Music in Medicine

The introduction of music into the hospital will depend not so much upon its proven value as an aid to medical practice as upon the interest of someone on the staff who loves music or recognizes its importance in the mental hygiene of the patients. There are many reasons for the absence of music in some hospitals which may seem difficult for the musician to comprehend. The acceptance of a music program in a hospital calls for increased budget and space. These are two items which constantly beset the hospital director and they are sometimes matters of improbable solution. For the chronic type of hospital the problem must be solved. Other drawbacks are found in the contemplated interference of medical and nursing procedures. Hospitals are traditionally havens of quiet and the uninformed hospital director or his staff may envisage a conversion to a three-ringed circus of sound. The progress of music in hospitals will depend largely upon the ingenuity and intelligence of existing organizations and the examples they can set for prospective hospitals.

The musical program of a hospital need not necessarily be conducted by a musician, but a trained person is most desirable. There are people with an intense love for music and so comprehensive a grasp of its many fields that they might be capable of conducting a hospital program although unable to play an instrument. At some institutions music has been guided by volunteers with great satisfaction to staff and patients, but this is an age of specialization and a paid, trained musician will usually be worth the salary in efficiency, dependability, and control.

Director

Music for patients differs from music for the well. The average musician is not qualified to decide which patients should or should not have music. There are too many well meaning musicians who have had one or two personal experiences or heard of others in which the efforts of the musician were rewarded by apparent miracles of mental reaction. Musicians are not capable of evaluating such changes nor do they bother to recount what the condition of the patient was an hour or a day after this personal exposure. Musicians must have medical direction. The medical director of music does not have to be a trained musician but he should be acquainted in a general way with most musical forms which appeal to a majority of patients. His most important qualification will be the ability to rise above personal prejudices of musical taste. He must recognize that musical tastes can be as diverse as individual appetites for different foods, and feel free to order music as he would food for patients. It will be his duty to prescribe quantity, quality, duration, and intervals of music; to contraindicate music for the irritable, certain post-operative patients, the acutely ill, and any others for whom he thinks music is wrong. It will be necessary for him to protect the patients from the possible musical whims, hobbies, convictions or over-enthusiasm of the musical aide.

The director should be selected from volunteers on the staff. For the physician director of music to be chosen in any other way is to hamper the musical program. He must be a physician who has the time or can make the time to carry out his part adequately. At the outset the director should have daily conferences with the senior musical aide in which he should not only outline the procedures desired but should observe the musician at work with patients.

Music Aide

There is considerable disagreement concerning the title most desirable for the person conducting music in the hospital. The term “musical therapist” implies a training not only in music but in treatment. The occupational therapist has had a training not only in crafts, but in basic medical subjects, psychology, and some clinical subjects. Until musicians can take similar courses at accredited schools a different title seems wiser. At some hospitals the workers are called recreational aides, but such people also conduct other recreational activities. It seems picayune to argue over terminology, but the hospital music worker must be called something and it is hard to conceive that anyone would find fault with the appellation “music aide” for those people who bring music to the patient.

A music aide may be of either sex and of any age. The choice will depend not only upon what is available locally but on such considerations as the personalities involved and personal recommendations. If intelligence is not exercised, the program will fail because the senior music aide is the keystone of the entire structure. For a children’s hospital, a woman who has raised children would seem most suitable. The aide for children should be able to sing and play the piano. She should also be able to play musical games with children.

For a hospital of young adults, such as the average hospital for the tuberculous, a young woman between thirty and forty will have the energy, drive and spirit to match the requirements and contemporary tastes of the patients under her care. The aide for this type of work should also be able to lead group and mass singing and be able to play an instrument. Ability to play a second instrument, or to teach it is a valuable asset.

For the mental hospital an aide should be mature, patient, well informed and have the urge, but not the preformed opinions, for handling the mental patient. For the hospital treating the aged or other chronic patients, an older man or woman is desirable.

It is preferable for any aide to have had some formal musical instruction. Most desirable is a graduate of a musical conservatory or of a college which offers a major in music. The music aide should play at least one instrument, and preferably the piano. If the hospital budget permits additional music aides each successive one should know another instrument. The aide should be able to play music at sight and sing with an acceptable voice. The chief qualification should be the absence of “artistic temperament.” Patients are admitted to a hospital for medical care, not musical knowledge. The aide should not consider them as music students. Music should be given to them with patience and without undue emotion. If music evokes a marked mental response it may be beneficial, but it should be the music and not the musician which elicits such reactions. Previous experience in teaching music is a valuable asset to the music aide.

The duties of the music aide will vary with the number and type of patients. In hospitals with a large number of ambulatory patients emphasis will be placed on group activities; in hospitals where children predominate music will be used largely as diversion, in games, dancing and other bodily activities called “rhythms” which is a development of Eurhythmics.

Under the supervision of the medical director, the music aide should outline a definite schedule of musical activities and adhere to it. This will require much preparation and the best hours for preparatory work will be those during which patients are resting, sleeping, or receiving active medical and nursing care. The preparation will include maintenance and cataloguing of instruments and the medical library; tabulation of patient requests for instruction, books and recordings; programming for concerts, ward songs and the public address system; correspondence with musicians and musical groups in the community; ordering of equipment and music; and scheduling.

The schedule should be patterned to fit into the hospital routine. The first hour of the day should be reserved for preparatory activities. Individual instruction in music may be given from nine until ten. At ten the music cart may be taken to the wards until mealtime. Following the meal hour, the aide can prepare for the afternoon ward visits. Recreation Hall activities or the listening room may be scheduled for the period of two to three. Three to four-thirty may be used for ward entertainment, either with the music cart or with portable instruments. On one or two nights a weeks, an hour or more may be set aside for the hospital concert or a music appreciation hour.

Training

At present, no accredited school of music or medicine offers a compete course of instruction leading to a degree in music in medical practice, or a major in that subject. It is believed that eventually the demand may bring about the establishment of such a course in a musical college, where it belongs. It will be necessary for the school of music to secure liaison with a medical college or school of occupational therapy and this will limit instruction to those cities where grade A institutions of both kinds are to be found. There are at least ten cities scattered throughout the United States in which this happy combination may be found, but there is hardly need for more than six.

Applicants should be interviewed by a representative of both the medical and music schools. A projected curriculum is suggested as follows:

A brief explanation of courses not normally found at music schools and which should be given at medical or professional schools follows.

Anatomy for Nurses. This should consist of a brief survey of the anatomy of the human body with especial reference to the muscles, nerves, brain, and a casual introduction to the internal organs.

History of Medicine. This would be an orientation course on the development of medicine and hospitals.

Physiology. Especial attention should be drawn to the physiology of the nervous system and the muscles.

Psychology. Normal psychology, including laboratory experimentation in the psychology of music, would be the basis of this course.

Kinesiology. The standard course as taught in schools of physical and occupational therapy, and physical education, would be sufficient.

Occupational Therapy. An introduction into craft analysis and psychiatric occupational therapy is necessary.

Abnormal Psychology. An introduction to psychiatry is sufficient.

Music in Medicine. A course of lectures, including the subjects discussed in this volume, should be offered.

In the summer between the third and fourth years, the student should be affiliated with a hospital with a music program to work under the hospital staff.

These are suggestions only, and each school in consultation with an approved medical college will want to work out its own schedule. It is hoped that the above outline will be of definite assistance.