Op-Med is a collection of original articles contributed by Doximity members.

Humor, I believe, can be distilled down to two basic elements: spontaneity and intentionality. We’ve all encountered instances in our daily lives when something, regardless of our background, perspective, or point of view is just plain funny. The beauty and joy of spontaneous humor is that it transcends cultural barriers and differences and, in the moment of shared laughter, a bond, however brief, is formed. 

Intended humor is the staple of shared jokes and stand-up comics. Most are familiar with it. Few, however, are aware of the intended humor embedded in our corner of the world: medical literature. Certainly the layperson is unaware of it, and I venture to say that most of the medical world is as well.

Waldo E. Nelson, MD is oftentimes referred to as the Father of Pediatrics. The classic textbook “Nelson’s Pediatrics” bears his name, and he served as its editor for many years. Not only was he the Father of Pediatrics, he was also the father of three, including a clever and mischievous daughter. The preparation of the manuscripts for the sixth and seventh editions was an entire family affair; all three children were tasked with assisting in polishing the final manuscripts and, during the collating of the index, Nelson’s youngest daughter, Ann, slipped the following reference into the index: Birds, for the 1-1,413. 

Before the sixth edition went to press, the editor at Saunders detected the hoax and extracted it. A few years later, in the subsequent seventh edition (1959), he had a change of heart; he relented and made the decision to include the avian reference in the index. After the seventh edition’s release, the insertion was quickly noted and its notoriety spread. Dr. Nelson’s eldest daughter, Jane, fondly recalls her absolute astonishment upon hearing a CBS radio news announcer tell his listeners about the prank. (1)

In 1976, the 15th edition of “Williams Obstetrics” was published. Its senior author and editor was Jack Prichard, MD, chairman of ob/gyn at Parkland Hospital in Dallas. Signe Prichard, Jack’s wife, assisted her husband in many ways. She put out fires wherever and whenever needed and she was a trusted friend to all of the residents in the department. Further, she was solely responsible for collating the index — and there is little doubt she was endowed with a very creative wit. In an action that also attests to an independent streak, she slipped into the index, between Chancroid and Chemotherapy: Chauvinism, variable amounts, 1-923. Elsewhere in the index of the 15th edition, there is also reference to: Bullet, bite the, 826. On page 826 one finds a radiographic image (kidney, ureter, and bladder X-ray) of a pregnant woman with a bullet, presumably lodged in the uterus. The referenced article relates the patient’s clinical course following a gunshot. At the time of laparotomy, an entry wound in the uterus was noted, but no exit wound. A cesarean delivery was performed and an uninjured healthy fetus was delivered, … but no bullet was encountered. Only after X-raying the newborn fetus was it discovered that the bullet had been swallowed in-utero by the fetus! (2)

The 16th edition (1980) of “Williams Obstetrics” was the last to insert frivolity into the index, wherein the following entries, also products of Signe Prichard’s fertile mind, can be found: Eyes, of Texas are upon you, 1-1102 and Labor, of love, hardly a 1-1102. (3)

Similarly, the “Harriet Lane Handbook” is a must-have for pediatricians and pediatric residents. Published since the 1960s, each edition is edited by the pediatric chief residents of Johns Hopkins Hospital. As the story goes, during a late-night editing session Jerry Winkelstein, MD, the editor of the fifth edition (1969), inserted into the section on lab values the following reference: *Porcelain 8-20 meq/L. (4) This reference to “crack pots” remained mostly unchanged until the 15th edition, at which time the editors, Drs. George Siberry and Robert Iannone, extended the prank. Upon looking up “Porcelain,” the reader is referred to a table listing the appropriate lab values. Siberry and Lannone then introduced a two-pronged prank. The lab values were listed as: Porcelain (12) 0.52-1.94mg/dL (conventional units) / 0.32-9.93mmol/L (SI units). The reference values actually correspond to the editors’ respective wedding anniversaries, May 21, 1994 and March 29, 1993. The second prong of the prank is found in the 12th footnote, a shrewd and humorous fictitious reference that reads: 12. Iannone P, Reddy U, Siberry V, Siberry V. Surviving pediatric chief residency at Hopkins. Patience and virtue. 1998-1999, Baltimore and Wilmington, DE.

In the 13th edition, editor Kevin Johnson slipped the following loop into the index: Johnson, Kevin and Charlmain (see Newlyweds). And, when looking up Newlyweds, one finds: Newlyweds (see Johnson, Kevin and Charlmain). Subsequent editors of the “Harriet Lane Handbook” have continued these insertions acknowledging and honoring their spouses and children into the indices with insertions of birth dates following their names. The first such insertion can be found in the 1972 sixth edition (edited by Dr. Winkelstein) honoring Beth, 1971.

In the early 2000s, one would be hard pressed to find a medical student or resident without a copy of a Tarascon Pocket Pharmacopoeia in the pocket of their white coat. Not only does this handy guide contain a treasure trove of pharmacologic facts, within its pages are also embedded several humorous insertions (some of which are presented) that vary from one edition to the next. On the title page of the 2002 Classic edition, the following line from the 1980 movie “Airplane!” is found: A hospital is a big building with patients, but that’s not important now. Elsewhere, the well-known dermatome man has a toe tag attached to the right big toe. In a subsequent edition, the dermatome man sports a disconjugate gaze; in another, the “Q” sign first described in the satirical novel, “The House of God.” Finally, in the “Important Caution” section of the 2002 edition, the following disclaimer reads: This book is not meant to be a replacement for training, experience, continuing medical education, studying the latest drug prescribing literature, raw intelligence, good looks, or common sense.

At the dawn of the 21st century, the surgical world was applying laparoscopic techniques to seemingly everything. In the January 2000 issue of the journal “Obstetrics and Gynecology,” Mack Barham, a general ob/gyn from Monroe, Louisiana submitted a satirical article for publication entitled, “Laparoscopic Vaginal Delivery: Report of a Case, Literature Review and Discussion.” Roy Pitkin, MD, the journal’s editor at the time, clearly thought including Dr. Barham’s article as an “After Office Hours” piece would sufficiently indicate its satirical nature — but not all of the readers saw it as satire. Subsequent to the article’s publication, Dr. Barham was invited to a European conference to present his “new technique.” One U.S. researcher (in a letter to the editor that was not published) took Dr. Barham to task for embarking on such a risky procedure without IRB approval or the benefit of a clinical trial. 

How is this bit of history relevant today? Personally, in these times of pandemic-infused change and sociopolitical upheaval, I suspect it's a good idea for us all to take the time to observe and appreciate the lighthearted aspects of our lives and, perhaps, do our share of infusing a bit of humor into a world that is in dire need. Dr. Barham did not miss the mark when, in response to a published letter to the editor regarding his article he wrote, “… operating on the funny bone is perhaps the most difficult surgery of all.”

Have you encountered hidden humor in the course of your medical practice? Share your discoveries in the comments! 

Lloyd Holm is a retired obstetrician who lives in Cottage Grove, MN with his wife Gretchen. He has authored two novels and a children’s book and his writings have appeared in the Omaha World Herald, The Female Patient, Iowa Medicine, Contemporary OB/GYN, Hospital Drive, the American Journal of Obstetrics and Gynecology, and Obstetrics and Gynecology. While a member of the teaching faculty at the University of Nebraska Medical Center in Omaha, he received the Dean's Award for Excellence in Clinical Education and The Hirschmann Golden Apple Award. Dr. Holm is a 2021–2022 Doximity Op-Med Fellow.

Dr. Holm would like to thank all those who have been so generous with their time and willingness to assist him in documenting the history shared in this Op-Med, especially Jane N. Beatty, Dr. Jerry Winkelstein, Dr. Mack Barham, and Dr. Barbara Hoffman.

References

1) Personal correspondence with Jane N. Beatty, eldest daughter of Waldo Nelson, MD.

2) Obstet Gynecol 1969,33:673.

3) Personal correspondence with Barbara Hoffman, MD, co-editor of “Williams Obstetrics.”

4) Personal correspondence with Drs. Winkelstein, Siberry, and Nechyba.

Image by cosmaa / Getty

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