DR. J. W. KERR'S PAPER 181 



penalty for refusal of inspection being the shutting out 

 from the city of milk coming from such dairies. 



Unofficial Measures. As centres of population 

 grew and became overcrowded, infant morbidity in- 

 creased. In 1868 from one-fourth to one-half of the 

 total deaths occurring in New York City were among 

 children under one year of age. In an indefinite way 

 such high mortality in different cities was attributed 

 to milk. By 1890 there had been a slight relative 

 decrease, but in the meantime health authorities and 

 pediatrists had had impressed on them by long ex- 

 perience the dangers of contaminated milk as a cause 

 of infant morbidity and mortality. 



The then existing laws had not been aimed to 

 prevent the sale of milk that was too old, too warm 

 and too dirty. There thus arose the necessity of 

 amending them, and in the meantime efforts were 

 required which would place at the disposal of infants, 

 at least, a safer milk supply. Accordingly, through 

 private initiative two notable movements were started 

 in 1889 and 1890, the first, by Koplik, having for its 

 object the control and distribution of milk to infants 

 of the poor ; and the second, by Coit, the production 

 of clean or " certified" milk for clinical purposes under 

 the control of a medical milk commission. 



In 1889 Koplik started an infants' milk depot in 

 the Eastern Dispensary, New York, and like institu- 

 tions were shortly opened by others in that city and 

 other places. 1 In 1893 Coit was instrumental in 

 organizing the first Medical Milk Commission in 

 Essex County, New Jersey. These two achieve- 

 ments marked a new era in milk supervision in the 

 United States. In the milk depot mentioned the 

 milk was heated before dispensing, which is the 

 practice in many such institutions to-day, one of these 

 having in 1893 espoused the cause of pasteurization of 



1 Hygienic Laboratory Bulletin, No. 56, P.H.S., p. 629. 



