Physicians dressed themselves in black and were painted in black garb until the late 19th century. Black attire was, and is, considered formal (e.g., today’s tuxedo). Consequently until about 1900, physicians wore black for their patient interactions since medical encounters were thought of as serious and formal matters. Clergymen also dressed in black, which indicated the solemn nature of their role in encounters with parishioners. An additional or alternative possibility for the dark garb might be that until the late 19th century seeking medical advice was usually a last resort and frequently a precursor to death. Until the last third of the 1800s, an encounter with a physician rarely benefited the patient. In fact, up to that point, virtually all of “medicine” entailed many worthless cures and much quackery [4].
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At the end of the 19th and the beginning of the 20th centuries, when medicine became the truly scientific enterprise we now know, the “whiteness” or “pureness” of medicine became reflected in the garb of physicians and, interestingly, nurses [5]. Up until that time nuns in their black habits functioned as nurses, largely in almshouses. At the turn of the 19th century the black habits of the religious nursing orders became white. In fact to this day nurses in England are called sisters, because of their religious origins. Our society has carried this symbol of whiteness to the marriage altar where brides traditionally wear white as a symbol of their purity.
In the 20th century, the white coat continued as the symbol of medical authority and respect as advance upon advance firmly established the patient-doctor relationship as a beneficial encounter. Probably the greatest development of medical science in the 20th century was the advent of antibiotics toward the end of World War II—the completion of Lord Lister’s dream that bacteria could be successfully overcome. For the first time pneumonia, appendicitis, an infected blister or a toothache no longer condemned one to death.
A depiction of a physician in a white coat is indeed the symbol of medicine, eclipsing the black bag or the stethoscope [3]. But the image of the white coat has also become so intimidating that pediatricians and psychiatrists generally choose not to wear it in order to reduce anxiety on the part of their patients. The term “white coat syndrome” is used to describe unrepresentative high blood pressure recordings due to a patient’s anxiety upon seeing a doctor in a white coat.
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