James Alexander Kay, medical practitioner, was the son of William Thompson Kay, a Royal Navy surgeon. He qualified as a licentiate of the Faculty of Physicians and Surgeons of Glasgow (LFPS) in 1871 and during the next few years joined a whaling expedition to the Arctic. He came to South Africa during the Anglo-Zulu War of 1879, in which he served as a civil surgeon, acted as war correspondent for the Western Morning News, and was awarded the South African Medal with clasp. In October that same year he settled in Pretoria and was licensed to practice in the South African Republic (Transvaal). In 1881 he served during the siege of Pretoria by the British. In June that year the first statutory medical body in the Transvaal, the Transvaal Medical Committee (later the Geneeskundige Commissie) was appointed, with Kay as one of its three members. On the establishment of the New Public Hospital (Volks Hospitaal) in the capital in 1888 he became one of its honorary visiting physicians. He was a member of the Pretoria Medical Society, which was founded around 1888, and one of the six physicians who drew up the Rules of the Pretoria Medical Society (not dated). In 1882 he married Alice Henrietta Ashburner, with whom he had four children. His son, H.W.A. Kay, also became a physician and later practiced in Port Elizabeth.
In 1892 a difference of opinion arose between Kay and the Board of Examiners of the South African Republic over his qualifications and his admission as a medical practitioner. He returned to Europe to continue his studies in Dublin and at Marischal College, Aberdeen, qualifying in 1894 as a licentiate of the Royal College of Surgeons of Ireland, a licentiate in midwifery, and a licentiate of the Apothecaries' Hall (Dublin). Around this time he was elected a Fellow of the Royal Microscopical Society and was a member of the British Medical Association. Upon his return to South Africa he was again licensed to practice in the Transvaal in 1895 and resumed his practice in Pretoria. During the Anglo-Boer War (1899-1902) he was a civil surgeon, was present at the siege of Ladysmith, again acted as war correspondent for the Western Morning News, and received another medal.
By 1905 Kay was president of the Pretoria Medical Society. He presented a paper before the society on the "History and eradication of leprosy", which was published in the Transvaal Medical Journal (Vol. 4, pp 55-59) in 1908. From 1907 to his death in 1915 he was a member of the Transvaal Medical Council. In March 1913 he presented a demonstration on Bilharzia to the Transvaal Biological Society and that same year published a paper "On the development of the bilharzia embryo" in the Transvaal Medical Journal.
A box of miscellaneous material relating to kay is housed in the Strange Collection of the Johannesburg public library, also a manuscript, "A stranger in Pretoria: Dr James Alexander Kay" (237p) by P. Riley. The author of this manuscript published an article on Kay's Ladysmith siege diary in Africana Notes and News (December 1971).