1791 Engraving entitled: Procedure for treating cleft lip. Partial view of a face showing the steps for treating a cleft lip. Plate LVII from Benjamin Bell's "A System of Surgery". The history of surgery of cleft lip and palates reaches as far backwards as the pre-christian era to 390 B.C. when for the first time a cleft lip was closed successfully in China. In the middle ages operations on cleft lip have been several times described. A successful operation on a cleft palate did however not occur until 1816. This can be explained by the fact that cleft palates were thought to be secondary to syphilis, but also because without anesthetic this operation was extremely painful and difficult.