Take Off Your Tie!

Abstract & Commentary

By Stan Deresinski, MD, FACP, Clinical Professor of Medicine, Stanford, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, is Editor for Infectious Disease Alert.

The UK Department of Health has instituted measures they believe will prevent hospital acquired infections. These measures, implemented January 1, 2008, include, among other things, that individuals involved in clinical care are not to wear unnecessary jewelry, such as watches (apparently wedding rings are approved), white coats, sleeves below the elbows, or neckties.1 These measures are being taken seriously because of evidence that these items may be contaminated with hospital pathogens, despite an admitted lack of conclusive evidence that these items pose a significant hazard in terms of spreading infection. They are, instead, mostly based on "informed common sense" and a perceived preference of the public, and obviously, a perceived need of bureaucrats to do something — anything.


These measures are unlikely to have a significant effect on controlling hospital infections, and seem gratuitous to me. I am, however, strongly in favor of the banishment of one to the targeted items — neckties. My attitude toward neckties, however, has nothing to do with infection control and everything to do with the tyranny of this culturally embedded useless and uncomfortable fashion. One question that can be asked is: How did we ever get to a circumstance in which men are expected to wear these worthless strips of cloth?

The beginnings of the popularity of the necktie in the West have been traced to the inclusion of Croatian mercenaries into French regiments in support of Cardinal Richelieu and King Louis XIII in the 1630s in their struggle with the Duc du Guise and Maria Medici, the Queen Mother. The Croatians were both militarily successful and sartorially prominent.2,3 Their distinctive knotted scarves which, in the case of officers, were comprised of fine linen and silk, became popular among the French aristocracy, replacing their starched linen ruffs or ruffled starched collars. In France, these novel bands of cloth were known as cravates, a word that resulted from a corruption of the French pronunciation of Croat. In fact, in 1643, the first year of the regency of Louis XIV, an elite Croatian regiment became known as the Royal Cravattes.2 The accession of Louis XIV to the throne in 1654 was followed by an increased enthusiasm for cravates. Louis, in fact, employed a man, the Cravatier du Roi, who provided him with a selection of cravates each day. The fashion spread to England after the return in 1660 of Charles II (Louis' cousin) from his continental exile.3 The success of British imperialism spread the pernicious contagion around the world, establishing the tyranny of the necktie, a tyranny that continues to plague males in large swaths of the planet. The British, however, may have now placed the first nail in the coffin of this useless annoying fashion requirement by their proscription in hospitals.

Taking into account their history, banishing neckties strikes a blow against monarchy, mercenary militarism, and foolish fashion. Other benefits may accrue. In the words of the writer, philosopher, and poet, Lin Yutang, "I have a desire to return to the Orient and discard my necktie. Neckties strangle clear thinking." Perhaps the measures taken in the United Kingdom (as ill-founded as they are) will provide a more general impetus to action and, having accepted the analysis of the journalist Linda Ellerbee ("If men can run the world, why can't they stop wearing neckties? How intelligent is it to start the day by tying a little noose around your neck?"), prod men into casting off this tether to societal foolishness.


  1. Uniforms and workwear: An evidence base for developing local policy. www.dh.gov.uk
  2. The diary of Samuel Pepys. http://www.pepysdiary.com/p/594.php
  3. The complete history of neckties. http://www.abcneckties.com/necktiehistory.html