Ramsay was born on his parents' (David Ramsay and Margaret Foster (Graham) Ramsay) plantation in the Coddle Creek area of
Iredell County, North Carolina. He received an education from local schools and then attended
Davidson College, where he graduated in 1841. After teaching for a year and studying privately for medical school, he attended
Thomas Jefferson Medical College in Philadelphia where he graduated with a medical degree in 1848. He opened a medical practice on his estate, Palermo, near the town of
Cleveland, North Carolina, where he practiced for 51 years. In 1849, he was elected the first president of the Rowan County medical society, which he helped form. He owned a small farm and had slaves before the U.S. Civil War. He lived in
Scotch Irish Township until 1900 when he was living with his son, James Hill Ramsay, in
Salisbury, North Carolina. He died in Salisbury. He is buried in the
Third Creek Presbyterian Church cemetery near
Cleveland, North Carolina. It was added to the
National Register of Historic Places in 1983. He married Sarah Jane Foster on September 23, 1846 in Mocksville, Davie County, North Carolina. James and Sarah had eight children: Margaret Foster (Ramsay) Nelson, Florence May Ramsay, David Allen Ramsay, James Hill Ramsay, Edgar Burton Ramsay, William G. Ramsay, Robert L. Ramsay, and Claudius Clinton. ==Political career==