New York's housing problems continued to deteriorate, and soon the social implications of the tenement slums began receiving increasing attention. Alarmed by the appalling conditions of the poor, and following the "draft-riots" of 1863, a journalist wrote that the "the high brick blocks of closely packed houses where the mobs originated seemed to be literally hives of sickness and vice. It was wonderful to see and difficult to believe that so much misery, disease, and wretchedness could huddle together, hidden by high walls, unvisited and unthought of so near our own abodes."

With a constant stream of newly arrived immigrants vying for space on New York City's severely over-crowded streets, the small, cramped housing proved to be a far cry from the open rural houses of Ireland, or the open fields of Southern Italy. The streets-the only playground known to most neighborhood children-soon became an extension to the immigrant's home, as row upon row of tenement houses lined the unclean and unpaved City streets. The first Tenement House Act, passed in 1867, helped pave the way for the more effective legislation that followed, but tenement conditions remained largely unaltered until after the turn of the century.

Rose Cohen, on first arriving in New York in 1892, lived with her father and aunt with another family of five. The floors of her family's first tenement dwelling were "unpainted and tick with dirt" and water available only at a common pump in the courtyard. During the depression of 1893, Rose's family found itself forced to move into smaller, cheaper quarters and take on three boarders. Ten people lived in three small rooms "in the stoop in the rear. The toilets, for the whole building, were in the yard, facing our windows, the water pump in the street hall." The rent was $10 a month-as much as Rose's father could expect to make in a week when fully employed-which they split with their tenants, two brothers and a sister. Cramped, stifling tenements framed not only home life, but also work life. Upon arriving at her first job, Rose Cohen "climbed the dark, narrow stairs of a tenement house on Monroe Street" to begin work as a feller, sewing the lining of men's coat sleeves. Wrote Rose, "You with your eyes close to the coat on your lap are sitting and sweating the livelong day. The black cloth dust eats into your very pores. You are breathing the air that all the other bent and sweating bodies in the shop are throwing off, and the air that comes in from the yard heavy and disgusting with filth and the odour of the open toilets."

The turn of the century witnessed a period of tenement reform, with the New York State Legislature creating a separate Tenement House Department devoted to the housing needs of the City of New York. City reformers, such as Jacob Riis and Lillian Wald, brought the appalling sanitary conditions of the City's new immigrants to the public's attention. Reformers' concern for the health and welfare of the city's poor immigrants led to an investigation of tenement houses by The Tenement House Committee of the Charity Organization. The investigation prompted the enactment of the Tenement House Law of 1901 that addressed some of the most egregious conditions.

The Tenement House Department enjoyed some success in accelerating the pace of housing reform. In 1919, Edith Elmer Wood reported that, although not all tenements were "'immaculate,' there were 'no accumulations of filth,' 'no dilapidation or extreme disrepair,' no privy vaults, and few old hall sinks." Tenement Department Commissioner Murphy announced in 1915, that New York's death rate had dropped to 13.52 per 1,000 from 19.90 per 1,000 when the Department was established in 1901. Commissioner Murphy lauded the Tenement House Department for its contribution to New York's improving health status in the twentieth century.