Black Sheep and the Doctor’s White Coat

“Why do doctors still wear the white coat?” a student wrote to me. “In Denmark and in England we rarely see the white coat anymore.”

For a second I recalled the "The Gross Clinic" painting by Thomas Eakins, where Dr. Gross is performing orthopaedic surgery at the Jefferson Medical College's amphitheater in Philadelphia. He and his assistants were all dressed in black formal attire.

I knew the white coat was adopted a century or so ago, but why did western physician, and nurses, wear black? I had always thought that before the understanding of bacteria and modes of contamination, a patient sought medical advice as last resort. In fact before Lister and the understanding of antisepsis, an encounter with a physician was bad for one’s health; and hospitals were where people went to die. Was it the somber nature of this non-scientific profession that justified the black garb?

Thinking about this question I realized that there was a bigger question I had not posed before: what is the significance of the color black in human history? Sure, that was a big question, but at least I could start addressing my curiosity.

As a Westerner, the first impressions I have of the color black are associated with funerals and mourning. When I was a kid, the average life expectancy for a male was late 50's, so I was surrounded with widows wearing black, sometimes 2 years after the death of their husbands, but often for the rest of their lives. They mourned for the rest of their days and I do not remember any widow remarrying, although I am sure there were.

But black is not the colour of funerals and of mourning. In India it is brown that is worn at funerals and widows in India are expected to wear white for the rest of their lives. In parts of the Middle East White is also the colour of mourning, although black is always associated with death. But for Egyptians, yellow and gold are associated with mourning mostly based on the historic tradition of belief in afterlife and the riches the dead supposed to take with them for a comfortable eternity! Look at the color paintings on the sarcophagus and mummies’ masks. In Mexico they mourn the departed in yellow and gold as well. Finally it is blue that dominates the mourning colours in Korea, whereas purple is the popular funeral and mourning colour in Thailand and Brasil.

So, perhaps there is a difference in how people express their sadness but not in how they describe death and evil?

Black on the colour spectrum is defined as the result of the absence of or complete absorption of light.  And isn’t light a requisite for, even synonymous with life? Not always, I learned. Indeed, in ancient Egypt black was the color of the rich black soil flooded by the Nile. Perhaps more striking is the fact that black was the colour of Anubis, the god of the underworld, who took the form of a black jackal, and offered protection against evil to the dead. But the ancients did not share the same attitude vis à vis this darkest of colours: for the ancient Greeks, black was the colour of the underworld, separated from the world of the living by the river Acheron, whose water was black.

I was perplexed and totally absorbed by my search. Dogmatic thinking, pain, sorrow and hope expressed through the colour black but often interpreted differently. No unifying traits that I could find so far across cultures and time. But what about social movements?

Perhaps it is natural to think about wars and violent events when one first thinks about social movements and change. The first colour-associated war imagery that came to my mind was the Bolshevik Red Army during the Russian Civil war. But I was surprised to learn that there were also a Black Army and a White Army fighting during that civil war! Then I progressed to the fascist movement and the Blackshirts in Italy (camicie nere) organized by Mussolini. Then the black uniform of the Nazi Party paramilitary, the SS (Schutzstaffe). Then the black flags of pirates, and more contemporaneous social and military movements.

Yet, for a photographer who treasures B&W photography as a candid mode of expression, I felt more comfortable thinking about black colour in the arts and fashion. The masculine black kimono in Japan, the Chinese brush painting using the darkest of the black inks made of soot and animal glue, of course the most recent impact on fashion by Coco Chanel and her 1926 “little black dress”!

Is it the simplicity and purity of lines that black provides more than any other colour? Could it be that it is in the arts and fashion where black is universally associated with that purity? After 40 years of B&W photography, I know it is for me. And that I still fancy a woman in that little black dress….

… Back to the doctor’s white coat. An article published in the American Medical Association Journal of Ethics, Mark S. Hochberg proposes that “the foundation of all professional societies is candor or truth“, and that the word candor is derived from the Latin candidus which means white. Interestingly he explains that “the term "candidate" comes from the fact that Romans seeking public office wore the white togas. The depiction of justice over the millennia has been a statue or painting of an individual clothed in white. The converse, of course, is evil or death depicted in black.”

Candor or truth.  Candidus or veritas. But would Edith Piaf show her candor and true feelings if she wore white on stage? Or rose? How about imagining clergy in white?  Well, the Pope does wear white, and sometimes red.  And why do Supreme Court (and all) judges wear black when Lady Justice is never shown wearing a black toga?

So I wrote back to the young woman who asked the question. “When physicians in Denmark and England do not wear the white coat it probably helps them listen to the patients, and hear them better.”

July 3, 2014

© Vahé Kazandjian, 2014

About the picture: I took this picture of the “little black dress” in a church.