In 1812 James K. Polk underwent a lithotomy procedure by Dr. Ephraim McDowell of Kentucky to remove a bladder stone. Polk had an uneventful post-operative course and many years later became the 11th President of the United States. Lithotomy was a term initially used in anti-quity to describe a surgical procedure to remove bladder stones. Today, the term lithotomy commonly refers to the positioning of a patient in the operating room or on an exam table. This paper will review Polk’s medical history, McDowell’s operation, and its impact on the future President’s life in and out of politics. We will also review the evolution of the term “lithotomy.”