Measured in money, the Panama Canal was to cost $375,000,000.  This is impressive, but there is another item of cost more important, namely, "The Life Cost," or the cost, in human lives, of digging the canal.

Contemplating the record of the Isthmus for unhealthfulness, it could not but be anticipated, in 1904, when the Americans took charge, that this cost would be heavy.  That it should be surprisingly low constitutes a more significant achievement than any saving in the money or time cost of the project.

On July 1, 1912, the Americans had been eight years in the actual work of building the canal.  In that period of eight years there were:

Deaths from disease


Deaths from violence



   Total deaths


Another full year before the passage of the first ship,and eighteen months before the practical and continuous operation of the completed canal, will bring that total of deaths, estimating on the average of previous years and not considering unprecedented increases, to less than 6,000 by January 1, 1914.  The Sanitary Department makes the following report for the eight-year period ending July 1, 1912:


No. of Employees


Rate per 1,000





































The foregoing figures not only cover those actually at work on the canal, but as well include those who while not regularly employed, are the wards of the Commission when idle.   From 1907 onward health has been normal on the Isthmus, within the Canal Zone, with a death rate, among the Americans, frequently lower than in large centers of population in the United States.

President Roosevelt selected Col. William Crawford Gorgas to clean up the Isthmus because of his record in sanitary work in Cuba and elsewhere.  Chief Engineer Wallace doubted his capacity, and so did Secretary of War Taft, but, by 1906, the latter was ready to acknowledge his mistake.  Col. Gorgas is a Southern man, a native of Alabama, and so naturally quiet and reserved in demeanor and deportment that men accustomed to measure a man by bluster and self-assertiveness make the mistake of assuming that he is not strong.  His manner and methods suggest Gen. Robert E. Lee.

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There were two prime needs, as Col. Gorgas viewed the Isthmus in 1904, in any campaign for improved health conditions.  One was to make the Isthmus clean and the other was to kill the mosquitoes which he considered a means of propagating disease.   Practically everything done by the health department has been along these main lines of theory.

The United States profited by the mistakes of the French to the extent of reserving, in the treaty with the Republic of Panama, the exclusive right to control the sanitation of Panama and Colon.  So, in 1904, the engineers immediately went to work on a sewer, waterworks, and street-paving plan that would make of these two characteristically filthy Central American cities, clean, decent, sanitary places of abode.

The native population dumped all garbage, and matter usually consigned to sewers, into the streets.  These streets were mud holes which, with the admixture of refuse, made a condition inconceivably dirty and naturally unhealthful.  The Americans made a reservoir in the mountains a dozen miles away for the water supply of Panama, dug sewers and forced the native houses to connect with them, and then paved the streets with brick.  A system of garbage collection was organized, and the city was cleared of all rubbish.  Today the tourist sees some evidence of slovenly living, but conditions generally are surprisingly smart.

The second part of the program—killing the mosquitoes—was accomplished principally by the use of crude oil.  Every stagnant pool of water, and most of the running streams—except rivers—were treated with oil, and the rank grass and tropical growth was kept cut by hundreds of scythemen.  As a further war measure all houses were screened, the amount spent on this item alone amounting to a sum between $750,000 and $1,000,000.

Having cleaned up within, rigid quarantine regulations were made to keep out persons who might be brought in a diseased condition from other ports.  Vaccination of every person who enters the Canal Zone is compulsory, unless a good scar can be shown.  In 1905 a ship load of natives from Martinique, imported to work on the canal, refused to land because they though vaccination was a  plan to brand them so they could never return to their home.  They were forced out at the point of the bayonet and vaccinated.

It was before these plans had been matured that the first and only epidemic of yellow fever occurred in the Canal Zone.  In April, 1905, an employee in the Administration building in Panama became sick with the fever, and from then on to September the Canal Zone was in the throes of a fear that was featured by the wholesale departure of employees.  The newspapers gave the epidemic wide and oftentimes erroneous publicity, with the consequence that the government had to pay for the fear of the isthmus thus created, in greatly increased salaries and gratuities, to secure American employees.

By October, 1905, Col. Gorgas had mastered the epidemic, and, although isolated cases have occurred since, yellow fever was permanently banished as the bugbear of Panama.  From July 1, 1904, to November 1, 1905, 44 employees succumbed to this disease.  While the epidemic raged, from April to September, 1905, there were 37 deaths among employees, mainly among Americans, with whom the epidemic started.

There was a siege with smallpox and the plague, but they, too, were eradicated in so far as epidemics are concerned, and malaria, pneumonia, and tuberculosis remain as the most frequent attributed causes of death.   Quinine has been bought by the ton for the Canal Zone dispensaries and hospitals.   In 1908 each employee averaged about an ounce of quinine, and they were advised to take three grains daily.

The French had left hospital buildings in Colon and on the side of Ancon hill, just outside of Panama.  The American renovated these and added to them until the present vast facilities came into form.  They sometimes have more than 1,200 patients.  A large asylum for the insane also is maintained.  Hospital cars are attached to the passenger trains to bring in patients to the Ancon and Colon hospitals each day.  In every town or settlement there is a dispensary with a physician in charge and a sanitary officer to inspect conditions of living.  There are about 24 employees out of every thousand constantly sick.

For the Canal Zone, Panama and Colon, in 1905 the death rate was 49.94 per 1,000.  In 1911 it was 21.46, or cut down more than one half.  In 1906 the death rate among the Americans from disease was 5.36, and in 1911 it was 2.82.  In 1908 and 1910 there were more Americans killed in accidents or died from violence than died from disease.

It necessarily follows, from an engineering task of this magnitude, where vast quantities of explosives are handled, where there is a considerable railroad mileage and other hazardous features of construction, that the death rate from violence or accidents would be large.

Every month since the American occupation began in May, 1904, there has been an average of 10 employees killed or have died from external causes.  The total to July 1, 1912, was 995, and by the time the canal is completed, barring unusual catastrophes, the deaths from this cause will be around 1,100.   Under the head of violence are included deaths by drowning, suicide, dynamite explosions, railroad accidents, poisonings, homicides, electric shocks, burns, lightning, and accidental traumatism of various kinds.

Scores of deaths have resulted from the practice of the native employees in using the railroad tracks as public highways.   There have been bad collisions and wrecks with fatalities, and dynamite has claimed about one tenth of the victims of external violence.  In the handling of 25,259 tons of dynamite, or 50,517,650 pounds, to July 1, 1912, the following principal accidents have occurred:

December 12, 1908, at Bas Obispo, premature explosion of twenty-two tons in the Culebra cut, 26 killed and 40 injured.
October 10, 1908, at Mindi, 7 killed and 10 injured, premature explosion.  Dredging in Pacific entrance.
October 8, 1908, at Empire, in the Culebra cut, 5 killed and 8 injured, premature explosion.
August 30, 1910, at Ancon quarry, 4 killed.
July 19, 1911, at Ancon quarry, 4 killed, 2 injured.
January 10, 1909, at Paraiso, 2 killed, 10 injured.
July 25, 1909, on Panama Railroad, 4 killed, 9 injured.
May 22, 1908, in Chagres division, 2 killed, premature explosion of twenty-six tons, caused by lightning.

Forty deaths from dynamite explosions are noted for the year 1908, the largest number for any one year of canal construction, and this does not take into account several individual fatalities.  Chief Engineer Goethals issued stringent regulations to govern the handling of the dynamite, but it was in such common use that the employees naturally became careless.  An instance is afforded by two employees who knocked an iron pipe against a railroad track to dislodge some dynamite.  They were angels in less than two seconds after the first blow.  The worst accident, at Bas Obispo, has not been explained.

Most of the accidents have occurred since the working force has been in excess of 20,000 men.  When the number killed outside the line of duty is subtracted from the total deaths by violence, it will be found that the actual building of the canal has been attended by a normal percentage of such fatalities—certainly no larger than in any private construction of the same character or approximating the same magnitude.  The largest number of deaths by violence among employees in one year was in 1909, when 178 were killed, and this was equaled again in 1911.  The following table shows the number of American employees, the total death rate, and the relation of deaths from disease to deaths by violence from 1906 to 1911, inclusive:


No. of

Death Rate
Per 1,000

By Disease






























Col. Gorgas found, in the early years of canal work, that the Americans and Europeans were three times as healthy as the natives of the tropics, who as Chief Engineer Stevens noted in 1905, "are supposed to be immune from everything, but who, as a matter of fact, are subject to almost everything."  This somewhat upsets the theory that northern races cannot live readily in tropical climates.

Several of the annual reports of the Sanitary Department have noted the remarkably few diseases peculiar to men, such as alcoholism, etc.  Mr. Tracy Robinson, in his book of personal reminiscences, "Fifty Years at Panama," speaks authoritatively on the use of liquor in the tropics as follows:

"Many foreigners have fallen victims to fear rather than fever; while many others have wrought their own destruction by drink, which is the greatest curse of mankind in all lands, but more especially in hot countries.  It has killed, directly and indirectly, more than the entire list of diseases put together; for it induces by its derangement of the vital forces, every ill to which flesh is heir.   Candor compels me to state that I have tried both abstinence and moderate indulgence; and when it is said that strong drink is necessary in the tropics to tone the system up, or for any good purpose under heaven, I say emphatically, it is not so!   It is absolutely best to let it entirely alone.  My fifty years' experience gives me authority to write as I do."

Allowance must be made, in considering the favorable health showing on the Isthmus, to the fact that the employees in one sense are picked men.  They must be in sound condition when employed and usually in the prime of life.  Another thing that has kept the death rate down among the Americans has been the practice of returning to the United States many patients who apparently had not long to live.  Thus their deaths were not a charge against the Canal Zone.

It cannot be assumed that all the deaths from disease in the Canal Zone were from causes that originated there.  The diseases peculiar to the tropics have not claimed as many victims amount the Americans as the diseases peculiar to the northern climates.  But there has been a steady improvement, as may be noted in a fall in the death rate among the Americans, from 8.14 per 1,000 in 1907 to 5.14 per 1,000 in 1911.

An incident in the sanitary government of the Isthmus was an Executive Order by President Taft, effective on December 12, 1911, which prohibited the practice of any system of therapeutics or healing that the Sanitary Department, the allopathic school, should rule against.  The President, upon its possible application to create a monopoly of healing in the Canal Zone being pointed out to him, revoked the order on January 1, 1912.

Employees are not permitted to remain in their homes or quarters when sick, but must go to the Colon or Ancon hospital, unless the district physician expressly rules otherwise.   The hospital grounds at Ancon are beautiful, and convalescent patients are sent to Taboga Island, ten miles out in Panama Bay, for final treatment.  A dairy of 125 cows supplies fresh milk to the Ancon hospital.

At first Col. Gorgas was not a member of the Isthmian Canal Commission.  But the extraordinary ability he displayed resulted in the separation of the Sanitary Department from the jurisdiction of the Governor of the Canal Zone, and on February 28, 1907, Col. Gorgas was made a member of the Commission, with the Department of Sanitation having equal dignity with other grand divisions of the work.  He is the only official of the highest rank who has been with the canal project from its earliest days to the present.

The cost of the sanitary conquest of the Isthmus, to July 1, 1912, was the somewhat impressive total of $15,000,000.  Here, as in the pay and treatment of employees, the government has sought results without regard to the expense.  For the remaining days the canal the cost of sanitation will be approximately $2,500,000, or $17,500,000 in all by January 1, 1914, which amount is nearly $3,000,000 less than the cost estimated for the department in 1908.

The first grand lesson from the life cost of the Panama Canal is that the tropics no longer offer insuperable obstacles to the health of northern races.  For all South and Central America the work of the Americans in Panama teaches the imperative necessity of a literal belief in the old adage:  "Cleanliness is next to Godliness."   At every point where disease has dominated the situation, it has been found that filth abounded.  Guayaquil, in Ecuador, sometimes is quarantined half the year, and it is a significant fact that this has been one of the dirtiest ports in South America.   Any people who are willing to live indecently will pay the penalty in a high death rate.

When the ordinary cleanliness to which the American, or the European, is accustomed is observed in the tropics, and if intoxicants are not permitted to dominate the individual life, there will not be the slightest difficulty in living near the Equator.  The ultimate crowding of North America will force population into Central and South America, and among the world benefits of the Panama Canal none is more flattering to the Americans than just this lesson that he who will live decently may live healthfully.