In 1847, the founding year of the New York Academy of Medicine, Smith was nominated for Resident Fellowship by two founding members of the Academy. Because of his race, Smith’s nomination posed a challenge for the fledgling but rapidly growing Academy and its Committee on Admissions, who wished to avoid “agitation of the question.” After discussions, correspondence, and procedural postponements throughout 1847, the Committee on Admissions eventually neither accepted nor rejected Smith, but instead implemented a rule to permit Smith to be regarded as “not nominated,” a unique designation that effectively rejected his fellowship.