He was a delegate for Delaware in the Continental Congress of 1783 and 1784 and served as Surgeon General of the United States Army during the War of 1812.

When the Revolutionary War began, his militia became part of the 1st Delaware Regiment of the Continental Army.

Tilton remained in service with the Continental Army as the head of military hospitals, first at Princeton and later at Trenton, New Jersey and other sites.

As the war was ending, the surviving Delaware officers organized a chapter in the Society of the Cincinnati.

Delaware named Tilton as a delegate to the Continental Congress three times from 1783 to 1785, but he did not attend sessions in the last year.