Dolley and James Madison through the lens of medicine,sickness,and health

The political lives of America's founding fathers and mothers have been examined in great detail by many historians, but their experiences with health, illness, and medicine have generally received only cursory attention from most biographers. Yet focusing a lens on their dramatic encounters with epidemics, disease, and medical treatments in early America not only reflects the social impact of illness in their era but lends them a corporeal presence that is absent from most historical accounts and serves to humanize them. It reminds us that the founders were flesh-and-blood individuals who had to navigate their lives in many ways similar to ours but without the benefits of many of the hallmarks of modern medicine, including antibiotics and reliable anesthesia and antiseptics.

Dolley and James Madison serve as prime examples of American icons, who frequently dealt with health challenges in the trajectory of their daily lives. Indeed, it was the infamous Philadelphia yellow fever epidemic of 1793 that first thrust Dolley Payne Todd Madison into her significant “role in [American] history.” ¹ Ultimately, it was that health crisis that led to her marriage to rising politician James Madison. An attractive widow, Dolley would marry future American president Madison less than a year after the death of her first husband John Todd. The Madison stories also open a revealing window into eighteenth century medicine, demonstrating graphically that even the elite, who had access to the best of contemporary medicine and physicians, were far from immune to debilitating illness. As Dolley remarked to her sister after the death of President Thomas Jefferson's 25-year-old daughter in 1804, “This is among the many proofs, my dear sister, of the uncertainty of life! A girl so young, so lovely – all the efforts of her Father, doctors and friends availed nothing.” ²

Although the first three United States presidents, George Washington, John Adams, and Thomas Jefferson were robustly built and relatively healthy men for their era, chronic health issues plagued the delicate James Madison from a young age. Historian Garry Wills described him as a slight “short frail man” and observed, “his sense of discipline and self-restraint stemmed from his concern for his health.” ³ Madison, who went on to become known as the respected “Father of the Constitution” and the nation's fourth president, likely suffered from some form of epilepsy, based on inferences in his writings about vaguely described sudden “attacks” akin to seizures which he first experienced as a student at Princeton. He was also often troubled by “bilious” stomach upsets and fevers, probably related to malarial reoccurrences or one of the other many undifferentiated but debilitating viruses circulating at the time. Madison often expressed doubts about his potential longevity. When he was only twenty-one, in what may have been a veiled reference to his epilepsy, Madison confided to a college friend that he was unable to formulate firm plans for his future because “my sensations of many months past have intimated to me not to expect a long or healthy life.” ⁴

Madison was a brilliant student who was attracted to the philosophy of the Enlightenment. He was especially drawn to the work of John Locke, who influenced Madison's liberal political development. Locke may have also indirectly had an unusual impact on Madison's views about his own health. One biographer speculates that the concern Madison suffered from the stigmatized disease of epilepsy prompted him to record in his commonplace book a quotation from a letter sent to Locke that maintained “The strongest and soundest minds often possess the weakest and most sickly bodies.” ⁵

As Madison scholar Ralph Ketcham has observed, James Madison exhibited “a hypochondriacal tendency to ‘fear the worst.’” ⁶ “Crossing the sea would be unfriendly to a singular disease of my constitution,” Madison wrote in 1785 to his political mentor Jefferson, possibly another reference to his epileptic condition. ⁷ The fear of impending serious illness seems to have been a lifetime if intermittent preoccupation with Madison, but fortunately increasing political responsibilities and later concerns for his wife Dolley often trumped worries about his own health. He clearly exhibited necessary stamina during pivotal occasions, such as the intense debates over the constitution. And like many hypochondriacs, Madison, who died at 85, lived a long life for the era.

Biographer Irving Brant has argued that instead of classic epilepsy, Madison suffered from epileptoid hysteria, a psychosomatic condition, and Ketcham has suggested that the underlying problem was actually a nervous disorder, which coupled with “an inclination toward hypochondria, strengthen the impression that its cause [ill health] was in part functional.” ⁸ A physician has speculated that Madison may have had the petit mal type of epilepsy. Madison's description of episodes in which he was “paralyzed” for short periods both mentally and physically, but never experienced convulsions is consistent with that diagnosis. These types of episodes occurred periodically during Madison's long life, including one witnessed by his wife Dolley when she observed “I saw you in your chamber unable to move.” ⁹ Madison's form of the disease perhaps resulted in his being in a suspended state for only a few minutes, but one which may have left him feeling weak and somewhat disoriented for a short time afterwards. ¹⁰ Even in his later years, Madison maintained that he suffered from a “constitutional liability to sudden attacks, somewhat resembling epilepsy and suspending the intellectual functions.” ¹¹

James Madison was born into a prosperous family of longtime Virginians in Orange County on 16 March1751. His father James Sr. was the wealthiest landowner in the area and controlled substantial estates, where tobacco fields were worked by enslaved people. The elder Madison and his wife Nelly Conway Madison became the parents of twelve children, only seven of whom survived into adulthood, reflecting the high childhood mortality rate of the era.

As the privileged eldest son, James was educated first at a local school and then by private tutors before entering the College of New Jersey at Princeton, later known as Princeton University, which at the time was a fertile incubator of revolutionary thought. Madison's family probably sent him to Princeton instead of a local college in part to protect their son from the threat of malaria and other fevers, which were commonly contracted in the hot southern summers, particularly in the swampy areas of Tidewater Virginia. Long hours of study may also have weakened Madison's fragile health as he frequently slept only 4 or 5 hours a night. When Madison returned to Virginia in 1772, he felt so unwell he worried that his end was near and therefore undertook a restorative visit to the famed waters of the Berkeley Warm Springs. ¹² In April 1773, Madison was finally able to write a friend that “My Health is a little better owing I believe to more activity and less Study recommended by the Physicians.” ¹³

Despite health challenges, Madison soon became drawn to politics. Indeed, scholar Richard Brookhiser has maintained that Madison was the most political of the American founders, describing him as the “Father of Politics.” ¹⁴ The Enlightenment ideals which Madison absorbed in college helped shape his devotion to public service. In the spring of 1776, when he was 25, Madison was elected as a delegate from Orange County to the Virginia convention in Williamsburg, where he became acquainted with many prominent politicians. More importantly, in 1779 when Thomas Jefferson was elected governor of Virginia, the two men would initiate a close life-long friendship, which would help elevate Madison's political status.

As the youngest member of the Continental Congress in 1780, Madison only 29, would develop into a national leader. Madison took his political duties very seriously, and intense work sometimes left his health debilitated. In the early months of 1781, another possible recurrence of epilepsy, nervous exhaustion, or malaria, descended on the overworked Madison. Whatever the cause, ill health forced him to be absent from congressional meetings for a month-long period in early 1781, but he was well enough to take part in the ratification of the Articles of Confederation in March.

In 1787, as a member of the Virginia delegation, Madison played a key role in the convention held in Philadelphia, which was to produce the new constitution. Like Jefferson, Madison most often succumbed to illness during stressful times. Following two impassioned speeches in favor of ratification, Madison took to his bed for three days. He often described his sicknesses as “bilious indispositions,” vaguely defined illnesses which included fever, jaundice, and stomach upsets. If severe headaches were Jefferson's health nemesis, Madison often fell ill to what may have been recurrent malaria coupled with some relatively mild epileptic episodes.

Fortunately, Madison's marriage to Dolley Madison would help distract him from such strong focus on his own illnesses. Madison's future wife, born Dorothea Payne, and known affectionately as Dolley, exhibited a charismatic personality almost from birth. She was born on 20 May1768 in North Carolina to committed Virginia Quakers John and Mary Coles Payne, who transplanted their growing family to that southern colony before returning after a year to Virginia, where Dolley grew up. Dolley was fifteen when the Paynes and their eight children moved again, this time north to Philadelphia. Financial success eluded John Payne in the bustling commercial urban center; his laundry-starch business failed, and he died a broken man in 1792. Dolley's mother Mary was forced to take in boarders to help sustain the family, and her elite establishment attracted many young men active in politics who sought lodging. ¹⁵

Although Dolley's education at a small country school in Virginia had been rudimentary, she was a lively conversationalist with a vivacious manner. In 1790, Dolley married rising young attorney and fellow Quaker, John Todd, and they moved into a comfortable home in a fine Philadelphia neighborhood. Illness tragically impacted Dolley as a young wife. The notorious yellow fever epidemic of 1793 swept away a beloved husband, her sickly 6-week-old infant baby boy William Temple, and her in-laws in one fell swoop, leaving her ill and weak from complications following childbirth, and with her young remaining son John Payne to care for. ¹⁶ Dolley's correspondence and the details of her harrowing days in the midst of the epidemic offer a graphic glimpse into the anguish experienced by the victims of yellow fever as well as the widespread health challenges faced by early Americans, regardless of social and economic status.

As the epidemic spread, Dolley's husband sent her and the children away to a safer area in the countryside. However, John Todd remained in Philadelphia to care for his parents and conduct his law practice. As the sad events unfolded, Dolley poured out her heart to her brother: “A reveared Father in the Jaws of Death, & a Love’d Husband in perpetual danger… I am almost destracted with distress & apprehension – is it too late for their removal…I wish much to see you, but my Child is sick & I have no way of getting to you.” ¹⁷ Fortunately, the 26-year old Dolley recovered, although as many as 5000 other Philadelphians died before cooler weather finally brought an end to the mysterious “plague,” which no one at the time understood was spread by infected mosquitoes. Unsurprisingly, Dolley was left with a lifelong heightened sense of anxiety over health issues.

Less than a year later in 1794, Dolley captured the heart of the 43-year-old Episcopalian Virginia planter James Madison. He was a rising Republican politician when he was introduced to Dolley by fellow politician Aaron Burr, who had boarded at the Payne house. The couple married on September 15, 1794. Illness surfaced almost immediately after the Madison's marriage. During their honeymoon, Dolley was attacked with fever and chills, presumably a recurrence of an earlier bout of malaria the previous summer, which was treated successfully by a local Virginia doctor with the typical administration of bark (quinine). At her husband's side, Dolley became a formidable political player in her own right and a consummate hostess.

Political life did not always go smoothly for Madison, and he began to consider leaving politics. In 1797, after the Federalist candidate John Adams was elected president, the Madisons retired to the Virginia family home at Montpelier. Although Madison took a respite from formal politics, he and Thomas Jefferson remained allies as Jefferson took over primary leadership in the Republican Party. When Jefferson was elected president in 1801, Madison became a highly valued cabinet member as secretary of state. James and Dolley were unable to attend Jefferson's inauguration because of the death of Madison's father and due to James's own illness. Madison confided that “My health still suffers from several complaints, and I am much afraid that any changes that make take place are not likely to be for the better.” ¹⁸ Jefferson took Madison's words with a grain of salt, no doubt recalling that faced with public responsibility a refocused Madison often overcame sickness. In his reply to Madison's letter, Jefferson, a firm advocate of the healing powers of nature, offered his encouraging opinion that “I think nothing more possible than that a change of climate, even from a better to a worse, and a change in the habits and mode of life, might have a favorable effect on your system.” ¹⁹

On 4 March 1801 Jefferson became the first American president to be inaugurated in Washington. Dolley and James ushered in their 16-year public residence in the then unfinished capital when they arrived in May. Strain from overwork as secretary of state and diplomatic negotiations wore him down, and the new president seems to have intuitively understood the connection between Madison's psychological state and his physical health. By June, however, Jefferson was able to report to James Monroe that “Mr Madison's health is sensibly improved, and we hope it is the effect of the application of his mind to things more congenial to it than the vexatory details of a farm.” ²⁰ Still, the sweltering Washington summer took its toll on Madison, bringing on another “slight” bilious attack in July, which influenced his decision to retreat to Montpelier for August and September: “If I can get into the pure air which I breathe at home, without a return of the attack, I shall have a more flattering prospect than I have had for nearly two years past.” ²¹

Since Jefferson was a widower, Dolley often took over the role of capable hostess when women were present at social events in the President's House. Dolley's son Payne also occupied much of her attention, and like most parents of the era, every illness provoked severe anxiety as even common childhood diseases such as measles and whopping cough often turned fatal. As she wrote her sister with palpable concern in 1804 “Payne continues weak and sick; and my prospects rise and fall to sadness as this precious child recovers or declines.” ²²

In 1804 she wrote her newly married sister Anna that “I have been very ill since I wrote last, with inflammatory rheumatism; never had I more extreme pain in sickness. Dr Willis bled me, and Mother Madison nursed, and waited upon me with great attention and kindness… the day I was most ill, fifteen or twenty of the family and connections dined here, and I did not quit my bed.” ²³ Dolley's remarks reveal how common a treatment venesection or bleeding was for virtually all illnesses at the time.

In 1805, Dolley developed what she called a tumor but what we would consider a severe abscess or infection of the knee that put her out of commission for upwards of six months. From Washington, she told her sister Anna:

I now write to you from my bed, to which I have been confined for Ten days with a sad knee - it has become very painful, & two doctors were called in, & their application of caustic & so forth gives me hopes of getting well but heaven knows when as it promises to be tedious. I feel as if I should never walk again. My dear husband insists upon taking me to Philadelphia to be under Dr Physic's care, but he cannot stay with me, and I dread the separation.” ²⁴

A month later Dolley was still confined to bed and worried the hot summer weather in Washington and the annual threat of malaria would be detrimental to her health as well as that of her husband's. By then she had hoped to be experiencing the “change of air” at Montpelier and she lamented “My knee will keep me in Washington longer, I fear than will be conducive to our health or interest.” ²⁵ Later in the month Madison wrote Jefferson that he and Dolley would indeed have to forego their usual summer trip back to Virginia as “A consultation of the Doctors Winn and Elzey on the situation of my wife's knee has ended in the joint opinion that an operation is indispensable which can best be performed at Philadelphia and that it is prudent to avoid delay as much as possible. We shall accordingly set of tomorrow, in order to put her under the care of Docr. Physic.” ²⁶

The intense pain finally prompted Dolley to follow her doctor's advice and travel to Philadelphia in late July despite “dangerously hot weather.” Still, her “health and spirits revived every day with the drive, and here I am on my bed, with my dear husband sitting anxiously beside me, who is my most willing nurse.” Dolley's concern about her infirmity was compounded by her worry over her husband. “You know how delicate he is,” she confided to her sister Anna. “I tremble for him; one night on the way he was taken very ill with his old complaint, and I could not fly to aid him as I used to do. Heaven in its mercy restored him the next morning.” ²⁷ Though Dolley did not spell out Madison's sickness it appears to have been one of the epileptic-like episodes.

Dr. Physick immobilized her painfully ulcerated knee and promised “he will cure me in a month… “my knee is better. Doct. P. has splintered it, that is fixt from the bed – not a step can I take.” ²⁸ During the yellow fever epidemic of 1793 the aptly named Physick, later known as the “Father of American Surgery,” had been one of the few doctors who stayed in Philadelphia to aid the sick.

Soon James was able to report with evident relief that “Docr. Physic has no doubt of effecting the cure for which his assistance was acquired; and without the use of the knife,” ²⁹ for even minor surgery could prove fatal during an era where there were no antibiotics to help control infections. Dolley remained anxious about James and the threat of another fever epidemic such as the one she had experienced in 1793. “Mr. M. goes out a great deal,& does not tell me he hears of it [fever] - he is very subject to bilious attack's & I am often miserable with fears for his health, as I have been the cause of bringing him here at this dangerous season, he laughs at my anxieties & our acquaintances aid him in persuading me were are both in safety,” she confided. ³⁰

Ironically, yellow fever did break out again while the Madisons were in Philadelphia in 1805, and they were forced to move to the suburbs to flee possible contagion. James's comments reveal that medical understanding of yellow fever and a variety of “bilious” disorders was still poorly understood and evoked controversy. As he reported:

the fever began to show itself in so many parts of the City, and so far westwardly, that we thought it prudent to retire from the scene…In the meantime the Medical corps continues split into opposite and obstinate opinions on whether it be or be not contagious. Each side puzzles itself with its own theory, and the other side with facts which the theory of the other does not explain. ³¹

Madison was torn between remaining in Philadelphia to offer needed moral support to his ailing wife and returning to Washington to take a more active role in cabinet discussions, and Madison told Jefferson at the beginning of September that “a small operation which could not be avoided, will detain us a little longer.” ³²

Toward late October the fever was on the wane and Dolley was sufficiently improved for the couple to return to Philadelphia. Dolley's full recuperation would take several more weeks, but with Dolley on the road to recovery, Madison returned to Washington in late October to take up urgent diplomatic business at Jefferson's side. In November, Dr. Physick pronounced Dolley's knee sufficiently healed to allow her to join her husband and son in Washington.

The death of two nieces and her mother in 1807, followed by that of her youngest sister Mary in 1808, reminded Dolley of the many tragic losses she had sustained throughout her life, and those sad events thrust her into deep despondency. Dolley opened her heart to a close friend:

Oh God! We must bow our heads to thy decrees however awful –we cannot change or avert them…when I trace the sad events that have occurred to me, I feel as if I should die two [sic]… My Husband is nearly well & I have exerted all my fortitude, all my religion, in order to live for him & my son…I used to think I could not survive the loss of my Mother & my sisters yet am I still here & in all the bitterness of mourning striving to reconcile my heart to the great misfortune! ³³

But soon Dolley was distracted by politics. At the end of 1807, Jefferson announced he would not seek a third term, and Madison moved into the role of heir apparent, garnering the nomination of the Republican Party and moving on to a relatively easy win of the presidency. Madison was inaugurated as president in 1809, and Dolley perfected her role as hostess and political doyen.

During Madison's tenure, she continued to keep tabs on her husbands’ health and found Washington an especially unhealthy environment, with either malaria or typhoid threatening the local population. For example, the summer of 1810 brought a vague weeklong fever to Madison. However, by the fall of 1811, Dolley reported that she and her husband had “passed two months on our mountain [Montpelier] in health and peace, returning [to Washington] the first of October to a sick and afflicted city. The unfinished canal caused a bilious fever to prevail through all its streets; many died, and Congress convened in dread of contagion. Happily all fear is now over.” ³⁴ Dolley was reflecting the common belief at the time that most illnesses, including yellow fever, arose from vague miasmas in the air.

Madison won a second term in office in 1812, and as relations with Great Britain continued to deteriorate, in June Madison asked Congress for a declaration of war. Dolley curtailed her public duties to minister to her husband, whose health had been negatively impacted by the stress of a string of unsuccessful military undertakings and long hours of work. Madison again became critically ill with “bilious fever,” probably the ubiquitous malaria. Those who visited the president during his illness were alarmed by his appearance, and rumors of his impending death rippled through the capital. The Federal Republican, for example, maintained that Madison was in “a state of debility, so exhausted, as to render his chance of even a few more months at least precarious” ³⁵

Fortunately, Madison improved, and in early July, Dolley was able to report that “for the last three days his fever has been so slight as to permit him to take bark every hour and with good effect.” Peruvian Bark, which contained quinine was a favored and generally effective medication for treatment of malaria, but Madison's doctors had been reluctant to use it at first while his fever was still high. Madison was bedridden for weeks. Dolley had devotedly “nursed him night & day – sometimes in despair.” When her husband finally recovered, although he remained pale and tired, Dolley could take a breather but admitted “Now that I see he will get well I feel as if I should die myself, with fatigue.” ³⁶

A letter from Jefferson to Madison revealed the widespread concern that had been generated by the president's illness. Jefferson wrote that he hoped Madison was “entirely recovered. If the prayers of millions have been of avail, they have been poured forth with the deepest anxiety. ³⁷ Later in the month Dolley confided to a friend that “You can…have no idea of its extent and the despair in which I attended his bed for nearly five weeks! Even now I watch over him as I would an infant, so precarious is his convalescence.” ³⁸

The war dragged on, but the formal end was proclaimed by Madison on 17 February 1815. Despite numerous diplomatic challenges and serious military blunders, in the end Madison had successfully led the country through a war which helped foster national unity. He also played a role in larger medical issues which affected the new republic. In 1813, Madison signed into law a statute to encourage wider smallpox vaccination, one of the nation's earliest public health bills. The legislation was aimed at regulating the Jenner vaccine to protect American citizens from unscrupulous purveyors who offered adulterated versions. The Vaccine Act of 1813 was the first federal law to oversee drug purity with an eye toward consumer protection. It also gave the president the power to “appoint an agent to preserve the genuine vaccine matter, and to furnish the same to any citizen of the United States.” The medical officer was instructed to send packages of vaccine weighing under a half an ounce free of charge through the U.S. mail to all interested parties. The act was repealed in 1822, when the authority to regulate vaccine was transferred to the states, but it established an important precedent. ³⁹

At the close of Madison's second term in 1817, James and Dolley retired to Montpelier, where the Madisons had looked forward to living out the rest of their lives peacefully. Madison experienced periodic flare ups of malaria, and in the later years, he even became housebound due to escalating ill health. The first winter after their return to Montpelier, Madison was still in good health and assisted by Dolley and her brother John C. Payne, Madison began to edit his political papers with an eye toward publication. For the first decade, Madison remained active in supervising the Montpelier farm and took daily invigorating rides through the countryside. Indeed, later in 1824 Dolley was able to write her brother-in-law John G. Jackson that “Mr Madison and myself have been favored with fine health since our residence at Monpelleir, & tho we have not been far from home within 8 years, we have had the satisfaction of seeing many of our friends from a distance.” ⁴⁰

Although increasingly crippled with arthritic rheumatism in the 1830s, Madison enjoyed reading in his sitting room, where he took his meals at a table positioned close to the door of the dining room so he could interact with guests. In brief periods when his rheumatism receded, he took pleasure in writing letters and working on his papers. By the time Madison reached the age of eighty, his infirmities had made him a spectator rather than participant in public affairs.

In 1831, Dolley told a niece that “I have long been confined by the side of my sick husband and never see or hear interesting subjects except him…Your Uncle is better now than he was a few days ago and I trust will continue to mend; his hand and fingers are still so swelled and sore as to be nearly useless, but I lend him mine.” ⁴¹ Madison was confined to bed for most of 1831 and 1832, a result of chronic bilious fever, rheumatism, and anxiety, although warmer weather seemed to bring temporary relief. By 1834 he was totally bedridden, and was forced to resign his position as rector of the University of Virginia. ⁴² Madison wrote of his limitations “With my malady, my debility, and my age in triple alliance against me.” ⁴³ That Madison felt his usefulness waning was apparent when he asserted “having outlived so many of my contemporaries, I ought not to forget that I may be thought to have outlived myself.” ⁴⁴

Still, Dolley and James managed to escape the notorious cholera epidemic of 1832, which had taken the lives of thousands of Americans, many in nearby Richmond. Madison's health continued to be uncertain, but letters exchanged with family members offered the housebound Dolley a lifeline to the outside world. Her devotion to Madison remained strong, and she wrote a niece “I have never left him half an hour, for the last two years – so deep is the interest, & sympathy I feel for him.” ⁴⁵

By then, Madison's hearing and eyesight were greatly diminished, and he became even thinner and frailer. Yet, the well-known English writer Harriet Martineau, who met with Madison when he was nearly 84, recalled that although the former president complained of very poor eyesight and deafness in one ear, he remained an engaging and lively conversationalist. ⁴⁶ A month before Madison passed away, a friend who visited Montpelier found that the former president “although he was never strong, now often breathless and infirm…extremely emaciated, feeble,” but reported that he became animated when conversing. ⁴⁷ James Madison died peacefully on June 28, 1836, refusing to take any further medications to prolong his life.

For so many years their lives had been so intertwined that understandably Dolley was overcome with “grief and dejected spirit which could not at first be restrained.” ⁴⁸ Shortly before his death, Madison had implored Dolley “to be composed if not cheerful.” In the spring of 1835, he had already finalized his will, leaving many charitable bequests and generous financial gifts to friends and relatives, with the bulk of his estate going to Dolley.

With the support of her close circle of relatives and friends Dolley moved determinedly forward to keeping their plantation on an even keel, settling Madison's estate, and perhaps most challenging of all, overseeing the project to publish his papers. Two days after Madison's death, President Andrew Jackson reported the former president's death to the American Congress, noting he had “departed this life…full of years and full of honors.” Dolley's cousin Edward Coles comforted her from afar: “… to lose such a Husband, between whom and yourself there had been for so long a series of years such a devoted and reciprocal attachment. Time alone can blunt the poignancy of your grief, and reconcile you to your loss.” ⁴⁹

Literally worn out from years of tending to her sick husband and sadness over his death, as well as her often taxing role as a primary support to her siblings, Dolley's own health declined precipitously. As she put it, “my health which supported me in his illness has forsaken me since his death.” ⁵⁰ By September of 1836, Dolley's brother John Payne informed Coles that his sister's “general health has been much impaired,” and she was in too much pain to even dictate a letter. ⁵¹ Dolley's health was clearly failing. She experienced a near physical and mental collapse, and her eyesight became so poor she was barely able to sign her name. John wrote Dolley's son, imploring him to visit because he felt Payne's presence would help “in tranquillising [sic] her nervous agitation.” ⁵²

Dolley traveled to the White Sulphur Springs for her health in the late summer of 1837, and the visit appears to have had a positive result. Perhaps it allowed her a hiatus from the underlying mental stress she was experiencing. To her friend Anthony Morris, she reported almost euphorically that:

“I passed three or four days at the Warm Springs, and two weeks at the White sulphur, drinking moderately of the waters and bathing my poor eyes a dozen times a day. The effect was excellent. My health was strengthened to its former standing, and my eyes grew white again; but in my drive home of six days in the dust they took the fancy to relapse a little.” ⁵³

Dolley experienced great financial anxiety in her last years but worked diligently to compile her husband's papers for sale to Congress and keep the plantation afloat. However, she only realized $30,000 from the transaction, and she was finally forced to sell Montpelier in 1844 in the face of mounting debt. Earlier, Dolley confided to her brother-in-law Richard Cutts that “I am sick and overwhelmed with business.” ⁵⁴

The spring of 1849 ushered in a period of escalating debility for Dolley. She died at the age of eighty-two, and shortly before her death on 12 July 1849 the once lively, optimistic first lady despondently counseled a niece that “there is nothing in this world below worth caring for.” ⁵⁵ Her longtime closest friend Elizabeth Collins Lee had been beside Dolly throughout her final illness and reported that she had been fully alert. ⁵⁶ Mrs. Madison had served as a loyal and supportive helpmate to her husband, a political force in her own right, and a friend of eight American presidents. Her funeral became a state affair attended by President Tyler and other important members of the American government, and the memory of her diplomatic talents and courage in the face of personal and political challenges remained long after her passing.

Did early Americans such as the Madisons suffer an unusual number of illnesses compared to our era? It certainly seems as if health and sickness were focal points of their correspondence, but perhaps they can be forgiven their almost fixation given the fact that terrifying epidemics and unexplained sickness were regular occurrences at the time for Americans regardless of their socio-economic level. Dolley's experience with yellow fever likely left her with lifetime trauma. And despite their privileged status and access to the best medical knowledge and physicians of the day, those advantages did not protect the Madisons nor other American founders and members of the elite from the life-threatening diseases of their time. Viewing them from the perspective of sickness and health adds another compelling dimension to their life histories as well as a better understanding of daily life in the early republic.