"Physically Madison was always frail in appearance, short of stature, and slight." He never weighed more than 100 pounds. His height is a little uncertain: five feet, four to six inches. 1

Madison, from a well-to-do Virginia family, would ordinarily have gone to college at William and Mary. But malaria was common in that area of southeastern Virginia, and so his physician strongly urged him to go elsewhere 2a. He therefore attended Princeton. Decades later, one of his classmates, Aaron Burr, introduced Madison to woman who had been widowed in the great Philadelphia yellow fever epidemic of 1793. Although Madison was 17 years older than her, and a head shorter, he was by then famous as a founding father, and so she accepted his proposal to become Dolley Madison 3a.

After graduating from Princeton (in only two years), Madison did not immediately return home, saying that he was too ill to travel 2a. Physicians would often label him as frail throughout his [long] life. They would prescribe various programs to increase his strength and stamina, sending him once to recuperate at Warm Springs, a spa in western Virginia 2a.

During his teens and early twenties, Madison complained of a voice impairment. This was "a functional handicap that prevented his public speaking until age 30" 1.

In this period of his life, Madison escaped the scourges of his day, i.e. malaria, smallpox, tuberculosis, and yellow fever, but was neurotically convinced that his body harbored some insidious disease -- an obsession he overcame only after tremendous determination 1.

Madison may or may not have had a seizure disorder. On July 28, 1775 (age 24) he collapsed during a military drill while being watched by his father, among others. Abrupt spells would continue to afflict him the rest of his life. Madison wrote that he had "a constitutional tendency to sudden attacks somewhat resembling epilepsy which suspended all intellectual function.... They continued throughout my life with prolonged intensity" 4a.

After his death, his brother-in-law attempted to describe this illness in the best possible light. In three drafts, he descibed Madison's "constitutional liability to sudden attacks" variously as: "of the nature of epilepsy, " "of a character and effect which suspended his powers of action," and as the reason Madison did not enter military service 4b. Comment: Imagine if Madison had joined the military and been killed before writing the Constitution!

Writers since 1940 have spilled much ink debating whether Madison's spells were a psychiatric illness or a physical illness. Psychiatrically, labels such as "doubtless hysteric" 1, "epileptoid hysteria" 5a, "conversion reactions" 3b, and panic attacks 4c have been proposed -- all of which may be classed as "psychogenic non-epileptic seizures" 4c. Others believe that Madison had the physical illness of epilepsy, perhaps with petit mal seizures 2b. Comment: It would be interesting to tabulate all eye-witness accounts of Madison's spells, looking for the motor and autonomic epiphenomena that typically accompany petit mal seizures 6a.

While out campaining for the First Congress in 1788, Madison's nose became frost-bitten, leaving a scar. In later years, he would jokingly claim it as "his scar of a wound received in defense of his country" 7a.

From his middle years on, Madison was plagued with "biliousness." This included attacks of "bilious fever" 1. A physician writing in the 1960s thought these symptoms of chronic cholecystitis 1 (inflammation of the gallbladder).

Chronic arthritis afflicted Madison from middle age onwards 1.

In his late 70s Madison was still mentally sharp. In 1828, one visitor found his conversation "a stream of history... so rich in sentiments and facts, so enlivened by anecdotes and epigrammatic remarks, so frank and confidential as to opinions on men and measures, that it had an interest and charm, which the conversation of few men now living, could have." Physically, Madison's "little blue eyes sparkled like stars from under his bushy grey eyebrows and amidst the deep wrinkles of his poor thin face" 7a. With age, his complexion became yellowish, and his eyes "blepharitic" 1 (i.e. puffiness around the eyes).

By the fall of 1831 (age 80), he was doing poorly. His wife wrote to a friend:

My dear Husband is still confined to his bed -- In addition to a disabling Rheumatism throughout the winter, he has had a bilious fever, which has reduced him so much that he can only walk from one bed to another. I never leave him, more than a few minutes at a time, and have not left the enclosure around our house for the last eight months on account of his continued indisposition ... Our Physicians have advised the warm springs for Mr Madison, and we hoped to have him taken there, but as he could not travel unless conveyed in his bed, we dare not think of it for the present. 1

By his early 80s, Madison started to fade away. His vision and his hearing deteriorated, and he grew thinner and weaker 1. During his final illness in summer 1836, he refused the requests of friends to take stimulants in order to prolong his life until July 4, the 60th anniversary of the Declaration of Independence. 7b (Both Thomas Jefferson and John Adams had died on the 50th anniversary, July 4, 1826). Finally, one morning, a few days before the 4th, Madison was found dead in his bedroom, sitting in front of his untouched breakfast tray 1. Comment: Goes to show that even in the 1800s, breakfast trays were handed to patients without realizing they were dead!