By the end of the Progressive era, Manhattan and Brooklyn had gone through a radical transformation. Clearly, Brooklyn was no longer the “City of Churches” nor the “City of Homes.” Its nineteenth-century rural, bucolic flavor was gone. Manhattan had become the center of finance and industry for the entire country. New York was a highly industrial, crowded city with a large portion of its population composed of immigrants and their children.

Manhattan, the home for millions of immigrants, thousands of banks and commercial enterprises, and a score of millionaires, became the undisputed economic capital of an increasingly powerful country. Brooklyn, once known for Henry Ward Beecher and his Plymouth Church, became known for its massive bridges and factories. Even the local baseball team had to change its name to conform to the new reality. The Brooklyn Robins, named for the team's original owner, became the Brooklyn Dodgers by the 1920s, as trolley dodging became a widespread popular sport and as robins were replaced by pigeons in the downtown area. Soon the Dodgers would be nicknamed the Brooklyn “Bums,” in a further reflection of the growing city's urban, working-class character.

It is paradoxical, perhaps, that just as New York was emerging as a working-class city, its charity and other health institutions began to turn away form the poor and to remodel their services around the needs of wealthier clients.