The Shoreditch Vestry was authorised, in 1774, by an Act of Parliament to levy a special poor rate for the purpose of setting up a workhouse for the parish of St Leonard's. The new workhouse was built on land known as the 'Land of Promise', which had been given to the Trustees of the Parish Poor. The three-storey building, fronting onto Kingsland Road, opened in 1777. It included an infirmary and apothecary. In 1784, a burial ground for deceased inmates was consecrated at the southwest corner of the site. 

The workhouse incorporated two sick wards. In 1813, James Parkinson was appointed as the parish surgeon, apothecary and man-midwife, Amongst other improvements to the medical facilities, Parkinson established an isolation ward in the workhouse, the first in London, for the segregation of infectious patients, particularly those suffering from cholera. In 1817 he published an Essay on the Shaking Palsy in which he described the condition that is now known as Parkinson's Disease.

In July 1865, during the rebuilding work, the Shoreditch Workhouse was the subject of one of a series of articles in the medical journal The Lancet investigating conditions in London workhouses and their infirmaries. The report contained many criticisms of the conditions and practices that were found at Shoreditch:

ST. LEONARD'S, SHOREDITCH.

In this house are combined many of the principal merits and most glaring defects of the system which we are investigating. The population of the house at the time of our visit (fine summer weather) was about 700; the sick actually in the wards numbered about 240, and there were 130 in the lunatic and imbecile wards, with about as many absolutely infirm. It may give some idea, however, of the general character of what are called the "able-bodied" inmates if we state that the medical officer and the master agree that about seven-eighths may be considered as belonging to the permanent population of the place, and that as to age they might be divided into two classes, averaging from fifty to sixty and from seventy to eighty years respectively. It will be understood, therefore, at once that here is a great population, of whom considerably more than a half require constant and careful medical supervision, while about 300 are actually and acutely suffering from definite disease of one kind or another.

There are many grievous faults in the present state of things which are incidental to the temporary conduct of building operations in the house. The workhouse and in firmary are being entirely rebuilt, and at a cost, we believe, of about 60,000l. Meanwhile the patients are rather pushed about. Some of the able-bodied are sleeping far too closely packed; and a number of the patients (122, including chiefly the female imbeciles and chronic cases of disease) are temporarily housed at Wapping, in the old condemned and abandoned house of the Stepney Union, which was subjected a few years since to the strictures of Mr. Charles Dickens. Of course, if the latter building, straggling, ill-built, with narrow staircases, low-raftered ceilings, stinking ill-trapped drains, abominable closets, and almost every fault which a house can have, were meant as anything more fault be a great deal to say about the crowding of the patients, the utter cheerlessness and misery of the rooms, and other prominent evils, which could not be tolerated. But as the guardians are pushing forward the completion of their premises at Shoreditch, we shall as far as possible separate the accidental from the essential defects of the arrangements, and treat of them as at their highest existing standard in the best wards at Shoreditch.
The aspect of the wards in the new building is east and vest. The drainage of the building is very good. The wards are not built on the best plan, for they lie each side of a central passage, which is a plan long since condemned; but the passage is lofty and well-ventilated, and so are the wards. The new infirmary is intended for 400 sick, and the imbeciles' wards accommodate 150 more. The average numbers in these two sets of wards now vary from 100 to 350. The males occupy the north end of the building, the females the south end. It is a great recommendation to these wards that they are provided with excellent closets, having separate ventilation into the open air and a dirty-water shoot; that hot and cold water are supplied to each ward; and that there are capital baths and lavatories attached, with self-acting water-taps and enamel basins. Thus in the construction of these wards the guardians have shown liberality and judgment; and the shell is good although the kernel is rotten.
The general aspect of the wards, however, is one of extreme cheerlessness and desolation. This is painful throughout; but it is especially lamentable in the case of the lunatics and imbeciles. Moping about in herds, without any occupation whatever; neither classified, nor amused, nor employed; congregated in a miserable day-room, where they sit and stare at each other or at the bare walls, and where the monotony is only broken by the occasional excitement due to an epileptic or the gibbering and fitful laughter of some more excitable lunatic, - they pass a life uncheered by any of the brightening influences which in well-managed asylums are employed to develop the remnants of intelligence and to preserve them from total degradation. They have here neither fresh air nor exercise, no out-door or indoor occupation of any kind. The exercise-ground is a wretched yard with bare walls, confined in space, and utterly miserable and unfit for its purposes. It is a frightful accumulation of human failures, treated with utter neglect of their human character; kept in tolerably clean rooms, and fed with sufficient food, as we would kennel dogs in decent kennels, but not otherwise recognised or treated as deserving of moral or intellectual consideration. We denounce the cruelty of keeping these imbeciles in a cheerless town workhouse. We protest against their exclusion from the natural blessings of fresh air and exercise, and labour in the open air or in proper workrooms; against the absence of classification; against the total absence of any effort to keep alive the existing glean of intelligence.
In many respects, however, the imbeciles and lunatics are better off in this workhouse than the sick. We have stated that the duties of the medical officer include the charge of the whole of this great population of sick, imbecile, and infirm; and, besides prescribing for them, to dispense their medicines; that there is no resident surgeon, and no dispenser. It will give a startling form to the medical outline if the administration if we add that there are no prescription cards overt lie beds. So that, under this system, the medical officer is supposed to recall to memory, as he passes the bed, the treatment which each patient has had, to make up his mind as to variation, and then, after completing his rounds and on descending into the dispensary, to remember en masse all the changes which he desires to make, and forthwith to prepare the medicines. The medicine-bottles are kept in a mass in a cupboard at the end of the ward with the bread and butter; thus yet further complicating the difficulties even of administering the medicines ordered and supplied.cum libro salis. Obviously, since the doctor's visit is in the forenoon, and he bas the trouble of dispensing all the medicines wanted at the close of this toilsome duty, the dispensing facilities are brought to the lowest ebb.--
To make matters as bad as possible, the nurses, with one exception, are pauper nurses, having improved rations and different dress, but no pecuniary encouragements. They are mostly a very inferior set of women; and the males, who are "nursed" by male paupers, are yet worse off. The nursing organization at this establishment is as bad as can be. The male nurses especially struck us as a peculiarly rough, ignorant, and uncouth set. There are no night-nurses. The outer surface of the beds was clean, and the linen generally, through the able-bodied wards, tolerably so; but as to the lying-in wards, they were frequently filthy with crusted blood and discharges, and in the sick wards also they were far from being well kept.
The next part of inquiry was as to the regularity of the administration of food and medicines. Medicines are administered in this house with shameful irregularity. The result of our inquiries showed that of nine consecutive patients, only four were receiving their medicines regularly. A poor fellow lying very dangerously ill with gangrene of the leg bad had no medicine for three days, because, as the male "nurse" said, his mouth had been sore. The doctor had not been made acquainted either with the fact that the man's mouth was sore or that he had not had the medicines ordered for him. A female, also very ill, had not had her medicine for two days, because the very infirm old lady in the next bed, who it seemed was appointed by the nurse to fulfil this duty, had been too completely bedridden for the last few days to rise amid give it to her. Other patients had not had their medicines because they had diarrhoea: but the suspension had not been made known to the doctor, nor had medicine been given to them for their diarrhoea. The nurses generally had the most imperfect idea of their duties in this respect. One nurse plainly avowed that she gave medicines three times a day to those who were very ill, and twice or once a day as they improved. The medicines were given all down a ward in a cup; elsewhere in a gallipot. The nurse said she "poured out the medicine, and judged according." In other respects the nursing was equally deficient. The dressings were roughly and badly applied. Lotions and water-dressings were applied in rags, which were allowed to dry and stick. We saw sloughing ulcers and cancers so treated. In fact, this was the rule. Bandages seemed to be unknown. But the general character of the nursing will be appreciated by the detail of the one fact, that we found in one ward two paralytic patients with frightful sloughs of the back: they were both dirty, and lying on hard straw mattresses; the one dressed only with a rag steeped in chloride of lime solution, the other with a rag thickly covered with ointment. This latter was a fearful and very extensive sore, in a state of absolute putridity; the buttocks of the patient were covered with filth and excoriated, and the stench was masked by strewing dry chloride of lime on the floor under the bed. A spectacle more saddening or more discreditable cannot be imagined. Both these patient have since died: no inquest has been held on either.
With such general and extensive defects in the sick wards of this establishment, it is perhaps undesirable to enter into minor details. We must, however, note the total absence of any attempt to give an air of comfort to the sick wards, or to supply the reality; the entire absence of colour on the walls; the scanty supply of books; the absence of any cheap coloured prints or devices or mottoes on the walls, a pot of flowers in the windows, or of anything that could give a cheerful idea to the mind of the invalid. These are little comforts which cost really next to nothing, but have a considerable and useful influence. Other defects are more openly and decidedly reprehensible. The want of ward furniture especially; the wretched little tables and scanty forms are so insufficient for the number of patients, that they have to eat their dinners on the beds-a habit which is slovenly and improper for patients who are up and can move about. There is a marked absence of chairs, and especially of plain wooden arm-chairs, which are an almost essential comfort for infirm and semi-paralytic patients not absolutely confined to bed. The deficiency of bed-pulls, by which the sick can raise and shift themselves, and the want of so much as a shelf at each bed, on which the wine or brandy, the medicines, or the necessaries of frequent use, may be kept at hand, were pointed out by us: and we were told that such things near the bed "bred vermin." An extensive hospital experience enables us to say, however, that with ordinary care they do not afford lodgment for anything of the sort; and the absence of this species of dumb waiter is much felt by the helpless sick.
The total expenditure here for drugs, including quinine, cod-liver oil, &c., was stated to be about 50l. per annum. At the much smaller infirmary which we have presently to describe, it is more than that per quarter.
The dietaries, on the whole, were up to the average, with the exception that the patients get a great deal too much of boiled meat and too little roast; that the dietary is extremely monotonous, anti that owing to the unusual number of sick to be looked after, and the consequent trouble of frequent special changes, the acutely sick get far too little variety of diet, and are kept too long upon the same thing.
A severe commentary on the nursing staff is supplied by the information given to us by the master, that the average age of the nurses is sixty, and their average duration in office from six to nine months. Remember that these are pauper inmates, commonly without special training; that the men are nursed by males, and how overworked and underpaid the doctor is, and the key will be readily found to many of the abuses which we have described. Where there are so many glaring defects it were unwise to refer to smaller matters, or there are many minor points to which we should further advert, such as the want of bed-rests for patients who could sit up in bed for an hour or two occasionally, of foot-rests or stools, of stomach and feet warmers, and so on. But we have said enough,