Europeans had been producing fustian, a rough fabric woven of cotton and linen yarn, with cotton grown around the Mediterranean. Spinning and weaving raw cotton into relatively cheap, standardized fabrics, Britain’s highly productive cotton industry set a standard for the entire world. Before the late eighteenth century, the European cotton industry produced mainly through putting out. Cotton textiles, coal mining, and health care—our three main cases—each cover a wide range of productive organization and distinctly different paths of change. At first glance, coal mining seems less attractive work than spinning or weaving: dirtier, darker, more dangerous, more taxing physically, more threatening to health. Miners at the coalface worked quite independently for payment by the ton, the carload, or the unit volume. For the duration of a given field’s productivity, furthermore, coal production typically supported relatively isolated single-industry communities. The American College of Surgeons established a rating system for hospitals that promoted scientific medicine and physician control.