Medical ledger of James Keen, a physician in Mecklenburg County, Virginia. Notes about visits to patients which include treatments, medicines dispensed, prescriptions, notes, calculations, and payment records. There are over 60 entries for the treatment of enslaved individuals and several are named. One entry notes the removal of a tumor from a "Negro Woman."

The last page of the ledger lists births of foals and their lineage.

A handwritten note is on page two, “James Keen MD, Mecklenburg, Virginia, Commenced the Practice of Medicine June 1st, 1826.” An alphabetical index in the back of the ledger lists the names of the patients and the respective pages on which the records are located. The ledger contains loose receipts for visits, treatments, prescriptions and an 1825 ticket for a University of Pennsylvania lecture on Midwifery by Thomas C. James.

On page 196, the heading is "List of Bonds and Acct put into the hands of James Williamson for collection due the estate of Doct. James Keen" with the date February 8, 1831 and a long list of names and amounts owed. An undated loose paper lists 11 names, including Joseph Wilkins, Obadiah Vaughan, Peter Vaughan, Stephen Hendrick, Capt. Lancelotte G. Wade, on a "Memorandum of claims against the estate of Jas Keen."

Accounts are for Stanley Hyte (Hite), Jr., Hezekiah Tally, Obadiah Overby, Robert Griffin, lots of Jones’, James Newton, Edward Royster (and grandson Royster), Edward Tuck, William Yancey, Stephen Worsham, Capt. Stephen Pool, Henry Green, James Williamson, Peyton Puryear, Thomas Moss, Elisha Bowen, Thomas Staples, Miles Wall, Milly Vaughan and many others. James Keen oftens notes the names of the children he treats.

Some medicines prescribed are : 1 doz pills, opiate pills, laudanum, Canthar pills, epsom salts, castor oil, hive syrup, nitric acid, blue pills and magnesium. Some treatments include tumor extraction, blister plaster and coughs.

After 1831, possibly the year James Keen died, other entries near the end of the book include,"May 1838, Plank bought of Major Thos. Nelson" and "Plank got from Lewis Burwell."