INSTRUMENTAL LABOR

\ˌɪnstɹəmˈɛntə͡l lˈe͡ɪbə], \ˌɪnstɹəmˈɛntə‍l lˈe‍ɪbə], \ˌɪ_n_s_t_ɹ_ə_m_ˈɛ_n_t_əl l_ˈeɪ_b_ə]\
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1898 - American pocket medical dictionary
By Willam Alexander Newman Dorland
 
1916 - Appleton's medical dictionary
By Smith Ely Jelliffe