James received his medical education at Trinity College, Dublin, qualifying M.B. in 1883. He gained a commission in the Medical Services at the rank of Surgeon Captain on 1st August 1885. He served in Manipur in 1891, then Burma from 1891 to 1892. On 1st August 1897 he was promoted to the rank of Major. From 1899 - 1902 he saw active service in South Africa, then on 1st August 1905 gained the rank of Lieutenant Colonel. Between 22nd May and 22nd October 1907, he was reduced to half pay. On the outbreak of war James was serving in Fermony. He went to Dublin where he formed No 3 Stationary Hospital, becoming the Commanding Officer. He travelled with the unit to France, entering the war on 20th August 1914. James was retained on the active service list on 29th June 1916, however he retired with pay on account of ill health on 29th September 1916.