
+cent. The per cent of the tonsil group which reaches or exceeds the
+median of the normal is 49 per cent.
+
+These figures seem to indicate remarkable similarity between the two
+groups considered. The two distributions are almost identical. While the
+slight predominance of cases below normal mentality in the tonsil group
+may indicate a very feeble tendency toward coincidence of tonsillar
+defect and mental dullness, it does not seem large enough to be at all
+significant. This is especially true when we consider that the tonsil
+group exceeds in superior children. If we allow the preceding contention
+of coincidence between dullness and tonsils, must we not argue here in
+the same manner for a tendency toward coincidence of superiority and
+tonsils?
+
+The chief source of error in this part of the study is the fact that the
+throat examinations were not conducted by the same person throughout the
+investigation. For this reason there must have been some slight
+disagreement as to what should constitute a reportable case. In the
+event, then, of a positive relationship between tonsil defect and
+lowering of the intelligence quotient, placement of normal tonsils in
+the "tonsil" group, and of diseased tonsils in the "normal" group would
+raise the first, and lower the second, thus tending to conceal the
+difference between the two. On the other hand, the cases where
+disagreement would occur would naturally be those of slighter defect, in
+which the intellectual retardation would be less likely to occur, so
+that the result would probably be merely an increased height at the
+overlapping portion of the curves, with no change at the ends.
+
+In any case, the two examiners had worked together previously, so that
+each must have been somewhat familiar with the opinions of the other.
+They were aware, also, that pronounced tonsillar defect was what we were
+attempting to detect. However this may be, there must always be some
+disagreement in diagnosis. When this is allowed for, the results of the
+investigation may be taken for what they are worth. Contrary to
+expectation, there seems to be very little difference in intelligence
+between a group of children whose throats are normal, and one in whom
+the tonsils are diseased or badly enlarged.
+
+
+STUDY OF IMPROVEMENT AFTER OPERATION
+
+The complete results of the tests and retests are collected in Table II,
+where each control case is listed immediately below its respective test
+case, and where age, height, weight, grip, tapping rate, I.Q., and score
+in Healy Picture Completion are shown. From these data the more detailed
+observations have been made. The improvement of each child in the
+various tests has been computed, and a comparison drawn between the two
+groups. As we have previously stated, any improvement shown by the test
+group in excess of that of the control group, may be looked upon as
+significant.
+
+Let us consider first the improvement of the children in general health,
+as shown by height and weight. In Tables III and IV we have tabulated
+the results, in such shape as to permit of comparison. An inspection of
+these tables will establish the fact that after a six months' interval,
+the test group shows, in respect to height and weight, a very slight
+gain over the control group. In weight, the average of the amounts by
+which the test group gains exceed the control group gains is 1.37 lbs.,
+and in height, only .16 inches. The medians of these amounts are 1.2
+lbs. and .2 inches respectively. Comparing the improvements for the two
+groups, we find that in the case of the weights, the smallest gain (a
+loss of 1.2 lbs.) occurs in the control group, while the largest gain
+(10.7 lbs.) is in the test group.
+
+ TABLE II. RESULTS OF TESTS
+
+ Blank spaces indicate where tests were omitted for one reason or another
+
+ N Age Weight Height Grip, Kg.
+ lbs. in. best hand
+
+ 1 2 1 2 1 2 1 2
+
+ 1 7- 7 8- 1 50.4 54.2 46 47.6 13 12
+ 1C 8- 1 8- 7 53.5 57.2 46.4 47.8 11 13
+
+ 2 6- 9 7- 3 40.9 42.9 42.6 41.1 9 9
+ 2C 7- 1 7- 7 52.3 57.4 45.2 47 10 12
+
+ 3 8- 8- 6 55 59.5 47 48.4 12.8 14.5
+ 3C 9- 9 10- 3 61.5 62.9 51.7 52.9 14 15
+
+ 4 8-10 9- 4 51.1 54.2 47.5 49.2 9
+ 4C 9-10 10- 4 49.4 51 48.9 52 9.5
+
+ 5 6- 1 6- 7 45 47 44.9 45.2 11
+ 5C 8- 2 8- 8 56.2 57 46.6 48.1 12
+
+ 6 5- 2 5- 8 43.8 44.5 43.1 43.9 8
+ 6C 7- 1 7- 7 50.6 52.5 45.4 47.3 10.5
+
+ 7 6- 7 7- 1 39.9 41 42.9 44.8 7 6.5
+ 7C 6- 7 7- 1 38.4 38.7 41.9 43.2 9 10
+
+ 8 8- 6 9- 60.8 63.3 50.8 51.8 10
+ 8C 8- 5 8-11 45.4 52.1 46.8 47.6 15 16
+
+ 9 9- 4 9-10 50.6 53.2 48.1 49.4 10.5 13
+ 9C 9- 6 10- 59.8 61.4 51.9 55.2 16.5 21
+
+ 10 6- 7 7-1 48.9 51.4 46.1 47.7 12.5 11
+ 10C 7- 7-6 47.1 47.5 45.6 47.2 10 15
+
+ 11 6- 7 7- 47.8 47.5 45.8 47.7 11 15
+ 11C 6- 8 7-1 41.6 42.5 43.6 44.9 11.5 11.5
+
+ 12 7- 8 8-2 48 52.5 44.8 14
+ 12C 7- 1 7-8 41 44.5 41.5 43.3 6 4.5
+
+ 13 13- 3 13-10 90 98 61.5 65 26.5 28.5
+ 13C 14- 6 15- 74.7 76.8 56.8 57.8 22 23
+
+ 14 11- 9 12-4 56 62 51 51.6 16 15
+ 14C 11-10 12-4 81.9 86 57.9 58.3 22 24
+
+ 15 10- 3 10-10 57.5 51.1 15.5
+ 15C 10- 1 10-7 67.2 70.3 50.1 51 15 15.5
+
+ 16 10- 9 11-3 56 57 51.6 52.3 19 17.5
+ 16C 10- 9 11-3 51.2 50 48.7 49.5 10 10
+
+ 17 8- 1 8-7 57 48.7 14
+ 17C 7-10 8-4 45.3 44.8 10 8.5
+
+ 18 7- 2 7-8 58.2 47.3 11
+ 18C 6-11 7-5 45.3 47 46.7 47.1 8 6.5
+
+ 19 11- 4 11-10 90 96.3 57.7 59 22 21
+ 19C 7-11 8-5 52.4 54.4 46.7 47.2 15 12
+
+ 20 7- 1 7- 7 44.2 47.2 11.
+ 20C 7- 3 7-10 61.3 66 49.6 55 15 12.5
+
+ 21 11- 11- 6 70.7 76.5 54.1 16.5 16.5
+ 21C 10- 1 10- 7 62.4 67 49.6 50.4 19 15
+
+ 22 10- 9 11- 3 73.3 53 56.4 18 22.5
+ 22C 11- 7 12- 1 70.7 80.5 56.8 58.1 19.5 21.5
+
+ 23 8- 7 9- 1 51.7 47.8 11.5 15.5
+ 23C 8-11 9- 4 64.1 66.5 51.4 53.1 14.5 14
+
+ 24 9- 8 10- 2 58.5 62.5 51 19 20
+ 24C 10- 2 10- 8 60 61 50.1 51.5 15 15
+
+ 25 10- 1 10- 7 55.5 59.5 50 50.8 14
+ 25C 10-10 11- 4 63.3 63.8 50.2 50.9 12.5 21.5
+
+ 26 9- 8 10- 2 63.8 74.5 51.6 54.3 14
+ 26C 10- 4 10- 9 64.2 67 51.4 52.3 20 16.5
+
+ 27 6- 7 7- 1 43.7 45.4 9 6
+ 27C 6- 3 6- 9 41 44 44.6 45.4 8 9
+
+ 28 12-11 13- 5 71.3 75.5 54.9 55.8 23.5 21
+ 28C 13- 8 14- 2 74.2 79.8 53.4 54.5 21
+
+
+ TABLE II. RESULTS (Continued)
+
+ Blank spaces indicate where tests were omitted for one reason or another
+
+ N Tapping, 1/2 min. I.Q. Healy, Score
+ best hand
+
+ 1 2 1 2 1 2
+ 1 135 120 82 83 -25 -2
+ 1C 106 115 80 76 -50 -16
+
+ 2 105 112 107 114 28.5 30
+ 2C 152 114 91 96 3 -11
+
+ 3 136 139 94 91 21.5 22.5
+ 3C 135 129 82 85 17 19
+
+ 4 103 96 96 8.5
+ 4C 109 83 85 33
+
+ 5 110 95 99 -25
+ 5C 156 114 117 40.5
+
+ 6 110 95 101 -33
+ 6C 126 88 89 -32
+
+ 7 125 113 91 99 6 -28
+ 7C 105 95 99 4.5 27.5
+
+ 8 113 110 91 86 32.5
+ 8C 131 101 98 104 4 23
+
+ 9 149 135 83 93 3.5 10.5
+ 9C 144 150 87 90 34 55
+
+ 10 68+ 74 88+ 82 110 109 -12 6.5
+ 10C 70+ 54 135+109 104 100 27 65
+
+ 11 125+ 90 98+ 87 103 100 - 8 6
+ 11C 155+125 101+107 101 102 -29 -3.5
+
+ 12 98+69 98 95 20 21
+ 12C 102 84 98 101 -10 -12
+
+ 13 160+165 142+134 70 78 43 42
+ 13C 150+109 122+ 94 66 64 - 1.5 30.5
+
+ 14 190+172 138+130 96 107 12.5 48.5
+ 14C 175+152 175+164 140 137 - 5 25.5
+
+ 15 172+167 170+156 97 94 7 25
+ 15C 140+115 137+115 78 79 1 42.5
+
+ 16 145+131 65 73 49 47.5
+ 16C 145+99 135+135 74 82 30 37
+
+ 17 90+89 150+100 71 77 29.5 12
+ 17C 125+116 121+ 97 96 99 1.5 15
+
+ 18 133+115 135+111 98 98 -13.5 -12
+ 18C 100+ 99 84+ 74 90 94 -32 -28
+
+ 19 168+136 96 101 57.5 49
+ 19C 100+115 118+ 92 98 98 -22 -11
+
+ 20 105+115 110+ 93 106 102 0 -11
+ 20C 150+120 155+149 118 131 30 35
+
+ 21 152+111 132+125 64 67 20 32
+ 21C 140+136 138+110 86 97 70.5 58.5
+
+ 22 164+148 183+141 91 100 48.5 43.5
+ 22C 120+116 157+127 63 62 34.5 33.5
+
+ 23 150+119 141+136 85 94 49.5 68
+ 23C 122+115 140+110 81 96 4 25
+
+ 24 157+136 142+126 131 124 54.5 63
+ 24C 155+135 155+100 89 92 31.5 59.5
+
+ 25 140+127 150+119 77 76 8 25
+ 25C 148+134 151+135 145 137 29.5 29
+
+ 26 137+113 138+117 80 76 22.5 7
+ 26C 125+105 125+ 79 90 88 56 61.5
+
+ 27 108+ 92 97+ 92 110 109 -25 15
+ 27C 115+105 112+109 72 96 2 27.5
+
+ 28 150+148 162+143 81 84 29.5 73.5
+ 28C 178+148 170+163 95 98 64.5 51.5
+
+ We have therefore:
+
+ 28 pairs of I.Q.'s to be compared
+ 21 pairs of weights
+ 19 pairs of heights
+ 16 pairs of grip measurements
+ 20 pairs of tapping speeds
+ 24 pairs of Healy Completion scores.
+
+Again, in only five pairs does the gain of the control exceed that of
+the test case, while in the remaining sixteen pairs the gains of the
+test cases are greater than those of their respective controls. The
+greatest loss of test as compared to control is 4.2 lbs., while the
+largest gain is 7.9. It would seem then, that after a six months'
+interval a child who has been operated on for adenoids and tonsils will
+tend to show a slightly greater increase in weight than a child who
+continues to suffer from the defects. The very small group renders this
+conclusion far from assured. Since it doubtless takes some little time
+to recover from the effects of the operation, and since there is
+comparatively little gain in weight in a six months' interval, it would
+be well to extend the experiment over another year. For the greater
+reliability of results, some degree of after-care should be given the
+operative cases, the control cases of course receiving the same
+treatment. While this was impracticable in the present study, it
+happened that three pairs of cases were members of a nutrition class,
+and therefore underwent some hygienic treatment. In one pair, (no. 11)
+the test case lost .3 of a pound, while the control gained .9. The test
+cases of pairs 7 and 10 gained .8 lb. and 2.1 lbs. respectively, over
+and above their controls. However, these three cases alone are of little
+significance.
+
+A study of increase in height suffers even more than one of weight gains
+from the short interval which elapsed between measurements. Normally,
+there is very little growth in six months. There are only nineteen pairs
+of cases in this portion of the study, a fact which renders it of even
+less value. However, results are offered for what they are worth. The
+smallest increase in height (.3 in.) is in the test group, while the
+greatest growth (3.5 in.) is also in the test group. There is, however,
+a gain of 3.3 inches in the control group as well as one of only .4
+inches. There are seven pairs in which the test group growth is less
+than that of the controls, one in which the two are equal, and in the
+remaining eleven the growth of the test cases exceeds that of the
+controls. The variability
+
+ TABLE III
+
+ Gain in weight, 6 months, 21 pairs
+
+
+ N[16] Test Group (A) Control Group (B) Lbs.
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 8 60.8 63.3 2.5 45.4 52.1 6.7 -4.2
+ 2 40.9 42.9 2.0 52.3 57.4 5.1 -3.1
+ 28 71.3 75.5 4.2 74.2 79.8 5.6 -1.4
+ 6 43.8 44.5 .7 50.6 52.5 1.9 -1.2
+ 11 47.8 47.5 -.3 41.6 42.5 .9 -1.2
+ 1 50.4 54.2 3.8 53.5 57.2 3.7 .1
+ 7 39.9 41.0 1.1 38.4 38.7 .3 .8
+ 9 50.6 53.2 2.6 59.8 61.4 1.6 1.0
+ 12 48.0 52.5 4.5 41.0 44.5 3.5 1.0
+ 14 56.0 62.0 6.0 81.9 86.0 4.9 1.1
+ 5 45.0 47.0 2.0 56.2 57.0 .8 1.2
+ 21 70.7 76.5 5.8 62.4 67.0 4.6 1.2
+ 4 51.1 54.2 3.1 49.4 51.0 1.6 1.5
+ 10 48.9 51.4 2.5 47.1 47.5 .4 2.1
+ 16 56.0 57.0 1.0 51.2 50.0 -1.2 2.2
+ 24 58.5 62.5 4.0 60.0 61.0 1.0 3.0
+ 3 55.0 59.5 4.5 61.5 62.9 1.4 3.1
+ 25 55.5 59.5 4.0 63.3 63.8 .5 3.5
+ 19 90.0 96.3 6.3 52.4 54.4 2.0 4.3
+ 13 90.0 98.0 8.0 74.7 76.8 2.1 5.9
+ 26 63.8 74.5 10.7 64.2 67.0 2.8 7.9
+
+ Av. 56.86 60.61 3.76 56.24 58.60 2.39 1.37
+
+ M 3.8 1.9 1.2
+ 75%ile 5.8 4.6 3.1
+ 25%ile 2.0 .9 .1
+ Q 1.9 1.85 1.5
+ P. E. (distribution) 1.76 1.39 1.63
+ P. E. (average) +-.38 +-.30 +-.48
+ ----------------
+ Av. =2.85 P. E.
+ M. =2.80 P. E.
+
+
+ [16]: Numbers refer to cases as listed on Table II.
+
+of the test group growth is greater than that of the control group. The
+three nutrition pairs show the following records of growth,--in number
+7, the test case shows a growth of..6 in. more than his control. Number
+10 is the pair in which the growth is equal. In number 11 the test case
+again exceeds in growth by .6 of an inch.
+
+More reliable than height and weight considered separately, as an index
+of physical welfare, is weight in relation to height and age. Table V
+shows the improvement in this relationship for the two groups. The
+numbers in columns 1, 2, 4 and 5 show the per cent under or over weight
+of the individual cases, in relation to their respective heights and
+ages. The authority upon which the figures are based, is the table
+published by the American Child Health Association, giving standard
+weights for height and age in boys.
+
+There was an average loss of .28 per cent in the weight-height-age
+relationship for the test group, and of 2.11 per cent for the control
+group. The average improvement of the test group in excess of the
+control group is, then, 1.83 per cent. The median improvement of test
+group over and above control is 4.00 per cent. The test group is more
+variable than the control in improvement. The greatest improvement, 8
+per cent, is found in both groups.
+
+
+ TABLE IV
+
+ Gain in Height--6 Months, 19 Pairs
+
+ N[16] Test Group (A) Control Group (B) Inches
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 9 48.1 49.4 1.3 51.9 55.2 3.3 -2.0
+ 4 47.5 49.2 1.7 48.9 52.0 3.1 -1.4
+ 5 44.9 45.2 .3 46.6 48.1 1.5 -1.2
+ 6 43.1 43.9 .8 45.4 47.3 1.9 -1.1
+ 2 42.5 44.1 1.6 45.2 47.0 1.8 -.2
+ 28 54.9 55.8 .9 53.4 54.5 1.1 -.2
+ 16 51.6 52.3 .7 48.7 49.5 .8 -.1
+ 10 46.1 47.7 1.6 45.6 47.2 1.6 0
+ 25 50.0 50.8 .8 50.2 50.9 .7 .1
+ 1 46.0 47.6 1.6 46.4 47.8 1.4 .2
+ 3 47.0 48.4 1.4 51.7 52.9 1.2 .2
+ 8 50.8 51.8 1.0 46.8 47.6 .8 .2
+ 14 51.0 51.6 .6 57.9 58.3 .4 .2
+ 7 42.9 44.8 1.9 41.9 43.2 1.3 .6
+ 11 45.8 47.7 1.9 43.6 44.9 1.3 .6
+ 19 57.7 59.0 1.3 46.7 47.2 .5 .8
+ 26 51.6 54.3 2.7 51.4 52.3 .9 1.8
+ 22 53.0 56.4 3.4 56.8 58.1 1.3 2.1
+ 13 61.5 65.0 3.5 56.8 57.8 1.0 2.5
+ Av. 49.26 50.79 1.53 49.20 50.62 1.36 .16
+ M 1.4 1.3 .2
+ 75%ile 1.90 1.75 .65
+ 25%ile .78 .8 -.43
+ Q .56 .48 .54
+ P. E. (distribution) .53 .44 .44
+ P. E. (average) +-.12 +-.10 +-.16
+ Av.=1 P. E.
+ M=1.25 P. E.
+
+The greatest loss, 10 per cent, is in the control group. Eight cases
+show a loss in comparison to their controls, and nine reveal a gain. On
+the whole, there is some significance in the small net improvement
+manifested by the test group. The average is 2.02 P. E.'s, and the
+median 4.40 P. E.'s.
+
+The dynamometer results show no gain in strength of grip six months
+after operation. Indeed the average of the gains of the operative cases
+is slightly less than the average gain of the controls. Comparing the
+test group with the control, we find the average of the differences to
+be -.24. But the variability is so high (P. E. = +-.48) as to render this
+figure unreliable. The greatest loss in strength of grip is found in the
+control group, but the greatest gain is also in this group. Seven cases
+in the test group show a loss, as compared with only three control
+cases. In eight, or one-half of the sixteen cases, the control member of
+a pair gained more than the test member. Considering the three pairs of
+nutrition cases, we find that in pair number 7 the test case loses 1.5
+Kg. when compared with the control; and in pair number 10, 6.5 Kg.,
+while the test case in pair 11 gains 4 Kg. The conclusion from the data
+would seem to be that, within the space of six months at any rate,
+operation for adenoids and tonsils brings about no increase in strength
+of grip.
+
+ TABLE V
+
+ Showing change in per cent over or underweight for height and age,
+ 18 pairs
+
+ A B A-B
+
+ N[16] 1 2 3 4 5 6 7
+
+ 8 - 1 - 1 0 -13 - 5 + 8 - 8
+ 11 - 3 -12 -9 - 9 -11 - 2 - 7
+ 10 - 1 - 5 -4 - 6 - 8 - 2 - 2
+ 28 - 7 - 7 0 0 + 2 + 2 - 2
+ 13 -13 -19 -6 -11 -15 - 4 - 2
+ 19 + 6 + 8 +2 + 1 + 5 + 4 - 2
+ 6 + 2 - 3 -5 + 5 + 1 - 4 - 1
+ 14 -13 - 9 +4 - 5 0 + 5 - 1
+ 7 - 8 -15 -7 - 7 -14 - 7 0
+ 2 - 8 - 6 +2 + 9 +10 + 1 + 1
+ 3 + 6 + 8 +2 - 5 - 8 - 3 + 5
+ 16 -16 -15 +1 -13 -17 - 4 + 5
+ 25 - 8 - 7 +1 + 4 - 1 - 5 + 6
+ 5 - 4 - 1 +3 + 8 + 4 - 4 + 7
+ 9 - 8 -11 -3 - 7 -17 -10 + 7
+ 26 - 1 + 5 +6 + 1 0 - 1 + 7
+ 4 - 7 - 7 0 -15 -23 - 8 + 8
+ 1 0 + 8 +8 + 8 + 4 - 4 +12
+
+ Av. - 4.67 - 4.94 - .28 - 3.06 - 5.17 - 2.11 + 1.83
+ M + .5 - 3.5 + 4.00
+ 75%ile +2 0 6.5
+ 25%ile -2 - 4.5 - 2
+ Q 2 2.25 4.25
+ P. E. (distribution) 3 2.39 1.33
+ P. E. (average) +-.71 +- 57 +- 91
+
+ Av.=2.02 P. E.
+ M.=4.40 P. E.
+
+Is there, after operation, an improvement in motor control and
+attention, and a lessening of fatiguability as these may be demonstrated
+in the tapping test? Table VI gives the number of taps in the first half
+minute of tapping for both groups before and after the six months
+interval. The test group suffers an average loss of 2.24 taps, and a
+median loss of 2. The average loss of the control group is 2.33, and the
+median 2.
+
+ TABLE VI
+
+ Gain in Grip--6 Months--16 Pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 10 12.5 11 -1.5 10 15 5 -6.5
+ 27 9 6 -3 8 9 1 -4
+ 1 13 12 -1 11 13 2 -3
+ 14 16 15 -1 22 24 2 -3
+ 2 9 9 0 10 12 2 -2
+ 9 10.5 13 2.5 16.5 21 4.5 -2
+ 7 7 6.5 - .5 9 10 1 -1.5
+ 16 19 17.5 -1.5 10 10 0 -1.5
+ 3 12.8 14.5 1.7 14 15 1 .7
+ 13 26.5 28.5 2 22 23 1 1
+ 24 19 20 1 15 15 0 1
+ 19 22 21 -1 15 12 -3 2
+ 22 18 22.5 4.5 19.5 21.5 2 2.5
+ 11 11 15 4 11.5 11.5 0 4
+ 21 16.5 16.5 0 19 15 -4 4
+ 23 11.5 15.5 4 14.5 14 - .5 4.5
+ Av. 14.58 15.22 .62 14.19 15.06 .875 - .24
+ M 0 1 -1.0
+ 75%ile 3 2 2.25
+ 25%ile -1 0 -2.5
+ Q 2 1 2.38
+ P. E. (distribution) 1.58 1.02 2.49
+ P. E. (average) +-.40 +-.26 +-.48
+
+ Av.= -.50 P. E.
+ M.= -2.08 P. E.
+
+There is practically no change then in the tapping ability of either
+group. The high unreliability of the difference (P. E. = +- 3.10) is
+noteworthy. It would seem that incidental causes have a much greater
+effect upon tapping ability than can be demonstrated as resulting from
+the removal of adenoids and tonsils.
+
+Use of the tapping test as a measure of the decrease in tendency to
+fatigue similarly brings out no indication of any improvement in the
+operative group of cases. The measure of fatigue was taken as a ratio;
+namely, the number of taps in the first, minus the number in the second
+half minute over the number of taps in the first half minute. Then, if
+there is a greater number of taps in the second, the ratio will be
+minus, indicating that fatigue effect is so small as to be overcome by
+practice effect. This was a fact in only four cases. Since what we are
+measuring is improvement, the ratio for test 2 is subtracted from the
+ratio for test 1 to find the gain in overcoming fatigue. Table VIII
+shows the average gain for group one to be -.0196, and the median -.045.
+That is, there is an average increase in fatiguability of .0196 units
+and a median increase of .045 with a P. E. of +- .02. This increase in
+fatiguability occurs also in the control group, average 0, and median
+.03 with P. E. of +- .03. The average gain of test group over control
+group is -.02 and the median gain is -.015. Again variability is
+relatively large, P. E. being 1.04, so that the median and average gains
+are -.50 P. E. and -.38 P. E. respectively.
+
+We may say, then, that the capacities brought out by the tapping test
+seem to undergo no improvement in six months after removal of adenoids
+and tonsils.
+
+The main line of interest in the present experiment lay with the
+relation of adenoid and tonsil defects to general intelligence. The
+results of the two tests dealing more specifically with this side of the
+problem are here set forth. Table IX shows the I.Q.'s. of the two groups
+before and after the six months' interval, together with changes plus or
+minus in I.Q., and a comparison of the separate pairs in respect to
+improvement.
+
+We find that the test group shows an average gain in I.Q. of 2.25
+points. The median gain is 2 points, the total range 18 points and P. E.
+of the average is +- .99. The control group shows an average gain very
+slightly higher, 3.25 points, the median gain being 3. The range in this
+case is 32 points, but P. E. is only +- .47. The average of the compared
+gains of separate pairs is -1.035. These numbers are so small as to be
+insignificant. Actually, we may say that the operative group as a whole
+showed no gain over the control group. If we examine individual cases we
+find that the greatest loss in I.Q. was in the control group, (8 points)
+but the greatest gain (24 points) also appears in this group. In the
+test group 11 cases
+
+ TABLE VII
+
+ Gain in number of taps in one-half minute, 21 pairs--right hand
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 14 190 138 -52 175 175 0 -52
+ 10 68 88 20 70 135 65 -45
+ 23 150 141 - 9 122 140 18 -27
+ 1 135 120 -15 106 115 9 -24
+ 9 149 135 -14 144 150 6 -20
+ 21 152 132 -20 140 138 - 2 -18
+ 22 164 183 19 120 157 37 -18
+ 24 157 142 -15 155 155 0 -15
+ 27 108 97 -11 115 112 - 3 - 8
+ 20 105 110 5 150 155 5 0
+ 15 172 170 - 2 140 137 - 3 1
+ 26 137 138 1 125 125 0 1
+ 25 140 150 10 148 151 3 7
+ 3 136 139 3 135 129 - 6 9
+ 13 160 142 -18 150 122 -28 10
+ 18 133 135 2 100 84 -16 18
+ 28 150 162 12 178 170 - 8 20
+ 8 113 110 - 3 131 101 -30 27
+ 11 125 98 -27 155 101 -54 27
+ 2 105 112 7 152 114 -38 45
+ 17 90 150 60 125 121 - 4 64
+
+ Av. 135.19 132.95 - 2.24 136.47 134.14 - 2.33 .09
+
+ M - 2 - 2 0
+ 75%ile 6.5 4.5 16.0
+ 25%ile -15 -14 19.5
+ Q 10.75 9.25 17.75
+ P. E. (distribution) 12.24 7.33 18.09
+ P. E. (average) +-2.66 +-1.59 +-3.10
+
+ Av. = .03 P. E.
+ M. = .0 P. E.
+
+lost in I.Q., as compared with 7 in the control group. Thirteen test
+cases lost in comparison with their respective controls. Two gained
+equally with their controls, and the remaining thirteen showed a larger
+gain. In regard to the three pairs taken from the nutrition class,
+number 7 gained 8 points and his control, 4. Number 10 lost a point and
+his control lost 4, while number 11 lost 3 points with a gain of 1 point
+by his control. So that these cases, in spite of most favorable
+conditions, show no consistent gain in I.Q.
+
+The results of the Healy tests are similar. There is a slightly higher
+average gain in the control group. The test group contains eight cases
+which made a poorer score at the end of the interval, the control group
+six. The range of gains is from -22 to +44, or 66 points, in the test
+group, while in the control group the gains range from -14 to +41.5 or
+55.5
+
+ TABLE VIII
+
+ Decrease in fatigue in tapping--Difference in rates of second half
+ minute over first half minute. Sixteen pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 13 -.03 .05 -.08 .27 -.28 .55 -.63
+ 28 .01 .11 -.10 .17 .04 .13 -.23
+ 20 .10 .15 -.05 .20 .04 .16 -.21
+ 10 -.09 .07 -.16 .23 .19 .04 -.20
+ 17 .01 .33 -.32 .07 .20 -.13 -.19
+ 25 .09 .21 -.12 .09 .11 -.02 -.10
+ 11 .28 .11 .17 .19 -.06 .25 -.08
+ 15 .03 .08 -.05 .18 .16 .02 -.07
+ 22 .10 .23 -.13 .03 .19 -.16 .03
+ 27 .15 .05 .10 .09 .03 .06 .04
+ 14 .09 .06 .03 .02 .06 -.04 .07
+ 18 .14 .18 -.04 .01 .12 -.11 .07
+ 24 .13 .11 .02 .13 .35 -.22 .24
+ 26 .18 .15 .03 .16 .37 -.21 .24
+ 23 .21 .04 .17 .06 .21 -.15 .32
+ 21 .27 .05 .22 .03 .20 -.17 .39
+
+ Av. .104 .124 -.020 .121 .121 .0 -.020
+ M -.045 -.03 -.015
+ 75%ile .03 +.04 .07
+ 25%ile -.12 -.16 -.20
+ Q .075 .10 .135
+ P. E. (distribution) .09 .11 .05
+ P. E. (average) +-.02 +-.03 +-.04
+
+ Av. = -.5 P. E.
+ M. = -.38 P. E.
+
+points. Seventeen of the operative cases showed a smaller gain than
+their respective controls. The three pairs of cases from the nutrition
+class show the following gains:--pair 7; the test case loses 22 points,
+the control gains 23 points; pair 10, test case gains 18.5, but control
+gains 38 points; pair 11, test case gains 14 points, and control gains
+25.5 points. From this test then, we can find no general tendency for
+cases operated on to improve in intelligence in excess of improvement in
+a control group which was not so treated.
+
+This question presents itself:--is there any relationship between
+improvement in physical well-being as revealed in weight, and
+improvement in intelligence? If, as has been supposed, adenoids and
+diseased tonsils cause mental retardation indirectly through physical
+deprivation, it would seem as though greater improvement in intelligence
+after operation should accompany greater improvement in weight, and
+smaller intelligence gain should accompany slighter gain in weight. In
+order to determine whether this was true for our cases, improvement in
+I.Q. was correlated with gain in weight, for the test group. The order
+of merit method was used, and the formula [Rho] = 1 - ((6 [Sum] D_n) /( n(n squared-1)))
+where f = 2 sin ([Pi]/6)[Rho]. The resulting value of r was -.10 with
+unreliability of .226, calculated by the formula [Sigma]t.r - obt.r =
+(1.05(1-r squared)) / [sqrt]n. There is therefore no correlation between
+improvement in intelligence and gain in weight.
+
+ TABLE IX
+
+ Improvement in I.Q., 28 Pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 27 110 109 -1 72 96 24 -25
+ 20 106 102 -4 118 131 13 -17
+ 8 91 86 -5 98 104 6 -11
+ 24 131 124 -7 89 92 3 -10
+ 21 64 67 3 86 97 11 -8
+ 3 94 91 -3 82 85 3 -6
+ 12 98 95 -3 98 101 3 -6
+ 23 85 94 9 81 96 15 -6
+ 11 103 100 -3 101 102 1 -4
+ 15 97 94 -3 78 79 1 -4
+ 18 98 98 0 90 94 4 -4
+ 4 96 96 0 83 85 2 -2
+ 26 80 76 -4 90 88 -2 -2
+ 16 65 73 8 74 82 8 0
+ 28 81 84 3 95 98 3 0
+ 5 95 99 4 114 117 3 1
+ 2 107 114 7 91 96 5 2
+ 10 110 109 -1 104 100 -4 3
+ 17 71 77 6 96 99 3 3
+ 7 91 99 8 95 99 4 4
+ 1 82 83 1 80 76 -4 5
+ 6 95 101 6 88 89 1 5
+ 19 96 101 5 98 98 0 5
+ 9 83 93 10 87 90 3 7
+ 25 77 76 -1 145 137 -8 7
+ 13 70 78 8 66 64 -2 10
+ 22 91 100 9 63 62 -1 10
+ 14 96 107 11 140 137 3 14
+
+ Av. 91.53 93.78 2.25 92.93 96.21 3.285 -1.035
+ M 2 3 -1
+ 75%ile 7 4 5
+ 25%ile -3 -1 -6
+ Q 5 2.5 5.5
+ P. E. (distribution) 5.25 2.5 5
+ P. E. (average) +-.99 +-.47 +-1.10
+ Av. = -.94 P. E.
+ M. = -.99 P. E.
+
+ TABLE X
+
+ Improvement in Performance of Healy Test, 24 Pairs
+
+ N[16] Test Group (A) Control Group (B)
+
+ Test 1 Test 2 Gain Test 1 Test 2 Gain A-B
+
+ 7 - 6 -28 -22 4.5 27.5 23 -45
+ 13 43 42 - 1 - 1.5 30.5 -32 -33
+ 17 29.5 12 -17.5 1.5 15 13.5 -31
+ 15 7 25 18 1 42.5 41.5 -23.5
+ 26 22.5 7 -15.5 56 61.5 5.5 -21.5
+ 10 -12 6.5 18.5 27 65 38 -19.5
+ 19 57.5 49 - 8.5 -22 -11 11 -19.5
+ 24 54.5 63 8.5 31.5 59.5 28 -19.5
+ 20 0 -11 -11 30 35 5 -16
+ 9 3.5 10.5 7 34 55 21 -14
+ 11 -8 6 14 -29 -3.5 25.5 -11.5
+ 16 49 47.5 - 1.5 30 37 7 - 8.5
+ 1 -25 2 27 -50 -16 34 - 7
+ 22 48.5 43.5 - 5 34.5 33.5 - 1 - 4
+ 18 -13.5 -12 1.5 -32 -28 4 - 2.5
+ 23 49.5 68 18.5 4 25 21 - 2.5
+ 3 21.5 22.5 1 17 19 2 - 1
+ 12 20 21 1 -10 -12 - 2 3
+ 14 12.5 48.5 36 - 5 25.5 30.5 6.5
+ 27 -25 15 40 2 27.5 25.5 14.5
+ 2 28.5 30 1.5 3 -11 -14 15.5
+ 25 8 25 17 29.5 29 - .5 17.5
+ 21 20 32 12 70.5 58.5 -12 24
+ 28 29.5 73.5 44 64.5 51.5 -13 57
+ Av. 17.29 24.94 7.64 12.12 25.69 13.56 - 5.85
+ M 4.25 12.25 - 7.75
+ 75%ile 18 25.5 3
+ 25%ile - 5 - .5 -19.5
+ Q 11.5 13 11.25
+ P. E. (distribution) 10.6 10.56 13.65
+ P. E. (average) +-2.16 +- 2.16 +- 3.05
+
+ Av. = -1.92 P. E.
+ M. = -2.54 P. E.
+
+Similarly, it might be thought that the children who had suffered from
+the defects for a comparatively short time, might reveal greater
+improvement in intelligence after six months than those who had been
+afflicted for a longer space of time. We had no way of knowing
+definitely how long the defects had been present in the cases studied.
+Roughly, though, we may say that in general the older boys have had
+defective tonsils and adenoids for a longer time than the younger ones,
+and that the older the boy, the older the defect. On this basis, if
+correlation of youth with gain in I.Q. should give a larger positive
+value for r, we might be justified in saying that the younger boys, who
+have been handicapped for a lesser period, show greater mental
+recuperation than their older companions. Such a correlation was
+attempted in the test group, correlating age at the first test with gain
+in I.Q. The same methods and formulae were used as in the weight and
+intelligence comparison, the greatest gain in I.Q. being given first
+position, and the lowest age. The resulting value for r was -.24, with
+an unreliability of .186. The relationship would appear to be in the
+other direction but it is so small, with an unreliability measure so
+large as to be insignificant. Once more, then, we find in our results no
+correspondence between recency of defect and quick mental recovery.
+
+ TABLE XI
+
+ Showing percentile ratings of the members of the two groups at the
+ beginning and end of the six months' interval
+
+ Weight Height Grip Tapping
+
+ 1 .29 .44 .25 .40 .47 .40 .51 .33
+ 1C .43 .54 .27 .45 .33 .47 .17 .30
+
+ 2 .04 .10 .04 .11 .16 .16 .16 .25
+ 2C .38 .55 .20 .32 .25 .40 .80 .28
+
+ 3 .46 .59 .32 .49 .44 .56 .52 .58
+ 3C .65 .69 .74 .81 .54 .67 .51 .42
+
+ 4 .33 .44 .39 .52 .16 .13
+ 4C .27 .32 .51 .78 .18 .19
+
+ 5 .16 .20 .18 .20 .33 .23
+ 5C .50 .53 .28 .47 .40 .87
+
+ 6 .12 .15 .06 .10 .10 .23
+ 6C .31 .40 .22 .38 .27 .41
+
+ 7 .03 .07 .05 .15 .07 .06 .40 .27
+ 7C .01 .02 .03 .07 .16 .24 .16
+
+ 8 .62 .71 .63 .75 .24 .27 .23
+ 8C .18 .37 .31 .40 .67 .72 .43 .11
+
+ 9 .31 .41 .47 .53 .26 .47 .71 .51
+ 9C .60 .65 .76 .89 .76 .89 .63 .78
+
+ 10 .26 .35 .26 .43 .44 .33 .01 .04
+ 10C .21 .22 .23 .37 .24 .67 .02 .51
+
+ 11 .24 .23 .25 .43 .33 .67 .40 .08
+ 11C .08 .09 .09 .17 .36 .36 .86 .11
+
+ 12 .25 .40 .15 .53 .08
+ 12C .06 .15 .02 .08 .04 .01 .12 .03
+
+ 13 .95 1.00 .99 1.00 .99 1.00 .90 .66
+ 13C .87 .89 .93 .96 .94 .96 .78 .36
+
+ 14 .49 .66 .67 .74 .72 .67 1.00 .57
+ 14C .92 .93 .96 .98 .93 .98 .97 .97
+
+ 15 .56 .68 .70 .95 .94
+ 15C .79 .80 .59 .66 .67 .70 .62 .54
+
+ 16 .49 .53 .74 .79 .81 .77 .69
+ 16C .34 .28 .50 .54 .24 .24 .69 .51
+
+ 17 .53 .50 .53 .05 .78
+ 17C .17 .15 .24 .11 .40 .34
+
+ 18 .57 .38 .33 .45 .51
+ 18C .17 .20 .30 .34 .10 .06 .09 .03
+
+ 19 .95 .99 .94 .98 .94 .88 .93
+ 19 .38 .45 .30 .37 .67 .40 .09 .31
+
+ 20 .13 .37 .33 .16 .23
+ 20C .63 .75 .56 .88 .67 .44 .78 .86
+
+ 21 .83 .89 .84 .76 .76 .80 .44
+ 21C .67 .77 .55 .61 .81 .67 .62 .57
+
+ 22 .85 .81 .91 .78 .95 .92 .99
+ 22C .83 .92 .93 .97 .82 .91 .33 .89
+
+ 23 .36 .45 .36 .70 .78 .63
+ 23C .73 .74 .70 .82 .55 .53 .36 .62
+
+ 24 .59 .69 .67 .81 .85 .89 .66
+ 24C .62 .63 .59 .71 .67 .67 .86 .86
+
+ 25 .47 .60 .57 .63 .53 .62 .78
+ 25C .73 .74 .60 .64 .44 .91 .70 .79
+
+ 26 .74 .89 .74 .85 .53 .54 .57
+ 26C .76 .81 .70 .79 .84 .76 .40 .40
+
+ 27 .11 .23 .16 .04 .18 .06
+ 27C .07 .12 .12 .23 .10 .16 .30 .25
+
+ 28 .86 .90 .87 .90 .97 .88 .78 .91
+ 28C .87 .93 .83 .86 .88 .98 .94
+
+TABLE XI (Continued)
+
+Showing percentile ratings of the two groups at the beginning and end of
+the six months' interval
+
+ N[16] I.Q. Healy Total Possible Average
+ Gain
+
+ 1 .25 .27 .10 .29 .30 415 .05
+ 1C .21 .15 .01 .12 .53 462 .089
+
+ 2 .84 .89 .60 .66 .38 416 .063
+ 2C .45 .51 .29 .18 -.07 358 -.011
+
+ 3 .49 .44 .49 .51 .40 328 .066
+ 3C .25 .32 .44 .45 .30 287 .05
+
+ 4 .59 .59 .38 .22 168 .073
+ 4C .27 .32 .71 .42 195 .14
+
+ 5 .53 .71 .10 .42 213 .14
+ 5C .89 .90 .77 .24 133 .08
+
+ 6 .53 .77 .02 .55 229 .183
+ 6C .37 .38 .04 .27 210 .09
+
+ 7 .45 .71 .22 .07 .37 478 .062
+ 7C .53 .71 .34 .59 .74 393 .148
+
+ 8 .45 .34 .70 -.50 303 -.125
+ 8C .67 .81 .33 .52 .10 241 .025
+
+ 9 .27 .46 .23 .39 .71 375 .118
+ 9C .35 .40 .73 .89 .72 217 .12
+
+ 10 .88 .86 .15 .35 .34 400 .056
+ 10C .81 .73 .57 .97 1.39 392 .218
+
+ 11 .79 .73 .20 .34 .21 379 .035
+ 11C .77 .79 .05 .23 -.44 379 -.073
+
+ 12 .67 .53 .47 .49 -.11 161 -.036
+ 12C .67 .77 .19 .15 .19 208 .032
+
+ 13 .09 .19 .79 .78 .02 129 .003
+ 13C .06 .05 .24 .67 .06 178 .01
+
+ 14 .59 .84 .41 .84 .69 212 .115
+ 14C .97 .96 .21 .56 .41 104 .068
+
+ 15 .62 .49 .38 .55 .12 106 .04
+ 15C .19 .20 .26 .79 .66 193 .11
+
+ 16 .05 .12 .86 .82 .15 205 .03
+ 16C .13 .25 .66 .76 .24 313 .04
+
+ 17 .09 .17 .63 .40 .66 223 .220
+ 17C .59 .71 .27 .43 .21 174 .053
+
+ 18 .67 .67 .13 .15 .08 175 .027
+ 18C .40 .49 .04 .07 .18 247 .03
+
+ 19 .59 .69 .91 .85 .16 67 .032
+ 19C .67 .67 .11 .18 .16 287 .027
+
+ 20 .82 .79 .25 .18 -.06 177 -.02
+ 20C .91 .94 .66 .75 .20 65 .066
+
+ 21 .05 .07 .47 .69 -.16 209 -.032
+ 21C .34 .62 .99 .92 .46 157 .077
+
+ 22 .45 .73 .84 .81 .87 120 .174
+ 22C .03 .02 .74 .72 .74 275 .123
+
+ 23 .32 .49 .86 .98 .65 168 .163
+ 23C .23 .59 .33 .50 1.26 253 .21
+
+ 24 .94 .92 .88 .95 - .06 89 -.012
+ 24C .38 .46 .68 .93 .54 179 .09
+
+ 25 .17 .15 .37 .55 .49 280 .098
+ 25C 1.00 .97 .63 .60 .53 134 .088
+
+ 26 .21 .15 .51 .36 0 226 0
+ 26C .40 .37 .90 .94 .04 184 .007
+
+ 27 .88 .86 .10 .43 .05 268 .013
+ 27C .11 .59 .29 .59 1.49 320 .25
+
+ 28 .23 .29 .63 1.00 .59 153 .097
+ 28C .53 .67 .96 .87 .24 83 .048
+
+Table XI expresses the results of Table II, with the scores given in
+percentile values. In each test, the group was taken as composed of the
+two scores of every individual--the total number of scores in tests and
+retests, eliminating those scores where the other member of the pair was
+lacking, or where no retest was given. Thus case number 1 was just
+within the lowest 27% of the group in weight at the first weighing, but
+had advanced to the 44 percentile at the second. In height he gained
+from the 25 percentile to the 40 percentile. His total gain in all tests
+is 30 percentile out of a possible 415, and the average gain is..05. The
+reader may see by scanning the table that the gains in the test group
+are practically equaled by those in the control group. There seems to be
+no consistent relationship between a low score in the first test and a
+large gain. This is true even though the method of calculation tends to
+minimize gains at the high end of the group, and losses at the low end.
+In table XII this may be seen more clearly in respect to I.Q. and the
+results for all the tests taken together with the I.Q. weighted by being
+counted twice. A large possible gain indicates that the score at the
+first testing was low, and vice versa. Considering I.Q. values, the
+largest possible gain in the test group was 95 per cent of the group.
+This occurred twice, in one case the actual gain being 7% of the group
+and in the other 2%. In the control group, the largest possible gain was
+97% of the group, but actually this case fell 1% of the group. If we
+correlate possible gain with actual gain for each group, using the
+formula r = 2sin(([Pi]/6)[Rho]) when [Rho] = 1 - ((6 [Sum] D squared)/(n(n squared-1)))
+we get a coefficient of correlation .36 in the test group, and .19
+
+ TABLE XII
+
+ Showing gains in percentile rating for I.Q., and for a total of all the
+ tests with I.Q. weighted by being counted twice.
+
+ I.Q. Total
+ A B
+ 1st 2d possible actual possible actual Av. Gain
+ P.R. P.R. gain gain gain gain
+
+ 1 25 27 75 2 415 30 5
+ 1C 21 15 79 -6 462 53 8.9
+
+ 2 84 89 16 5 416 38 6.3
+ 2C 45 51 55 6 358 - 7 -1.1
+
+ 3 49 44 51 -5 328 40 6.6
+ 3C 25 32 75 7 287 30 5
+
+ 4 59 59 41 0 168 22 7.3
+ 4C 27 32 73 5 195 42 14
+
+ 5 53 71 47 18 213 42 14
+ 5C 89 90 11 1 133 24 8
+
+ 6 53 77 47 24 229 55 18.3
+ 6C 37 38 63 1 210 27 9
+
+ 7 45 71 55 26 478 37 6.2
+ 7C 53 71 47 18 393 74 14.8
+
+ 8 45 34 55 -11 203 -50 -12.5
+ 8C 67 81 33 14 241 10 2.5
+
+ 9 27 46 73 19 375 71 11.8
+ 9C 35 40 65 5 217 72 12
+
+ 10 88 86 12 -2 400 34 5.6
+ 10C 81 73 19 -8 392 139 21.8
+
+ 11 79 73 21 -6 379 21 3.5
+ 11C 77 79 23 2 379 -44 -7.3
+
+ 12 67 53 33 - 6 161 - 11 - 3.6
+ 12C 67 77 33 10 208 19 3.2
+
+ 13 9 19 91 10 129 2 .3
+ 13C 6 5 94 - 1 178 6 1
+
+ 14 59 84 41 25 212 69 11.5
+ 14C 97 96 3 - 1 104 41 6.8
+
+ 15 62 49 38 -13 106 12 4
+ 15C 19 20 81 1 193 66 11
+
+ 16 5 12 95 7 205 15 3
+ 16C 13 25 87 12 213 24 4
+
+ 17 9 17 81 8 223 66 22
+ 17C 59 71 41 12 174 21 5.3
+
+ 18 67 67 33 0 175 8 2.7
+ 18C 40 49 60 9 247 18 3
+
+ 19 59 69 41 10 67 16 3.2
+ 19C 67 67 33 0 287 16 2.7
+
+ 20 82 79 18 - 3 177 - 6 - 2
+ 20C 91 94 9 3 65 20 6.6
+
+ 21 5 7 95 2 209 - 16 - 3.2
+ 21C 34 62 66 28 157 46 7.7
+
+ 22 45 73 55 28 120 87 17.4
+ 22C 3 2 97 - 1 275 74 12.3
+
+ 23 32 49 68 17 168 65 16.3
+ 23C 23 59 77 36 253 126 21
+
+ 24 94 92 6 - 2 89 - 6 - 1.2
+ 24C 38 46 62 8 179 54 9
+
+ 25 17 15 83 - 2 280 49 9.8
+ 25C 100 97 0 - 3 134 53 8.8
+
+ 26 21 15 79 - 6 226 0 0
+ 26C 40 37 60 - 3 184 4 .7
+
+ 27 88 86 12 - 2 268 5 1.3
+ 27C 11 59 89 48 320 148 25
+
+ 28 23 29 77 6 153 59 9.7
+ 28C 53 67 47 14 83 24 4.8
+
+in the control group. With the small number of cases involved the
+probable error is too great to allow either of these measures as
+indicative of relationship. We may say, then, that there is no definite
+tendency for those of low I.Q. to improve in six months after operation
+to a greater degree than those of higher I.Q.
+
+Finally, in order to compare the results of the various tests, the
+measures of the gains of the test group in excess of the control were,
+for each test, expressed in terms of P. E. The averages and medians of
+these measures are collected in Table XIII. They show a very slight
+tendency toward gain in weight, height, and weight-height-age
+relationship; neither improvement nor loss in grip, tapping
+fatigueability and I.Q., and a rather curious tendency to loss in the
+Healy scores. This latter is very probably not a true measure since
+performance in the Healy Picture Completion test shows a rather high
+variability, and the cases are so few as to make the influence of single
+very high or low scores unduly great.
+
+ TABLE XIII
+
+ Showing improvement in various tests of operative group over and above
+ such improvement in control group. Expressed in Terms of P. E.
+
+ Weight Height Height- Grip Tapping Tapping I.Q. Healy
+ Weight fatigue
+
+ P. E. P. E. P. E. P. E. P. E. P. E. P. E. P. E.
+
+ Average 2.85 1.00 2.02 -.50 .03 -.50 -.94 -1.92
+ Median 2.80 1.25 .55 -.83 .32 -.50 0 -2.54
+
+
+
+
+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.
+
+ [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.
+
+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 49.7 13 18
+ 1C 15 53.5 62.8 46.4 49.7 11 15
+
+ 2 15 40.9 47.9 42.6 45.9 9 10
+ 2C 17 52.3 65.5 45.2 49.8 10 15
+
+ 3 16 55 67.5 47 50.2 12.8 13
+ 3C 14 61.5 57.8 51.7 54 14 14.5
+
+ 4 13 51.1 60.2 47.5 50.5 9
+ 4C 13 49.4 54.2 48.9 50.8 9.5
+
+ 7 14 39.9 45.8 42.9 45.6 7 6
+ 7C 12 38.4 42.1 41.9 43.7 9 14
+
+ 8 11 60.8 69.2 50.8 52.3 10
+ 8C 11 45.4 57.9 36.8 48.7 15
+
+ 10 11 48.9 56.7 46.1 48.6 12.5 12
+ 10C 11 47.1 51.8 45.6 48.1 10 12
+
+ 11 12 47.8 55 45.8 49.5 11 11
+ 11C 12 41.6 47 43.6 46.8 11.5 7.5
+
+ 12 12 48 66.5 44.8 14
+ 12C 11 41 69.6 41.5 6
+
+ 13 12 90 112 61.3 61.8 26.5 28.5
+ 13C 12 74.7 88 56.8 60.0 22 27
+
+ 14 12 56 66 51 53.3 16 17
+ 14C 12 81.9 98 57.9 59.5 22 22.5
+
+ 15 12 57.5 51.1 15.5
+ 15C 10 67.2 50.1 15
+
+ 16 12 56 60.3 51.6 53.5 19 18.5
+ 16C 11 51.2 55 48.7 50.1 10 10
+
+ 18 12 58.2 47.3 18
+ 18C 11 45.3 46.7 8
+
+ 19 12 90 108 57.7 60.5 22 20
+ 19C 11 52.4 59 46.7 48 15 18
+
+ 20 12 44.2 47.2 11
+ 20C 11 61.3 49.6 15
+
+ 21 12 70.7 85.5 54.1 16.5 15
+ 21C 10 62.4 69.2 49.6 19 17
+
+ 23 12 51.7 47.8 11.5 15
+ 23C 11 64.1 51.4 14.5 16
+
+ 27 12 43.7 45.4 9 6
+ 27C 11 41 44.6 8 9
+
+ 28 12 71.3 78.5 54.9 56.3 23.5
+ 28C 11 74.2 85.8 53.4 55.9 21
+
+
+ TABLE XIV (Continued)
+
+ N[16] Tapping I.Q. Healy
+
+ Test 1 Test 3 (1) (3) (1) (3)
+
+ 1 135 142 82 93 -25 11
+ 1C 106 134 80 85 -50 11
+
+ 2 105 135 107 113 28.5 24.5
+ 2C 152 139 91 86 3 19.5
+
+ 3 136 144 94 91 21.5 15.5
+ 3C 135 135 82 96 17 25.5
+
+ 4 103 96 111 8.5
+ 4C 109 83 102 33
+
+ 7 125 91 93 - 6 16
+ 7C 105 95 112 4.5 11
+
+ 8 113 128 91 92 32.5
+ 8C 131 121 98 111 4
+
+ 10 68+ 74 145+106 110 116 -12 11
+ 10C 70+ 74 148+124 104 107 27 48.5
+
+ 11 125+ 90 120+125 103 102 - 8 15.5
+ 11C 155+125 102+112 101 95 -29 -20
+
+ 12 98+ 69 98 86 20 1
+ 12C 102 98 90 -10 41.5
+
+ 13 160+165 176+187 70 61 43 62.5
+ 13C 150+109 188+174 66 60 -1.5 21.5
+
+ 14 190+172 228+215 96 102 12.5 77
+ 14C 175+152 165+186 140 138 - 5 48.5
+
+ 15 172+167 192+186 97 97 7 19
+ 15C 140+115 145+133 78 98 1 54.5
+
+ 16 145+131 65 74 49 79
+ 16C 145+ 99 74 81 30 45.5
+
+ 18 133+115 126+145 98 101 -13.5 13.5
+ 18C 100+ 99 108+ 92 90 92 -32 -35
+
+ 19 168+136 96 97 57.5 60.5
+ 19C 100+115 98 90 -22 -15
+
+ 20 105+115 122+118 106 116 0 55
+ 20C 150+120 154+154 118 140 30 48.5
+
+ 21 152+111 154+155 64 66 20 38
+ 21C 140+136 174+150 86 93 70.5 88
+
+ 23 150+119 157+157 85 80 49.5 62.5
+ 23C 122+115 141+141 81 88 4 64
+
+ 27 108+ 92 114+ 95 110 112 -25 25.5
+ 27C 115+105 101+118 72 98 2 39.5
+
+ 28 150+148 176+168 81 83 29.5 77.5
+ 28C 178+148 172+157 95 94 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
+
+ 12 48 66.5 18.5 41 69.6 28.6 -10.1
+ 2 40.9 47.9 7 52.3 65.5 13.2 -6.2
+ 14 56 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
+ 16 56 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
+ 13 90 112 22 74.7 88 13.3 8.7
+ 19 90 108 18 52.4 59 6.6 11.4
+ 3 55 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 1.9
+ Median 1.2 2.2
+ 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 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 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 53.3 2.3 57.9 59.5 1.6 .7
+ 3 47 50.2 3.2 51.7 54 2.3 .9
+ 7 42.9 45.6 2.7 41.9 43.7 1.8 .9
+ 4 47.5 50.5 3 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 .2 .5
+ 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
+ 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 0 - .5
+ 3 12.5 13 .5 14 14.5 .5 0
+ 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 0 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 12
+ months 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 11
+ P. E. of difference +-3.10 +- 5.26
+ Average in terms of P. E. .03 1.89
+ Median in terms of P. E. 0 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 - .06
+ Median of gains of test group in excess of control -.015 - .09
+ P. E. of difference +-.04 +- .036
+ Average in terms of P. E. -.50 -1.66
+ Median in terms of P. E. -.38 -2.50
+
+ 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 12
+ months 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 0 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.
+
+ Lost in 2nd Gained in 2nd No Gained equally
+ period period change with gain in
+ 1st period
+ Test group 9 11 1 9
+ Control group 10 11 8
+
+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
+ 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
+
+ Weight in Height in Height-weight Grip in
+ Gains pounds inches percents Kg.
+
+ lb. P. E. in. P. E. % P. E. Kg. P. E.
+ Av. 1 1.37 2.85 .16 1. 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
+
+ Gains Taps in Tapping in
+ 1/2 min. fatigue ratios I.Q. Healy Score
+ 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 -3.14 -1.71 -3.36 - .87
+ M. 1 0. 0. -.015 - .38 -1. - .99 -7.75 -2.54
+ M. 2 11. 2.09 -.09 -2.50 -3. -1.63 1 .26
+ P. E. 1 +-3.10 +-.04 +-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.
+
+
+
+
+
+End of the Project Gutenberg EBook of Adenoids and Diseased Tonsils, by
+Margaret Cobb Rogers
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