An Invited Article Treatment of Cleft Lip and Palate during The Revolutionary Wa Bicentennial Reflections BLAIR O. ROGERS, M.D. New York City, New York (Cleft palate surgery was not performed either in Europe or in America during the time of America’s Revolutionary War. Cleft lip surgery was performed by the pinning and figure-of-eight thread method of closure in keeping with current European teachings on the subject. This surgery was frequently performed by itinerant mendicants, charlatans, and also by the more legitimate members ofthe surgieal community living in the 13 states at the time of the Revolution. A brief review of the surgical methods employed form the ‘major portion of this article During this exicting year in our Nation’s history, one can try to look back- ward to learn what type of surgery was performed during the Revolutionary War and soon thereafter on patients with cleft lip and cleft palate. A thorough review of the literature (Rogers, 1964, 1967, 1971, 1972) reveals that, to begin with, it can be stated quite categorically that cleft palate surgery was completely non-existent. The reason for this will be dealt with later on in this article. Cleft lip surgery was performed in a manner similar to those operations being taught in Europe from the early and mid-1700’s and onward. What we might ask, therefore, was the type of training the surgeon went through to perform this type of surgery at the time of the Revolution and what, one might also ask, were the types of surgeons available during the Revolution who could perform this sur- gery? Our knowledge of Revolutionary War surgery, or surgery performed just before and during that war, comes to us exclusively from one man, John Jones (Figure 1), a New Yorker by birth who was and should rightfully be called the “Father of American surgery” (Smith, 1910; Rogers, 1972; Stark, 1976). He was a founder and the first full Professor of Surgery of the Medical School of King’s College in New York City (Gallagher, 1967). This was a feat unheard of in European medical schools—or even in neighboring Philadelphia, where separate chairs for surgery did not exist because of the subservient role “surgeons” played to the condescending arrogance of many of the so-called “physicians” of the times. ‘The disdain with which many English and European physicians looked down upon surgeons in the 18th century (and in earlier centuries) was referred to in Jones's manual on surgery, Plain Concise Practical Remarks on the Treatment Dr, Rogers is Attending Plastic Surgeon, Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital, New Vork City, Associate Profesor of Clinical Surgery (Paste Surgery), Neve York University Medical Center; Consultant in Plastic Surgery, United Nations Medical Sta Consultant in Plastic Surgery, Suint Barnabas Medical Center, Livingston, New Jersey. 371372 Rogers FIGURE 1. Dr. John Jones. (From a por- trait in the Library of The New York Academy ‘of Medicine.) of Wounds and Fractures... (Jones, 1775). This was the first surgical text published by an American in the United States. Two later editions appeared in 1776 (Jones, 1776) and posthumously in 1795 (Jones, 1795). Jones stated in his 1775 edition “In most European countries, an invidious distinction has prevailed, between physic and surgery; but in this part of the world the two professions are generally united.” In the English colonies of America prior to the Revolutionary War, surgery ‘was essentially in the hands of general practitioners who very rarely had any opportunity to develop special skills (Bell, 1976; Blake, 1959; Shryock, 1960), Dr. John Morgan, one of the two principal founders of the Medical Department of the College of Philadelphia, suggested in 1765 that a man engaged only in the practice of surgery was much better qualified for this work than the Jack-of-all- medical-trades practitioner who was the commonest type of physician in pre-Revolutionary times (Shryock, 1960). But confining one’s talents only to a surgical practice did not make its appearance during the Revolutionary War. In fact, it was probably not until the early to mid-19th century that such specialization first came upon the scene. ‘The mother country, England, had three classes of medical practitioners. The elite among the medical men were the “physicians,” who were essentially internists, gentlemen, and scholars but who did not work with their hands. This differentiated them from the second group, the surgeons—as well as setting them apart from the third group, the apothecaries, who engaged in the merchandisingREVOLUTIONARY WAR TREATMENT 373 and the selling of drugs. These three types of medical practitioners, however, did not exist in the American colonies. The medical guilds, which were so characteristic of these three separate trades in England, were not to be found in the small towns and the rural areas of Colonial America (Shryock, 1960). Colonial physicians were not only general practitioners who prescribed, but they also sold drugs and engaged in whatever surgery they were capable of. In many cases they lacked medical degrees; they were, therefore, sometimes called “surgeon-apothecaries.” Using the general terminology of today, they could be fondly called “good old-fashioned general practitioners.” Licensing regulations for the practice of medicine and surgery were somewhat vague. Although they had some value in labeling the qualified practitioners who lived in any particular city or small town, they were never strictly enforced; therefore, quacks, charlatans, and folk healers were very much on the scene. In fact, the art of printing and advertising in the newspapers helped the quack immeasurably in advertising his wares when he rapidly moved to another city before the law caught up with him. Quite frequently, testimonials by gratified patients in Colonial newspaper advertisements (Rogers, 1964) announced in sometimes glowing terms the cure of a harelip, or the couching of a stone, by a quack—who, of course, placed the advertisement-testimonial in the newspaper himself to help drum up a new group of potential patients. Newspaper coverage also helped the public to learn of a legitimate surgeon, Mr. Hall, who in 1770 twice performed a successful repair of a harelip. We learn of this by reading The Boston Evening Post of September 10, 1770 A few Weeks since the Operation for the Hare-Lip was performed to great Perfection on a young Man in Milton near Brush-Hill; and a Child in Boston has received as much Benefit from the Operation as the Case would admit of, by Mr. HALL, Surgeon to the 14th. Regiment . . . . The Impression these unhappy Sights are apt to make on married Women, should be an Inducement to have this Defect in Nature rectified early in Life, as there are numerous Instances of the Mother's Affection having impressed her Offspring with the like Deformity. ‘This reference to two successful harelip operations is matched by the newspaper advertisements of a certain mysterious “Dr.” Anthony Yeldall (apparently from Philadelphia) whose advertisement included four testimonials from satisfied patients: For the benefit of others, be it made public, that I John Dunbar, of the City of Philadelphia, had a daughter with the deformity of a Hare-lip; I had it cut by a surgeon, but it broke open; I had it cut again and it broke open again; I then applied to Dr. YELDALL, who, to my satisfaction, did the operation in one minute, by the watch, and compleated the cure in four days.—John Dunbar None need dispair, having the above mentioned deformity, for let them be ever so large.or frightful, or have been cut ever so often before, they will be done in one minute, and the cure compleated in four days, or nothing will be required Poor people may have them done GRATIS. And the following advertisement appeared in a New London, Connecticut, newspaper on March 29, 1780, placed there by a certain “Dr.” Lawrence Stork (from Germany).