James was educated at Ballymena Academy; at Queen’s College, Belfast; and at the Royal University of Ireland - where he graduated M.B., B.S.R.U.I. in 1906. He had been in practice at Cloughmills, co. Antrim, and when war broke out he was engaged in an extensive practice in Durham. He gained a temporary commission in the R.A.M.C. at the rank of lieutenant on 28th December 1914 and was promoted to temporary Captain one year later. James entered the war in France on 19th May 1915. After serving with a West Riding Field Ambulance became attached as Medical Officer to the 5th Bn. King’s Own Yorkshire Light Infantry. He was wounded in September 1916, then after recovering returned to France in January 1917, and was attached as Medical Officer to the 4th Bn. Suffolk Regiment. He was awarded the Military Cross “For conspicuous gallantry and devotion to duty. He attended the wounded of five other units besides his own throughout the day. The next day he led a party out in front and recovered twelve more wounded who were lying out. Throughout he set a splendid example to all.” James was the eldest son of Andrew and Marian Gaston of Carabeg, Cloughmills, co. Antrim.