The sound of laughter cascaded down the halls of the University of Maryland Medical Center. It's a sound not heard all that often in hospitals, and a clown from the Ringling Bros. and Barnum & Bailey Circus was there trying to make sure it would be heard again.
The laughter arose from the antics of David Larible, a headlining clown who was giving a seminar on humor to a group of doctors, medical students and nurses, most from the hospital's pediatric department.
"With children, it is no good to approach them too directly, to go up like this -- 'Hey, how are you?' -- trying to be funny," Mr. Larible said, assisted in his demonstration by April Buracker, a young patient hospitalized for a perforated eardrum.
"You have to be cool. Just be funny for yourself, and the child will appreciate it more."
Mr. Larible then demonstrated how to make a comic routine out of trying to put on a medical coat, looking like Groucho Marx as Dr. Quackenbush in "A Day at the Races." He stretched a rubber glove and pretended to snap it back in his face. An oxygen mask and tube became an elephant's nose.
"Everybody expects you to put these on like this," he said, a stethoscope properly fitted in his ears. "Why not do it like this?" he suggested, sticking it on his nose.
Though simple slapstick, his routines had the audience roaring. In the skilled hands of Mr. Larible, 33, they became masterpieces of timing and surprise.
He came to the seminar in full make-up and regalia, but advised against the doctors putting on a clown's nose.
"As soon as you do that, they expect you to be funny," he said. "It is better if the humor is not expected."
Mr. Larible was visiting at the request of Judy Goldblum-Carlton, a volunteer working at the hospital as a humor therapist.
"We gave him these props two weeks ago," she said of the medical devices with which Mr. Larible created laughter. "He said that he's been living with them ever since."
Michael Berman, clinical chief of the hospital's pediatric department, pointed out that most patients in pediatric units these days are quite sick.
"About 70 percent of our beds are intensive care," he said. "A few years ago, we might have had only three or four. But that's the nature of hospitals like this these days."
Laughter is welcome, he said. "There is more than anecdotal evidence to show that humor can aid in the healing process, though it has not been scientifically proven.
"But it can help with burnout, of doctors and nurses, and patients and their parents."
"I think there's a clown within all of us," Mr. Larible said of the challenge of turning dour physicians into comedians. "Everybody likes to be funny sometime. When you do things that make everybody laugh, you feel good because you have given something to other people."
Mr. Larible had April raise her hand and, imitating the serious mien of a doctor, told her to stretch out her fingers and then start moving them in and out. With that, he took off his coat and turned around so that she was scratching his back.
"It is always better to make a joke on yourself. It's much more funny than making fun of the other guy," he said.
"I think it's important with kids to let them know you have a sense of humor. You just have to let your clown come out."