Alfred K. Middleton, physician, farmer, Confederate surgeon, and state representative, was born in McMinn County, Tennessee, on December 29, 1829, the son of John and Rebecca (Callison) Middleton. Middleton was raised in Tennessee and was educated in several schools there, culminating with his graduation from Hiwassee College in 1849. Upon graduation Middleton undertook two years of coursework in medicine in Louisville, Kentucky. On February 21, 1850, while at home in Tennessee, Middleton married Frances Hutchison. This couple had three sons and three daughters. Middleton earned his medical degree in 1851 and that same year immigrated with this family to Texas. He initially located in Rusk County but, following a brief tour of the settled areas of Texas, opted to relocate in Cherokee County. Middleton practiced medicine here until 1859 at which time he moved his family to a 240-acre farm near Johnson's Station, Tarrant County, where he resumed his medical practice and engaged as a farmer.
During the Civil War Middleton served the Confederacy as both a conscript surgeon and regular regimental surgeon. At the cessation of hostilities, Middleton resumed his residence in Tarrant County. Though not especially interested in politics, Middleton won election in 1873 on the Democratic ticket as representative for District Twenty—comprised of Dallas, Ellis, and Tarrant counties—to the Fourteenth Texas Legislature. His wife died in 1874; Middleton remarried on December 8, 1875, to Margaret E. Coupland. This couple had one daughter. In 1877 Middleton began the operation of a drugstore in Johnson's Station. Middleton died sometime after 1895. He was a Royal Arch Mason, holding the rank of Worshipful Master, and was a Presbyterian.