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During the 1920s, the Port of Quebec remained a major point of entry for immigrants to Canada. To better accommodate immigrants, Canadian officials improved the appearance and sanitary conditions of the immigration facilities. A 1925 earthquake and 1927 fire forced the Quebec Harbour Commission to reconstruct site infrastructure, but the subsequent development of the l’Anse-au-Foulon Terminals and its gare maritime, for future transatlantic passenger traffic, would result in the relocation of immigration operations.

By 1850, the Port of Quebec handled two-thirds of European immigration to British North America. Transatlantic passenger traffic increased due to Quebec City’s geographic proximity to Europe. Accordingly, the Quebec Harbour Commission improved port infrastructure with the construction of the Bassin Louise and the Princess Louise docks, and expanded immigration facilities further improving the reception of immigrants. During the First World War, the Port of Quebec was an embarkation point for soldiers heading to Europe.

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…” 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. 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. These policies were updated regularly, which led to the medical facilities being the most dynamic structures in historic Pier 21. This also influenced personal experience and practices at Pier 21, for immigrants and staff alike.