On Friday, August 18, 1865, at age 44, he suffered a stroke of paralysis. By that time James was was president of the General Conference; head of the General Conference Committee; president of the SDA Publishing Association; active in writing, publishing, traveling, and filling appointments. In addition he had been intimately involved in publishing the first of a series of Ellen's pamphlets, Health; or How to Live. Too much for one person.
It started at a morning walk with Ellen on Wednesday, August 16: His right arm drop helpless to his side. He staggered, but did not falll. He was unable to speak. Through prayer he was able to speak again and his hand was partially recovered, but not fully. Two days later he was carried on a couch to his home.