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In the 19th century, hospitals lacked the technology we associate with health care today. Instead, they were institutions of last resort, places for sick individuals whose communities had abandoned them to the care of strangers. In 1835, Philadelphia hospitals and almshouses organized women’s wards not by diagnosis, but by what kind of useful work patients — then known as inmates — could do for the hospital: “aged and helpless women in bad health; aged and helpless women who can sew and knit; aged and helpless women who are good sewers” and, finally, “spinners.” The patients in these early American institutions were charity patients, expected to stay a long time. And so, if they were physically able, they were often pressed into direct service to keep the hospital running.

Spinning wool into thread was about the most valuable work a patient could do at the time. Thread was needed for making and repairing bedsheets, curtains and nurses’ uniforms, to name just a few items essential to the functioning of these early institutions. Surplus thread could be stored and saved for future use or even sold to support the work of the hospital.

As decades went by, medicine and hospital care changed dramatically. As both public and private investment in science and medicine yielded novel and effective therapeutics — think vaccines, antibiotics and organ transplants, to name just a few — the United States’ private system of health-care provisioning meant that medicine rapidly became big business in the country. American medicine came to be characterized by its new and expensive technologies, ideally housed in new and expensive hospital buildings.

Dazzled and inspired by success stories, advertisements and their own experiences, many Americans adopted a presumption that newer, expensive technologies necessarily equaled better care. In that moment, with hospitals no longer a last resort but a vaunted destination for care, it seemed increasingly absurd to imagine patients or neighboring laypeople could be a part of creating the materials or machinery that could be found inside. Though area women were and are still to this day called on to volunteer to knit hats for newborns, sew puppets for children or devise and knit cannula sleeves for dementia patients, in the eyes of the modern hospital and its administrators, the value of this labor paled in comparison to the therapeutic or economic potential of other interventions and technologies.

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