Music in Medicine

The average mind is incapable of engaging effectively in two thought processes simultaneously, but it can in the course of daily routine accept a multitude of mental stimuli at any one moment. If one of these stimuli is sound, it may be the natural complement to the visual experience without which a feeling of incompleteness may result. The observer at the sea-side is intrigued by the cyclic rolling of the waves, and the periodic crashing of the breakers is an integral part of the pleasure of watching waves. Yet, that same series of sounds might be very disturbing to the same person who is trying to work out his income tax return in the quiet of his study. The importance of complementary sound becomes more apparent when one studies the reaction of an audience attending the “movies” during periods of faulty mechanical silence. Sound as a background to mental or physiologic processes may be natural or undesirable but can be very important. If carefully selected, there are few situations in which music cannot be used advantageously as a background to improve the quality or pleasure of activities and living.

At this point it must be repeated that the importance of music in the lives of people is not uniform and that, for those few who dislike music, background music is not recommended.

Background music, as its name implies, is always secondary to some other activity. Only those phases of the subject which touch upon hospital life will be discussed here, and they are, in order of importance: the music which accompanies meals, painful procedures, calisthenics, and work. Inasmuch as the latter two are not encountered in all hospitals they will be given only brief consideration. The subject of mealtime music is of sufficient importance to be treated at length and will be discussed in the following chapter.

Counter-irritation is a very old method of treating pain. For painful conditions where specific relief can be given in no other manner, physicians did and still do try to distract the mind from the site and severity of the pain by transferring attention to another area. This can be accomplished by irritating the skin over the affected area in the hope that the resultant inflammation will be more superficial and visible and in that way neutralize the pain. In a less physical sense people “take their mind off” unpleasant subjects by exposure to humor or other forms of entertainment. Avicenna, the great Bagdad physician (980-1037 A.D.) included in his Canons of Medicine[37] the following suggestions:

Music has been used against pain for centuries not only by musicians and physicians, but by the people. We find this practice referred to in a letter from Maria Cosway to Thomas Jefferson concerning his recently sprained wrist:

In 1915 two surgeons named Burdick and Kane used music as a diversion during local anesthesia. They ascertained the musical preference of the patient prior to operation and played recorded music in muffled tones during the operation. Later they played music in an adjacent room while general anesthesia was being induced and found that it was accomplished with less resistance[32]. Since that time other surgeons have used music for similar purposes. There are some operations which are done under local anesthesia and are prolonged. The absence of sounds other than awe-inspiring whispers, or the presence of technical talk may cause the patient unnecessary alarm.

The use of well selected music or a good radio program may be of great benefit in the operating room. Its value will depend upon the operating surgeon and how well he can operate while music is being played. There are times during an operation when delicate maneuvers become trying and the wrong music or increased volume might lead to exasperation. One advocate of music in the operating room has called it a “psychic anesthetic”[53].

The use of local anesthetics in dentistry has made possible the painless extraction of teeth. Most dentists, however, do not inject local anesthetics before drilling cavities. For many people, drilling is a frightful experience. Some dentists have advocated the playing of music at a loud level during this procedure. Still another has incorporated ear-phones into the head rest of the dental chair for diversional sound.

A more obvious use of diversional sound in the professional office is in the reception or waiting room to supplement the magazines and diminish the terror of waiting. Music may also be used during such time-consuming treatment as physical therapy, deep x-ray therapy, and fever-therapy.

Physical Exercise

Some forms of physical exercise are carried out most successfully when accompanied by music. Plato recommended such a practice in his Republic. In the ancient triremes or boats with three banks of oars, there was always a tibicen or flute player, not only to keep uniform rhythm among the workmen, but to sooth and cheer them. From this custom Quintillian took occasion to say that music enables us more patiently to support toil and labor[15].

During the Six-Day Bicycle Race at the Madison Square Garden in 1911 forty-six mile races were separately timed on three evenings; half were ridden to music. The average time with music was 19.6 miles per hour, and without it only 17.9[5].

Tarchanoff found that

Such an observation leaves little doubt that physical endeavor is more productive when done to music.

Calisthenics. This is not the place to discuss the value of calisthenics or its use in hospitals. Exercise has come to be considered the important physical conditioner, and calisthenics is the universally practiced exercise. Its proper performance will depend upon the ability of the leader, the willingness of the participants and the ingenuity expended to make it interesting. The willingness of the group can be enhanced by large numbers of performers, but under any circumstances, since it is unproductive and involves work, any adjunct which will increase interest is welcome. The exponents of both the Swedish and the German systems of calisthenics claim equally good results, but the former do not use any musical accompaniment, whereas some schools in Germany, particularly the one at Hellerau, make extensive use of it. In fact, Dalcroze and his followers have built an entire philosophy of esthetics called “Eurhythmics” based upon the relationship between body motion and music.

Unproductive exercise can undoubtedly be made more interesting by musical accompaniment. Music can regulate the orderliness of action by relating the sense of hearing to the sense of muscular movement.

Johnson[51] believed that the strength of muscle contraction increases with the intensity and pitch of accompanying music, and that the point of fatigue is postponed when calisthenics is given to music, but that unsteadiness might result from variation in the musical score. Anything that will divert the attention from the proper execution of the exercise is a hindrance, and music should not be used until the exercise has become thoroughly mastered. Once the exercise has become second nature, music becomes very useful because it acts as a stimulus and adds interest.

It is difficult to move rhythmically out of time with the music. Most popular recorded music is in a tempo too rapid to be satisfactory for calisthenics. For this reason live music is far more satisfactory as an accompaniment, and a single instrument, preferably the piano, is most suited to it. The pianist can take the cue from the exercise leader for tempo. The piano should be played in a steady unvarying rhythmic style. Well known tunes and folk-songs should be used. The piano must be played loud and with strongly accentuated rhythm. Hulbert[49] relied largely on waltzes, marches, and folk-songs played slowly. The songs he used to advantage include “Believe Me If All Those Endearing Young Charms,” “Bonnie Dundee” and “O No, John.” In this country such songs as “The Skater’s Waltz” and “There’s a Long, Long Trail A Winding” are popular for this use.

Ideally, live music should be used to accompany exercise so that the tempo can be readily adjusted to the speed of the participants. If commercial recordings must be used they should be carefully selected to rule out those containing vocal or other interludes which break up the continuity of the rhythmic pattern, and the operator should silence the machine between successive exercises.

The use of music during exercises will depend upon the value attached to it by the instructor. Some may find the time and trouble required unwarranted. Others may find in it a way to get better co-operation or increased pleasure. There is one use of music in connection with group exercise which is strongly recommended. Preceding the actual period of exercise the playing of a stirring march, while the participants march to their places of assembly, acts as a stimulant and conditioner for the activity to follow.

Remedial Exercise and Dancing

When one or more groups of muscles have become weakened as a result of misuse or disease, it is proper to engage them in strengthening gymnastics called remedial exercises. Although these can frequently be given to groups, the groups are ordinarily small. The nature of these exercises and their administration may lead to boredom rapidly. Soft music can be used as an antidote to their monotony. Those exercises for the correction of spinal deformity which require crawling and free swinging are well adapted to musical accompaniment, and exercise in the form of the dance used for correction or maintenance of good posture is undoubtedly enhanced by background music.

Although not in common use for such purpose, ballroom and tap-dancing could be used to advantage in selected groups of patients for the improvement of disabilities of the ankles, knees and hips. Modern or interpretative dancing may in like manner be used for upper extremity strengthening and co-ordination.

Shop Work

In those hospitals which possess an occupational therapy shop, music may be used to increase the pleasantness of the surroundings and possibly to increase the endurance and efficiency of work projects.

Music is not recommended as a background to work which requires mental concentration, even though it is used by a great many students who believe that they can do their home-work better with the radio on. If the melody is too interesting or too popular at the time, it may be distracting, but where the work is largely physical, soft music has been shown to be a desirable adjuvant. Gatewood[33] studied the effect of background music on workers in an architectural drafting room and discovered that although a minority found it distracting, most of the workers worked better and faster. They preferred familiar music and found instrumental music less distracting than vocal renditions.

More recently this subject has received the attention of many investigators who have shown its value among factory workers and have called it “Industrial Music.”[III.] Their findings and conclusions are so closely allied with the use of background music that a few excerpts from the growing literature will be mentioned.

Beckett[9] analyzed the reports made by those factories which have been broadcasting music to their employes through public address systems. There was improved morale in every plant where the music lasted for at least one hour daily. Two-thirds of the factories which played music for at least one hour on each shift claimed an increase in production of from five to ten percent. Greater efficiency results from using music to relieve the boredom of repetitive operations, to reduce nervous tension, to take the worker’s mind off himself, and in general to make the shop a more attractive place in which to work. He finds the evidence undeniable that music can increase production, but points out that this result will depend upon how the project is managed. If the acoustics or mechanical reproduction is poor, the value of music may be lost. The most important short-coming at present is the difficulty in obtaining suitable commercial recordings. Because of the noise in the average plant, the volume of the music must be slightly greater than that produced by the machines. But the average recording has such fluctuations in volume that some parts will be drowned out by the hum of the work and other sections will be too loud. Ideally, recordings for industrial music should vary only slightly in volume, from “plus or minus two decibels of tone intensity”, and these are not available in variety at present.

“The kind of music played is of paramount importance, but no one type of music can be used exclusively without becoming a bore to the listener. When request boxes are installed, it is often the young and enthusiastic ‘jive fans’ who use them to the fullest, while the more conservative music lovers usually sit back and take what comes. Sometimes this has led to the mistaken view that the whole plant desired the more raucous music. After a trial of this type of music some firms received unfavorable reports on production and lost faith in music. In some instances music was then abandoned altogether, whereupon there was such an outcry from the workers that the program was reinstated with hot swing entirely eliminated. Both extremes are bad. Giving the workers what they want is a more difficult problem than it appears at first. It requires not one but a number of questionnaires over a period of time to keep up with changing tastes.”

“Music must be played at the right time to obtain the best results. Marches create a cheerful atmosphere and should be played at the beginning of sessions, as well as at the end. The best time of the day for Strauss waltzes is at the so-called ‘fatigue periods.’ There is something about three-quarter time that is very refreshing at moments of fatigue. Besides the music is gay and light-hearted, and leads all other forms in popular appeal according to questionnaires filled in at three large plants.”

In the hospital occupational therapy shop, music may originate from the public address system, a record player, or the radio. It would seem that the most suitable in the average hospital would be the use of the radio, which the therapist can change at intervals of fifteen minutes or longer in an attempt to get unexciting music at a low volume level.