View Full Version : Cleft palate treatment circa 1920, rural USA

09-08-2012, 08:42 PM
Say a child is born with complete bilateral cleft lip/palate in the USA in the early 20s. The parents are not destitute, but certainly not affluent. Farmers in rural Mississippi, as the story currently stands. Assuming that the child survives infancy despite feeding difficulties and ear infections and any other complications, what (if any) surgeries would've been available? Keeping in mind the very limited financial resources of the parents.

Would it be plausible for the child to grow up (to age 20ish, at least) without ever receiving a surgery? That scenario would benefit my story, but if corrective surgeries were commonplace in this area/time, I'd rather the story reflect that.

Thanks in advance for any info. :)

09-08-2012, 09:02 PM
Your character would be a child dead-smack in the middle of the great depression. Add rural poverty (depending on the area, not a lot of sustainable farms at that point) to feeding difficulty and lack of funds for medical care and it would be a miracle if they survived period.

09-08-2012, 10:10 PM
Like mental illness, deformity was a family secret in this period, wasn't it? Assuming the family farm is isolated, if this child survived he might have the run of the farm but be severely punished for going beyond certain points--the places where a passerby or people working neighboring fields might see him. Or he might live in an attic or basement, never allowed outside at all.

While there was a depression going on, in the 1920s physicians still sometimes performed needed surgery for no cost, or for whatever the parents could pay--and my grandfather (an obstetric surgeon at the time) accepted payment in produce, dressed rabbit, and field greens. The knowledge of cleft lip and palate repair was present, although I gather there have since been substantial refinements resulting in better cosmetic outcomes.

I think if you need him to reach adulthood with the cleft, it's fully plausible if his family was ashamed of it and hid him--even though they loved him. Or didn't. Whichever works for your story is believable to me.

Maryn, whose mother would not even try rabbit as an adult

09-10-2012, 01:42 AM
Cleft lip and palate repair techniques go back to the late 19th century at least -- PubMed tells me that the first reports of successful repairs (http://www.ncbi.nlm.nih.gov/pubmed/3095876) were in 1816 and 1819. So your character could certainly have it done. The cosmetic results, I'm sure, were not good by modern standards, but the defect could be improved. One thing to keep in mind is that the malformation is a spectrum, ranging from small defects in the lip and/or soft palate to huge double defects affecting the entire area between the upper gums and nose and extending back through both hard and soft palate to the back of the throat. I doubt surgeons of a century ago would be able to help those severe ones much.

09-10-2012, 06:56 AM
My parents were foster parents for many years. Back in the 1980s, they received a little girl (maybe 6 months old) who had a cleft lip and palate. She had a feeding tube installed in her stomach, I'm assuming because any formula would have gone into her sinuses. (I don't know at what point she was given the feeding tube, whether it was before or after she entered foster care.)

09-10-2012, 07:05 AM
That baby will have feeding difficulties if it's not corrected. Which could lead to starvation and milk coming out of the nose and aspiration of milk.

All of which, if the baby survived, would lead to chronic ear infections, which if left untreated would lead to deafness.

The child would also most likely have speech difficulties because of the lack of roof to form sounds. A cleft palate can also cause dental issues. It's possible the child would grow up without it corrected, but not without some serious defects to go with it.

09-10-2012, 07:36 AM
Yeah, all those particular complications, and the cosmetic deformity all figure hugely into the story. This particular arc hinges on it, really. If surgical treatment would've been readily available to a rural family in the Depression, I was going to have to either change my setting or change the time period. And that would've caused further rewrites in different parts of the book.

But as long as it would be plausible for a poor kid in that era/region to go without having surgery, it's all good for now. :)

You know, I'm sooo glad I found this forum, 'cause I've had a hell of time finding info on certain important details. Definitely gonna put a thank you to y'all in the back of my book. ;) The AW Coolerites? Coolarians? The Cult of C'thooler? Hmm...