Although they may appear to be innocuous collections of school memories, yearbooks have fueled major political controversies in recent months. Whether it be the racist photograph of a student in blackface and another in a Ku Klux Klan costume on Virginia Gov. Ralph Northam’s medical school yearbook page or Supreme Court Justice Brett M. Kavanaugh’s high school yearbook jokes about drinking and sex, decades-old school publications have returned to public scrutiny for politicians, and it’s guaranteed that Northam’s will not be the last.

But these shocking pages aren’t as much of an outlier as they may have seemed. During my research on women in medicine in the 20th century, I came across the seemingly peculiar incident of a Playboy centerfold in a medical school yearbook. I soon discovered similar pages in yearbooks from this time across the United States. The books — as yearbooks always do — reflected the contemporaneous culture of the institutions that published them. In medical school in the 1960s and ’70s, that culture was often roiled by a backlash against women and minorities, as the medical world increasingly opened for people other than white men.

My research found that editors at that time deliberately deployed sexism in yearbooks as women fought to enter coeducational medical schools in higher numbers. In 1965, women made up less than 10 percent of medical college matriculants. By 1975, that figure had increased to nearly 25 percent. To wrestle with the significance of this change, predominantly male yearbook editors drew upon the template and vocabulary of Playboy magazine.

If you flick through the 1969 yearbook from Jefferson Medical College in Philadelphia, you’ll find a centerfold featuring a naked model wearing only a nurse’s cap, posed on a bed contemplating medical diagrams of vaginal surgery. This image was far from unique. In the same year, the University of Kansas medical school yearbook adopted a “PlayDoc” theme, with a front cover showing a blond, humanized, and feminized illustration of the Jayhawk mascot in a white coat, as well as Playboy-style and centerfold features. Medical school yearbooks most explicitly associated this sexual imagery with nursing.

That “sexy nurse” trope had become a staple of American culture by mid-century, because of wartime propaganda and pornography. Playboy regularly featured it in the late 1960s in depictions of Playmates in nursing roles and cartoons showing medical scenarios as moments of erotic possibility. For the nursing profession, such depictions had real consequences, depressing recruitment rates, and contributing to physical and verbal mistreatment of nurses.

The dismissive attitude toward nursing and the assumption that it was “a woman’s place” was readily apparent to women attempting to enter medical school. In an oral history, Nadine Bruce recalled an admissions interview at St. Louis Medical School in the 1960s where a physician asked, “Your grades are OK, but you’ve gone to a small girls’ school. You’re nothing special, so why don’t you just go and be a nurse?” She replied, “If your foot itches, you don’t scratch your shoe.” A week later, she received her rejection.

Teaching practices nurtured this focus on male heterosexual desire. Female students from numerous medical schools remembered professors using dirty jokes and photographs of naked women in lectures to hold the attention of male students, which implied that a women’s place in the lecture theater was not to learn but to be leered at by men. This practice extended beyond individual classrooms. In 1971, Williams and Wilkins published The Anatomical Basis of Medical Practice, an anatomy textbook written by three professors from Duke University School of Medicine that illustrated anatomy through pinup photographs of women, taken by Playboy photographers Peter and Alice Gowland.

African American women were especially marginalized in medical schools. In 1980, African Americans constituted just 6 percent of medical students and at that time were mostly trained at Howard University College of Medicine and Meharry Medical College. Therefore, black women entering white-majority coeducational medical schools faced particular challenges. At medical school in the 1970s, Vanessa Gamble was often the only black person in her class, and was made to feel like “a fly in the bowl of buttermilk.”

Sharon Brangman recalled one white male professor who smoked a pipe and would purposely stand behind black students as they took tests and blow smoke over them. The same professor used a photo of a black athlete and adopted a “black dialect” to teach about muscles, while also using Playboy photos to illustrate anatomy.

This culture could also shape black women’s experiences on the ward. One male patient didn’t believe Gamble when she introduced herself as a student physician, insisting she was a maid and asking why she hadn’t cleaned his room.

The culture of misogyny included physical harassment and assault, also memorialized in the yearbooks. Like many others, the 1969 Columbia medical school yearbook included sections dedicated to students’ extracurricular sporting activities. The sport branded “hunting” involved male students attempting to grab nurses’ and female physicians’ buttocks while their backs were turned.

Although perhaps some women posed for such photos or found the Playboy references sexually liberating, many more female students and professors contested this culture. Estelle Ramey of Georgetown School of Medicine led a boycott of The Anatomical Basis of Medical Practice, and consequently Williams and Wilkins published no further editions.

Yearbooks also contain evidence of this resistance — and of male editors’ mockery of it. The 1972 University of Southern California Dentistry School yearbook adopted a “PlayDent” theme, complete with a centerfold featuring a graduating dental assistant posing naked in a dentistry chair, alongside many other images and crude cartoons featuring naked women. Lynette Emiko Kagihara was a yearbook staff writer and photographer, and as a woman of color, she was the particular target of male editors’ contempt. Editors infused her profile with irony, writing that Kagihara was “never ‘one of the guys’” and that ‘’the editorial staff being 100 percent male” needed to lay aside its “natural inbred chauvinism” to praise her. Editors also captioned one of her photographs “Let me make myself perfectly clear,” which suggests Kagihara often tried to protest over editors’ misogyny, even if her voice was drowned out.

However, by the late 1970s, women’s voices were less frequently alone. When in the late 1970s, a University of Pennsylvania physician told a lecture theater that “medicine is the profession that separates the men from the boys,” he was met with hisses so loud that he announced that he couldn’t keep lecturing like this — to which a student shouted, “That’s right.”

Yearbooks provide a window into how students created professional identities as they moved from school to work. For decades in medical schools, this creative process emboldened pervasive misogyny and racism. In turn, this shaped the treatment of patients, namely systemic pain bias against women, especially African American women.

Apologists too often resort to bad cliches to explain these examples away: They can be a case of “a few bad apples” or “boys being boys” or the byproduct of “a different time.” But these excuses minimize the significance of the hostility that women and people of color navigated every day in these student cultures. Editors’ commemorative work on yearbooks was part of a system that subordinated women and people of color within the highly stratified and hierarchical structures of universities and hospitals that promoted discrimination and harassment. Our medical world is still struggling to overcome those structures today.

Elizabeth Evens is a Ph.D. student at University College London researching gender, sexuality, and medicine. This piece first appeared in the Washington Post. @Lizzieevens