Studied at Westminster Hospital, where he gained an entrance scholarship, and later was House Surgeon and House Physician. Then he was Clinical Assistant at the Royal Westminster Ophthalmic Hospital, and, having become FRCS in 1896, was appointed Surgeon to the Royal Eye Hospital, Southwark; Assistant Ophthalmic Surgeon and then Ophthalmic Surgeon to Westminster Hospital. He practised at 5 Harley Street, but also had a house and practised at Eastbourne, where he was Ophthalmic Surgeon to the Princess Alice Memorial Hospital. James began rapidly to exhibit originality over various problems in ophthalmology. Difficult refraction errors were treated in his paper "On the Measurement of the Stereoscopic Visual Acuity", which was written in conjunction with J Stroud Horsford, and appeared in the *Lancet* in 1909. He was particularly successful in the treatment of gonorrhoeal conjunctivitis in the adult by avoiding irritation with nitrate of silver and substituting continuous bland irrigation (*Lancet*, 1911). In "The Operative Treatment of Strabismus" (*Trans Ophthalmol Soc*, 1909) he noted advances made over the ordinary treatment by tenotomy. His "Operative Treatment of Glaucoma: a New Method" (*Trans Ophthalmol Soc*, 1909) described an original method of setting up permanent filtration which he practised with increasing success during his last years. Irritation of the buccal pouch by an upper third molar caused, within three months, an epitheliomatous ulceration which quickly spread to the neck, so that within a few months squamous-celled carcinoma had invaded the internal jugular vein, and spread in its lumen upwards and downwards. Several operations failed to overtake the disease, and he died on November 15th, 1928. He was unmarried, and was devoted to his mother and the home he had made for her at Eastbourne.