Philadelphia, Jan. 25, 1908.
To the Editor:
—In The Journal, Dee. 7, 1907, appears an interesting and valuable note by Dr. W. J. Calvert on "Increased Vocal Fremitus in Pleural Effusions. The increase or persistence of the voice vibrations is, as Dr. Calvert states, most unusual in the effusions of adults; but it does not seem to be generally appreciated that in infants and young children this phenomenon occurs with comparative frequency. I have repeatedly satisfied myself of this and have demonstrated it to, and have had my observation confirmed by internes at the Children's Hospital, Philadelphia.The character of the fremitus, while it constitutes one of the most valuable means of diagnosis of pleural effusions, I have come to regard as unreliable in young children, because I have found it so variable: unchanged, retained or even increased. This fact, together with the frequency of bronchial breathing and voice over