In the nineteenth and early twentieth centuries, scientific and technological developments made surgery safer, more reliable, and, with the corresponding increase in experimentation permitted, more exploratory and successful than ever before. The age of the heroic surgeon, however, obscured procedures that relied on the patient’s cooperation for a final, positive outcome. This essay focuses on the debates surrounding cleft palate surgery in Britain, Europe, and North America between about 1800 and 1930, where the constancy of failure dogged the surgeon, even (...) with improved operative surroundings. Although an anatomical correction could eventually be secured by surgery, without the patient’s participation in learning “normal” speech, the ultimate result was unsuccessful. Patient responsibility and self-control became, therefore, the key to success. By exploring what this meant for patients, their families, and surgeons, a new way of thinking about surgical outcomes, even during a period of increasing confidence in surgery, can be posited. -/- . (shrink)