James was educated at Andrew’s College, Dublin, and at Trinity College, where he graduated B.A. and M.B. in 1902, and D.P.H. in 1911. He joined the R.A.M.C. on 31st August 1903, then served in South Africa from 1904-1910, during which time he gained promotion to Captain on 28th February 1907, and on the West Coast of Africa from 1911-1913. He went to France from Ireland, entering the war on 19th August 1914 serving with the 15th Field Ambulance. In recognition of his work in the early fighting, in which he was often in position of great danger, the French Government conferred on him the Legion of Honour after the first battle of Le Cateau. On 28th February 1915, he gained promotion to Major. In 1917, after a short rest at home, James was sent to Salonika in charge of the surgical division of a general hospital, and early 1918 he was given command of No 20 Stationary Hospital, with the acting rank of Lieutenant Colonel, a role he remained in until he died of pneumonia following influenza. James was the eldest son of Alexander Knox J.P., (B. L. Dublin) official assignee in Ireland; and the husband of Mary McEntire (daughter of James Little of Damfries, N.B.) of 16 Nottingham Place, London - they had one daughter.