Recalling his years as a student, Jefferson described Small as:
a man profound in most of the useful branches of science, with a happy talent of communication, correct and gentlemanly manners, and a large and liberal mind... from his conversation I got my first views of the expansion of science and of the system of things in which we are placed.
Return to England
In 1764, Small returned to Britain with a letter of introduction to Matthew Boulton from Benjamin Franklin. Through this connection with Franklin, Small helped form the Lunar Society, a club of scientists and industrialists.
In 1765, he received his MD degree and established a medical practice in Birmingham, where he shared a house with fellow physician John Ash, the chief campaigner for the Birmingham infirmary. Small was Boulton's physician and became a close friend of Erasmus Darwin, Thomas Day, James Keir, James Watt, Anna Seward, and others connected with the Lunar Society. Small was among the most popular members of the society and an active contributor to the society's debates.
Small helped to bring the Theatre Royal to Birmingham in 1774 and, together with Ash, was involved in planning and building Birmingham General Hospital, which was completed in 1779.