giving rise to the clinical picture known as interstitial nephritis. The essential clinical phnenomena of the acute stage are (1) The urinary changes, of which blood cells, albumin, and casts are the distinctive features; (2) The oedema: (3) The increase in blood pressure; (4) The changes in the blood, i. e. an increase in nitrogenous substances and anaemia of the secondary type; (5) and as a complication, the phenomena, especially of the nervous system which go by the name of uremia.

In conclusion a few brief case reports will serve to illustrate some of the etiological factors and clinical points. Case 1. Hazel E; aged 17, on May 8th developed a typical scarlet rash. The throat was sharply reddened but no exudate was noted at any time. The maximum temperature for two days was 100.2 after which the temperature remained normal. She was kept in bed, protected from draughts, the bowels kept open by phenolphthalein, and mild antiseptics used in the throat. The diet was low in protein. On the 10th and 18th the urine was normal and on the latter date-ten days after the onset-she was allowed up in a chair for a few hours. Two days later slight puffiness about the eyes was noted and the urine showed a large trace of albumin. No other pathological findings. There was no appreciable diminution in the urinary output. The blood pressure was not increased. Treatment: mild purgation, maintenance of almost constant skin moisture without profuse sweating, a flannel abdominal binder worn for three weeks, sodium citrate given to the point of rendering the urine neutral, and a low protein, low salt diet given. The oedema disappeared in two days and the albuminuria in two weeks. She was not permitted to return to school until one month after the disappearance of albumin from the urine. She has remained well since.

Case 2. Ralph B. was quarantined March 12th, 1920, with scarlet fever. The attending physician found only a faint blush on the abdomen and the family dismissed him because they believed the boy had only "a stomach rash." The boy did not appear at all ill and was allowed to play about the yard until two weeks later when the parents noted puffiness about the face. I saw him the following day. At that time the face was moderately oedematous and he had vomited several times. Temperature normal, pulse 80. There was no dyspnoea and no headache. He did not appear very ill. The urine had a heavy coagulum of albumin, sp. gr. 1024, acid, and gross blood was present. He was put to bed on treatment similar to that given above. On the 31st, two days later, the oedema had increased, the breath had a uriniferous odor, there was dyspnoea with a short frequent cough, and he complained of pain at the scapular angles. Physical examination showed the typical signs of a fully developed broncho-pneumonia at the right base behind with moist rales at

the left base. The temperature was normal and remained so. The chest signs cleared in a week, the oedema in about two weeks, and the urine in about three months. Six months later the boy seemed well.

Case 3. John C. Aged 10, was seen Oct, 26, 1920, with oedema of the face, temperature 102, and a leukocyte count of 15,290. The urine contained much albumin, and some blood and granular casts. According to the history there had been no illness prior to the onset of oedema and fever two days before, except the mother stated that he had shown less energy than usual for a week or more. Physical examination showed a sinus in the gum at the base of a tooth and pressure on the swelling about this produced a free flow of pus. No other abnormal findings. A dentist removed the tooth at once. The usual other treatment instituted and fever subsided in three days. The oedema subsided in about a week and the urine became normal on Nov. 19th, twenty-three days after the onset. He has remained well since.

Case 4. Baby McH., aged 18 months, had diphtheria beginning Nov. 19, 1922. The attack was mild and responded to 5,000 units of antitoxin in two doses. The child was apparently doing well until two weeks later when the attending physician, Dr. Karney, was called because of oedema of the face. I saw the child a day or two later in consultation. There was marked general oedema and considerable stupor. The urine contained much albumin and some blood and casts. There was no history of serum sickness. Sharp saline purgation was instituted and sodium bicarbonate given to maintain neutrality of the urine. In two weeks the child was apparently well.

Case 5. Esther H., occupation school teacher, aged 21, was referred to me on Aug. 5, 1920 by Dr. Young, whom she had consulted because of poor vision. Had measles and chicken pox in childhood. Had tonsillitis almost every winter for several years and frequently had peritonsillar abscess. Shortly following an attack of tonsillitis in the spring of 1919, she noticed a swelling of the lower extremities, and some oedema of the face. This continued although she continued to teach school. The vision failed gradually. The menses ceased in May. Two months before I saw her she had vomiting and headaches followed by convulsions lasting 14 hours. She was entirely blind for a few days following this attack. Then slowly improved but can now read headlines only. She now has "neuralgic" headaches, tires easily, and shows considerable oedema of the face and ankles. There was marked pallor of the skin and mucous membranes. Wt. 107, height 63 inches, systolic blood pressure 165, diastolic 115. Heart sounds normal except some accentuation of the second aortic. The blood showed a rather severe secondary anaemia. The urine had a specific gravity of 1012 and showed a heavy cloud of albumin with

a few hyaline casts. Two days later at the hospital, she went into coma. From this she gradually recovered. Her general condition and her vision slowly improved. The albuminuria lessened but never disappeared. Since then her condition from a clinical standpoint has changed very little except at times there have been short acute exacerbations. She recently married, against my advice. This case will never recover. A pregnancy or any acute infection would, of course, hasten the end.

THE EXTENSION SERVICE AND THE COUNTY FARM BUREAUS

Don E. Fish, District Extension Agent, Iowa State College,

Ames, Iowa.

The subject which I have chosen is familiar to most of you but it occurred to me that as the two organized groups which we represent have numerous opportunities for contact with each other that a discussion of the history, organization, aims and purposes of the Extension Service and the Farm Bureaus might be mutually helpful.

We are all Iowans by birth or choice of residence, and as Iowans we must of necessity be interested in agriculture. According to the last census, in 1919 Iowa's farms produced in actual wealth over one billion dollars. The whole Nation is interested in agriculture for Uncle Sam has an investment of $78,000,000,000 in that industry.

The problem of maintaining a food supply, has since the beginning of history been one of the problems of the nations. That the American farmer has met the situation well, must be conceded when we compare the fruits of his efforts with those of his foreign brethern. The world contents itself with producing on the average, one and one-half tons of cereals to the worker. In America, under American methods, the production is 12 tons per worker. It is calculated that our wheat crop of today requires an equivalent of 7,000,000 days of manual labor. If it were produced by methods in vogue before the advent of the reaper, and even yet, in most foreign countries it would require 130 million working days. The average amount of crops cared for per worker in Japan is one and one-half acres; in France and Germany 7 acres; in Russia 9 acres, and in the United States 28 to 39 acres. In Iowa it runs even higher. In fact, I doubt, if in any part of the world the production of food per worker runs higher than in Iowa.

Our national food production per capita reached its peak in 1905 and 1906. In the period between 1900 and 1920 our food production increased 38 per cent, but our population increased 40 per cent. This period marks the development of the automobile industry, the motion picture industry, the electrical industry and the chemical industry. These four major industries employ 20, 000,000 workers, a large percentage of whom are recruited from agriculture. In the United States we lost from our farms in the period from 1910 to 1920, 1,700,000 workers. Just now the move

ment of the farm population to the urban industries, as those of you who employ farm labor may have noted, is quite marked, so marked in fact that many predict that the resultant increase in industrial consumption and the curtailed production of shorthanded farms will serve in time to correct the purchasing power of farm products in exchange for other commodities from its present status of 69 per cent pre-war level taken as a normal. In the face of this shortage of workers, those who were left have tightened up their belts, hitched up bigger teams, bought more efficient machinery, used better and more scientific methods and increased their production per man 15 per cent in the last decade. In the words of Julius Barnes, “Our food production is secure." "At no time will our population ever menace adequate production because science in the aid of agriculture will keep step or ahead of increasing needs."

The importance of agriculture as a fundamental industry was early recognized by the founders of the nation. In fact, Washington recommended that a department of agriculture be established. Although there was no apparent objection the matter went by default and it was not until 1862 that the Department of Agriculture came into existence as a bureau which in 1889 became an executive branch of our government thereby giving to the Secretary of Agriculture a voice in the councils of the nation in the president's cabinet. To quote from the law, it is the business of the department of agriculture to acquire and diffuse among the people of the United States useful information on subjects connected with agriculture in the most general and comprehensive sense of the word. As time went on and the nation progressed, more work was given to the department and at the present time it functions in four fields of endeavor-research, extension, regulation and supervision. It is estimated that about three-fifths of the work of the department is of regulatory or supervisory nature. As the total annual appropriation to the department of agriculture since the department was established in 1862, represents about one-half of one per cent of total federal appropriations it would not appear that for the nation's good, research and extension had been unduly featured.

The same year that the department of agriculture came into existence another law that has had profound influence upon the agricultural history of the nation was placed upon the statute books. This was the first Morrill Act which donated to the states 30,000 acres of public land for each senator and representative in congress, the proceeds from the sale of which were to be invested in interest-bearing securities, the income from same to be used by each state for the support of a college of agriculture and mechanical arts. Iowa, taking advantage of the provisions of this act, founded the college at Ames in 1869. To quote from the