Smith built a cabin and, the next year, an infirmary at what is today Grand Boulevard (Dravus Street) and 15th Avenue W. Seattle was at the time hilly and heavily forested; the only route to the main settlement was by small boat or canoe until Smith cut a trail through the woods.

He farmed, invested in a general store, logging camps, and fruit orchards, and developed in land as far north as Smith Island, at the mouth of the Snohomish River.

He made house calls throughout most of the Puget Sound area, often by canoe, and was appointed official physician for the Tulalip Indian Reservation.

The meeting had been called by Governor Isaac Ingalls Stevens to discuss the surrender or sale of native land to white settlers.

About thirty years later, the Seattle Sunday Star published Smith's rendition of the speech, based on notes he took at the time.

[4] The speech forms the basis of a popular children's book, "Brother Eagle, Sister Sky: A Message from Chief Seattle".