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Southworth managed Rochester to the 1928 International League pennant and was promoted to the Cardinals the following year. Attempts to force his methods on former teammates led to dissension, and he was dismissed in July. Returning to Rochester, he won three successive pennants from 1929 to 1931, but because of bitterness and personal difficulties, he continued to incur the disfavor of the Cardinals organization. He coached the Giants in 1933, but was soon out of baseball.
Offered another chance by the Cardinals in 1935, Southworth worked his way back to the majors. Taking over in July of 1940 with St. Louis in sixth place, he guided the club to third. Under his direction, the Cardinals finished second in 1941 and then captured three successive NL pennants (1942-44) and two World Championships. He was a strict taskmaster, but displayed great skill with young players. A $50,000 offer lured him to the Braves in 1946, and two years later he led them to their first pennant since 1914.
In 13 years as a ML manager,
Southworth only once finished in the second division.