He was a distinguished member of the Colonial Medical Service who pioneered social welfare and hygiene education in remote areas of the Protectorate. He encouraged leaders of the Mende Women's Secret Society, the Sande, to include training courses in hygiene, literacy and childcare in their program of initiation for young girls.
These courses were taught by qualified instructors, most of whom were trained by Sir Milton himself.
In 1950, Sir Milton retired from the Government Medical Service and set up private practice. As me the first National Chairman. After the 1951 elections, he became leader of Government Business and in 1954 Chief Minister.
In politics Sir Milton was the consummate negotiator and a skilful strategist. At the time he entered politics, Sierra Leone was divided into Colony and Protectorate with separate and different political systems. Antagonism between the two entities came to a head in 1947 when proposals were introduced to provide for a single political system for both the Colony and the Protectorate, with an unofficial African majority in the Legislative Council, most of whom were to come from the Protectorate. The Creoles of the Colony naturally opposed the proposals whose effect would have been to diminish their political power. Joining the Creoles in opposition to some aspects of the proposals however, were the educated elite of the Protectorate who saw in the proposals a means of transferring the dominant position of the chiefs from the Protectorate Assembly to the Legislative Council. It was due to the astute politics of Sir Milton that the younger educated Protectorate elite were won over to join forces with the chiefs in the face of Creole intransigence. Later, Sir Milton was to use the same skills to win over opposition leaders and moderate Creole elements to his United Front Government for the achievement of Independence.
He offered top Ministerial positions within the SLPP Cabinet to such opposition leaders as Albert Margai who had earlier broken away from the SLPP to form the PNP; C.B. Rogers-Wright, leader of the main surviving Creole Party, the UPP; and G.Dickson-Thomas, leader of the IPP, a splinter of the UPP. As a result of this, the leaders agreed to disband their parties to serve under the banner of the SLPP.
An important aspect of Sir Milton's character was his self effacement. He was neither corrupt nor did he make a lavish display of his power or status. Although he was conservative, he was tolerant of his opponents, and was not one to insist on having his way all the time. These qualities endeared him to all Sierra Leoneans who loved, respected and admired him. Many Sierra Leoneans look back to the age of "Pa", as he was fondly known, as one of almost idyllic stability, and there can he no doubt that Sir Milton left deep and indelible footprints on the sands of time.