Boston, on the other hand, lived up to its puritanical heritage. There seemed to be no change in clothing styles with the passing of each season. Faded khakis and checkered shirts were the year-round staple, and in the hospitals, there was the ubiquitous white coat. I noticed that there were two styles, the short white jacket and the long, full-length coat. I was accustomed to identifying the rank of strangers in the hallways based on the length of this item. I assumed that faculty members and some fellows wore full-length coats while students and residents preferred short jackets. But in Boston, this assumption did not hold true. Many faculty members preferred wearing the short white coat. This observation puzzled me. Alas, I discovered that in Boston, physicians who trained at that “great hospital built on the marshes of Back Bay” often wore the short coat as a way of signaling to others their common training heritage. This must be the apparel equivalent of a secret society handshake.
Whether short or long, the white coat has symbolized the integrity and professionalism of our craft.1 Surprisingly, the adoption of the white coat by the medical profession is a fairly recent development. During the Middle Ages, doctors in Europe preferred wearing long dark robes with pointed hoods, leather gloves, boots, and the most bizarre masks featuring long beaks, which were filled with lavender or bergamot oil. Amulets of dried blood and ground-up toads were worn at their waists. They doused themselves with vinegar and chewed the bitter angelica root before approaching a victim, all in an effort to protect themselves against the bad odors that were considered to be the vectors of disease.2 Eventually, these nightmarish outfits were replaced by a more stylish and less frightening choice, namely, black clothing. This preference made sense, since medical encounters were considered to be serious and formal matters. During this era, virtually all of medicine entailed many worthless cures and much quackery. Most encounters with a physician rarely benefited the patient, and frequently were a precursor to death. Thus, patients seeking medical advice did so only as a decision of last resort. Doctors may have chosen to wear black as a way of emulating the attire of the other professions that dealt with death—the clergy and undertakers. Talk about color-coding the subject of death!
From Black To White
The transition from black to white took place during the latter half of the 19th century. Evidence of this change can be observed by comparing two historic paintings. Thomas Eakins was a renowned realist painter, known for his exacting work. In 1875, he created what is arguably one of America’s greatest paintings, entitled “The Gross Clinic” (see Figure 1).3 It depicts a scene from Jefferson Medical College’s amphitheater in Philadelphia, showing Dr. Samuel Gross and his assistants, all dressed in black formal attire, performing an operation on the leg of a young man. Though the concepts of Joseph Lister were slowly gaining popularity in European medical circles during this era, there was still a high degree of naiveté regarding antisepsis. Apparently, Lister would perform operations wearing his black suits.
