How an 18th-Century Doctor from Dover was Ahead of His Time

Dying patients get a physician’s attention. That’s how it was for James Tilton, M.D., (1745-1822) of Dover, who, a century before germ theory was widely accepted, grasped the principle and used it to save the lives of men under his care.

Tilton, the first surgeon general of the U.S. Army, noticed that soldiers mixed together in military hospitals tended to catch things from each other. “Many a fine fellow have I brought into the hospital for slight syphilitic affections and carried out dead of a hospital fever,” he lamented to a colleague. Dysentery and typhus (known as camp fever) killed more men than musket balls. So, in a move radical for the time, Tilton separated patients with such maladies. Mortality dropped, and Tilton’s system was adopted throughout the army.

Born in Kent County, Tilton was the son of a farmer who died when the lad was only 3. Fortunately, his father’s estate was large enough to provide him a classical education at West Nottingham Academy, a Presbyterian boarding school in Colora, Md. Tilton then enrolled at the College of Philadelphia (now the University of Pennsylvania), where he was granted a medical degree in 1771.

At the age of 26, Tilton returned to Kent County to establish a medical practice and, according to historian John Scharf, “was beginning to achieve a reputation for ability and conscientious devotion to his duties.” It was probably a hard beginning. University-trained physicians were a rarity at a time when most received their training as apprentices.

“Faith in the curative powers of the decoctions of some venerable grandmother were held by many to be superior to the remedies which an educated physician could provide,” wrote Scharf, author of an 1888 history of Delaware.

Tilton was also a farmer whose letters with French agronomist Henri-Alexandre Tessier would later be published as “Notes on the Agriculture of Delaware.” He wrote about the growing of peach trees and the fruit weevil and asserted that farmers should eat only their own produce. Tilton opposed imports such as tea and wine. He endorsed the consumption of milk and brandy, as well as clothing made of homespun yarn. Tilton represented Delaware in the Continental Congress from 1783 into 1785, and served several terms in the state Legislature. During the War of 1812, he would rejoin the Army as its first surgeon general. In 1815, at age 70, he would have a leg amputated at the hip without anesthetics. He advised the surgeons during the operation.

Lean, unusually tall and eccentric, Tilton was “an original,” according to Elizabeth Montgomery, a historian of early Wilmington who knew him, but also “a Christian, a scholar and a gentleman, though … without polish.”

At the outbreak of the Revolution, Tilton enlisted in the infantry. According to one historian, he sacrificed a large income to do so. But he soon received an appointment as surgeon of the First Delaware Regiment—the Delaware Blues—which participated in the battles of Long Island, White Plains, Trenton and Princeton.

If Tilton expected his primary task to be treating battle wounds, he soon learned better. The British had abandoned Boston in March 1776. Gen. George Washington believed they would next attack New York, so he began concentrating troops in Brooklyn. Typhus and dysentery soon appeared in those camps, in part because of poor sanitation, according to historian Louis Duncan, author of “Medical Men of the American Revolution.” Orders to dig latrines, and to cover the contents regularly, were generally ignored.

“The Flying Camp of 1776 melted like snow in a field—dropped like rotten sheep on their struggling route home, where they communicated the camp infection to their friends and neighbors, of whom many died,” Duncan wrote.

What to do? At this point, Tilton was just an underling. The top physician of the Continental forces was John Morgan of Pennsylvania, who had made genuine progress organizing the medical service. Morgan was, however, unable to provide adequate supplies, and many blamed him, perhaps unfairly.

By winter, Morgan had been dismissed from the army. At Morristown, N.J., where the army was camped for the winter, Tilton was in charge of the hospital. 

Along with log huts, he ordered construction of a hospital with three noncommunicating rooms—one for patients who were feverish, one for those with infections and one for wounded. The hospital’s log walls were only partially chinked (to let in fresh air) and a hole was left in the roof. In the center of each room was a fire pit with beds gathered around, as in an Indian hut. 

“The wards were thus completely ventilated,” wrote Tilton. “The smoke contributed to combat infections, without giving the least offence to the patients; for it always rose above their heads, before it spread abroad in the ward.”

Tilton’s system yielded results.

“There are no reports,” wrote Duncan, “of any considerable amount of sickness in camp or in the army generally during the winter.”

The Tilton Awards Gala will be held at the University & Whist Club, Tilton’s former home, on April 28. For more, click here.

A portrait of James Tilton, M.D., of Dover.