history

Would this Kill Me in the 1800s: Cleft Palate

It’s been a while since we had a good old fashioned WTKM. This time, we’re exploring cleft palate.

Cleft palate/lip occures when the tissue on the roof of the mouth doesn’t fully form/develop, leaving a gap. We don’t know why this happens, whether it’s genetics, some kind of mutation, or if it’s caused by environmental factors. We do know that some behaviors increase the risk of having a baby with this condition, such as smoking and taking certain epilepsy drugs.

Today, most cases are diagnosed by ultrasound in the first or second trimester, and are surgically corrected by 18 months, if not right after birth. Occasionally, some follow up surgeries are required as the child grows.

Even without surgery, cleft palate is not life threatening, though it can make speaking and eating difficult, and patients are prone to hearing problems and ear infection, and sometimes dental issues.

But, that’s today.

We have records dating back to ancient Rome & Greece, and at least one Egyptian mummy, so it was certainly known to our ancestors. Among the more innocent causes, it was believe that eating or stepping over a hare would cause the condition (historically it was also called being “harelipped”), or looking at a person with a physical deformity while pregnant.

However, both the Romans and the Spartans believed that birth defects were caused by evil spirits, and would leave newborns out in the wilderness to die.

In 390 BCE, a Chinese physician performed the first successful corrective surgery. His patient, an 18 year old male, later joined the army and became a well respected leader.

In the west, little constructive research was done until the 15-1600s, because why try to fix a problem when you can throw holy water at it or lock someone away in an attic or asylum?

*cough*

In the early modern period, several theoretical papers were published exploring possible causes and corrections, but it wasn’t until 1763 that a French dentist performed the first successful surgery in Europe. It was later perfected in Germany, England, and America with the final form emerging around the 1950s-1960s.

So, this isn’t a big deal, right?

Well…yes and no.

Like our discussion of autism and mental health in the 1800s, if the condition doesn’t kill you, the treatment just might.

For starters, that cleft makes patients more prone to infections in the mouth, sinuses, throat, and ears. With no antibiotics, even something as simple as an ear infection could be deadly or leave a person completely deaf or blind.

And that’s for even middle or upper class people with loving families, access to doctors and medicines, and generally good health.

The majority, however, were not this lucky. Physical abnormalities were often seen as a mark of shame, a visible representation of a moral failing in either the mother or her child. In the United States, up until the closure of group homes, hospitals, and asylums for the mentally and physically disabled in the 1980s, “unsightly” family members were often sent away or hidden in spare rooms or attics. Hospitals, etc, were often filled with underpaid, overworked employees who were abusive, physically, sexually, emotionally, and verbally. I’m not going to delve into all of that abuse here since we’ve gone over it many times in other posts, but for many, those homes were the only shelter they had, the only place they could get help, and a lot of people with cleft palate have other comorbidities, which can be mental or physical (though in most cases, the cleft is an isolated defect).

All of that combined means that if you were born with a cleft palate, you probably wouldn’t survive as long as an average person, because infection would be such a high risk. And we haven’t even touched on things like the way people who are physically different are often subject to abuse just by walking down the street, or how much harder it is to find and keep work–especially with something like chronic illnesses.

Anyway, I’ve kept it a little shorter this time, because the history is just so frustratingly depressing, especially with events directly impacting American healthcare in the past couple of weeks. Is it too much to say we’re all screwed?

If anyone needs me, I’ll be rage-reading feminist literature and eating chocolate.


If you like this post, check out By the Grace, a ghost story set during the 1918 flu pandemic with an autistic heroine. Well, if you can tolerate seeing history repeating itself.