1 IN MAY 1919 MARGARET LOW was hard at work in her Halifax home, patiently cutting histological sections with a microtome, mounting slides and taking them up to Dalhousie University’s Medical School, where students used them in their studies.1 Low had attended the medical college from 1900 to 1902 although she never completed her medical education. Instead, she worked first in the university’s medical science laboratories and then in Halifax’s Pathological Institute during its formative years between the world wars. For nearly 30 years Low was a dynamic presence among laboratory workers, offering "faithful and efficient service". She was often responsible for training other women and was remembered by her co-workers as the unquestioned authority in the day-to-day work in the lab. Her value was evident in 1927-28 when, due to the extended absence of the director, Low was responsible for supervising laboratory operations.2
2 Despite the contributions of Margaret Low and others like her who quietly toiled in hospital and university laboratories and despite the current recognition that laboratories were a significant development in the history of public health, the rise of "scientific medicine" and the modernization of medical education, we know very little about the internal workings of such laboratories or their staff, particularly in the North American context.3 What attention has been given to this area has focused invariably on physicians, scientists and researchers. Very rarely has the labour of "laboratory workers"4 been acknowledged. These workers were a diverse lot, including university-educated women, young men, medical students and high school graduates pursuing careers as nurses, dietitians, x-ray assistants or volunteers. They performed a variety of tasks, including the processing of clinical samples and public health specimens in addition to assisting in university laboratory classes. In keeping with the disparate background of the workers, the boundaries between the kinds of work they performed were hardly rigid.5
3 This study explores the permeable boundaries and ambiguous identities found within these laboratories – in particular, those at the Pathological Institute and at Dalhousie University. The focus is on the interwar years because this period saw a rapid expansion of laboratory staff at the Pathological Institute in Halifax, as well as in other large provincially-operated laboratories across Canada and in rural hospitals in Nova Scotia. These years also witnessed the establishment of new medical science laboratories at Dalhousie which, in turn, created employment opportunities at the university. Examining these two facilities is appropriate for several reasons. Nova Scotia, like other Canadian provinces, established a public health laboratory in the last decade of the 19th century and, like other jurisdictions, struggled with the pressing health questions of the day, including food and water purity, tuberculosis, diphtheria and other diseases. Nova Scotia, then, is representative of a broader North American trend in laboratory development. But this study also looks beyond the city limits, to the small hospitals, in an effort to understand how laboratories in rural settings were staffed. Indeed, hospital work looks very different from the countryside. Finally, examining the laboratory workforce at Dalhousie University and in hospital settings reveals a diversity that an exclusive focus on health care settings obscures. This approach should help to broaden the social history of health care, while suggesting areas in need of further exploration.
4 By the 1920s hospitals, public health care and medical education were growing more complex. As a commemorative booklet produced for St. Martha’s Hospital in Antigonish, Nova Scotia during a 1925 fund-raising campaign declared with optimism, "In the hospital alone, can a complete and accurate diagnosis be made. Here alone can be found the X-ray machinery, the laboratories, the individual records so necessary to a useful diagnosis".6 Mary Kinnear, using an appropriate metaphor, has described the Canadian hospital of this period as "a modern, scientific, progressive laboratory" where doctors demonstrated their skill, supported by a variety of other health care workers.7 But who were these workers? In Halifax, most laboratory workers found employment either in the Pathological Institute on Morris Street or across the street in the Dalhousie Medical School. The Pathological Institute performed all the clinical laboratory work for the Victoria General Hospital, selected laboratory analyses for hospitals and individual physicians throughout Nova Scotia, and public health work for the province, including testing for diseases such as syphilis, diphtheria and tuberculosis.
5 The Pathological Institute, opened in March 1914, provided Dalhousie’s medical school with substantial new teaching facilities. These were augmented by the addition of laboratory facilities within Dalhousie for histology, physiology and biochemistry. Offering medical students practical laboratory experience addressed one of the key concerns of the report of Abraham Flexner, who had investigated the state of medical education in the United States and Canada, and had severely criticized many schools, including the Halifax Medical School.8 By the mid-1920s, through the assistance of American philanthropic agencies, medical education at Dalhousie included a substantial laboratory component. These two settings, the Pathological Institute and the university’s medical science laboratories, were indicative of the escalating demand for basic and applied scientific knowledge common in municipalities and medical schools across Canada. But while the two sites emerged during the same period, often with key players sharing an interest in both, the location of the work did matter greatly. The composition of the labour force, definitions of skill, the nature of work and wages paid varied significantly across the two sites, and often in surprising ways.9
6 Dalhousie University was in the process of rebuilding figuratively and literally in the early 1910s. Medical education had only recently been re-integrated into the university, in the wake of the damning Flexner report. And while the Carnegie Corporation (which had funded Flexner) was critical of medical education in Halifax, it also served, together with the Rockefeller Foundation, as a major benefactor of the school’s rejuvenation. Together, these agencies provided Dalhousie with a one million dollar gift that spurred the growth of the medical science departments.10 By the 1920s, physiology, biochemistry and histology were all growing disciplines and routinely employed young men to assist in the laboratories. Characterized as "laboratory boys", they endured low wages, lack of mobility and, ultimately, constraints on their independence.
7 For example, many of the "laboratory boys" worked for only short periods, earning very modest wages. Charlie Mitchum went to work in the physiology department in the autumn of 1926,11 replacing Samuel Richards. Richards had been hired on a trial basis in September 1925 and worked until the following May when, in keeping with university practice, he was terminated.12 Mitchum proved to be an exceptional worker, efficient, innovative and a bargain at $30 a month. Professor Boris Babkin wanted to induce him to stay and asked Dalhousie President A.S. MacKenzie if young Charlie could be employed through the summer, contrary to tradition. MacKenzie telephoned Babkin on 10 May, telling him that Mitchum could be retained "if he could be kept busy". The young man would spend the summer taking electrocardiograms, filing documents and maintaining animals with fistula. Mitchum worked in the laboratory, including summers, until April 1929.13 A series of young men followed. When 17-year-old Charles Livingstone was hired, Dalhousie paid him $15 from May to July on a probationary basis, due to his age and "immaturity". He was promised an increase to $35 if his work was found to be satisfactory, "with assurance of [further] advance if worthy of it". It did not work out and, in July 1929, Robert John Dempsey replaced him. Dempsey, however, decided to return to school in August and left at the end of the month. There were others: Gregory James in 1929-30 and Daniel Mitchum, who was appointed in the autumn of 1930 and worked in physiology until December 1931.14
8 Physiology’s laboratory workers were often in their teens or early twenties, and the work was probably never intended to be more than a temporary position to bridge the gap to full adulthood. Other workers, however, were in search of permanent employment. Many of the men who worked in biochemistry, for example, were seeking something other than a brief period of work.15 Shortly after receiving his faculty appointment in biochemistry, Dr. E. Gordon Young initiated a search for an aide. Young, who intended to arrive in Halifax early in 1924, asked MacKenzie whether there were laboratory technicians available. MacKenzie replied that it "would depend so much upon the qualifications which he must possess".16 Young wrote to MacKenzie that there were two "types" of laboratory technicians:Either a young man of about 20 or a middle aged man with moderate intelligence but without initiative. They can both be trained to be good technicians. I think that I prefer the former. A knowledge of elementary chemistry is desirable but very rare. It is however very essential that the applicant have a useful pair of hands and be naturally careful. In a few months work I can train him in ordinary manipulation.17Young’s preference for trainable young men tempers any temptation to explain Dalhousie’s wages exclusively in terms of the youthfulness and transitory nature of the staff. The employment of two biochemistry workers, Stephen Brown and John Grey, reveals that for some workers employment in the medical science laboratories was fraught with frustration, as their personal aspirations conflicted with the constraints of being merely "lab boys".
9 Stephen Brown, a young man of about 20, began work in the biochemistry lab in October 1925 at a salary of $25 a month. By early in the new year, he had proved himself "intelligent, most reliable and teachable". Despite salary increases (to $35 a month by September 1926) and satisfaction with the work, Young reported that Brown was "discouraged" and was threatening to leave "unless he can see a living wage and some prospects ahead of him". Now 21, Brown believed his age and experience warranted a wage of $45 or $50 a month. Equally important for Brown was a promise of regular advancement. He had the support of Professor Young, who appreciated his services. Young believed that without Brown there would either be no time for research or a "trained faculty assistant" would be required, presumably a more expensive option. Indeed, it was only the extraordinary capability of Brown that permitted the absence of such an assistant. MacKenzie increased Brown’s wages in March to $45 per month, to be raised to $50 when he celebrated his second anniversary. With continued progress through "his industry and improved skill" he could expect $60. Brown proved industrious and achieved this wage in October 1928, his fourth year in the laboratory. His effort was extraordinary, for Brown often worked on Saturday afternoons and Sunday mornings because of the large class sizes. He also trained himself to blow glass and work metal, thereby saving the university money for new apparatus or the employment of craftsmen. Perhaps because of his obvious initiative and a sense of frustration over his low wages, Brown was growing restless. Young reported that Brown felt he should "be getting a living wage at least comparable with the boys of his own age" and that for Young "it would be a severe loss if he were to leave". Subsequently, Brown resigned in June 1929.18
10 He was replaced by another young man, 18-year-old John Grey. Young reported that, like Brown before him, Grey "likes the work and is learning fast". Young apparently learned from Brown’s resignation and suggested that "from the standpoint of the University it is very essential that he should be contented financially, as good boys are hard to get and hard to train", while noting that there would be a need to consider further salary increases. President MacKenzie apparently concurred and increased the monthly salary to $45 in May 1930. He added that "laboratory boys" needed something to "stimulate them to do better work" and suggested that if his work continued to be satisfactory, an increase to $50 was possible. MacKenzie and Young agreed that the university would never pay a wage "suitable" for a married man, even though they recognized that staff turnover resulted in lost productivity. MacKenzie explained to Young that the university "cannot afford to pay a salary to a laboratory assistant that will keep a married man". When told this, Grey was "very discouraged", a disappointment made worse as he was in the midst of preparing for his marriage. But Young’s intervention carried the day, and MacKenzie was persuaded to increase Grey’s salary by another five dollars, effective 1 April 1931, "with the expectation that he will look and find a job" that would provide for him (and presumably his anticipated family). He charged Young to make it clear to Grey that there would be no further increases.19 In the midst of the Depression, when university finances were tight, the need for fiscal caution was not invoked in the debate.20 Rather, the search for a living wage for John Grey was framed in the language of marriage and the need to support a family. Dalhousie, content to employ "lab boys", could not contemplate employing family men.
11 Despite his January 1931 marriage, Grey did not leave the biochemistry department at the end of the academic year, as suggested by MacKenzie. In correspondence with new Dalhousie President Carleton W. Stanley, Young argued that he was "entirely opposed to the policy of starving our laboratory assistants so that it is necessary to train new ones every two or three years with a decreased efficiency in the preparation for classes and a decreased research output on the part of the professor. All this is for a saving of a few hundred dollars a year".21 Stanley promised to raise the matter at the next executive meeting of the Board of Governors. While there is no recorded response to Young’s appeal, a budget dated 29 December 1932 shows that $780, or $65 a month, was allocated for a laboratory assistant during 1933-34. Young managed to retain Grey through the rest of the 1930s for $75 a month, the maximum the university would pay for technical workers.22
12 The debate surrounding the wages for the marriage-minded John Grey did not prevent the appointment of another married man. In December 1931 the physiology department hired Albert Hallett, a married man with five children.23 The appointment of Hallett might have been a direct response to the frequent turnover of technical staff in the physiology department. An equally plausible explanation is that during the depths of the Depression the university considered it more important to hire a married man with children. The historical record offers only that Hallett had "considerable training in hospital technique" and came well recommended. His age, family situation and experience did prompt Professor E.W.H. Cruickshank to ask for a starting salary of $50 a month. This request was refused. His predecessor had earned only $45 a month, and only that amount had been budgeted.24 When Cruickshank renewed his request nearly a year later, he noted again that Hallett was married and had a family to support, adding that only Hallett’s eldest boy was contributing a wage to the maintenance of the family.25
13 The medical schools in the 1930s simply could not function without workers such as Brown, Grey or Hallett who worked in the university laboratories.26 The medical science departments were content to employ young men to perform the necessary tasks for the university to conduct both research and teaching. Staff turnover and the loss of productivity did not emerge as significant issues for the university, even with the apparent difficulty professors such as Gordon Young and Boris Babkin had in finding and retaining competent personnel. Research in the university, which would have demanded some stability in the staff, was not yet pre-eminent at Dalhousie.27 While Young may have desired consistency, the administration did not see expenditures for technical hands as a priority. What professors and administrators did agree upon was that Dalhousie would never pay a wage sufficient to support a married man. Ambitious men, according to Young, would not be attracted to the work. Only young men or those without initiative would submit to the low wages offered. Thus, laboratory workers at Dalhousie were viewed as something other than men supporting families, even if they in fact aspired to married life or already supported children. With laboratory workers so easily replaced and in the absence of a substantial research programme that necessitated the continuity of staff, the university was content to offer low wages and bear the cost of turnover.
14 While Dalhousie’s medical science laboratories were being created and staffed in an effort to modernize medical teaching in the university, the Pathological Institute was hiring and organizing its own labour pool. When it opened in March 1914, W.W. Kenney, the superintendent of the Victoria General Hospital, claimed that "there are few better laboratories in Canada".28 The opening of a newly equipped facility in a rapidly changing context of medical science probably did much to bolster Kenney’s claim. But the new facilities did fit a broad pattern of laboratory building by municipal, provincial and federal governments during the late 19th and early 20th centuries.29 New Brunswick joined the trend in 1918 when the provincially-operated Bureau of Laboratories opened in the Saint John General Hospital to service the province, while throughout the Maritimes many hospitals established sparse laboratories through the 1920s capable of performing a narrow range of tests to meet accreditation standards.30 Facilities throughout the region, a growing commitment to public health, a widening array of available tests and an increasing demand from physicians and others combined to create a demand for capable laboratory workers.
15 Hospital work was very different from that of the university. The earliest hospital laboratory workers were young, like their Dalhousie counterparts, but they were also overwhelmingly women and, perhaps surprisingly, better paid. Wages for the "lab boys" of Dalhousie ranged from $25 a month for Stephen Brown in 1925 to $45 for the married Albert Hallett in 1931 and $65 for John Grey. Margaret Low, who worked in the medical school between 1915 and 1920, received a $100 annual honorarium. While demonstrating, she worked approximately four days a week for two hours a day, in addition to preparing her slides. She would obtain fresh tissues from a butcher, and George Burbridge, a local pharmacist, would supply alcohol. President MacKenzie claimed that Dalhousie "could not put [compensation] on a really proper basis" but could "recognize that we appreciated [Low’s] services". "Recognition", of course, did not demand that Dalhousie pay Low a living wage. The honorarium was considered both appropriate and sufficient until the late fall of 1919, when her brother died. With no other family member to support her, Professor D. Fraser Harris acknowledged her financial need. He wrote that "as long as her brother was alive she had an income from him, but at his death that ceased. She is a[t] present doing so much for my department . . . that it is only fair she should get something more than an honorarium".31 Margaret Low, in search of a better wage, went to work at the Pathological Institute when a job became available. She began there in 1920, chiefly to handle the large volume of venereal disease tests, and earned $70 a month.32 This more than doubled to $150 a month by the late 1920s. Other workers conducting public health tests earned approximately $1,000 a year through the 1930s, and by the end of that decade Low was earning $2,000. By this time the lowest paid worker in the public health section of the Pathological Institute earned at least $80 a month. In contrast, throughout the 1930s, the best paid of Dalhousie’s "lab boys" commanded only $75 monthly.33
16 There were other differences between university-based laboratories and those situated in hospitals or elsewhere, whether in Halifax or beyond. Whereas the raison d’être of the university labs was to teach and facilitate learning, with research a very distant secondary activity, the hospital laboratories throughout the region were primarily concerned with providing accurate information for clinicians. As new tests became available, the work in the laboratory grew. For example, a therapeutic innovation such as insulin treatment had a significant impact on laboratory work. When insulin treatment began in the Saint John General Hospital, the diabetic patients strained the laboratory’s capacity because they required daily examination of their urine for sugar levels. Urinalyses, which had been performed regularly since the Saint John lab’s inception, increased by 1,100 during 1922-23.34 Similarly, newly identified public health "menaces", such as venereal disease in the late 1910s and 1920s or cancer in the 1930s, prompted new staff and equipment to be added to those laboratory sections dedicated to public health. The provincial public health laboratories in Saint John and Halifax also augmented the work of smaller hospital laboratories by performing selected tests. The large urban laboratories also conducted milk and water testing for various municipalities on a contract basis. The cumulative result of new facilities and an expanded range of tests for both clinical and public health work was a demand for workers capable of taking charge of the laboratory work and performing a narrow range of tests. The rapid expansion of laboratory work through the 1920s led to the presence of workers at the laboratory bench who had different backgrounds and training, and performed different tasks.
17 In small community hospitals, work in the laboratory was simply added to the duties of the existing labour force. Not surprisingly, nurses were among the earliest laboratory workers, and many rural nurses recalled their laboratory experience in oral histories collected during the 1980s.35 Greta MacPherson was 20 when she entered Glace Bay General Hospital to undertake nurses’ training. She had taught school for one year but found it unsatisfactory. The hospital superintendent, Isabel MacNeil, was a neighbour of Greta, and influenced her decision. After graduating, MacPherson began work at Glace Bay General in the summer of 1922 and found herself responsible for x-ray and laboratory work. A staff nurse had performed this work after taking a "short course" in Halifax. The chance to add time in the x-ray and laboratory rooms to an already long list of duties was hardly coveted. Several other young women refused the offer to undertake these tasks, and Nurse MacPherson was likewise not enthused. The young nurse did demonstrate some aptitude for the work, though she worried that these responsibilities would interfere with her nursing work. The superintendent reassured her that there was not much lab work, only straightforward tests such as blood counts and urines, and that the x-rays would not be burdensome. MacPherson recalled that the superintendent "was anxious for me to do this. Nobody would touch it. So I took instruction".36 Staff nursing positions were few, in large part because of the free labour rendered by student nurses, but MacPherson was offered a position doing lab work, x-rays, some nursing and even anaesthesia. MacPherson stated that "to be a nurse-technician, you’re a jump ahead of when you’ve just taken a technician’s course because you already know how to handle patients".37
18 The combined skill-set secured for MacPherson and other nurses precious positions, but their ability to work across services clearly benefited small hospitals, which did not have the patient loads or budgets to justify hiring staff members dedicated for laboratory work. Nurses in community hospitals throughout Nova Scotia were to "do everything, every department of the hospital and fill in", recalled one nurse, "whether it’s the kitchen . . . even the furnace room . . . and you should know the lab, the x-ray, the pharmacy, the laundry, the whole business. Make yourself aware that you know that you can fill in anywhere if you’re in the hospital. . . . [a] Jack-of-all-trades".38 Other nurses recounted similar stories. "You were everywhere", recalled another, "and you could handle anything".39 Evelyn Purdy, who graduated from the Yarmouth Hospital School of Nursing in 1920, worked on the hospital books for one month, spent a month in the kitchen assisting the cook and undertook x-ray training.40 Clearly, hospital superintendents had an expectation that nurses would perform a variety of tasks, yet even the upper reaches of hospital workers were not immune from such demands. A senior member of the Charlottetown Hospital joined the Canadian Society of Laboratory Technologists (CSLT) in 1939.41 In addition to supervising the laboratory, she also worked in the records and pharmacy departments. She was well-prepared for all these duties, holding certifications as a records librarian, a degree in Pharmacy and an American Society of Clinical Pathologists Medical Technologist (MT) designation for laboratory work. While her education was extraordinary, her work across departments and disciplines, and across the boundaries of hospital work, was more typical.
19 Although superintendents wanted staff nurses to add the emerging service departments to their list of regular duties, that prospect seemed daunting to some.42 A nurse from the Colchester County Hospital in Truro questioned her abilities. She was responsible for routine laboratory work, including blood counts, fecal examinations, urinalyses, sputum, blood groupings and a variety of other tests. Other analyses, such as all the pathology work, serological tests for syphilis and some blood work, were sent to the Pathological Institute in Halifax. In addition to the laboratory work, she also assisted with x-rays and, in her capacity as nurse, was in charge of the operating room. Despite these responsibilities, the nurse was by no means sure of her competence in all these areas. In 1939 she wrote to the CSLT to ask whether there was a one-year course in laboratory technique "for people who already have some knowledge of the subject, but feel that their training and experience is not sufficient".43 Other nurses refused "opportunities" for additional training or simply did not want to add any tasks to an already busy day.
20 As new responsibilities were assumed and old ones relinquished, the content of nursing work, and other work in the hospital, became a matter for discussion. At the heart of the debate was establishing the "boundaries" between these new tasks and older patterns of work.44 Negotiating the content of a day’s labour had implications for staffing levels, worker satisfaction and opportunities for advancement and was a key feature of the division of labour in the modern hospital. Nurses responded differently to the mounting demands being placed upon them. While some felt ill-equipped for the new tasks, others were able to use work in the new departments to shape, at least in part, their workday. An illustration from the immediate post-Second World War period makes this clear. Grace Cann returned to nursing in 1946 near her home town of Overton, Nova Scotia. She had been out of nursing for five years and unexpectedly assumed the position of second night supervisor following the death of her husband. She found the night work a strain and had difficulty sleeping during the day, with the noises of downtown Yarmouth filling her room. She eventually found day work at the hospital, rotating through all the wards before finally landing in the laboratory. She worked exclusively in the lab for more than a year before assuming responsibility for the children’s ward. Interestingly, while Cann "took charge" of the ward, she also "helped" with medical records, "did some work in the lab" and dispensed drugs.45
21 The experiences of nurses who worked in laboratories illustrate an important national debate about the scope and content of nursing work, a debate that extended into the 1940s and 1950s. A contributor to Canadian Nurse in 1940 considered work as a laboratory technician, in the x-ray department or as a records librarian to be "good fields" for the graduate nurse. In laboratory work, women could escape the demands of patients and physicians alike to a large extent, a freedom that undoubtedly appealed to some. The author ended by noting that nurses were "being shut out more and more from choice positions in the hospital", concluding that the nurse is "losing out in the hospital because she is not willing to prove that she can do better work than those who are not nurses".46 Certainly the experience of Grace Cann and the many other Nova Scotian nurses who worked in other services, in whole or in part, refutes this assertion. Nurses were performing a widening array of tasks in smaller hospitals.47
22 Debates about whether nurses should or should not perform other tasks within the hospital continued in the post-war period. Clearly, the addition of new services in the interwar period had posed challenges to existing hospital workers and placed new demands on them. The emergence of new services, such as laboratories, pharmacies or x-ray plants, also introduced entirely new workers. By the mid-1920s, the Pathological Institute was providing more tests, and physicians and health authorities were making greater use of the laboratory. Through the first decades of the 20th century, the laboratory built a steady clientele and the health department suggested that the lab’s equipment and personnel were being "taxed to [the] utmost".48 By 1920, the specimen total exceeded 3,300, and it topped 6,200 in 1921.49 By the late 1920s, throat swabs, venereal disease smears and cerebro-spinal fluid examinations increased annually by 33, 35 and 60 per cent respectively.50 Public health tests, exclusive of routine clinical work, expanded by almost 300 per cent from 1926 to 1931.51
23 With the rising demand for laboratory tests, hospital administrators at the Victoria General Hospital and elsewhere recognized the need for some kind of training programme in medical laboratory technique. Many students made their way into the laboratory of Dr. A.G. Nicholls, the director of the Pathological Institute. Usually, Nicholls trained two students at any one time, although requests sometimes exceeded this number.52 Although it has been claimed that these individuals were likely high school graduates, with neither university experience nor nursing education, the evidence suggests otherwise.53 Many of the laboratory women had university experience, and nurses were among the earliest students.54 Nurses from hospitals throughout the Maritimes typically came to the Institute for a few weeks. All acquired practical education at the bench, and they frequently also received instruction in both laboratory and x-ray work.
24 Other women received more extensive training. Nicholls reported in 1924 that two women had taken a course of eight months’ duration.55 A worker from the 1930s recalled that, in addition to nurses, "there were always people who would come in to take the course". This same worker did not feel it was much of a training programme, however. "Usually it was somebody who wanted to get away from home every day. It really wasn’t very much of a course. And they helped out you see, they were another body to do things. And they would pick up quite a bit". She also thought that the students were overwhelmingly "local girls". She remembered that "Some were doctor’s daughters, or somebody would have an interest or want during the summer something to do or it was a change perhaps from going down to work in a store, or they didn’t want to become a nurse or who weren’t interested in schoolteaching. So this was a big deal, I suppose. So we always had somebody".56 What is clear is that Nicholls was training a variety of workers, including some who were already working in hospitals and others who required more extensive preparation.
25 Another important source of workers for the Pathological Institute was Dalhousie University. One early addition to the staff was Dr. Margaret Chase. Dr. Chase was appointed as a technician in May 1923 in the Department of Pathology and Bacteriology, and Nicholls wanted her to be recognized as well as an assistant in the Pathological Laboratory.57 In correspondence, Nicholls noted that Chase, who had graduated in Medicine the previous day, was "willing to come on a technician’s salary, that is $75.00 per month", for duties in the medical school, the pathology laboratory and museum work! Chase did not labour in the laboratory for long. Her subsequent career took her to the United States, including Philadelphia and New York. Nevertheless, Dr. Chase may be said to be the first female physician to have been employed by the Victoria General Hospital, a distinction traditionally granted to Dr. Eliza Perley Brison.58 That a physician would toil in the laboratory as a technician, for however short a period, suggests the many obstacles facing women doctors in establishing a practice. Gender shaped the experience of women and shaped it differently from men. Women physicians could be found at work in the "feminine specialties", which in the 19th century meant obstetrics and gynecology and in the 20th, pediatrics, public health, teaching and counselling.59 Certainly, this pattern was apparent among Dalhousie graduates in medicine and serves as an important reminder that gender was deeply embedded in the provision of health care. As health care services expanded through the early decades of the 20th century, hospitals and agencies alike turned to women to fill the new positions, yet even women physicians, who were unquestionably privileged when compared with other women, did not enjoy the same opportunities as their male colleagues.
26 In addition to Chase, other Dalhousie graduates made their way into the Pathological Institute.60 Patricia S. Tingley, who held a B.Sc. with special training in chemistry, joined the laboratory in 1926-27.61 Peggy Cameron was working on her Bachelor of Arts degree when she began as a "volunteer worker" in the laboratory in June 1929. Following graduation, Cameron took further courses in bacteriology and biology, and in June 1931 she became a full-time technician. Her additional course-work complemented her earlier education in chemistry and biochemistry, making her in the opinion of the director "exceptionally well trained for Public Health Laboratory work". Another well-trained worker was Mary MacDonald, who was appointed in June 1938. Like Cameron, MacDonald had pursued classes in bacteriology, chemistry and biochemistry, in addition to physiology. And again like Cameron, she had worked as a "voluntary technician at the laboratory for nine months" before her appointment. Other workers brought university experience as well, including Betty Foster (B.Sc.), Katherine Miller (M.Sc.) and Pauline Webster (M.A.). For university-educated women, with few other employment opportunities, work in the Pathological Institute probably had some appeal. It offered an opportunity to use one’s degree or undertake only limited further training; for women the compensation and hours of work were favourable and the work respectable.
27 University-educated women, nurses and those who undertook specific training staffed Nova Scotia laboratories in the late 1920s and 1930s. There were many paths to the laboratory bench, and evidence from the membership rolls of the Canadian Society of Laboratory Technology confirms this diversity. During the society’s first decade 74 workers from the Maritimes and Newfoundland became CSLT members. Nineteen of the applicants had university degrees, while another 19 had some university education. Fourteen of the members had undertaken laboratory courses of varying length in a hospital. There were also eight applicants who had nursing education, while another eight had some other education, including business courses. Twenty-three had no education beyond high school, while 15 had combined educations. The early membership data of this professional society reveals the diversity that was characteristic of laboratory workers and suggests that other aspects of hospital work might be similarly constituted. Such diversity was not a relic of an earlier era, nor was it entirely or quickly eliminated. Morover this diversity poses a significant challenge to our understandings of hospital work in particular, and health care work more generally. Examinations that focus on occupational groups in isolation obscure the variability that prevailed within the professional societies and, indeed, within modern Canadian hospitals. The small laboratory of interwar hospitals required workers with a knowledge of a range of tests, perhaps in addition to other duties such as dietetics, x-ray technology or nursing. The multi-tasking characteristic of work in smaller hospitals during the interwar period thus contradicted the normative dream of 20th-century health care professions, as each tried to carve out and maintain a sphere of activity in an increasingly crowded and competitive occupational environment.
28 Work in the laboratory or in other hospital departments or services should not necessarily be viewed as evidence of an individual’s unproblematic professional identity. Rather, this issue needs to be historicized, and the ways in which the prevailing diversity was incorporated into the "professional portrait" of the workers must be considered. Clearly, the CSLT, both through pronouncements from the head office and through its national journal, the Canadian Journal of Medical Technology, believed that laboratory workers were part of a health care team, with an emphasis on co-operation with and subordination to other interests, including those of hospital administrators, public health planners and physicians.62 Laboratory workers, it was presumed, were "only a link in the chain" and "responsibility for action will always rest with the members of the medical profession".63 Physicians were responsible for the intellectual work of reading laboratory results and making diagnoses or case management decisions on the basis of those reports. While many laboratory workers fulfilled a variety of roles within the hospital and combined modalities of work, their duties, rights and responsibilities in all these areas were highly circumscribed. Their place in the hospital hierarchy was entrenched and their working conditions fairly rigid, despite the illusion of option.
29 The portrait of the "professional" laboratory worker consisted of other critical elements. Employers emphasized "thoroughness" and dedication, with one commenting that "I have no use at all for the type of assistant who works with his eye on the clock. The laboratory technician must always be prepared to go on till the work is done".64 Another author suggested that "of course, we all like our pay cheques. But the true technician is interested in his work to the extent that the money side of it is of secondary importance. If you haven’t a genuine love for the work itself you aren’t living up to your true capacity as a technician".65 Laboratory workers were not supposed to accrue material benefits for working overtime, nor were they supposed to become ill. A writer in the Canadian Journal of Medical Technology suggested in 1939 that absence from work, even for a day, disrupted the work of the laboratory, perhaps a recognition of inadequate staffing levels. To avoid this problem he always told his employees "not to go too often to the movies and in times of epidemics of influenza they should avoid them altogether". Workers were to avoid trolleys for similar reasons. To preserve one’s health and ensure reliable service to one’s employer, "take plenty of exercise in the fresh air both summer and winter and be wise in your dieting".66
30 "Skill" completed the emerging professional portrait expounded by the "professionalizers". Manual dexterity and competence were what counted, and these attributes could not be guaranteed through a university education, noted one writer; only natural ability or experience could ensure this facility.67 A worker from Nova Scotia recalled how excited laboratory director D.J. MacKenzie was when he recruited a young woman from St. Francis Xavier University in Antigonish. "She knew all about bacteriology", recalled the worker. "She came, she might have known her stuff, but she was totally useless. She would get mouthfuls of stuff, and spill things".68 Technicians were to be "neat handed", and many thought women to be particularly suited to some tasks. There were also exceptions to all these elements. Supposed dexterity made women desirable, but "the young woman whose main object in life is to secure a husband is out of place in the profession". Also, although women were generally thought to be more nimble, superior workers came in all shapes. One writer cited the example of a "massive bombardier" who could mount incomparable pathological specimens. Although vigour and health were desired, they were not absolutely mandatory. It was a profession where those with "delicate" health could find a home, with one author reminiscing fondly about an Edinburgh "hunchback" who could produce superior microscopic slides of tissue samples.69
31 Behind the artifice of specialized work was a complex milieu of hospital relations. Laboratory workers, in an age when new tests were being added, did not successfully articulate a claim to any body of knowledge, to the labour process in laboratories or to interpretation or use of results. The flexibility that was a feature of many aspects of hospital work was particularly damaging to an emerging labour force. The ambiguity of laboratory roles essentially meant that laboratory workers were grouped as an undifferentiated mass: either as students, or as those who were labeled "technicians" or as those merely providing "services" ranging from vacation relief to bottle-washing. The fact that individuals could not be distinguished from one another homogenized and effectively devalued laboratory work. What is most striking is how this sharply contrasts with the growing specialization of medicine. Laboratory workers were viewed as interchangeable, while physicians, most of whom were men, were believed to have recognizable and individual skills.70
32 Most germane to the laboratory is the fact that physicians occupied the critical position of laboratory director, and from their position in the socio-cultural network of medicine, valorized the interpretation over the preparation of results. The skill attached to the reading is what was important and shaped how work was organized and rewarded within the hospital. Few women and virtually no laboratory workers shared in this culture. The gendering of skill is a rich historiographic theme,71 and the two sites studied here, Dalhousie’s medical science laboratories as well as those found in hospitals, confirm this richness. Laboratory work was certainly gendered, but it was gendered differently in the two settings. Both groups of laboratory workers lacked exclusive ownership over their skills. In the case of Dalhousie’s "lab boys", they were considered replaceable. A new laboratory "boy", with a little effort, could acquire the necessary abilities. Similarly, with a little training, high school graduates or university women could become competent at basic clinical or public health tests. So too could other hospital workers.
33 How did laboratory workers, with diverse educations and labour processes, work to create a modern identity that was shared and stable? The short answer is that they did not. The need for workers with adequate training to perform a widening array of tests for an expanding public health system and a growing number of clinicians predated any social recognition of these workers. Gradually (and only generally) were the new workers distinguished from others in the hospital, though the transition was lengthy, highly variable and remained remarkably incomplete. The growth of hospital facilities and the expanding workforce are not evidence of an increasing and linear trend toward specialization. Many hospital employees worked in several services and filled a variety of roles in the modernizing hospital. Local factors, including hospital size, the presence or absence of a nursing school and the clinical load of the hospital (which determined the kind of laboratory tests required) all shaped how laboratories were staffed.72
34 While the opportunities for laboratory work in hospitals grew substantially in volume, scope and complexity during the 1920s, the staff was far from homogeneous. The variability of the laboratory workers themselves and the work they performed serve to correct the view that health care workers increasingly specialized over 20th century.73 Evidence from Nova Scotia, the Maritimes and indeed nationally suggests that many workers did not have highly defined and restricted duties. Moreover, in the large laboratories in Halifax and Saint John, workers came from a variety of backgrounds and did not even share a common education. The specialization that is so often touted as a characteristic of the modern hospital is severely complicated by the experience of laboratory workers. This analysis suggests that we need more studies of relationships among workers. Further explication is also necessary regarding the creation of modern identities in this context of multi-tasking and boundary crossing.
35 One identity factor about which there is no doubt is that gender was a significant force in creating a laboratory workforce for hospitals and public health work. The practice of foisting new duties on an existing labour force (in the case of nurses who worked in the emerging services) or exploiting well-educated university women with few other employment prospects is evidence that confirms much of what is known about women’s paid employment. Gender was also central to the casting of the Dalhousie "lab boys", although here it operated much differently. The debate over wages within Dalhousie University often concerned the question of family maintenance. Men were usually thought to be primarily responsible for sustaining families, as in the case of Albert Hallett. Marriage complicated the discourse surrounding wages in the Dalhousie laboratories. The university maintained that the work was not suitable for a married man who had a family to support. Moreover, men who worked in the laboratories were thought to be less ambitious than other men. It seemed the university believed that determined men would simply look for more remunerative work, despite the obvious recognition that an effective laboratory worker aided instruction and research. The skill of these workers was not acknowledged either ideologically or financially. The university was willing to bear the cost of frequently training new workers, rather than paying a wage sufficient to retain competent staff. Age, gender roles and a belief about ambition in the capitalist world combined to justify the low wages paid to the support staff in the university. What is interesting is that any justification was proffered at all. For the women across Morris Street in the Pathological Institute, or in New Brunswick’s Bureau of Laboratories or elsewhere, no similar explanation was necessary. Nevertheless, their wages were often better than those paid at Dalhousie. Finally, while there were connections between Dalhousie’s medical school and the Pathological Institute, including at the most senior levels, there was very little movement of laboratory staff between the two sites.
36 The laboratory workers of Dalhousie and the Pathological Institute were separated only by a city street, yet they were clearly discrete establishments. This was the case even though the medical school had a direct interest in the Pathological Institute, and the connections between the two facilities frequently traversed the boulevard. Women who graduated from the university often took up employment at the Pathological Institute, but the workers in the Dalhousie labs rarely did. Studying the details of occupational formation in these two settings reveals the ways in which gender operated differently even for similar work. This study serves as a reminder that the gendering of work, and the embedded assumptions about matters such as skill or wages, are highly dependent upon other factors and interests, including the availability of workers, occupational mobility or workers’ willingness to retrain or fill multiple roles. Moreover, the case of the laboratory worker also illuminates work in health care in new ways by drawing attention to the permeable boundaries within the division of labour. That nurses were prominent among the early laboratory staff and that there were debates within Canadian nursing about new tasks within hospitals suggests that this is an area in need of further research. How did work in the laboratory and in other services such as physio- or occupational therapy shape nursing (and vice versa) during the inter and post-war period and beyond? The practice of multi-tasking within the hospital seems to have applied to many occupations and is in need of further consideration.
37 "Profession" is a term that is both bountiful and barren for most historians. Its meaning is elusive and, as a category of analysis, perhaps too elusive to be useful.74 There is a need to transcend such portrayals, and to move beyond tired discussions of presumed "professionalization". The identity of laboratory workers was not a stable, bounded and unchanging one. Instead, their work environment was shared, and their membership and daily labour were highly dependent upon context. What this study of the laboratory suggests is that we need histories of health care that challenge the limits of occupational borders and return to the archives to describe how these workers made their identity and interacted with other workers engaged in similar projects. While "professionalism" stands as the predominant cultural interpretation of health care work in 20th-century Canada, it is an approach that privileges a single identity and often ignores the relationships that existed among health care workers. In many settings occupational identity and the boundaries of work were not tightly drawn and roles for workers remained highly ambiguous and more variable than many accounts assume. Understanding this complexity in the hospital or the university is only the first step towards articulating an identity other than that of "professional" for all workers. It is also a re-orientation that could serve political and symbolic functions in the face of a restructuring health care system and a workforce imbued with messages that it must constantly acquire new skills and training.
Notes