There’s a small-town feeling that comes when traversing Roosevelt Island, albeit one that involves a smattering of Brutalist architecture. The view toward Queens and the East River offers pristine views of the water. Hop on board the free bus that circles the island and you may hear people greet one another by name. Whether you’ve arrived by subway, ferry, or tram, the place has a distinctive charm—and that’s not even going into the green hills and futuristic architecture on the island’s southern tip.

It wasn’t always like this. In the 19th century, Roosevelt Island was known as Blackwell’s Island—and rather than bucolic splendor, it housed a series of structures that put New York City’s myriad inequalities into sharp relief, creating horrific conditions for those dwelling there. The island’s prisons, hospitals, and asylum were a target for reformers and journalists seeking to expose incompetence and corruption. A new book explores this unsettling history, and demonstrates its relevance to the present day.

“I’ve always been drawn to more morbid stories, especially stories that involved people that have been wronged in some way and then completely forgotten,” says author Stacy Horn. “I just love resurrecting these stories and giving these people some sort of justice.” In Horn’s new book Damnation Island: Poor, Sick, Mad & Criminal in 19th-Century New York (Workman Publishing, $27.95), she meticulously reconstructs the long-since-demolished structures of Blackwell’s Island—and gives a sense of the people both operating those institutions and trapped within them.

For Horn, the path to Blackwell’s Island was a roundabout one, which arose out of work she was doing on an entirely different project. “I originally had proposed a book about the Municipal Archives,” she says. “I just love that place, because every time I go there I’ll be researching one thing, and I’ll end up taking a million side trips.”

“I wanted to write about how that happens and what wonderful materials are there so I did a proposal where I gave a taste of what you could find there and among the materials that I included were a few pieces about Blackwell’s Island,” she explains. Those pieces resonated with her publisher, and so Damnation Island was born.

Rather than following a chronological structure, Horn structured Damnation Island around the different buildings on Blackwell’s Island. The first and longest section focuses on the New York City Lunatic Asylum, located near the northern tip of the island, which began operations in 1839. From there, it moves to the workhouse, just south of the asylum, which opened in 1852; the almshouse, in the center of the island, which dated back to four years earlier; and then the island’s hospitals and penitentiary, at its southern edge, which began operations in 1832. This was not, Horn says, an arbitrary decision.

One of the book’s central figures is the Rev. William Glenney French, a missionary who served on the island from 1872 until his death in 1895. When researching the book, Horn explored the documents French had left behind. “He walked the island every day, institution by institution, and he wrote his annual reports in order of the buildings as he came across them,” she says. “That made the reading for me, those annual reports, much more interesting, so I copied him.”

The narrative that emerges is cyclical: The then-deserted island was populated by institutions that housed many of the poor, destitute, and criminal; soon enough, though, the systems began to fail, to horrific effect. Horn’s account of an 1880 investigation into conditions on the island’s asylum quotes alienist Edward C. Spitzka, whose testimony, taken from a log of accidents, reveals a succession of patients attacking one another and the injuries (in one case, fatal) that resulted. At the time, the city’s Department of Public Charities and Correction handled two wildly different functions, and frequently treated the poor little differently than those convicted of crimes. Horn’s book ends in 1895, when the department split into two distinct entities.

The island was a target of many a reformer, though some were far from what we’d consider progressive today. Josephine Shaw Lowell, another recurring figure, is first introduced seeking increased funding for the poor—but also advocating in favor of sending many poor people to workhouses. Horn charts Lowell’s evolution toward a more progressive worldview. “She worked for charitable institutions where she would visit these institutions and she saw, over time, that they weren’t what they should be,” Horn says. “She ended up changing her mind about everything in the end.”

A different sort of reform came from the city’s newspapers. Legendary reporter Nellie Bly went undercover at the asylum for 10 days in 1887, then wrote a series of articles documenting the experience for the New York World. (These would later be published as a book, Ten Days in a Mad-House.) Bly’s writings led to an increase in funding for the Asylum, and the hiring of several female doctors.

Only a handful of buildings on present-day Roosevelt Island predate the turn of the last century. “There’s almost nothing left on Blackwell’s Island from the 19th century,” Horn says. “There’s one piece of the lunatic asylum, and the smallpox hospital, which I didn’t write about, is crumbling on the other end.” Blackwell House, a farmhouse occupied by the Blackwell family and built in the late 18th century, is currently closed for renovations.

Look closely enough, though, and traces of the past emerge. Near the tram station that connects the island to Manhattan is a kiosk run by the Roosevelt Island Historical Society. For sale, along with postcards, stuffed squirrels, and puzzles, are copies of Nellie Bly’s Ten Days in a Mad-House—a concrete reminder of the island’s bleak history.

Horn closes Damnation Island on an ominous note, even as the relevant agencies enacted reforms to create better and more humane institutions. Horn notes that by the late 1890s, “the penitentiary and the workhouse were just beyond reform.” Their replacement? A facility on nearby Rikers Island, which has proven to be every bit the nightmare that Blackwell’s Island was over a century ago.

With a host of abuses on Rikers Island revealed and a timeline in place to close the jail located there, it’s impossible to not see clear parallels between the two islands. After completing her book and reading about the abuses enacted on Rikers Island, Horn believes that we should “not isolate these populations on some remote island, and just put them right dab in the middle of our lives.” The final pages of her book encapsulate the troubled history of Rikers Island, and the harrowing conditions there.

As many readers of Luc Sante’s Low Life or viewers of the film Gangs of New York knows, the most discomfiting parts of New York City’s history can also make for gripping, compelling drama. Horn’s book aptly makes the case that present-day Roosevelt Island had its share of this—but it also offers a clear line between the uncomfortable parts of history and the societal debates of today. It’s a reminder that the troubles of today can sometimes be found in the histories of the spaces around us—or on a peaceful island a stone’s throw away.