Chilton is first introduced in Harris' 1981 novel Red Dragon as the pompous, incompetent director of a sanitarium near Baltimore, Maryland, acting as the jailer for the cannibalistic serial killer Hannibal Lecter.

In The Silence of the Lambs, Chilton allows Crawford to send an FBI trainee, Clarice Starling, to interview Lecter about another serial killer, Buffalo Bill.

He eventually uses a recording device to eavesdrop on their interviews, from which he learns of Crawford's offer to transfer Lecter to a better prison facility in exchange for revealing Buffalo Bill's identity.

In the film adaptation, he gives the name "Louis Friend", an anagram for "iron sulfide", or fool's gold, as a red herring.

In this continuity, Chilton was originally a "dangerously incompetent" surgeon who switched his specialty to psychiatry after accidentally killing a patient.

[1] In each season, as a running gag, he suffers and improbably survives gruesome and near-fatal injuries, leaving him increasingly debilitated.

He first appears in the episode "Entrée", in which his patient Dr. Abel Gideon (Eddie Izzard) kills a nurse after Chilton unwittingly influences him into believing that he is the serial killer known as the Chesapeake Ripper.

[2] Gideon eventually learns the truth and suffers an identity crisis, and he escapes to seek revenge against all of his previous psychiatrists, including Chilton.

He successfully appeals to Chilton's vanity and convinces him to help expose Hannibal Lecter (Mads Mikkelsen) as the real killer.

Chilton begins to believe Graham's accusations against Lecter, but attempts to maintain the pretense of ignorance when socializing with the doctor.

During Chilton's interrogation, a surviving Ripper victim, Miriam Lass (Anna Chlumsky), is observing behind a one-way mirror.

[6] The season 3 episode "Aperitivo" reveals that Chilton survived the gunshot wound, but was disfigured, losing an eye and his upper teeth on the left side of his face.