Goforth decided to leave the city, moved west with his brother-in-law,
John S. Gano, and arrived at Limestone, now
Maysville, Kentucky, on June 10, 1788. He moved on to
Washington, Kentucky, near the
Ohio River, and had a large medical practice there for eleven years. Here he married the daughter of Rev. William Wood, a Baptist pastor. In 1799, Goforth moved to
Columbia,
Northwest Territory, where his father was one of the earliest settlers of the territory. The next year he settled in
Cincinnati. He was the first doctor in the frontier west to acquire and administer the smallpox vaccine in 1801. Goforth had "the most remarkable and diversified mass" of fossil bones of
megafauna dug up, at great expense, in 1803 from the
Big Bone Lick in
Kentucky; he entrusted these to an Englishman named Thomas Ashe, who sold them in Europe, and absconded with the money. He also was active in the trade of locally harvested
Ginseng that was shipped to
China. In 1804, either he or his father was a
Presidential elector, voting for
Thomas Jefferson and
George Clinton. In late 1800, Goforth took on
Daniel Drake as a medical student, having previously trained his brother John Drake in Kentucky. Goforth presented Daniel Drake a diploma in August 1805, which he signed as "Surgeon-General of the First Division of the Ohio Militia". This was the first diploma issued to a student of medicine west of the Alleghanies. In 1807, Goforth asked Drake to take over his medical practice, as he wished to move on to
Louisiana. "In the medical history of the west one gigantic figure towers above all others. For nearly half a century, Daniel Drake was the dominant factor in educational development of every kind, medical, scientific, and literary." ==Life in Louisiana==