James received his medical training at Glasgow University, qualifying M.B., C.M. in 1891. He then went into practice at Ilford, Essex, where he was honorary surgeon to the Merchant Seaman's Orphanage before going into active service. For some years prior to the war he held a commission in the Volunteer and Territorial Forces, taking a commission in the auxiliary forces on 29th May 1901, and had been surgeon-captain in the 4th Bn. Essex Regiment. According to The British Medical Journal, James became major in the 1st East Anglian (Norwich) Brigade of the Royal Field Artillery on 5th August 1914. He entered the war in France on 2nd November 1915.
James died at Yorkhill Military Hospital, Glasgow. He was the son of William Aitken of Glasgow.