On Friday afternoon, Virginia Governor Ralph Northam’s medical school yearbook page surfaced online. One featured photo contained two figures: one dressed in blackface, the other draped in Klan robes.

The Democratic governor quickly released a statement admitting that he was one of the figures in the photograph. “I am deeply sorry for the decision I made to appear as I did in this photo and for the hurt that decision caused then and now," wrote Northam, following up with a video message in which he insisted "that photo, and the racist and offensive attitudes it represents, does not represent the person that I am today, and the way that I have conducted myself as a soldier, a doctor, and a public servant."

Northam faces mounting pressure from within his own party to resign; Virginia House Democrats issued a statement calling for Northam’s resignation, while presidential candidates Senators Kamala Harris and Kirsten Gillibrand, as well as other prominent Democratic figures, have urged the governor to step down. Northam is resisting the calls to resign and is beginning to backtrack from his initial statement, now reportedly denying that he may be in the picture at all.

Ralph Northam, the Democratic governor of Virginia, is under pressure from within his own party to resign over a racist photo in his medical school yearbook. The Washington Post Getty Images

If that is Northam in the photo—and again, he publicly admitted it was—consider this: for decades before he entered politics, Northam literally had the lives of children of color in his hands as a pediatric neurologist. While few cases illustrate the racism present in American medical institutions quite as vividly as this yearbook photo, history is littered with evidence of medical racism. It’s one of the most dangerous forms of bigotry—a bigotry directly imperiling the physical wellbeing of Americans of color.

“We know through data that African Americans still experience a great deal of racism, a great deal of discrimination and racial bias in the medical arena,” Harriet Washington, author of the seminal examination of racism in medicine, 2007's Medical Apartheid, told me.

In 2016, researchers at the University of Virginia completed a study that sought to explain why black patients are routinely undertreated for pain compared to whites. The disparity in treatment is a long-established finding—one of the many studies examining the phenomenon found that only 57 percent of black patients treated for extremity fractures received pain medication compared to 74 percent of similarly injured white patients.

And the UVA researchers uncovered one of the reasons black pain goes untreated: Medical professionals routinely profess racist beliefs about black patients’ bodies. Around half of medically trained respondents believed at least one false statement about biological differences—overtly racist sentiments like “Blacks' skin is thicker than whites’,” or “Blacks’ nerve endings are less sensitive than whites’.”

That finding, said Washington, “is actually a holdover from Victorian times.” Supporters of American slavery, keen to justify the institution as a scientific necessity rather than an economic convenience, insisted that black people were biologically different than whites, subhumans uniquely suited to brutal labor and neither deserving nor capable of handling freedom.

Nineteenth century Louisiana doctor and plantation owner Samuel A. Cartwright became famous for identifying a number of black diseases like drapetomania, a peculiar mental illness marked by the desire to escape slavery and which could thankfully be cured by “whipping the devil” out of afflicted patients. He also posited that blacks had singular knees, which meant they were created to be “submissive knee benders” who served whites.

Today, the briefest of Google searches shows that some people still believe that African Americans have extra muscles in their legs which render us superior athletes—the times change, the social contexts change, and the myths evolve to suit.

But beliefs about black biological deviance weren’t only used to illustrate inferiority and justify slavery. They also propelled medical progress, as African Americans—powerless, and supposedly indifferent to pain—were the ideal subjects for gruesome experimentation. The Tuskegee syphilis experiment is the most famous example of racist barbarism in the name of American scientific progress, but is by no means the only instance of it. “Father of gynecology” J. Marion Sims developed the first surgery repairing vaginal fistulas over four years of agonizing, purposefully un-anesthetized experimental surgeries on slave women.

New York City workers take down a statue of "father of gynecology" J. Marion Sims from Central Park. Activists pushed for the statue’s removal, citing the fact that Sims experimented on enslaved women without anesthesia Andrew Lichtenstein Getty Images

While not all medical schools may have permitted the overt bigotry of Northam’s photograph to make its way into a yearbook, “more subtle but equally damaging forms of racism,” explained Washington, are very much on medical curricula. “Implying that African-Americans are less intelligent, more inclined to stigmatizing diseases like sexually transmitted diseases, less able to feel pain—all of these things become part of a tacit education of medical students,” she said. (I reached out to the American Medical Association for comment but haven't heard back yet.)

Though the effect of medical racism can be immediate and personal for all the black patients who find their health and wellbeing in the hands of racist medical providers, the effects of this history of bigotry are even more broadly felt. Black Americans are understandably far less likely than their white counterparts to trust doctors, and are accordingly less likely to seek out necessary medical care.

“There’s a lot of inherited trauma in terms of recognizing what the medical system has done to communities of color, all the unethical things that have happened,” said Dr. Jennifer Adaeze Okwerekwu, who writes a column for the health news outlet Stat News. “And so when people are suspicious, it’s not completely unwarranted. It’s not unwarranted at all.”

But it's hard to have faith in a medical world that’s only now beginning to reckon with its racism-filled history. “We can’t talk about African American’s distrust of the system,” said Washington, “without talking about how untrustworthy the system is.”

Gabrielle Bruney Gabrielle Bruney is a writer and editor for Esquire, where she focuses on politics and culture.

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