The tipping point for the 23-year old Poole as a settlement worker came when he was selected to investigate the problem of tuberculosis in New York City's Lower East Side tenement slums. Poole spent weeks going from room to room observing and surveying residents and taking testimony about the fate of previous inhabitants. His report, "The Plague in Its Stronghold," generated attention from the press and Poole conducted tours of reporters and photographers around the tenement blocks, with the coverage spurring hearings of the New York State Legislature in Albany. The task proved a strain on Poole's mental and physical well-being and he himself became feverish and was sent home to the family summer home in Lake Forest to recuperate.