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However, laughter is no joke—dangers include syncope, cardiac and oesophageal rupture, and protrusion of abdominal hernias (from side splitting laughter or laughing fit to burst), asthma attacks, interlobular emphysema, cataplexy, headaches, jaw dislocation, and stress incontinence (from laughing like a drain).
By contrast, failure to laugh is an important sign of intra-abdominal infection in children.67 Laughter is an unusual precipitant of Boerhaave’s syndrome, spontaneous oesophageal perforation.68Laughing like a drain can cause stress incontinence.71 It can also cause “enuresis risoria” (“giggle micturition” or “giggle incontinence”),72 73 a consequence of uncontrolled detrusor contraction induced by laughing, for which methylphenidate has been advocated.74We limited our search to “laugh$,” and did not explicitly seek cacchinations, cackles, chortles, chuckles, giggles, grins, guffaws, smiles, smirks, sneers, sniggers, teehees, or titters; we also ignored sources of laughter (comedy, drollery, humour, jest, jocularity, whimsy, wit, and wisecracks).
Laughter can increase pain thresholds,10 although hospital clowns had no discernible effect on distress in children undergoing minor surgery.11 Perhaps surgical patients derive no advantage from being in stitches.
The presumed positive effects of laughter on wellbeing have been harnessed in serious mental disorders, without much evidence of benefit.12 13 14Some psychoanalysts believe that a joke can substitute for interpretation—provided that the patient appreciates the joke.
His saucy jokes were a recipe for success— the pregnancy rate was 36% in those whom he entertained compared with 20% in the controls (adjusted odds ratio 2.67; 95% confidence interval 1.36 to 5.24).25 Clowning may cost effectively vitiate Lord Chesterfield’s last proposition.
Laughter has no consistent effect on immune functions, such as the activity of natural killer cells.27 28 Work on how laughter affects Ig E production by seminal cells in atopic eczema29 has sown the seeds for further studies.