11th President James Knox Polk

In the early 19th century, any surgery was always dangerous.

Young Polk

A recreated log cabin in NC suggesting Polk’s birthplace.

Born in 1795 in North Carolina, James Knox Polk was the oldest of ten children born to a middle-class North Carolina family. They moved to Tennessee when Polk was ten.

Always considered a frail boy, he was one of our shortest Presidents (perhaps 5’6”), and like James Madison, he was also slight. Perhaps 130 lbs. max.

A residence of the Polks in Columbia, TN

Partly because of his frail health, and partly because of their remote location, he learned his educational basics at home. He would not have any formal education until his late teens.

Dr. Ephraim McDowell (1771-1830)

A commemorative postage stamp in 1959 for McDowell!

Nevertheless, while young-man Polk seemed bright enough, and had become accustomed to the rigors of “frontier” living, he seemed lethargic and incapable of hard physical labor. His academic prowess was mediocre at best. He began complaining of vague on-and-off pains by the time he was eleven, and a regular education was impossible. In 1812, at age seventeen, his pains had worsened seriously, and his father planned to take him back to North Carolina for better care than he could receive in rural Tennessee. En route, young Polk’s agony had become so severe, that his father detoured to Danville, KY to be treated by Ephraim McDowell, an early pioneer of ovarian surgery, and considered one of the finest physicians in the area.

According to sources of that time, Dr. McDowell diagnosed Polk with gallstones, and insisted upon an immediate operation. The problem was…

Most modern physicians believe it was a bladder stone, not a gallstone. The symptoms were totally different; the type of pain was totally different; and the residual after effects were totally different. Impotence or sterility was practically a certainty, likely due to scarring from the rapid perineal dissection. And of course, the surgery itself is totally different.

For more than a hundred years, most history books that mentioned Polk’s health noted that he had gallstones. Not so.

Bladder Stones

Bladder stones are nothing new. There have been instances recorded as far back as the Egyptians. Hippocrates even mentioned them in the 4th century BC. According to Dr. Lindsey Fitzharris, while some stones can be relatively asymptomatic, more likely they are excruciatingly painful, and if not treated, can prove fatal, destroying the kidneys, possibly bursting the bladder, and unquestionably causing infection.

While they are rarer than kidney stones, bladder stones are more prevalent among men. They usually arise from crystallized minerals in concentrated urine. They are most common among older men, particularly when blockage from an enlarged prostate gland causes problems. 

What is extremely rare however, in Polk’s time as well as in modern time, is a bladder stone in children.

A bladder stone (if it doesn’t pass naturally by itself), must either be removed completely, or far more common today, by dissolving or breaking it in a way as to let the smaller particles be passed naturally. Today, non-invasive ultra sound procedures have become routine. In 1812, such measures were unknown.

This cystolithotomy (the formal medical terminology) likely required that the boy be secured for surgery by leather straps and a couple of strong assistants.  

Polk’s Problem

Young James Knox Polk definitely had a serious problem. It was 1812, and medical procedures, diagnosis and treatments were still in relatively primitive states. While Dr. McDowell may have mis-phrased the type of stone it was, he likely knew where it was. He also knew that the young man required immediate surgery, otherwise the consequences could be fatal.

The young man also had a secondary problem. Anesthesia would not be discovered for another three decades. Surgery of any kind, requiring sharp, pointed knives cutting into delicate tissue, is excruciating. Doctors provided strong whiskey or brandy to possibly dull some of the pain. Maybe. If the patient was lucky, he would faint. It is interesting to note that as an adult, Polk never touched spirits of any kind.

Then, of course, there was the mortifying procedure itself. The patient, naked from the waist down, was positioned on his knees, and firmly strapped down so the doctor (who obviously could not see the stone) could insert his finger or instrument in the rectum to “feel for the stone” and determine its relative size and position. Some practitioners then inserted a nail through the penis and urethra, and tapped it with a hammer to shatter the stone. There would be few other choices for more than a century – except for the use of anesthesia, which was a godsend. Dr. Fitzharris’ excellent website offers wonderful detailed drawings!

But it worked…

James and Sarah Polk

After his surgery, recovery and rest, the formerly ill Polk was able to focus on his education for the first time. He was obviously bright and capable, since he entered the University of North Carolina as a sophomore after just 2.5 years of formal schooling. At his graduation in 1818 he was the Latin salutatorian of his class, and considered a preeminent scholar in both the classics and mathematics. Then he returned to Tennessee, studied law and eventually opened up his own practice, and could claim Andrew Jackson as one of his mentors.

Polk got a stamp, too!

Polk obvious went on to a substantive career, not only in law, but in politics. He served for seven terms as a Congressman, including four years as Speaker of the House – the only President who could list “Speaker of the House” on his resume.

But notable career notwithstanding, although Polk married when he was 28, he had no children. Most modern physicians conclude that the cystolithotomy indeed left him sterile.

Sources:

Fitzharris, Dr. Lindsey  – http://www.drlindseyfitzharris.com

Ikard, Robert W. – Surgical Operation on James K. Polk by Ephraim McDowell or the Search for Polk’s Gallstone – Tennessee Historical Quarterly, Summer 1984

Sellers, Charles – James K. Polk: Jacksonian – Easton Press (reprint) – 1987

http://www.jstor.org/stable/42626441