Music in Medicine

A program of musical entertainment is not needed at all hospitals, nor for all patients. Entertainment is relatively new in hospitals. A need for it arose when hospitals for the chronically ill became greater in numbers and size. The average person soon becomes bored when restricted to bed or even the confining walls of an institution. Reading becomes tiresome for most because of position, eye-strain, or satiation. Similar limitations exist to a lesser degree for craftwork. There is a diminution in contact with the outside world except for the too infrequent and short visits of friends or relatives. In hospitals for the tuberculous adult or the crippled child, the average duration of hospitalization may be a year. Few leave before a period of three months and some remain for years. Life for the chronically hospitalized patient may become more monotonous than is wise. Monotony leads to discontent, irritability, apathy, and possibly disciplinary problems. Monotony may make meals even less attractive than they are in some hospitals. Lack of mental occupation may lead to a loss of desire to get well or give the patient too much time to think about himself, his helplessness and hopelessness. Most patients arrive at the point where they crave amusement, and most of them would rather be amused than work for their own entertainment.

In the field of entertainment, music is indispensable. In hospitals, music is frequently the only form of entertainment. Music can be used at the bedside, in the ward, the assembly hall, or when weather permits, outdoors. In hospitals equipped with public address systems the problem is decreased by the simultaneous performance of mechanically reproduced music throughout the wards and rooms of the hospital. Where public address systems have not been installed, entertainment will depend largely on radios, record reproducers, and personal appearances of musicians.

“Live” musicians are the most welcome source of entertainment. If the hospital has a music aide, this aim is partially fulfilled by his activities. If there is no full time musician, hospitals may be able to secure the part-time services of a musician or recreational aide. Some one person should have control of arranging programs, and an interested person will usually be found on the hospital staff. It may be an occupational therapist, a nurse, or even one of the physicians. The person selected to direct music will have little difficulty in finding in the community some musicians or groups of amateur entertainers who will be willing to assist in this work. Groups from schools of music, high schools, fraternal or benevolent organizations, women’s clubs, music clubs and veteran’s societies constitute an incomplete list of sources. Most communities have soloists or small groups which will be willing to perform. Direct solicitation by the hospital director, the ladies auxiliary, or members of the staff should be made personally or through the press.

A schedule of performances arranged for at least one month in advance is most important. There should be a regularity to performances even if they occur only once a month. It will give patients something to which they may look forward with the pleasure of anticipation. Whenever possible, musical programs should be prepared for the same weekday or night. These appearances should be announced or posted to increase the interest.

In hospitals for the chronically ill there is usually an assembly hall or recreational building, where entertainment may be given for ambulatory patients. The appearance of famous musicians on its stage will be rare or impossible, especially in hospitals not located near large cities. This is not as unfortunate as might be believed, because although some patients are impressed with names of national reputation, maximum enjoyment will result for the majority from listening to their fellow patients performing. Patient participation is always more desirable for the ambulatory than passive entertainment. Patient music may take one of three forms—formal, amateur, or spontaneous.

Formal presentations require much work on the part of the musical aide and the patients. Orchestras of variable size may be formed, depending upon the number and variety of talented patients. Inasmuch as quality of performance is the prime consideration, the repertoire of such groups will not be great. At the outset it will take almost a month to develop a one hour variety program. With the progress of time and increased work and co-operation it should be possible to rehearse enough new numbers each week to produce a weekly program with too few repetitions to arouse complaints on the part of the patients. The program should contain all types of music so that during the course of a performance almost everyone in the audience will have heard something to his taste. Vocal numbers are welcome and audience participation at one or two points will sustain interest. It is advisable for some one to act as master of ceremonies to announce selections and to evoke maximum response from the non-participating patients. There is usually one patient with a desire to be a master of ceremonies and, if he executes his work well, this will be a valuable asset to the project. A master of ceremonies is important and if necessary an outsider should be secured for this purpose.

Amateur programs have been present on the American scene for a long time but the efforts of Major Bowes have made them an American institution. People of almost all ages will attend them joyfully, but the performers will usually be in the second and third quarters of life’s span. There was a time when amateur performances were unrehearsed or sounded so. Major Bowes has changed that, too. The amateur show will now be found to demand rehearsals, expert accompaniment, and a certain amount of theatrical display. These factors should be encouraged and the music aide will do well to humor patients along, because success depends upon the seriousness, energy, and efforts of the performer. Care should be expended in careful programming. The best performers should be well spaced and appear in the second half of the program. Instrumentalists should be separated by vocalists. The procedure should follow the set pattern of regular amateur shows, including the award of prizes to the winner and second best. Where patient turn-over is slow, it is likely that the same performer may be first too often. Some limit should be set on the frequency or total number of times the same patient may receive an award to prevent participation from diminishing.

Spontaneous shows in the recreation hall will consist of community singing, humming, whistling, and occasional rhythmic hand-clapping. It is not difficult to get a group to sing but maximum response will call for ingenuity on the part of the leader. The series of motion picture shorts called “The Bouncing Ball”, “Community Sing”, and others of a similar nature are excellent because they are complete packages of music, words, direction, humor, and tricks. The song leader should adopt as many of the novelties included in these films as the facilities will allow. Next best to the motion picture is the lantern slide. There are a few available with humorous illustrations, but they may be difficult to obtain. Lantern slides may be made rapidly and inexpensively by the music aide. The makings of simple slides may be had in any large commercial photography supply shop. “Radio Mats” are slide-sized pieces of clear cellophane enclosed in a folded piece of carbon paper and surrounded by a black mask. The “Mat” is placed in a typewriter and the words of the song are typed on it. The carbonized paper is discarded, as is the back of the mask, and the cellophane with words imprinted is easily mounted between the two glass cover-slips joined by “Scotch Tape”. By this method a permanent slide may be produced for about eight cents. If a projector is not available, the words may be mimeographed, printed in the occupational therapy shop, or obtained commercially printed in pamphlet form. The salient need is that all may be permitted to read the words.

Community sings should not last too long. The music aide will soon learn to sense the capacity of the audience. To extend the period, patient participation may be interrupted by instrumental music or some other form of interlude.

Choir

Listening to a combination of trained voices is pleasurable to most people. Where the patient population is relatively static, the music aide will be well repaid by time spent on training quartettes or larger groups of singers. Such groups can be of value not only in any of the musical programs for the assembly hall but may be used on the wards, for religious services and on holiday occasions. If, as is usual, both sexes are represented among the patients, the range of selections will be limited only by the musicianship of the leader and the participants. The range of repertoire should be suited to all occasions and tastes from “barbershop” quartets to serious music.

All possible arrangements of voices should be exploited with a view to competitive singing between sexes and among wards. The range of usefulness of this activity will of course depend to a large extent on the size of the hospital and the predominant age group.

Diversion

Music may also be used to help time pass less noticeably. Listening is enjoyable but does not focus or sustain attention in any way comparable to playing. There will always be patients interested in learning to play music. The instrument of choice will depend upon individual taste, which of course is conditioned by background, education, nationality, age, and many other factors. The instruments which will be most acceptable are those which are not too difficult to play and which emit a pleasant sound with ease for a long period.

The piano is the instrument which best meets the qualifications of the ideal instrument for hospital use. When reduced to pure physics, the sound produced by striking a single note on the same keyboard will be of approximately the same quality whether made by a child or a virtuoso. This is not true of any other instruments, except to a degree in certain other percussion instruments, that produce less pleasant or interesting sounds. Piano fingering is more easily mastered than that of stringed instruments, and offers greater latitude in precision placement. The piano may be played in the restful sitting position and requires little effort to play. More people know how to play the piano than any other instrument. Patients may be interested in any of the other instruments, but with the exception of the plectrum type, may become too readily discouraged at the amount of practice required to elicit pleasant tones. If a patient is interested in learning an instrument for diversion, the piano should be the first offered. If the problem of replacing musicians in or completing a patient band arises, the missing instrument should be offered. But in order to get the maximum co-operation and application, the patient should be made to feel that the choice is his. The free choice might be vocal instruction. It may even be a disappointment to the musician when it turns out to be so-called instruments like the ocarina, but if the aim is diversion a maximum will be reached earliest by initial gratification. Perhaps at a later date the music aide may be able to inculcate enough sophistication to lead to the choice of a more musical instrument.

The scope of music as an educational diversion will expand in proportion to the training, patience and energy of the music aide. It will be limited by the number of patients who demonstrate an interest and also upon their intelligence and perseverance. For the major instruments, instruction is usually individual and much time is consumed in the diversion of a single patient. In a large hospital this will not be very practical unless there is a large staff, and there are many activities available to patients. Group diversion can be happily attained by some form of instruction in music appreciation. The nature of this instruction should be tailored to the intelligence and taste of the majority and the music aide must exercise common sense and free himself of prejudice. If the patients are young and uninterested in the classics he must devise a program around popular music and discuss current personalities and popular forms. A driving wedge into the classics may be constructed on the classic themes of Tschaikowsky, Chopin and others which are currently popular. If the group is very young, music appreciation demonstrations such as those conducted by Walter Damrosch should be followed. Whenever possible, the musician should illustrate with “live” music, but recordings will be well received. As with all other features of a musical program in the hospital, sessions should be regular and governed to some extent by the will of the majority.