James gained his medical training at the Royal College of Surgeons, Ireland, qualifying L.R.C.P.&S.I., L.M. in 1888. On 29th July 1893 he took up a commission at the rank of Surgeon Lieutenant within the Medical Services, then gained promotion to Captain on 9th July 1896. Between 1897 and 1898 he served on the North-West Frontier, India, and in 1902 served in South Africa. He gained promotion to the rank of Major on 29th April 1905. At the outbreak of war James was stationed in Netley. He proceeded to Devonport where he formed No 11 Stationary Hospital, becoming the unit’s Commanding Officer. The unit mobilized on 26th August 1914, then sailing from Southampton to Havre the same day he entered the war in France on 27th August 1914. On 1st March 1915 he gained promotion to the rank of Lieutenant Colonel, and in 1916 was appointed Companion of the Order of St Michael and St George. He succeeded Lt/Col G B Stanistreet as Assistant Director-General A.M.S. at the War Office on 1st March 1918, dealing with the branch overseeing questions of hospital equipment & surgical supplies, medical boards, professional matters and voluntary aid.