In 1813, surgery was carried out under the most humble circumstances, whether in Boston or in a rural area. In this case we have documentation from the patient as well as the independent report by the mother, Lucy Mack Smith. We also have interesting surgical documentation. Even though there were no individual patient records in those days, we have medical students' letters, their lecture notes, and we have the published work of Nathan Smith on his development of the surgical techniques that were to be applied in Joseph Smith's operation. Joseph's surgery has been described as "brutal" and "gruesome," but when seen through the eyes of the surgeon, there was a great sophistication in the operation performed. The purpose of this report is to examine Joseph Smith's illness and operation in its historical setting and to examine the surgical contributions of Nathan Smith as they relate to this episode.