Adenoids and Diseased Tonsils.

by Margaret Cobb Rogers.

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 mult.i.tude 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 exact.i.tude 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 cla.s.s 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.

"Apros.e.xia 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, da.s.s 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 Highmorshohle, 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 r.e.t.a.r.ded 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 r.e.t.a.r.dation 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 r.e.t.a.r.ded 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 r.e.t.a.r.ded children in each grade will be the older children in that grade, and since older children have fewer defects, the r.e.t.a.r.ded 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 165 130 107 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