[1] Smith began his career as a teacher in the private school of George Dermott in Bedford Square, and became an effective lecturer despite lacking natural gifts.

He continued his teaching there for the allotted term of twenty years, and on retirement was elected consulting physician accoucheur.

He purchased of land in and adjoining the town, and leased more from the corporation, on the condition that he should secure it against the frequent flooding by the sea, and build on it.

Marshall Hall, a close friend, suggested that he study applications of the reflex function in obstetrics, and Smith wrote on the topic in The Lancet.

In his time, these books by Smith, especially the Manual, became standard texts, alongside the works of Thomas Denman the elder, despite his relative lack of practical experience.

[1] Smith married Tryphena, daughter of Moses Yearsley, of Southwick Park, near Tewkesbury, and had seven children, two of whom died in infancy.

[1][2] Their son Giulio played for England against Scotland in the first (unofficial) international football match on 5 March 1870.