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Can you die laughing? - (5/19/2020)

By Dr. Ron Gasbarro 

Harvey came into the pharmacy and said to the pharmacist, “Do you want to hear a good joke?” "The way things are happening now with this virus and people not able to pay their bills, yes, a joke would be great," replied the pharmacist. “OK, here goes,” began Harvey.” This man walks into a bar with a monkey and an aardvark…” When the pharmacist heard the punch line, he doubled over and began to convulse. His face was purple, and tears were cascading down his face. Then, he let out a roar! “That. Was. The . Funniest. Thing. I. Ever. Heard,” he said between gasps for air. “Gee, Doc,” Harvey exclaimed. For a minute there, I thought I would have to call 9-1-1.”

Laughter is good medicine, to be sure, especially during these tough times. However, history recounts some events where the funny bone killed its owner. The Greek philosopher, Chrysippus of Soli (c. 279 – c. 206 BCE), was watching a donkey eat some figs and cried out: "Now give the donkey a drink of pure wine to wash down the figs!" Evidently, the scene was so uproarious to Chrysippus that he died in a fit of laughter. (The sight may have been funnier if one was in a Greek orchard at the time). In 1920, a 56-year-old Australian dog trainer named Arthur Cobcroft was reading a five-year-old newspaper. He was amused at the prices for items listed in the ads in 1915 (pre-World War 1) versus those in 1920 (post-WW1). While relaying this information to his wife, he burst into laughter, and suddenly collapsed and died. The doctor arrived and stated that Mr. Cobcroft’s demise was the result of heart failure, triggered by excessive laughter. 

To be honest, most people who died laughing had some type of underlying condition such as heart disease, which can result in cardiac arrest. Nevertheless, there are other ways. Pietro Aretino was a Tuscan author, playwright, vulgar poet, satirist, and blackmailer, who wielded influence on contemporary art and politics. In 1556, at the age of 64, he suffocated to death while laughing, presumably at an obscene joke. Perhaps he was eating a meatball at the same time, and it "went down the wrong tube." 

Some individuals have a history of brain injury caused by a stroke, Alzheimer's, or trauma that causes them to laugh uncontrollably. The condition, called pseudobulbar affect (PBA), is characterized by sudden, frequent, uncontrollable episodes of laughing (or crying) that do not match how one feels. In 2011, the US Food and Drug Administration approved the marketing of dextromethorphan and quinidine capsules (Neudexta®) to control such embarrassing outbursts.

But for the everyday person, why does laughter happen? We laugh because we like to connect with people. One study shows that humans are 30 times more likely to laugh when in a group. Kids between 2 and 4 years old were found to be eight times more likely to laugh at a cartoon when they watched it with another child than when they watched it alone. All societies laugh, albeit for different reasons. The tale of the flatulent hippopotamus at a head-shrinking ritual would likely only be funny to a select few (aka “You had to be there!). Even apes laugh, as reported by scientists who have gone out into the jungle expressly to tickle them. Laughing is healthy, normal, relieves stress, and is probably great for the cardiovascular system. 

Why was Harvey's joke about the monkey and the aardvark so funny? No one ever found out because the pharmacist could never finish the joke without laughing so hard that he was forced to change his underwear.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.


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