Medical Facilities at Pier 21

by Steve Schwinghamer, Historian
(Updated July 20, 2021)

Introduction: Medical Screening at Pier 21

The manual used by immigration staff in the 1950s stated that medical and physical requirements of the Immigration Act were “[f]or the protection of residents of Canada, and to ensure that persons seeking admission do not become public charges…”[1] This connection between public health and medical controls on immigrants in Canada has deep historical roots in Canada, notably in Halifax, which suffered several cholera outbreaks and scares connected with migration during the nineteenth century.[2] In response to the perceived public health risks, the immigration branch required prospective immigrants to clear medical examinations overseas and at their port of entry.[3] These policies were updated regularly, which led to the medical facilities being the most dynamic structures at Pier 21. This also influenced personal experience and practices at Pier 21, for immigrants and staff alike.

Overseas Examinations: Speeding Arrival Inspection

Pier 21’s medical officers worked for the Department of National Health and Welfare, not for the immigration department.[4] They ensured that arriving passengers were in compliance with the regulations and requirements of public health law, including the Immigration Act. However, it would not have been possible for them to conduct a full examination of every passenger arriving in port: the sheer volume would have been overwhelming.[5] This problem pre-dated Pier 21’s operation, and so did the solution: having immigrants obtain a medical check before crossing the ocean. Immigrants arriving at Pier 21 generally had obtained medical clearance abroad, usually from accredited Canadian medical officers abroad or from foreign doctors approved by Canadian immigration authorities.[6] Prospective immigrants who did not have access to these authorized doctors could, on advice from Canadian immigration authorities, obtain an examination and x-ray from “a trustworthy doctor of high repute.”[7]

This system dramatically reduced the burden of inspection on-site, but did not eliminate it entirely. Immigrants pre-screened by a doctor not normally authorized by Canadian immigration still required a full examination on arrival. In practice, the need was relatively small: during 1961-62, only 916 people required full examination at Halifax, an average of just over one person per day.[8] This illustrates the significant impact of overseas examination in reducing screening demands at the Canadian border. According to Dr. Lloyd Hirtle, a medical officer at Pier 21 through the 1950s, the process of overseas medical clearance “made it much easier for us, here, because it was just a matter of checking documents in most cases.”[9] However, the post-war expansion of points of origin for immigrants to Canada outstripped overseas medical infrastructure, which led to a renewed emphasis on careful medical examination of immigrants at their point of entry in Canada.[10] This change contributed to the medical facility being the only part of Pier 21’s physical plant that was regularly improved and expanded after 1954.[11]

Examinations and Exemptions

Whether obtained abroad, at the port of entry or inland after arrival, all immigrants were subject to medical examination before being granted status.[12] A full examination for immigration purposes included an assessment of the applicants’ mental and physical condition, chest x-rays, blood tests and so on. Medical officers also used a less formal visual inspection and conversation with applicants to confirm admissibility.[13] This quicker examination was the most common check at Pier 21, where immigrants who had spent months preparing and going through screening overseas often required a only few minutes to clear each of the required inspections on-site (medical, civil, and customs).[14] Hirtle recalls in particular looking for visible rashes as a sign of infectious disease.[15] As a backstop to these checks, immigration officers were expected to also assess for medical fitness, albeit only on the most general level.

Occasions where immigration officers at various ports admitted people with total deafness, double amputations and so on without reference to a follow-up medical examination, drew sharp criticism from the Chief of Operations Division, G.R. Benoit, in 1956. In his circular on the topic, he reminded officers of the health and fitness requirements for admission and suggested a basic pattern of assessment to ensure that officers would have no doubt as to an individual’s admissibility.[16]

Not all passengers entering Pier 21 were subject to inspection. Many groups were not normally examined, including tourists, business travelers, and people visiting Canada for less than a year.[17] Unlike adults, children under 10 years of age were not required to produce x-rays or a radiologist’s report unless there was a relevant clinical history.[18] The only people completely exempted from medical examination were returning Canadians and foreign diplomats or officials, although both these groups were still subject to quarantine provisions if appropriate.[19]

The Medical Clinic at Pier 21

Pier 21 was one of only a handful of major Canadian immigration facilities that integrated medical treatment areas and immigration accommodations.[20] At Pier 21 itself, there were two distinct medical spaces operated by the Immigration Medical Service. The medical clinic, staffed by two or three doctors, was located waterside on the second floor of Shed 21 near the assembly area. The second space was the immigration hospital, at the far north end of the immigration quarters in the interior of the building, almost at the firewall with Shed 20.[21] The medical clinic served as the hub for inspection and examination. There were desks in the assembly area for medical officers to check passengers’ documents – the first examination that immigrants passed at Pier 21 was medical.[22] If the passenger required complete examination, there was a waiting area and secondary exam rooms in the clinic.[23] After the Second World War, Pier 21 also had facilities on-site for x-ray and laboratory work, demonstrating the role of scientific and technological advances in the practices of screening.[24] There was a minor operating room, but it was only used for the most superficial of needs. Any patient requiring significant surgery was sent to a local hospital.[25]

The Hospital at Pier 21

In contrast to the immediate nature of the work done at the clinic, the hospital was for longer-term care and treatment. It could accommodate up to about thirty patients, and was often near its small capacity. The immigration hospital at Pier 21 was staffed by two nurses, one of whom lived in a small apartment on-site. Florence Waldron, the resident nurse at Pier 21 from 1949 to 1962, recalls dealing with a wide variety of medical needs, including chicken pox, measles, rheumatic fever, polio, bronchitis, typhoid, tuberculosis, and appendicitis.[26] Another staff member, Alison Trapnell, recalls patients with mental illnesses, whose situation generally resulted in deportation.[27]

Amid these diverse needs, the main occupants of the hospital, according to Waldron, were children. Family members of sick children generally stayed in the immigration quarters.[28] As reflected by the use of the hospital facility, children were particularly vulnerable to illness during migration. Outbreaks of diseases like measles aboard ship show up with some regularity in the early passenger lists of vessels arriving at Pier 21. Despite the advances in care, these cases still sometimes led to tragedy: for example, a Polish girl, Stefania Piasta, aged 5, died of measles in the immigration hospital on 23 March 1937.[29] She was the youngest in a large family headed out West that arrived in Canada on the Duchess of York on 19 March 1937.[30] Waldron also has memories of the happier occasion of hosting mothers and newborns in the facility. She was called on several times as a godmother, and hosted a baptism in her living room in the nurse’s apartment.[31] Although there are anecdotes of children being born at Pier 21, Hirtle does not recall any births during his tenure. Generally, pregnant women would be transferred to one of the city hospitals for delivery of their baby if the need arose.[32]

It is significant to note that the facilities at Pier 21 changed substantially over time. The medical clinic was a minor part of the structure as it opened in 1928: just two doctors’ offices and small examination rooms.[33] By 1971, the medical clinic expanded north into the office space with a minor operating room and comprised a complex of more than twenty rooms running about one hundred feet in length and about thirty feet in width.[34] The hospital and associated nurse’s accommodation were reorganized and changed after the 1944 fire – however, this area did not expand.[35]

Supporting Facilities

Besides the functions of the clinic and hospital, there was a small quarantine room at Pier 21, but in practice, cases of serious infectious disease were generally treated at Lawlor’s Island Quarantine Station or Rockhead Infectious Disease Hospital.[36] This need was rather limited, as the same medical changes that led to the closure of Lawlor’s Island in 1938 meant that Rockhead did not see much use as a regular quarantine station. However, its equipment was used for delousing of passengers and baggage if needed.[37] During larger movements with more medical demands, health and immigration authorities would use the facility at Rockhead to expand regular accommodation, as was done for the refugees who arrived aboard SS Walnut in 1948-1949, and again during 1956-57 for refugees from Hungary arriving in Halifax.[38]

Conclusion: Public Health as a Central Consideration for Pier 21 and Canadian Immigration Policy

Public health is a central consideration in the history of Canadian immigration policy and practice. Pier 21’s physical structures reflected this. The medical staff employed at Pier 21 drew on the results of Canada’s advance overseas medical screening programs and on local medical institutions for support in regulating admissions and providing care for prospective immigrants. The screening they conducted on-site was not a static program: their practices changed based on broader policy directions, public health needs and advances in medical care. For Pier 21 as a facility, this continuous pressure resulted in the medical clinic being the only area of the site that underwent constant renewal and renovation throughout the years of operation.