Wed, Apr 21, 2021

The Red Origins of the White Lab Coat in Medicine

Before the white lab coat become a symbol of the medical profession, the sector had some interesting hot takes.

Cocaine for sinuses, toothaches, depression, and impotence. Morphine to help teething babies. Pelvic massages to cure female hysteria. Plus, galvanic baths to restore sexual desire. 

It is fair to say that in the 19th century, the world of medicine had something of an image problem. Simply put, the profession was built on an unsound foundation of quackery, pseudoscience, and mysticism. 

For instance, cholera, which would wreak havoc through British cities in the mid-1850s, was believed to be caused by, among other things, cold fruits like cucumbers and melons or by intense fear and rage. A popular cure for this ailment was blood-letting via leeches to cleanse the body.

In fact, blood-letting was something of a medical man’s bread and butter. Many doctors of the era still worshipped an ancient form of medicine known as the humorous theory. This was based on the idea that when someone was unwell, it was because there was an imbalance of one of four liquids within the body – the blood, yellow bile, black bile, and phlegm. Naturally, the best way to rebalance this was through bleeding or purging! 

With all of this in mind, you may not be surprised to learn that more often than not, a visit from the good doctor himself was likely followed next by that of a priest and shortly afterward by an undertaker.

Combining these woes of the medical profession, doctors of the time wore more black than Johnny Cash could shake a stick at. Nothing like wearing the color of death to calm the nerves of a patient circling the drain. Moreover, their dark-colored attire would often be stiff with blood from a previous operation. Remarkably, this unkempt fashion choice was reputedly seen as an indicator of the doctor’s experience.

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Talk about needing a PR intervention! Ladies and gentlemen, enter the humble white lab coat

As we know now, today’s best coats are professionally styled garments tailored in LABTEX premium fabric to deliver dynamic function to the user. However, when the coats first came into the realm of the medical profession, their arrival was for a far more practical reason. 

A symbol of cleanness!

Yes, thanks to antiseptic surgical procedures first developed by Joseph Lister in the 1860s and 70s, whereby medical equipment and wounds would be sterilized with carbolic acid, medicine had a Eureka moment that blood and guts did not, in fact, lead to glory on the operating table. 

To emphasize the scientific breakthrough of germ theory and antiseptic surgery, doctors took cues from the laboratories where these evolutions in medicine were perfected and donned the most recognizable symbol of the profession, the white lab coat.

It soon became a symbol of cleanliness, in stark contrast to the battlefields which had so fast-tracked the need for advancement in medicine. Simply put, white allowed any sort of dirt or contamination to be noted at once, thus acting as a visual aid to keep doctors and their operating rooms sparkling clean.

But what’s this you say about battlefields? Well, the saying goes that a journey of a thousand miles starts with a single step. Unfortunately, the journey to realizing the benefits of a clean operating room that eventually bore the white lab coat was a bloody path to travel indeed. Take a walk with me as we explore the key moments that spurred on these monumental leaps in medical advancement at the close of the profession’s dark ages.

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The Wars That Led To The White Lab Coat

They say that things have to get worse before they get better, and that is certainly the case with the realization of how critical a clean and sterile medical environment was to patient survival rates. Many key developments in healthcare have their origins in the theater of war, where the treatment of wounded soldiers has led to innovations throughout history. 

In fact, it was two wars on either side of the Atlantic in the mid-1800s that really hammered home the point that soldiers were more likely to die from disease rather than the enemy and that something had to be done about that.

These wars were the Crimean War of 1853-56 and the US Civil War of 1861-65. Let’s start with the former, the war in Crimea. In this conflict, disease killed four times as many soldiers as battle wounds. Soberingly, nearly 80% of soldiers admitted to these hospitals died from infections from being in the hospitals and not from their original wounds.

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This was the battle arena where the legendary Florence Nightingale found her vocation. At one point during the height of the conflict, Nightingale penned a letter stating that they were up to their necks in blood every day. One can imagine the state of a white lab coat in those conditions had they been on the scene at the time.

Next, we cross the Atlantic. Breaking out nine years following the end of the Crimean tensions, the American Civil War proved to be an even more significant catalyst for advancement in medicine. This was because the war was one of the first truly advanced clashes with more technologically gifted weapons reaping greater woe upon the human flesh than ever before. Naturally, this meant an influx in surgeries, and subsequently, post-surgery deaths due to inflection. 

<img src="whitelabcoat.png" alt="Male model in open white lab coat">

Make White Lab Coats Not War

Before the war, soldiers typically carried muskets that held just one bullet at a time and were only accurate at about 80 yards. By the time the Civil War kicked into gear, repeating rifles were on the scene. They did exactly what they said on the tin - firing more than one bullet before needing a reload. For example, the Spencer carbine repeating rifle could fire seven shots in a mere 30 seconds.

Even more devastating was the introduction of the Gatling Gun, the original version of the machine gun. Ironically, the weapon’s inventor, Richard Gatling, notoriously designed the gun in the hopes that its severity would deter mankind from waging further war. Unfortunately, its effectiveness in killing instead made the gun an MVP of violence. Who wants to tell poor Richard how that turned out? 

Naturally, four years of technologically advanced warfare on the battlefields of America left hundreds of thousands of cases of battle wounds, disease, infection, and death. For instance, both armies found themselves short of surgeons, supplies, and hospitals. Various diseases such as measles, smallpox, and typhoid spread like wildfire through field hospitals. Antiseptic practices were still nonexistent. Thus, due to poor sanitation and inadequate hygiene, infection spread rampantly, making disease more deadly than the battle wounds experienced on the field. 

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Here’s how a typical visit to a field hospital would generally play out. When a soldier was wounded in battle, he was brought to a field hospital where he was treated with the same medical tools as the other wounded soldiers before him. Equipment was rinsed in a water bucket that was not boiled, and the doctor did not wear gloves or wash his hands with soap. After treatment, the soldier was bandaged up more often than not with resources such as curtains or bedsheets taken from nearby homes and placed on a bed of straw or the ground to recover. Many succumbed to their wounds due to infections such as gangrene.  

The fact that roughly three in five Union casualties and two in three Confederate casualties died of disease during the conflict, a similar issue that plagued armies of the Crimean conflict, further spurred on the eventual acceptance of germ theory and the breakthrough of antiseptic surgery.

<img src="whitelabcoat.png" alt="Female model posing in white lab coat">

Why Black Was Better Than A White Lab Coat

As referenced previously, doctors of the time dressed head to toe in the color black. This was to reflect the seriousness of their occupation and add a respectful tone in the presence of the sick and dying. Lab coats were not yet on the cusp of the profession’s wardrobe because infection of wounds was pinned on a completely different idea.

The dominant thinking believed that “bad air” was the sole culprit for infections in surgical wounds. To combat this, hospital wards were simply aired out at midday to avoid the spread of infection. Unfortunately, pus was also viewed as no more than a healthy part of the healing process, rather than the devastating alarm bell of sepsis that it actually was. Not surprisingly, most deaths were due to post-operative infections.

Louis Pasteur’s pioneering work on germ theory in the 1850s kicked off the climb to the summit of a medical breakthrough. In 1864, Lister, inspired by Pasteur’s research, began to experiment with an antiseptic spray that by 1866 was reducing the death rate in his patients by 45.7 percent. He quickly evolved from using the spray to developing special dressings that were doused in carbolic acid to keep the wound clean. 

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Sadly, while Lister’s antiseptic breakthrough came in the late-1860s, it was slow to take root in the medical industry. Many surgeons claimed that Lister’s antiseptic methods delayed the completion of surgeries when time was of the essence due to the problem of blood loss.  More sinisterly, for doctors, losing patients post-surgery was just an accepted nature of the game. This was surgery after all, not a manicure! 

It wasn’t until the 1890s that the roots of Lister’s work began to bud in the mainstream medical profession when aseptic surgery took hold. With this final deliverance, surgical instruments were steam-sterilized, and surgeons began wearing sterilized gowns, rubber gloves, and face masks to further reduce infection risk. The surgeon’s hands were even scrubbed clean beforehand! This caused deaths from surgeries to wildly plummet and even reduced the need for amputations. When you consider that Russia was said to have performed a massive 5,000 amputations in nine months during the Crimean War, that is a remarkable feat. 

But of course, the addition of rubber gloves and face masks wasn’t the only uniform change that doctors began to fashion to mark this turn of revolution within the industry.

<img src="whitelabcoat.png" alt="Male model walking in white lab coat">

The White Lab Coat's Reveal Party

Lister’s breakthrough had transformed the medical landscape. Thanks to a wild 180-degree swing in life expectancy chances following a life-threatening injury or illness, doctors cast off the shackles of pain, fear, and pending doom that they had carted with them into a patient’s room. And this was not just cause for celebration. It was cause for a makeover too!

With their long-overdue embrace of empirical science, the much-needed re-branding exercise could finally have its coronation. In line with the profession's changing times, a new uniform was needed as a symbol of their scientific undertaking. Once again, enter the humble white lab coat, ladies and gentlemen.

Today, the doctor's lab coat is as recognizable as the Golden Arch of McDonald’s. It speaks of professionalism, integrity, empathy, trustworthiness, and compassion. Reflecting the strong symbolism that the white coat carries the vast majority of medical schools today still host white coat ceremonies at graduation. 

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Further cementing the sense of respect and authority that the white lab coat carries on its shoulders, University of Michigan researchers surveyed 4,000 patients at 10 US academic medical centers. Their findings highlighted that a doctor’s clothing determines how a patient will relate to their doctor and how they will ultimately view the care they receive. Naturally, the white lab coat topped the chart in their findings. Simply put, the coat carries great power despite its humble origins. 

To conclude, psychology tells us that white conveys cleanliness, freshness, and simplicity. Moreover, the color white often appears like a blank slate, symbolizing a new beginning or a fresh start. This last idea lines up perfectly with how the white lab coat entered into a profession kicking their bloodletting habit and throwing its arms in a warm embrace around cleanliness and sterility.

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