Baylor University Medical Center Proceedings July 2017 - 379

of the Breakfast Table (1), fell short of humorous expectations.
In it Holmes surrounded himself with imaginary characters
contributing to what turned out mainly to be almost 400 pages
of monologue with a few memorable verses and just a scattering
of verbal gems among long stretches devoid of such rewards.
S. Weir Mitchell, a contemporary of Holmes, has been called
the father of American neurology. Clinically he made his reputation by introducing the rest cure for neurasthenia and hysteria,
popular diagnoses in the post-Civil War era, as well as his work
on nerve injuries and gunshot wounds. Toward the end of his
career, he devoted himself more to novels and these, at the
time, were once popular but devoid of humor, with the possible exception of a sardonic novella entitled The Autobiography
of a Quack (2).
Outstanding among this group of late 19th and 20th century physicians was William Osler, one of the founding professors at Johns Hopkins Medical School and the most revered
physician of his time. Unlike these other doctors aﬁeld, from
early childhood Willy was an indefatigable prankster whose
practical jokes got him expelled from one grammar school and
punished by a few days in jail while attending another. By the
time he reached adulthood, he chose to follow his mischievous inclinations in another way within a professional world
still dominated by Victorian rules of conduct. He adopted the
pseudonym of Egerton Yorrick Davis, in which guise he contributed to the medical literature amusements that ranged from
the relatively tame "Burrowings of a Bookworm" on bibliomania
to the frankly salacious and completely bogus case report of
vaginismus causing penile entrapment of an imaginary coachman and a housemaid who, reportedly, could not uncouple
following a roll in the hay (3).
Of all the physician authors identiﬁed, W. Somerset Maugham
must be considered the most proliﬁc and successful. Although
he earned a medical degree in 1897, he never practiced medicine
but went right to work as a creative writer. Over a career spanning almost 70 years, he produced over two dozen novels and
even more plays. Although best remembered for serious works
that included "Of Human Bondage" and "The Razor's Edge,"
the tireless Maugham also produced 90 short stories, among
them nine very funny ones including "The Facts of Life" and
"Three Fat Women" (4).
Bringing this list up to date, we should consider authors
Sherwin B. Nuland, Oliver Sacks, Michael Crichton, and, more
recently, Atul Gawande. But their worthy contributions have
all been deadly serious with no room for frivolity.
In the second category, that of nonphysicians who have
made their mark by setting their humorous ﬁctional work
within the ﬁeld of medicine, there is Molière, who achieved
great success by ridiculing the physicians of his day in plays
like "A Doctor in Spite of Himself " (1666) and "The Imaginary Invalid" (1673). More recently, we have had Joseph Heller
as a prime example. His antiwar book Catch 22 was published
in 1955 (5). The locale is an American air base and hospital
located in the Mediterranean during World War II. The world
Heller creates is one that, due to the ravages of war, has lost its
moral compass, where perversity has become the casual norm
July 2017

and logic has disappeared. Amid the outbursts of laughter that
reward the reader there persists a frisson of despair.
Thus far we have only considered what traditionally has
been thought of as literature: the printed words of novels, plays,
and nonﬁction. However, motion pictures and television play
an increasing role in our lives, and I have included these two
modalities in what might be called our cultural heritage.
Dr. Peter E. Dans has been an avid ﬁlm buﬀ all his life, with
a special interest in the portrayal of physicians in this medium.
His book, Doctors in the Movies: Boil the Water and Just Say Aah
(6), catalogues 176 features that appeared between 1931 and
1997. Although there is a good representation of biographies
(Louis Pasteur, Paul Ehrlich, Walter Reed) and melodramas
(Men in White, The Hospital), the yield of comedies is small.
Small but far from inconsequential. M*A*S*H, with a screenplay by Ring Lardner Jr. based on a book by Richard Hooker,
is set in a mobile army surgical hospital during the Korean war.
The main characters are two trauma surgeons, ill-suited to the
military roles they have been forced to play. They maintain their
equilibrium amidst the carnage surrounding them by perpetrating a series of practical jokes fueled by a seemingly endless
supply of homemade martinis. Produced in 1970, 5 years before
the end of the Vietnam War, M*A*S*H reﬂected the growing
antiwar spirit spreading throughout the country. The television
series that followed was one of the most successful in television history, with 256 episodes and a viewing audience of over
121 million for the ﬁnal broadcast.
Another notable entry of quite a diﬀerent comedic character is Doctor in the House, actually a British ﬁlm rather than
American. In it we follow a group of medical students through
their training. With an impeccable cast and sparkling dialogue
delivered with a mixture of tongue-in-cheek and slapstick humor, the story is told in a style that only the Brits seem to have
mastered. It led to a number of American television imitations,
but none with the panache of the original.
A ﬁnal category of medically derived humor, one not mentioned so far, is that of cartoons involving medical subjects, as
have appeared in The New Yorker (7) and other periodicals much
to the delight of their readers.
To summarize, it appears that, although humor occupies a
relatively small space in our cultural canon, the public's appetite
for such material is large. Next question: What role, if any, can
humor play at the bedside when we are unfortunate enough to
fall seriously ill?
Such questions immediately invoke the memory of Norman
Cousins, who took charge of his own illness and turned conventional medicine on its head. His story is related in his memoir,
Anatomy of an Illness as Perceived by the Patient (8). In 1964,
Cousins, at that time editor of the Saturday Review, was stricken
with a debilitating inﬂammation of the spine (then diagnosed
as ankylosing spondylitis). He lay mortally ill in the hospital,
unresponsive to the various medications being prescribed for
him, mainly painkillers. He had become desperate about his
condition and, somewhat aware of the writings of those such
as Walter B. Cannon and Hans Selye which dealt with the
"wisdom of the body," he took charge of his own care. He set

Humor in medicine: Can laughter help in healing?

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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017