Panama: the cost of sanitation

When the Americans came to the Isthmus, they found that in neither the city of Panama nor Colon was there any sanitary organization whatever, and the first thing they did was to create a Department of Municipal Engineering. It existed until August 1908, when its work was taken over by various divisions of the Construction Department.

During the four years of its activity it expended nearly $6,000,000, of which about $2,250,000 was for waterworks, sewers, and pavements in the city of Panama and Colon, and about $3,500,000 for work in the Canal zone. Subsequent expenditures in Colon and Panama brought the total cost of improvements made in them by the Commission up to nearly $3,500,000. All of this, in accordance with the treaty between the United States and Panama, will be paid back to the United States through water and sewerage rates, within a period of fifty years, at the expiration of which the system of waterworks and sewers within city limits will revert to the cities, and the use of water will be free to their inhabitants, with the exception of a sufficient water rate necessary for maintenance and operation.

Through these expenditures pure water was supplied to the cities of Panama and Colon, and all settlements in the Canal zone, the cities were converted from hotbeds of disease—without water supplies or decent pavements or sewers—into the best-paved, best-watered, and best-sewered cities in Central or South America.80

From this it will be seen that almost one-third of the whole amount debited to the Sanitary Department was expended on permanent works, most of which will be a great asset to the Republic of Panama, long after the construction force on the Canal has disappeared; and it is absurd to debit the construction force with the whole of this expenditure; the most that ought to be charged is such a sum as will pay an ordinary rate of interest on a proportionate share of the capital and the sinking fund.

While, of course, the whole sum expended by the Municipal Engineering Department was necessary for the public health, in an ordinary community it would appear not in the accounts of the Sanitary Department but in those of the Municipal Engineer. Personally I think it perfectly legitimate to charge it to the Sanitary Department, as has been done in Panama; nor need the Department shrink from the responsibility for the expenditure, for no money spent on the Isthmus has given a better return; but when comparisons with the costs of other sanitary departments are being made, it is important to keep this point in view.

To the Sanitary Department is also charged the cost of the collection and disposal of garbage, and this alone up to 1912 amounted to more than half a million of dollars.

The cost of the buildings used by all engaged in the work of the Sanitary Department is also debited to the Department: so, too, is the money spent on repairs. These items amount to over a million dollars, while quarantine amounts to over $300,000.

Under this heading there is a sum close on $800,000, which certainly has no parallel in the accounts of any other Sanitary Department. Through this account sanitation is charged with such curious items as a share of the Isthmian Canal Commission Band, the Y.M.C.A. clubhouses, and the official newspaper called the Canal Record. Referring to this subject Colonel Gorgas says:81

The overhead charges consist of such items as expenses of accounting, division, expenses of Pay Department, expenses of quarters, salaries of higher officials not connected with the Sanitary Department. While these charges may be just, they are not customary. In discussing the expense of the Health Department of New York, no one would think of including in it a charge for the Auditing Department, a charge for the Pay Department, a charge for the Mayor’s salary, a charge for the Governor’s salary, etc.

The care of the sick is also paid for by the Sanitary Department. Up to 1912, over $7,000,000 had been spent on hospitals, and when the Canal is opened the total sum will be close on $9,000,000, or almost one-half of the grand total expenditure of the Department of Sanitation in the ten and a half years of its existence. However useful the hospitals may have been, they have very little claim to be considered essential expenditure in the prevention of disease, even in the case of diseases like yellow fever or malaria.

Of course public opinion in America demanded the sick should be looked after as well as if they had been in the United States, and the splendid hospitals on the zone are the result. Had they not existed the cost of the Department would have been almost halved, while the total death rate of the zone would have been comparatively little higher. Colonel Gorgas himself points out that while sanitation cost them only 28 cents a month, the medical and hospital care of the employees and their families cost 2.6 cents per day, that is, 78 cents a month. It is important that this should be made clear, for when a government has only a limited sum to spend on hospitals and sanitation, it will do more good to the community by spending on prevention than on cure. It may seem brutal to put it so bluntly, but as a matter of fact the choice is made every year by every government, and one of the great lessons of Panama has been the demonstration to the whole world that it is not only better but actually cheaper to prevent disease than to cure it.

To come to sanitation proper now, almost suggests it is the Cinderella of the family; and indeed we find that, including the water supplies, sewers, etc., the total cost of this will not exceed $5,000,000, or just over one-quarter of the total expenditure. Lest some should imagine I represent the cost of the prevention of disease as less than it really is, I reproduce, from the Annual Report for the Fiscal year ending 30^th June 1912, Table 5, Appendix 1 (Department of Examination of Accounts), the total expenditure to that date (see Table 16.1).

From the table we see that, while hospitals cost $7,077,577.74, sanitation proper in Colon, Panama, and the Canal zone up to the 30^th June 1912 cost only the sum of $4,966,368.62; or at the rate of $624,548.07 per annum. The population during that period has averaged approximately 115,000, so that the cost per head for sanitation proper works out at $5.43 per annum, 45.2 cents a month, or 11/2 cents a day. To many it may appear that the cost of sanitation is very high, and that a rate of over £1 sterling per head per annum would be prohibitive for other lands; but the conversion of dollars into other currencies is entirely misleading in a matter like this. In the first place the lowest paid labourer gets 10 cents an hour and usually earns a dollar a day, so that to him the tax would probably amount to less than 2 percent of his annual salary. To put it another way, if he denies himself each month two bottles of Balboa beer—“The Best Beer Brewed”—he would save sufficient for his sanitation. I admit it would be a self-denying ordinance, for the beer was excellent; but perhaps this humble illustration will serve to show how necessary it is to consider a person’s income when trying to estimate the weight of a tax.

There is another way of viewing this expenditure, and it would be one which might occur to the agriculturist: it is to regard it as so much per acre. This can be found very simply. In the ten years sanitation proper will have cost approximately $6,000,000 or $600,000 per annum. The area under control is 50 square miles or 32,000 acres, so the cost per acre per annum is $18.75 or about £3,10s sterling. No tropical product, unless it contrived to produce an everlasting “boom,” could afford to spend so much on sanitation. But to think of it in this way is to overlook the peculiar conditions which exist in the Isthmus as described in Chapter 11, and to which I shall in a moment again refer. These conditions are such that they could not possibly exist in an agricultural community, and to discuss this way of regarding the expenditure is therefore a waste of time.

In the second place a very large part—almost a half—of the expenditure on sanitation has gone in wages. Had wages been lower, the cost of sanitation would also have been lower; almost an instance of tempering the wind. Thirdly, I have explained already that the water supplies, sewers, etc., will remain as assets for many years, and that it is absurd to debit the rates with the whole capital cost in the space of eight or ten years.

In the foregoing I have tried to show how the expenditure has been incurred, and I have attempted to answer on their own lines the arguments which have been used by those who accuse the Department of Sanitation of extravagance. All such arguments miss the real point. Of a truth the critics have lost the saving sense of humour when they accuse Colonel Gorgas of extravagance. Have they entirely forgotten that he has done what in the history of the whole world has never been done before, and he has done what perhaps only half a dozen men in the world believe could possibly be done? When a man does what to the world is a miracle, it ill becomes the world to grumble at the cost; least of all have they an excuse when the money spent has enabled an undertaking of unparalleled magnitude to be carried out at a fraction of what otherwise it would have cost in both money and lives. If every cent spent by the Department of Sanitation had been expended on the prevention of disease, the Department could still claim its place as the most important cost-reducing factor on the zone; nor could any one dispute its right to the supreme position among labour-saving appliances even in this great engineering work, where the last invention of human ingenuity finds full employment.

It is only the simplest justice to Colonel Gorgas and his staff to remember that he did not go to the Isthmus to work out the most economical way of freeing the tropics in general from the pestilences which make them so fatal to the human race. He went to assist in the construction of the greatest engineering work hitherto attempted. His task was one in many ways absolutely unique. It is true he was not hampered by want of money; in every other respect the difficulties with which he had to contend have no parallel in the ordinary conditions met with either in towns or villages in the tropics. In places which were occupied only for a short time, and in others where the engineers were continually creating new mosquito breeding places, it was impossible for him to lay down permanent drainage systems which are, in the end, both the cheapest and most effectual. What he did was to surmount every obstacle in his path, by devising and developing other methods when prevented from employing the best he knew. In this way he did what those who sent him to the Isthmus asked him to try to do—namely, he made it possible to establish the large labour force without which the Canal could not be constructed. No impartial or reasonable person can for a moment object to costs which have reached only 5 percent of the total cost of the undertaking, and without which the undertaking would surely have ended in the failure from which it so narrowly escaped in 1906, when for a time work had to be abandoned, and when, as Mr Bishop has so graphically described, “nothing except lack of sailing accommodation prevented the scattering" of the entire force.”

Colonel Gorgas has done something more than what he was sent to do, important though the great Canal is to the commerce of both the New and the Old Worlds. Although he went to construct a canal, he has also conducted a School of Applied Sanitation whose lesson will benefit the world—I say with confidence—for all time.

I believe, indeed, that because the conditions were unique, the lesson of Panama has its limitations; and that, because the value of agriculture in controlling malaria, under certain conditions, did not come within the experience of the sanitarian in Panama, he did not emphasise it. Of supreme and last importance is the great lesson of Panama that, when everything else fails, and when all the conditions are most adverse, the adoption of one of the subsidiary methods which they have evolved will enable people to live, if not completely free from disease, at least with far greater freedom than we ever imagined could ever be possible; and that where large masses of tropical labour are employed, the appalling mortality of the past need not recur in the future.