The young clinician immediately started his career in the Posto Médico-Cirúrgico in Porto and the following year he considered an academic career in the Academia Politécnica, but he put them both aside in favour of a military career, entering the army in Estremoz in 1883 as an assistant surgeon. Later he was posted to Porto and Pinhel, and was promoted to chief surgeon with the rank of Lieutenant Colonel. In parallel with private medicine, to which he devoted most of his life, Maximiano de Lemos continued with his researches into the history of medicine, creating, in collaboration with highly regarded Portuguese doctors, two vehicles for the transmission of his discoveries, studies and learnings: the Anuário dos Progressos da Medicina em Portugal (1883–85) and the Arquivos da História da Medicina Portuguesa (1886–1920). The latter in particular, which he continued to edit almost until his death, comprising two series of twenty volumes, constitutes an extremely rich collection of unpublished documents and important essays on the events and personalities in the History of Medicine in Portugal.

In 1889, against other candidates in open competition, he finally began his extensive career as a lecturer in the school where he first started out, the Escola Médico-Cirúrgica. He was appointed as substitute lecturer in the medical department with a promise of his own chair in Legal Medicine, which, however, he only came to occupy after five years of holding that in General Pathology. This was his most productive period in terms of intellectual activity and research, during which he produced material on various topics of a medical character, as well as literary criticism, historical and educational writings, and translations of the work of historians such as Louis Blanc and François Guizot. He also contributed to medical and cultural journals, and managed the publication of the Encyclopedia Portugueza Illustrada, himself signing the extensive biographies of the principal doctors of Jewish origin in the modern epoch.

He belonged to many scientific and cultural bodies, being most notably president of the Sociedade de Medicina e Cirurgia do Porto, the Associação Médica Lusitana and the Associação de Jornalistas e Homens de Letras do Porto; he was also elected a corresponding member of the Academia das Ciências de Lisboa, the Sociedade Portuguesa de Ciências Naturais, the Sociedade de Medicina e Cirurgia da Baía, the Leipzig Society of Natural Sciences and the German Society for the History of Medicine.

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