Music in Medicine

Modern hospitals are so different in organization and equipment from what they were a century ago, that it may be said that the hospital is a recently acquired phase of community life. Originally, the sick were treated in their own homes. The inconveniences and inadequacies of caring for the seriously, and especially the contagiously, ill at home led to the development of hospitals. The primary purpose of the hospital has not changed, and the musical aide must never forget that medical care and rest come before all else.

Some bed patients are too ill to listen to music. It is possible that judiciously offered music might be of value to all patients but it is safer to deny a few in the absence of expert medical guidance than to disturb the sick. The musical aide may not question the wisdom of the physician in prohibiting the use of music in some wards or for some patients. The physician knows many things about the patient which are unknown to the musician and there is insufficient time to explain these to the musician. In institutions where the public-address system distributes music through ear-phones rather than through loud speakers, listening presents no problem and head-phones are not supplied to patients until the physician permits it. When only loud speakers are available, and the ward houses a mixture of seriously ill and convalescent patients (as is fairly common in large public hospitals) it may be necessary to deprive the ward of music for the sake of the few who should not have it.

The number of possibilities which may be found on any one ward is so great that only the most general kinds of use will be mentioned. Pediatric wards are frequently arranged so that the acutely ill are segregated, and this permits ward music at most times. Where patients are intermixed, the attending physician will make the decision. The importance of scheduling for children is enhanced by the fact that most children prefer their music loud, and this can be especially annoying to the sicker children. As a general rule it might be stated that with the progress from childhood to old age, the preference shifts from fast loud high-pitched music to softer and slower music. The speaker volume on the pediatric ward may be increased to gain the attention of some children, and drown out the crying of others. Children can listen to the same set of records almost endlessly. They prefer to hear music with which they are acquainted. They like songs with words.

One reason for hospitalization is to get the patient away from the annoyances and noises of home. One of the modern noises is the radio. Most patients sleep and need more sleep than well people. In most hospitals certain hours of the day are chosen for rest in the hope that the patients will fall asleep. The usual period for daytime slumber is directly after lunch. The filling of the stomach is in itself a soporific. Warmth, darkness, and physical relaxation increase the tendency to sleep. Since there is no universally sleep-inducing music, music should be avoided at this time. It may keep some awake. If the patient is in a private room and is willing to be played to sleep it should be attempted. It must be remembered that if the music is sufficiently interesting or if the reproduction is poor or scratchy it may prolong wakefulness or even prevent sleep.

At those times when slumber music is requested by the physician or the patient, a few common sense rules should be followed. For children vocal lullabies should be tried. Slumber music should not be played for more than fifteen minutes. If it has not been effective in that period, silence is indicated.

Admission to a hospital usually means new eating and sleeping habits for the patient. The hours for each are frequently earlier than previously. Day-time naps and early “lights out” make it difficult for some to fall asleep promptly at night for the first few nights. Slumber music should take the form of restful music. The final fifteen minutes of the day should be given over to sweet melodies of old time favorites which may recall old pleasant memories and possibly place the patient in a “dreamy” mood of relaxation removed from the specious present and its worries. The operator of the sound control should gradually and imperceptibly reduce the volume so that the final moments are barely audible.

In hospitals equipped with “radio-pillows” in which telephones are concealed within the pillows, the music may remain continuous until the patient falls asleep. Many people have developed the habit of falling asleep to radio music or turning it off when they become sleepy. Radio programs are not recommended as slumber music. The musical program should use the old favorites or meal-time music selections (See Chapter VI) at a very low volume. Loud and stirring music before bed-time has been known to result in vivid auditory dreams, and should be avoided.[24]

The Bedside Radio

More than any other single factor, the radio has increased musical knowledge and appreciation in this country. The programs of Bing Crosby and Alec Templeton have great popular appeal because of the extensive preparation, humor, and showmanship contained in them. Yet these programs never fail to include classical music, and introduce serious music to those who would not freely choose to listen to it. But more than any other single factor, the improper use of the bedside radio can make patients hate music. The most passionate lovers of music will admit that it is possible to have too much music of the same kind for peaceful consumption. In hospitals with large wards, two or more radios may be found tuned in to different programs, and the desire to share the program with others means excessive volume. In those institutions which do not possess a public address system radios should be permitted on the wards but certain rules should be observed. The volume should be controlled so that patients who are not interested do not have to suffer. The volume should be one that makes the signal just audible to the owner and to those of his neighbors who wish to listen. For several hours of the day interludes of silence should be observed by all owners of radios. In hospitals with a loud-speaker system, all radios should be turned off during the hours of its operation.

In hospitals for the chronically ill, such as tuberculosis sanatoria, where the musical tastes on the ward may run a wide gamut, a schedule should be arranged for those possessing radios, allotting certain periods of the day to each owner and arranging the sound distribution so that two or more radios may be turned on simultaneously but spaced so far apart that the resulting sound will not result in a form of punishment for those caught in between or not fortunate enough to own their own radios.

After “lights out” radios frequently remain on unless supervision is severe. It is true that many of the better programs are heard after nine o’clock. Since some of the late programs are part of American life, it is unfair to the chronically ill to deprive them of this well planned entertainment. Yet there will be some on the ward who will want to sleep, and they should be given maximum consideration. Others should be permitted to keep their radios on at the lowest possible volume, and the possibility of headphone installations should be reviewed. The solution to this problem is possible but expensive. If a record-cutting device is available, the program may be recorded at night and replayed on the following day.

Public Address System

Many hospitals have already been equipped with either loud-speaker or headphone installations. For those hospitals which are still in the deciding stage, some of the advantages of each will be briefly considered.

Ideally, both speakers and head-phones should be available. This is a luxury in which few will be willing or able to indulge. When head-phones are used, they have a way of getting misplaced, broken or broken-down. Head-phones or listening devices are usually distributed to those patients who are medically eligible. Frequently the attendants are busy and forget to supply them, to the chagrin of the patient. When there are not enough to go around a further source of dissatisfaction arises. Head-phones must be adjusted for proper reception and comfort, and this may become a source of bother to patients or staff. Among the advantages of ’phones are the quietness of wards at all times for those who desire rest. Their use permits maximum focusing of attention on the music because of the exclusion of most other sounds. They become a mechanism of escape from the unwanted conversation of noisome neighbors. When double-jacks or two-channel wiring is used the patient is permitted some choice in music selection. The use of ’phones, however, limits the physical excursion of the ambulatory patient.

The use of a loud-speaker system permits those patients not strictly confined to their beds to visit other parts of the ward without interruption in their listening. Some patients enjoy music as a background to conversation or ward activities. The same switchboard may be used for musical programs and hospital announcements, and this may be desirable economically in some institutions. Strategically placed speakers may be channeled exclusively as a call system.

Laughter is a communal reaction. We rarely react completely to a radio joke if we are listening alone, but if several people listen simultaneously laughter becomes more pronounced and prolonged. Loud-speaker systems permit patients on the ward to enjoy music as a group. They also permit the greater use of background music. Eating with the encumbrance of head-phones is not desirable.

Each hospital will have to weigh these and other arguments of the speaker-phone dilemma and choose according to its individual requirements.

The most suitable number of channels for a small hospital is two. One operator can readily handle two channels. When the number of channels is increased above this the expense of installation and operation will increase, especially if recordings or transcriptions are to be used in addition to outside programs.

The operator of the public address system should be conversant with the Hooper or Crossley ratings of the more important programs and be certain to include the most popular at any one hour in re-broadcast.

Personalized Music

The more musically inclined or susceptible patient may not be satisfied with the routine musical program as furnished by the public address system or even his radio. In hospitals where the majority taste is for modern popular music, there will be a few who will hunger for classical. If a musical aide is available this may be accomplished by the use of a music cart. A box-like device on wheels such as is used for many purposes on hospital wards may be fitted with a record player and a rack for records and record albums. The music cart may carry some small instruments and other materials for bedside use. Music can be wheeled to the bedside for instruction, appreciation, diversion, or entertainment.

Instruction. Bedside instruction may be used as occupational therapy or for purely educational purposes. Small instruments such as the ukelele, mandolin, or even the guitar may be taught to the bed patient as upper extremity exercise. Instrumental instruction will usually have to be limited to patients in individual rooms. Occasionally wards will be arranged so that a day-room or sun porch is available for wheel chair or partially restricted patients, and there will be times when the patient may receive instruction there. There are some instruments which may be played with a minimum of instruction. Unfortunately most of these emit sounds which are quite annoying to all but the performer. The ocarina and harmonica may meet with some acceptance among young patients, but when older patients share the ward or adjoining room their feelings will have to come first. Some young patients will delight in the use of drum sticks on practice blocks, especially if they can use them during the reproduction of music on the public address system or the radio. If the block is made of rubber or some other noiseless material it will not be too annoying to neighboring patients.

Specially constructed “toneless” or “practice” instruments such as the violin without the resonator are of genuine value in diminishing neighbor annoyance. These may be built in the occupational therapy shop from discarded instruments.

Diversion. For those who desire diversion and music appreciation, the music aide may wheel the music cart to the bedside. By ascertaining the musical appetite of patients on the preceding day, the aide may stock the cart with the kind of recordings desired and play them for the interested patient and any of the neighboring patients whose interest she can stimulate. By making a few well chosen remarks before each record is played much interest can be developed and the patient will look forward to future visits. If patients express no special interest in music, albums may be passed out for browsing and played without predetermined continuity. If interest is greatly aroused the music aide may suggest supplemental reading and call on the librarian to visit the patient or supply some reading material from the music department collection. The commercially available program notes for sponsored radio programs should also be distributed.

Entertainment. Musical entertainment on the ward may take the form of patient participation or “live” music. For patient participation, there is nothing to equal ward sings. The music aide may use either the record-player in the music cart or, preferably, a portable instrument such as a small piano organ, or accordion. The words of the songs may be mimeographed or flashed on a screen, wall, or ceiling with a small projector. Hymn books or other books of songs may also be used to advantage. Songs should be chosen for their popularity and familiarity. Such songs as “Let Me Call You Sweetheart” and other old favorites are “sure fire”. The top songs on the “Hit Parade” are always enjoyed. The music aide should circulate if recorded music is used to stimulate non-participants into singing. The session should last from twenty to thirty minutes. It is desirable to have two of these per ward each week. Duration and frequency can be varied according to patient response.

Of all forms of ward music, good “live” music is perhaps the most entertaining. Ensembles may be of fair quality but soloists must not be mediocre or the presentation will suffer. The most popular entertainers are the singers who can accompany themselves on the portable piano or other instruments. They should keep the program at the popular-appeal level. They should not ask for requests unless their repertoire is adequate since the inability to grant them is both disappointing and embarrassing to both performer and patients.

Volunteers. It will be difficult for one music aide to carry out a music program by himself in a hospital of more than 500 beds. If the budget does not permit a second aide volunteers from the community should be enlisted to assist. This subject will be discussed further in the next chapter.