Civil War Profiles: James Tilton, M.D. — ‘Delaware’s greatest physician’

Tilton General Hospital in Wilmington, named after the first Surgeon General of the U.S. Army, was the primary medical facility in Delaware during the Civil War (see “Tilton General Hospital, a haven for Civil War casualties,” Coastal Point, Aug. 13, 2013). But, who was Dr. James Tilton?

Born on a farm near Duck Creek Hundred in Kent County on July 1, 1745, Tilton apprenticed in medicine with Dr. Charles Ridgely in Dover before going off to medical school at the College of Philadelphia. As an omen of future attainments, Tilton graduated No. 1 in his class and later earned a degree as a doctorate in medicine in 1771.

Tilton was practicing in Dover when the Revolutionary War began. By 1776, he was in uniform as an army surgeon and served during the Battle of Princeton, as well as at Long Island and White Plains, N.Y. Later, he and another Delaware physician, Nicholas Way, became staff members at an army hospital housed in the Wilmington Academy on Market Street in Wilmington.

This information about the good doctor comes to us from Alfred R. Shands Jr.’s article “James Tilton, M.D., Delaware’s Greatest Physician (1745-1822),” which appeared in the January 1974 issue of the Delaware Medical Journal. The author described Tilton as a “dramatic character with a unique honest-to-God personality, unlike other men in person, countenance, manner, and speech, gesture and habits.” In other words, Tilton was “an original” and “awaits his place in an historical novel.”

Living up to this animated description, Tilton commanded a number of hospitals during the Revolutionary War, including at Princeton and Morristown, N.J., New Windsor, N.Y., and Williamsburg, Va. He was seriously concerned about the much higher rate of deaths from disease contracted in hospitals than from battlefield wounds. To counteract deplorable conditions, he invented the “Indian Hut,” or “Tilton Hut.”

These huts were small buildings with three sections separated from each other. There were no windows, and they had packed-earth floors — given that Tilton believed that wood harbored infection. Each section included a fireplace with a hole in the roof to permit smoke to escape. Although the science of this concept was poorly understood at the time, it proved effective in practically eliminating the spread of infectious disease.

In 1780, Congress passed into law Tilton’s “Code of Regulations for the Army Medical Department,” which completely revamped the organization. Tilton was recognized as a pioneer in army sanitation and prevention of disease, and believed to have “great executive ability and one of Washingtonian proportions” (referring to the Revolutionary War general and first president of the United States).

Speaking of Washington — Tilton was among the invited guests at the general’s retirement ball held in the Maryland State House three days before Christmas 1783. Tilton exclaimed, “The feast … was the most extraordinary I ever attended.” Included were the customary 13 toasts to honor such eclectic entities as “The United States,” “His Most Christian Majesty,” “The Minister of France,” “The virtuous daughters of America” and “Long health and happiness to our illustrious general.”

Thomas Edwards’ portrait of Tilton depicts a somber-looking individual. His social skills apparently did not match his technical abilities, as seen in this complaint written to a friend after the above-mentioned ball, “Such was my villainous awkwardness that I could not venture to dance [with the belles in attendance] on this occasion,” he said in the correspondence recorded now in “The Resignation,” at

Despite lacking sophistication on the social circuit, Tilton became a member of the Continental Congress in 1783 and 1784, and was part of the Delaware state House of Representatives for several years. President James Madison appointed him Surgeon General of the United States Army during the War of 1812. As noted in the online “Biographical Directory of the United States Congress,” he was 68 years old at the time and served in that capacity for two years.

The Medical Society of Delaware elected Tilton as its first president. Following his death in 1822, the society erected a monument to him over his grave in the Wilmington-Brandywine Cemetery. It had become evident to his contemporaries that James Tilton was indeed Delaware’s greatest physician.

The illustrious and energetic doctor would have been pleased that Delaware officials named Tilton General Hospital in his honor during the Civil War. Recognition of his important contributions to the science of medicine continued when, some 75 years later in World War II, the U.S. Army medical facility at Fort Dix, N.J. became known as Tilton Army General Hospital.

Bethany Beach resident Thomas J. Ryan is the author of “Essays on Delaware during the Civil War: A Political, Military and Social Perspective” (available at Bethany Beach Books or his website, Contact him at