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HISTORY OF THE OFFICE OF MEDICAL HISTORY
JAMES TILTON (June 1, 1745 - May 14,1822), Physician and Surgeon General of the United States Army, June 11, 1813 - June 15, 1815, was born on a farm in Kent County, Delaware, at that time a part of Pennsylvania. His father, Thomas Tilton, is said to have been descended from John Tilton, who emigrated from England to Lynn, Mass., between 1630 and 1640. His mother, early left a widow, sent him to the Nottingham Academy, Nottingham, Pa., conducted by the Rev. Samuel Finley. Later, after studying under Dr. Ridgely, a prominent physician of Dover, Del., he entered the newly established medical department of the College of Philadelphia where he received the degree of B. M. with the first class graduated by that institution in 1768. He presented a graduation thesis on the physiology of respiration. He established himself for practice at Dover, but returning to his old school was given the degree of M. D. in 1771, his graduation thesis being entitled, De Hydrope. When the Revolutionary War broke out he was again a practitioner at Dover and a lieutenant of infantry in the local militia. When the Delaware Regiment, commanded by Colonel John Haslet, was organized, Tilton was appointed regimental surgeon on January 16, 1776. He served with the regiment through that year in the battle of Long Island, at White Plains, at Trenton, and until the regiment was practically wiped out and Colonel Haslet killed at the battle of Princeton on Jan. 2, 1777. He served with the sick and wounded remnant of the regiment in a hospital at Wilmington for the remainder of that winter. On April 3, 1777, he was appointed hospital physician and on April 23 Congress passed the following resolution:
“Resolved, That Dr. James Tilton be authorized to report to Dumfries in Virginia, there to take charge of all Continental soldiers that are or shall be inoculated, and that he shall be furnished with the necessary medicines.”
While inoculations for smallpox had been largely practiced since the beginning of the war this resolution and others following which called for the assembling of troops for inoculation were the first actions taken by Congress in the matter. Following this duty he was placed in command of a hospital established at Princeton, N. J., after the retreat from the battle at the Brandywine in September 1777. While on this duty lie contracted typhus which necessitated a sick leave of some months. During this time he visited the military hospitals at Bethlehem, Reading, Lancaster, and elsewhere studying conditions which later formed the basis for the sharpest criticism of military hospital management and of the system that made these conditions possible. He was also outspoken in criticism of the director general being also the purveyor of supplies. During the campaigns of 1775-80 he was in charge of hospitals at Morristown and Trenton, N. J., and at New Windsor, N. Y., at which places he was able to give trial, with considerable success, to his pet scheme of small well-ventilated log huts capable of holding but six or eight patients each. In the medical department reorganization of 1780 his name appeared at the head of the list of “hospital physicians and surgeons”. In this capacity be conducted a hospital at Williamsburg during the Yorktown campaign and was left in charge of the hospitals at Yorktown after its evacuation following the surrender. He bad been largely instrumental in securing the action of Congress on September 20, 1781, providing for promotion by seniority of medical officers. This legislation, however, placed hospital surgeons above regimental surgeons, who were given the same rank as hospital mates. Eventually regimental surgeons were given an intermediate position between hospital surgeons and hospital mates.
With the close of hostilities he returned to his practice at Dover. In the meantime he had been offered and had declined the chair of materia medica in his old school, reorganized in 1791 as the medical department of the University of Pennsylvania. He served one term (1783-85) in the Continental Congress, and repeated terms as member of the state House of Representatives. From 1785 to 1801 he occupied the position of government commissioner of loans for Delaware.
The climate of Dover not being to his satisfaction, he bought a farm in the hill country back of Wilmington and varied his medical practice with the cultivation of his fields and by an occasional essay on some agricultural subject. In these circumstances he continued for years the leading medical man and the most frequently employed consultant in the state. In February 1813, while the country was at war with Britain, he published a small treatise entitled, Economical Observations on Military Hospitals and the Prevention and Cure of Diseases Incident to an Army. It was dedicated to General John Armstrong, secretary of war, and embodied his observations during the Revolutionary War and repeated his former recommendations regarding the construction and administration of military hospitals. Probably as a result of this publication he was offered the position of physician and surgeon general of the army, an office created by a reorganization of the staff departments under an act of March 3, 1813 (2 Stat. 819). On account of his age he was loath to accept the appointment, but did so upon being assured that his duties would be chiefly executive in character and that he would not be required to serve in the field. His appointment was confirmed by the Senate to date from June 11, 1813. At the same time Dr. Francis Le Barron of Massachusetts was appointed apothecary general. In the meantime under date of May 1, 1813, the President caused to be issued Rules and Regulations for the Army, and therein were prescribed the duties of the chief medical officer as follows:
“It shall be the duty of the Physician and Surgeon General to prescribe rules for the government of the hospitals of the army, to see these enforced, to appoint stewards and nurses, to call for and receive returns of medicine, surgical instruments and hospital stores, to authorize and regulate the supply of regimental medical chests, to make out general half year returns of these and of the sick in hospital to the War Department, and yearly estimates of what may be wanted for the supply of the army.
The apothecary general shall assist the Physician and Surgeon General in the discharge of the above mentioned duties, and shall receive and obey his orders in relation thereto.”
One of his first acts after assuming office was to make a tour of inspection of the hospitals and camps along the northern frontier. Here he found that all the lessons of sanitation learned from the bitter experience of the last war had been forgotten. In both camp and hospitals he found such utter contempt for sanitary measures and such dire results of this neglect that immediate action was necessary. By moving the hospitals and establishing new ones and by the elimination of incompetent personnel he was able to do much in improving these unsatisfactory conditions. His efforts to improve hospital conditions and to rehabilitate the medical and hygienic service of the army resulted in the publication of the Regulations for the Medical Department issued in general orders of December 1814.
This, the most important result of his administration, defined clearly for the first time the duties of medical officers and other sanitary personnel. With the end of the war in the spring of 1815, the army was greatly reduced by the act of March 3, 1815 (3 Stat. 224), and the office held by Tilton was terminated June 15, 1815. During the later months of Tilton’s term of office his usefulness was greatly impaired by the development of a malignant tumor of the knee. On December 7 following his relief from office it became necessary to perform a thigh amputation in order to prolong his life. Despite his seventy years and his previous suffering, he withstood the pre-anaesthetic era agonies of the amputation with the utmost fortitude and even counseled with the operator and his assistants concerning the details of the operation.
The remaining years of his life were passed in the stone mansion he had built overlooking the city of Wilmington, his time occupied by the supervision of his fields and gardens. Here he died near the end of his seventy-seventh year.
After Yorktown, the Delaware troops were brought back from duty in the Carolinas and went into camp at New Castle awaiting discharge. The officers of this camp, with others, met at Wilmington, where following the example set by officers in other states, they formed on July 4, 1783, the Delaware State Society of the Cincinnati, and elected Tilton its first president. He held this office until 1795 and was delegate to the general meetings of the Society of the Cincinnati from 1784 to 1793.
He was a member of the American Philosophical Society and of his state medical society, which he served as president for years. He was not a prolific writer. Aside from his doctorate theses and his Economical Observations, his published writings were limited to four pamphlets on agricultural subjects.
Tilton was outstanding both in appearance and in character. He stood six and one-half feet tall, was spare in build and notably dark of hair and complexion. Though he never married, he was of a sociable nature and was companionable with all ages. He was especially generous in his friendships with the younger members of the medical profession of his community. Despite an absolute honesty, positive views, and unusual frankness of speech, he does not appear to have made active enemies. He was a man of many eccentricities, few of which seem to have been of a displeasing character.
Sources: H. E. Brown, Medical Department of the U.S Army from 1775 to 1873 (1873); L. C. Duncan Medical Men of the American Revolution, 1775-1783 (1931); H. H. Bellas, History of the Delaware Society of the Cincinnati (1895); F. J. Tilton, History of the Tilton Family of America, Vol. I (1928); J. T. Scharf, History of Delaware, Vol. I (1858).
[Extracted from "Chiefs of the Medical Department, U.S. Army 1775-1940, Biographical Sketches," Army Medical Bulletin, No. 52, April 1940, pp. 22-26, compiled by James M. Phalen, Colonel, Medical Corps, U.S. Army retired]