In 1837, due in part to his friendship with Sam Houston, Dr. Smith decided to move to the newly formed Republic of Texas. That same year, he was appointed the first Surgeon General of the Republic. In 1839, he served as the first Minister of the Republic of Texas to England and France where he reportedly danced with Queen Victoria and lunched with Napoleon III.
In 1839, Galveston suffered a severe yellow fever epidemic. Dr. Smith spent long hours treating patients and maintained meticulous case records. He strongly advocated that area marshy lands be filled and that the removal of filth would help prevent future outbreaks. In his work, Account of Yellow Fever in Galveston in 1839, Dr. Smith published his findings on the epidemic. This work was considered the first significant medical contribution to be printed and published in Texas.
While some considered Dr. Smith a terrible-tempered man who often “bellowed fire,” his patients appeared to love him. His dedication to the medical profession and to his patients was noted in a December 3, 1839 letter written by Mrs. Lucy P. Shaw of Galveston to her mother Mrs. Jane N. Weston of Eastport, Maine:
We are fortunate in having an excellent physician, Doctor Smith…I am perfectly well now and all our family are well, although we have had so many deaths in our house and the yellow fever has taken away a great many on the island…Dr. Smith has opened up nine bodies, has several phials of the black vomit and has even tasted it. Dr. Smith is perfectly well and has never had any symptoms of the disease, and if it was contagious I think he would…There are ten resident physicians on the island…but we think we have found the best.