History of the medical uniform: from white coats to scrubs

The modern medical uniform wasn't born from a single garment, nor did it follow a completely linear evolution. Its history combines the development of the white coat, nursing uniforms, clothing used in the operating room, and the top and pants sets we now know as scrubs.

Each of these garments emerged to meet different needs. Some helped identify a profession; others facilitated institutional cleanliness, movement during work, or compliance with specific regulations within hospitals and clinics.

Therefore, the history of the medical uniform cannot be summarized as a simple change from black to white and then to green. It involves several lines of evolution that eventually coexisted in the current healthcare system.

Timeline of Medical Uniform Evolution

The following timeline summarizes the most significant changes. Dates are approximate, as the adoption of each garment occurred differently depending on the country, profession, and institution.

The Plague Doctor's Attire: Protection Based on the Ideas of its Time

One of the most well-known images in the history of medicine is that of the plague doctor with a beak-shaped mask, hat, gloves, and a long tunic.

This attire is primarily associated with doctors who attended to plague epidemics in Europe during the 17th and 18th centuries. Historical descriptions mention garments made of thick materials, leather, or waxed fabrics, in addition to a mask whose beak could contain herbs, spices, or perfumes.

At that time, disease transmission was not understood as it is today. Part of the design responded to the miasma theory, according to which certain diseases spread through contaminated air or foul odors. The aromatic substances placed in the mask were used with the intention of purifying the air the doctor breathed. National Library of Medicine

The plague doctor's attire can be understood as an early example of clothing designed with a protective intent. However, it was not the direct ancestor of modern scrubs and was not based on modern knowledge of microorganisms, textile barriers, or infection control.

The 19th Century: Antisepsis, Science, and the Emergence of the White Coat

For much of history, doctors did not wear a unique uniform. They might attend to patients in formal clothing similar to that worn by other professionals of their era.

The situation began to change during the second half of the 19th century. The advancement of germ theory, laboratory medicine, and antiseptic practices modified the understanding of infections and cleanliness in medical settings.

Joseph Lister was an important figure in this transformation. Inspired by advances related to microbial theory, he developed an antiseptic system to reduce the entry of infectious agents into wounds during and after surgery. His methods included cleaning instruments, hands, and materials used in procedures. Science Museum

In this context, the white coat gradually became associated with science, cleanliness, the laboratory, and modern medicine. White also made it easier to spot stains, although a visually white garment should never be confused with a sterile one.

The lab coat did not appear simultaneously in all hospitals nor did it immediately replace formal wear. Its incorporation was gradual and was related to both scientific changes and the construction of a new professional identity for doctors, researchers, and laboratory personnel.

Over time, the white coat became one of the most recognized symbols of medicine. Even so, its use today depends on the specialty, country, institution, and type of care.

How the Nursing Uniform Evolved

The history of the nursing uniform followed its own trajectory. During the 19th and 20th centuries, uniforms could include long dresses, aprons, collars, structured sleeves, and caps that helped identify the nurse's school, rank, or institution.

There was no single universal uniform. Cuts, colors, and accessories varied considerably between countries, hospitals, religious organizations, military services, and nursing schools.

The historical collection of the National Library of Medicine on nursing uniforms from different nations precisely shows this diversity. The garments served as tools for professional identification, but also reflected the social and cultural norms of each place. National Library of Medicine

As nursing roles expanded and hospital work demanded greater mobility, many institutions gradually replaced long skirts, aprons, and caps with trousers and simpler garments.

The adoption of scrubs allowed for more practical designs for walking, bending, mobilizing patients, and performing clinical tasks. However, this change did not occur simultaneously in all countries or institutions.

Currently, doctors, nurses, dentists, physiotherapists, technicians, and other professionals may wear similar outfits. For this reason, the uniform no longer always allows recognition of a person's position without consulting their badge, name, or title.

The 20th Century: Surgical Attire Becomes More Practical and Standardized

The development of modern operating rooms created new clothing needs. Surgical teams required clothing that could be used within controlled areas, facilitated movement, and integrated with the hospital's laundry and textile management procedures.

During the 20th century, surgical attire adopted simpler structures. Top and pants sets made it easier to change clothes, allowed for mobility, and standardized sizes for different team members.

These sets should not be confused with sterile surgical gowns. Scrubs are used as workwear in specific areas, while surgical gowns are worn over them when the procedure and risk level require it.

Modern standards for surgical attire include not only tops and pants but also criteria for hair covering, additional garments, laundering, and circulation between areas. Specific policies may vary by institution and risk assessment. AORN

Why Green and Blue Became Associated with the Operating Room

White maintained a strong association with cleanliness and medicine, but it wasn't always ideal in brightly lit operating rooms. Over time, green and blue began to be used more frequently for surgical attire, drapes, and other elements of the environment.

One of the most cited explanations relates to visual contrast. Green and blue are near the complementary colors of various red tones present in blood and tissues.

After prolonged observation of a red area, vision can produce an afterimage in its complementary color. Looking at a green or blue surface can reduce the discomfort associated with this phenomenon and facilitate visual differentiation of some structures.

A study on background colors in microsurgery found that certain green or blue tones could improve contrast against red or pink tissues and reduce the discomfort associated with the complementary image. Microsurgery study

This does not mean that visual contrast was the sole reason these colors were adopted. Hospital organization, laundry systems, textile availability, and standardization of surgical attire also played a role.

Not all operating rooms use exactly the same shade either. Green, surgical blue, turquoise, and other variations can be found depending on the regulations and suppliers of each institution.

From the Operating Room to the Rest of the Hospital: The Expansion of Scrubs

Scrubs were initially closely associated with surgical areas and procedures. Over time, the top and pants sets began to be used in more hospital departments and by different professions.

This expansion is explained by several practical reasons:

• They facilitate movement during active shifts.
• They allow for relatively standardized sizes and cuts.
• They can include pockets for authorized work items.
• They are easy to integrate into an institution's uniform systems.
• They allow for different colors to be assigned by department or function.
• They can be adapted to different types of consultation and clinical care.

Currently, scrubs can be seen in nursing, medicine, dentistry, physical therapy, veterinary medicine, laboratory, imaging, and other areas. However, their use is not mandatory in all professions or all workplaces.

A psychologist in private practice, for example, might wear conventional professional clothing, while a psychologist integrated into a hospital might have to follow the uniform assigned by the institution.

Similarly, a doctor might wear scrubs in one department and a white coat or formal attire in another. The function, location, and internal regulations often matter more than the professional title alone.

The Medical Uniform Today

The contemporary medical uniform no longer has a single form. It can include two-piece scrubs, three-piece sets, lab coats, scrub tops, straight-leg pants, jogger cuts, and uniforms designed for different types of work.

Comfort and freedom of movement

Healthcare professionals can spend many hours walking, standing, sitting, or performing repetitive movements. Therefore, current clothing is often designed with mobility of shoulders, arms, waist, and legs in mind.

Some garments incorporate stretchy fabrics and less restrictive cuts. However, words like "stretch" or "high-performance" do not guarantee comfort on their own. Size, pattern, seam position, and type of activity must also be considered.

Identification of teams and areas

Some institutions use colors to differentiate departments, professions, or levels of responsibility. Others choose the same palette to reinforce their visual identity.

Color can aid identification, but it should not be the only resource. A badge, name, position, and clear communication are still necessary, as color codes are not universal.

Colors, cuts, and institutional regulations

Currently, scrubs are available in a much wider variety of colors than the traditional white, green, and blue. Black, wine, grey, pink, lilac, beige, and other shades can be used when allowed by workplace rules.

Cuts have also diversified. There are wider, straight, fitted, or athletic options, but no single form is suitable for everyone or every profession.

The choice must consider:

• Institutional rules.
• Actual daily activities.
• Freedom of movement.
• Number and location of pockets.
• Ease of washing and maintenance.
• Size and personal fit.
• Need to wear other garments or equipment over it.

Medical Uniform and Protective Equipment Are Not the Same

One of the most common mistakes when discussing the evolution of the medical uniform is to present any modern scrub as a biosafety barrier.

Common scrubs are primarily workwear. They can help identify staff, maintain a uniform appearance, and facilitate daily activities, but they do not automatically become personal protective equipment just by being used within a hospital.

The Occupational Safety and Health Administration (OSHA) expressly distinguishes protective equipment from general workwear. Uniforms, pants, shirts, and blouses that were not designed to protect against a specific hazard are not considered PPE. OSHA

When there is a risk of contact with blood, fluids, chemicals, or infectious agents, specific items may be required, such as:

• Gloves.
• Isolation gowns.
• Surgical gowns.
• Protective aprons.
• Eye or face protection.
• Masks or respirators, depending on the risk.
• Other equipment defined by the institution.

Selection should be based on the identified hazard, the task, and applicable standards. A comfortable, thick scrub or one advertised as fluid-resistant should not be used as a substitute for certified protective clothing when it is necessary.

What has changed and what remains in medical clothing

Medical attire has profoundly changed, but some of its historical functions are still present.

What has changed

• Garments became simpler and more suitable for movement.
• Pants and two-piece sets replaced many long uniforms.
• Colors were no longer limited to white, green, and blue.
• The same types of uniforms began to be used in more professions.
• Fit and design adapted to different body types and activities.
• Institutions developed their own dress codes.

What remains

• The uniform continues to help build a professional identity.
• Clothing allows for differentiation between staff and patients and visitors.
• Institutions continue to use colors, emblems, and cuts to create uniformity.
• Cleanliness and maintenance remain fundamental.
• Attire must adapt to the function and work environment.

The evolution of the uniform did not end with the appearance of scrubs. Garments continue to change as care models, staff needs, textile materials, and hospital policies evolve.

Conclusion: the medical uniform is the result of several histories

The history of the medical uniform is not a simple sequence in which one garment completely replaced the previous one. The white coat, nursing uniforms, surgical attire, and scrubs emerged in different contexts and still fulfill different functions.

The plague doctor's suit reflected the available ideas during the epidemics of his time. Antisepsis and scientific medicine transformed the importance of cleanliness. Nursing uniforms helped build a professional identity, while surgical attire adapted to the needs of the operating room.

Later, scrubs spread to different areas due to their practicality, mobility, and ease of integration into institutional systems. Currently, their colors and cuts are more varied, but they are still subject to the activities, risks, and regulations of each location.

The most important change is not simply transitioning from a gown to a set of pants and a top. The true evolution lies in understanding that each garment must respond to a specific function and that work uniform does not replace the protective equipment necessary to face specific risks.

Sources consulted

• Plague doctor — National Library of Medicine Digital Collections
• Joseph Lister’s antisepsis system — Science Museum
• A Universal Code: Nurse Uniforms of All Nations — National Library of Medicine, Circulating Now
• The Optimal Color of Background Sheets for Microsurgery — Microsurgery
• Surgical Attire in the Operating Room: An AORN Guideline — Association of periOperative Registered Nurses
• Bloodborne Pathogens Standard: definition of personal protective equipment — Occupational Safety and Health Administration