Through a conversation with an MBBS student, we learnt that racial slurs and anti-black discourses are quite common in medical terminology in undergraduate medical textbooks in India. In the wake of the global reckoning prompted by the Black Lives Matters Movement, this ThinkPiece seeks to point out and interrogate the continued use and implications of this terminology. In writing this, we are cognizant of the fact that anti-black racism in Indian textbooks, medical or otherwise, is a reflection of the colourism and racism deeply embedded within the national psyche.
Starting with an overview of scholarship on medical racism globally will be useful for our analysis since similar scholarship does not exist in India yet. Manifesting in medical education, medical racism mainly in the US—but percolating to other parts of the world—includes using white skin as the default to depict all illnesses in textbooks (Turbes, Krebs and Axtell 2002). For instance, cyanosis, or dermal blue discoloration is written as a symptom for Covid-19, but there is no information about how this symptom may manifest differently in other skin tones . The reality of medical racism in the US is further complicated by a history of unethical medical trials conducted on Black people (Berry 2017). The Tuskegee Syphilis experiment—a secret experiment by the US Public Health Service that misled and observed the progression of syphilis in Black men without their consent—is one such example. In the Indian context, medical textbooks do discuss different populations and skin tones. However, this inclusion is insensitive, and perpetuates harmful racial and religious stereotypes about different sections of the population.
A perusal of medical textbooks like SRB’s Manual of Surgery 6th Edition by Sriram Bhat, and Review of Forensic Medicine and Toxicology 3rd Edition by Gautam Biswas, widely used in undergraduate medical courses and colleges in India, reveals some of these stereotypes. When discussing degenerative atherosclerosis, SRB’s Manual claims that ‘mucoid degeneration of intima and media’ is most common in “South African young N*gr**s” (190). This is not the only time this racial slur is utilised as accepted medical terminology. Unsurprisingly, the slur is not just problematic: it also extends to fallacies in medical understanding of diseases. For example, in studying on the constriction of the base of the fifth toe, the author mentions that this is common in “blacks, in N*gr**s” (213). The study goes on to write that this is because of a history of running barefoot in childhood (213). This is entirely uncited, and appears to be based on assumptions made about the socio-economic lives of Black people.
While books on surgery are peppered with racial slurs, in the case of Review of Forensic Medicine and Toxicology, the matter assumes even graver implications, as forensics as a field is used by the police to track criminal activity. In view of global conversations around abolishing the police due to institutional anti-black violence, the presence of sections such as ‘Identification I: Race and Religion, Difference between Caucasian, Mongolian, and N*gr**d skull’ becomes all the more jarring (82). These sections continuously calculate brachial indexes or identify hyperpigmentation to classify people according to race, to “help in racial identification” (81). This language resembles harmful assumptions perpetuated by the discipline of anthropometry, which measured and studied human skulls, and was popular in the 18th-19th centuries. Used primarily by colonialists, anthropometric observations about sizes and shapes of skulls were used to claim that Caucasians had bigger brains while Black people had smaller ones. These methods were promoted as “scientific” and were also used to identify “criminals” (Mascie-Taylor, Yasukouchi, and Ulijasek 2010).
In addition to racist overtones, the textbook for forensic and toxicology also contains classification along the lines of religion (Biswas 82), which reveals communal and casteist biases. For example, Hindus are supposed to be identified by tufts of hair on the head—a casteist practice to demarcate Brahminism. While global scholarship on medical racism allows us to make observations regarding the treatment of Black people in India and identify racist language in Indian medical textbooks, it is important to keep in mind that in India, medical racism is further complicated by caste inequalities (Bates 1995) (Pol 2020). These classifications have larger implications since communal, casteist and racist hatred go hand in hand to reduce targeted sections of society to second-class citizens. For instance, the non-consensual medical testing discussed in the context of the US above takes place in India too, with Dalit communities . Between 2005 and 2012, over 73 trials were conducted unethically by big pharmaceuticals (including by AstraZeneca) with over 3,000 patients and these practices continue even today. Participants are recruited from Dalit communities, misled about their role in the trial, and administered drugs. In many cases, participants developed severe side effects , some even proving to be fatal.
Given that the Medical Council of India (now the National Medical Commission) issues annual guidelines to ensure that medical colleges follow a standard syllabus and these guidelines state the centrality of ‘forensic medicine and toxicology’ to the MBBS syllabus (Medical Council of India 2018), the textbook content described above are read and consumed widely. In February, a Wire article by Adil Rashid that discussed the homophobic language in use in Indian medical textbooks criticised the Medical Council of India (MCI)’s unscientific, stale reboot of the medical syllabi in 2018. While racism, colourism, casteism, and sexism are somewhat interrogated in fields such as social science or humanities, there is evidently very little cross-fertilisation of ideas between science and social science, vocational and pedagogical fields. Especially since medical textbooks discussed above have used baseless assumptions about the socio-economic context of communities (for example, the history of running barefoot), perhaps a consideration of socio-economic and cultural histories that combines academic knowledge from the humanities will contribute to a holistic understanding of the medical histories of communities. This is not to say, however, that social science curricula in India are devoid of racism (and have necessarily been criticised, though this is beyond the scope of the current paper).
We write this article to draw attention to the presence of racist slurs and beliefs in Indian medical textbooks, which we believe can be incredibly damaging if translated to practice. We also believe that these textbooks are doing a disservice to their students by propagating these notions. Our analysis of medical textbooks shows that in India, any discussions on racism must also consider casteism and communalism: these three factors are often intertwined and reflect in both medical education as well as in medical practices. The implication of these textbooks is that some communities are seen and treated as second-class citizens. Their content shows a desire to link medical conditions to larger socio-economic histories of communities to understand why these communities may be more prone to certain illnesses. If based on detailed understandings of histories using cross-disciplinary methods, and socially aware work on decolonisation, this can be done sensitively. It is our hope that this brief glimpse into medical education in India reveals the need for more critical research on racism and casteism in medical education and practice.
Arindaam Arjunrao Pol (2020). “Casteism Among Indian Doctors: A Critical Review”, World Journal of Public Health, 5(4): 99-104
Crispin Bates. (1995). “Race, caste and tribe in central India: the early origins of Indian anthropometry”, The Concept of Race in South Asia O.U.P Delhi
Daina Ramey Berry (2017). The Price for Their Pound of Flesh: The Value of Enslaved, from Womb to Grave, in the Building of a Nation . Boston: Beacon Press.
Gautam Biswas (2012). Review of Forensic Medicine and Toxicology. Jaypee Brothers Medical Publishers (P) Ltd.
Nicholas Mascie-Taylor, Akira Yasukouchi and Stanley Ulijasek (eds.) (2010). Human Variation: From the Laboratory to the Field. London: CRC Press.
Medical Council of India (2018). Competency based Undergraduate curriculum for the Indian Medical Graduate, Vol. 1.
Sandra Turbes, Erin Krebs, Sara Axtell (2002). The hidden curriculum in multicultural medical education: the role of case examples. cad Med. 77(3):209-16.
Sriram Bhat (2019). SRB’s manual of surgery. New Delhi: Jaypee Brothers.
Anushmita Mohanty and Nainika Dinesh are alumni of the University of Oxford and read for an MSt in World Literature and MPhil in Modern South Asian Studies respectively. They share research interests in education, gender, South Asian culture, and children’s literature
Anushmita Mohanty and Nainika Dinesh. 2021. ‘Indian Medical Textbooks: Racist Overtones?’, Think Pieces Series No. 15. Education.SouthAsia (https://educationsouthasia.web.ox.ac.uk/).