It’s 1857. You have smallpox. Welcome to Blackwell’s Island.

It’s 1857. You have smallpox. Welcome to Blackwell’s Island.

If you had the mixed blessing of being treated at the Smallpox Hospital in its infancy (your only other option would have been quarantine in a shantytown along the East River shoreline), here’s what you’d experience upon your arrival by boat:

Your presence would be announced to the hospital staff by the captain of your steamship, with three foghorn blasts. That was the code for smallpox, a scourge of humankind since the days of antiquity.

The Smallpox Hospital was the first in the nation to accept patients with the plague or other contagious diseases, and the only one in New York to treat smallpox. (Two foghorn blasts meant scarlet fever, four for measles, one long and one short for typhus.)

Now it comes into view: James Renwick Jr.’s imposing Gothic Revival building, built from 1854-56. Something of a prodigy, Renwick entered Columbia College (now Columbia University) at age 12 to study engineering; as an architect, he was self-taught, and his handiwork can be seen in such New York City stalwarts as St. Patrick’s Cathedral and Grace Church – as well as in Roosevelt Island’s own Lighthouse at the northern tip.

Perhaps you’d marvel at how the entire price tag of the building was only about $35,000 – which is the discount you get when you have free labor from the Island prison population and a quarry of local gray gneiss at your doorstep.

Your first sight of the Renwick building might be marred, though, by a slight distraction: stacks upon stacks of (occupied) wooden coffins awaiting a journey of a different kind, all lined up at the shoreline where you are about to disembark. The Smallpox Hospital, you see, had a high turnover.

The hospital was never designed to hold more than a few dozen patients, but as the only game in town in terms of smallpox treatment, it was overcrowded from the day it opened on Dec. 18, 1856. Records indicate it treated 3000-4000 patients in the 1850s, 6000 in the 1860s.

If you were deathly ill and rich, you were escorted to the third, or top, floor, where rooms went for $1 per day. If you were deathly ill and poor, you were dumped on the first or second floors, where some reports had it that patients were forced to sleep several to a bed amid appalling conditions.

For an extra $5 per week, you were entitled to marginally better food. But not for long, because smallpox claimed the lives of 20%-40% of its victims – which is why the hospital was also known by such charming epithets as "the Pest House" and "Deadhouse."

At least you were in good company. History shows that no less than George Washington survived smallpox, and that Lincoln contracted a mild case of it two days after he delivered the Gettysburg Address. Lincoln lived; his faithful valet died.

There was already a vaccine available in the 1800s to prevent smallpox, but it was expensive, and one out of 100 people who received it died anyway … of the vaccine itself. However, smallpox was enough on the wane – or at least the hospital’s patients had by then transferred elsewhere – so that the former Smallpox Hospital was expanded with the addition of a north and south wing, and turned into a respected training hospital for nurses.

The last known case of smallpox in the world was in Somalia in 1977 but, by then, the former Smallpox Hospital had long been abandoned. It fell into disuse in the 1950s, and was already in need of structural CPR in the 1960s.

It was declared a landmark in the 1970s.

Most of its north wall collapsed in 2007, and it continues to deteriorate.

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