The racist images on Ralph Northam’s yearbook page raise significant questions about the Virginia governor’s attitudes toward race. But they also reflect the culture of the time at Eastern Virginia Medical School and in the profession he later joined.

For historians who study racism, science and medicine, the discovery of racist imagery in a medical school yearbook was hardly surprising. Morbid racism has a long history in American medical schools, as well as the broader medical culture. Medical practitioners today are still battling the legacy of working in a field largely shaped by white men.

Some doctors, like Yale lecturer Sally Satel, contend that until personalized medicine is perfected, race can function as a proxy for genetic predisposition to certain illnesses, seeing ancestry analysis as beneficial to patients in some cases. Other doctors, however, rightly contend that racial medicine fails to solve the problem of health disparities and furthers African Americans’ long-standing skepticism toward the medical profession.

Before the Civil War, medical schools taught a brand of white supremacy that trained students to see black patients, enslaved or free, as less than human. As part of their study, medical students stole and mangled black cadavers, subjecting them to experimentation. In 1847, medical students at the Hampton Sydney College begged their anatomy professor, Jeffries Wyman, to lead them in galvanizing (running an electric current through) the corpse of an enslaved man executed for murder. While students clamored to disfigure the body, Wyman refused. He only denied them, though, because he had already done it himself and found the experience too grisly, even for a man whose job it was to procure stolen enslaved bodies so that students would dissect them to the point where only shreds remained.

Indeed, racism as a social activity — a way for the white upper-class men who would become doctors, dignitaries and politicians to bond — has a long pedigree in medical schools. For example, in 1828, Abraham Adams and a friend of his, both medical students at Transylvania University in Lexington, Ky., stole and dissected the body of a dead African American child. They sliced the body up, inadvertently discovering the cause of death when abscesses in the child’s lungs exploded.

Through clandestine but nonetheless communal activities like body-snatching and dissecting, students formed mutual bonds. As a rarefied club of professionals, they violated laws against grave-robbing, preying particularly on African American communities. Even official dissections in the school were not solitary activities, as students crowded together around a body to be led in dissection by their professors.

Cadavers weren’t the only subjects of abuse. Gruesome stories of physicians abusing African American patients as a part of their practice circulated regularly through 19th-century American medical schools. As a part of their training, medical schools taught students how to “detect” whether an enslaved person was faking an illness, a pedagogy common in elite Northern medical schools that attracted many faculty and students from slave states. During this period, for example, more than half of the medical students at the University of Pennsylvania came from the South.

In 1843, a medical student at Penn chronicled in his lecture notes an account of medical torture offered as a way of managing enslaved patients. In his lectures from Professor Nathaniel Chapman of Virginia, this student learned about a Virginian who had many enslaved people complaining of a fever that prevented them from working. As a method for rooting out these complaints, the student noted that “The Virginian had a grave dug and swore the first n—r got a chill should be buried alive.” The enslaved, students were taught, complained no more.

Not even racist humor is novel in the long history of medical education. In the early 20th century, it was common for medical students to pose with cadavers, often dressing bodies up or placing them in positions meant to be humorous. At times, these posed images could be quite racist, in addition to generally insensitive, as seen in John Harley Warner and James Edmonson’s “Dissection: Photographs of a Rite of Passage in American Medicine, 1880-1930.” In 1902, medical students from the College of Physicians and Surgeons of Baltimore staged a photo in which they gathered around a cadaver. (The body’s race is not identified in the photo.) The cadaver lay on a dissecting table with students holding bone saws and scalpels. They wrote in large print on the table, “All C—ns Smell Alike to Us.”

These racist photos again remind us of the social component of education: Students took these photos and made these racist jokes as mementos of the friendships and mastery over cadavers that they cultivated together in medical schools.

These photos were taken at the apex of the era of eugenics as well, a movement in which many medical professors played a leading role. In the now infamous correspondence published in 1893 between Hunter Holmes McGuire — medical professor in Richmond, president of the American Medical Association and namesake of the Hunter Holmes McGuire Veterans Administration Medical Center in Richmond — and George Frank Lydston, a professor at the Chicago College of Physicians and Surgeons, the two doctors advocated castration for African American men convicted of raping white women in the South. Lydston argued that this was a humane alternative to lynching. As in the antebellum medical school, eugenics-era doctors saw it as their duty to control African Americans for the benefit of the white population. Historians, however, have since proved that many African Americans lynched in the South were not even accused of rape, much less convicted of it.

In light of this history, Northam’s yearbook photos represent not an aberration or an unfortunate episode, but rather one more marker of medical schools’ ongoing problem with racism.

The consequences of this medical racism are profound. First, in a 2016 study of medical students at the University of Virginia, many students said they believed that African Americans feel less pain than other patients, which could explain why black patients’ pain often goes under-treated. Second, belief in race-based medicine prevents doctors from searching for social causes of racial health disparities. Take, for example, hypertension. Comparative studies of hypertension among African Americans, Afro-Caribbean people and West Africans reveals heightened levels only among African Americans, even though these groups have some shared ancestry. Thus, assuming genetics are at the root of hypertension discrepancies hinders searches into the real causes of the disparities.

Putting the Northam photo into the context of this longer history of racism in American medical schools shows that the stakes are higher than just the outing of a single politician with a racist past. In context, the photo reminds us of the multiple facets of institutional racism. Not only does it reveal how many contemporary politicians, Democrats and Republicans, were educated in institutions that promoted toxic whiteness, but also just how deeply entrenched these ideas and stories are in the history of medicine in the United States.

This piece has been updated