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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..a92593f --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #67545 (https://www.gutenberg.org/ebooks/67545) diff --git a/old/67545-0.txt b/old/67545-0.txt deleted file mode 100644 index 6409c4b..0000000 --- a/old/67545-0.txt +++ /dev/null @@ -1,5787 +0,0 @@ -The Project Gutenberg eBook of Music in Medicine, by Sidney Licht - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: Music in Medicine - -Author: Sidney Licht - -Release Date: March 2, 2022 [eBook #67545] - -Language: English - -Produced by: Tim Lindell and the Online Distributed Proofreading Team at - https://www.pgdp.net (This book was produced from images - made available by the HathiTrust Digital Library.) - -*** START OF THE PROJECT GUTENBERG EBOOK MUSIC IN MEDICINE *** - - - - - - MUSIC IN MEDICINE - - by - - SIDNEY LICHT, M.D. - - _Fellow, New York Academy of Medicine_ - - NEW ENGLAND CONSERVATORY OF MUSIC - BOSTON, MASSACHUSETTS - - - - - _Copyright, 1946, By_ - - SIDNEY LICHT, M.D. - - All rights reserved, including - the right to reproduce this book - or portions thereof in any form. - - _First Edition_ - - PRINTED IN THE UNITED STATES OF AMERICA - - - - -FOREWORD - - -In presenting a musician’s point of view on so specific a subject as -“Music in Medicine”, it seems to me necessary at the outset to clarify -the status of music as an independent aesthetic art, and its practical -adaptation for definite utilitarian purposes. We must clearly separate -the active individual process of artistic creation from the elements -of passive perception and from effects such perception may have when -applied for different realistic reasons. - -Taken aesthetically, as an art, music is a social “superstructure”, -which, as far as the individual creative act is concerned, remains -an abstract manifestation of the human mind and imagination. -Its existence as a creative art is possible only as long as the -practical “possibilities” and potentialities of its effects in the -phase of passive perception, do not intrude into and interfere -with its character as an absolute non-utilitarian phenomenon in -the processes of the creative art. Art, by its very nature is a -product of individuality. As opposed to the anonymous craft, the -main requirement of an aesthetically artistic product assuming the -presence of professional skill and knowledge is that it be the work -of a human organism, which possesses acceptable qualifications of -vocation and expression. To this attribute we have given such names -as talent, genius, imagination, and many others. This phenomenon of -specific predestination must also be accompanied by a characteristic -property which has received such names as personality, individuality or -originality. It is obvious that these fundamentals of artistic creation -prevent any general or universal approach to the creative processes -which, with the exception of purely technical and formal elements of -craftsmanship and common expression of specific style, exclude the -pattern and definite utilitarian aims. All these factors are obviously -concerned only with the living moment of the musical art in the essence -and genesis of the individual creation. - -Although music as a creative manifestation of the human mind does not -aim at social or utilitarian function, its materialized results may yet -find wide application in the manifold use of this aspect of passive -perception. This passive perception stimulates an active participation -by the listener in whom it may provoke definite emotional reactions -and mental modulations. If we think of music as the completed creation -of one mind, we can understand how its perception may have a genuine -influence on the listener’s mood and that it may be channeled into -desired directions which takes the forms of adaptation and adjustment. -This, in spite of the variety of tastes and reactions, can certainly be -generalized within limits by scientific methods. - -Although I do not believe that music should be written for purely -utilitarian reasons (and I am speaking not of the material advantages -it may bring the artist, but of the aesthetics of creative art) I see -no reason for not using any composition to such practical advantage as -its application may offer. Music as an _art appliqué_ has been known -since ancient times in many different roles, not all as laudable and -noble as its use in healing. Its property of melodical expansion, -propulsive character, rhythmical vitality, nervous insistence, harmonic -intricacy, development in time rather than space, its wealth of moods -(which extend from static calmness to wild exuberance with an enormous -range of intermediary impressions, even in its abstract character -of pure organized sound) provokes in listeners a response which is -primarily psychological and emotional, but which frequently influences -physiology and the nervous system. - -The use of music for work, marches, the stimulation of mass sentiment -or emotional impact (patriotism, war, etc.), for entertainment, -oblivion, mood change, mood creation, and background music for motion -pictures, evokes realistic responses, where music is applied for -its effect, rather than for its intrinsic value. It is therefore no -surprise that the applied use of music (which has nothing to do with -the active process of artistic creation) should be used in the care -and treatment of the sick mind and body. I do not know what subjective -responses result from such purely physical phenomena as vibration -and harmonics but I am convinced that listeners are physiologically -and psychically effected by such musical characteristics as mood, -intensity, pitch and rhythmical outline. It seems to me that the -right music should provoke remembrance and association of thoughts -and situations more easily in a mental patient than methods using -factual persuasion. Music can avoid the realistic approach and by its -absolute progression abstractly recreate a familiarity of situation -which may prove most useful in handling mental patients. By eliciting -a desired mood it may offer the physician a method of handling disease -as important as shock, and a result obtainable in no other way. To a -musician, completely unfamiliar with medicine and pathology this use -seems obvious and undeniable. Dr. Licht has made a thorough study -of this subject and has indicated some of the many uses of music -in mental and physical pathology. The work which has been based on -scientific research and clinical experience is most impressive and -encouraging. If we, as musicians, can bring our contribution to such a -wonderful purpose as healing, it would certainly be our most glorious -accomplishment for mankind, and the noblest use of our art. - -But, as I have said, aesthetically it should not be the aim but the -effect of art which should be considered. If _applied use_ rather -than creation were to assume greater importance, art would lose its -essential characteristics and would become a social manifestation of -mass production instead of an abstract phenomenon. It might work out -usefully, perhaps for a time, but in losing those primordial elements -which condition its own existence, it would also lose the _effects_ -which its use provoke not only in medicine but in other important -directions. The effects of music will progress satisfactorily to -the advantage of mankind only as long as it is permitted its normal -development regardless of motivations and their justifications. In -the long run it will find a greater and better use in the practical -sense, if its creation continues along traditional lines, and is not -diverted into the fallacious channel of anonymous mass production with -consequent loss of proper utility and aesthetic _raison d’etre_. - -It is likely that scientific research and clinical experience will -motivate the production of musical compositions which are designed -for certain classes of patients. This will require much skill, -craftsmanship, gift of adaptation and assimilation of established -patterns as well as disciplined imagination, but the creation of -such planned utilitarian works would not be possible without the -continuation of music as a self sufficient art activated by its own -emotional and spiritual reaction and enjoyment. No derivative may -exist and progress by suppression of the source which must aliment it -continuously by its own growth and through the conservation of its -individual characteristics. - -Music as an art has its own internal laws of creation and traditional -development. These laws are not casual but organic and they can not -be violated without self destruction. Consequently, the beneficial -effects of music can be applied for utilitarian purposes only if its -integrity is safe from external intervention, even if only temporarily, -and if the element of social usefulness does not influence the creative -process. - -The criteria of artistic and practical values do not necessarily -coincide. Artistic value is defined only by time, the practical value -is a matter of present usefulness. Works of great artistic value may be -useful, whereas facile “hits” which fall into oblivion within a brief -period may prove extremely useful, and that is why the two conceptions -must be differentiated. Michelangelo’s _Medici Tomb_, or a Bach _Mass_ -are completely useless in the practical sense of the work, and most -successful “hit-songs” are completely devoid of any artistic value -or originality. Yet both kinds supply the specific wants of those -who would lament the absence of either of them. This resolves itself -into a question of taste, educational background, musical culture and -other factors which I presume are of importance in the clinical use of -music. Patients will show preferential response to the music they like -regardless of the elements of mood, tempo, rhythm and pitch. - -But classifications are always dangerous. Good music is not necessarily -useless, and useful music is not necessarily bad music. The eternal -principal of _suum cuique_ is the principle of individual human -taste which can be placed into approximate categories, but cannot be -standardized without the artificial interference of external factors. -The same principle certainly applies to music as a weapon of healing, -where selection should be determined by science but at the same time -we must strive to adapt the results of research of the individual -preferences of normal subjects. - - Alexandre Tansman - Los Angeles, January 1946 - - - - - CONTENTS - - - _Introduction_ ix - - - Chapter I - - _History of Music in Medicine_ 1 - - Primitive use and the medicine man. Ancient - civilizations. Music against animal bites and mental - disease. Magic and the Middle Ages. The magic - flute. Recent developments. - - - Chapter II - - _Philosophy and Psychology of Music_ 15 - - Physiology of musical elements--pitch, intensity, - timbre, duration, rhythm, melody, mode, key. Color - in sound. Music interpretation. Live music and the - human voice. Listening and appreciation. Musical - taste and appetite. - - - Chapter III - - _Music as Occupational Therapy_ 44 - - Origins of occupational therapy. Advantages of - music as a modality. Analysis of motion in piano - playing. Analysis of string, plectrum, foot, wind - and percussion instruments. Use of voice as exercise. - - - Chapter IV - - _Psychiatry and Music_ 59 - - Criteria of therapeutics. Classification of mental - diseases. Description of diseases and indications for - music. - - - Chapter V - - _Background Music_ 73 - - Counter-irritation. Music in the operating room. - Effect on physical exercise. Use with calisthenics. - Eurhythmics. Remedial exercise. Industrial music. - - - Chapter VI - - _Mealtime Music_ 82 - - Criteria for mealtime music. Examples of orchestras - and songs most suitable. List of suggested - recordings. - - - Chapter VII - - _Music in Bed_ 89 - - Needs of children. Slumber music. Bedside - radio. Program distribution systems. Head phones - versus loud speakers. Personalized music. Instruction - in bed. Toneless instruments. - - - Chapter VIII - - _Diversion and Entertainment_ 98 - - Need for entertainment in hospitals. Programming - for patient groups. Amateur show. Group - singing. Music instruction. - - - Chapter IX - - _Public Address System_ 105 - - Basic equipment and personnel. Programming. - - - Chapter X - - _Equipment and Library_ 110 - - Patient band. Instruments and rooms. Record - library. Holiday music. - - - Chapter XI - - _Direction_ 118 - - Medical direction. Qualifications and duties of - the hospital musician. Training program and curriculum - for music aides. - - - _Bibliography_ 125 - - - _Index_ 129 - - - - -INTRODUCTION - - -In the middle of the eighteenth century there were two prominent men -in Paris whose conflict was typical of the controversial nature of the -subject known as Musical Therapy. The Abbé Nollet was not only one -of the most prominent clerics in France during his time but was in -addition the most famous of its physicists. He had constructed some -excellent models of machines which produced static electricity, but -he had had no medical training. At about this time throughout western -Europe, the subject of static electricity had become very popular. -Several physicians claimed that it was of great use in the treatment -of many diseases. Particularly did they say that it cured paralysis. -The Abbé Nollet wrote a book about static electricity and in it told -of the cases he had cured with it. The most prominent physician in -Paris was Doctor Louis, who was the chief physician at the Salpêtrière -Hospital, the largest and best known hospital in France. Dr. Louis -tried to repeat the cures promised by Nollet but was unable to secure -success in any of the patients whom he exposed to static electricity. -He published the story of his failure to do so, which so excited Abbé -Nollet that he wrote an entire volume condemning Dr. Louis. Instead of -refuting the ability of Dr. Louis to diagnose paralysis and evaluate a -cure, he climaxed his remarks with the classical question addressed to -the doctor, “Is electricity your field?”[61] - -For many centuries philosophers and musicians have claimed the ability -to cure mental illness through the use of music, and have at times -called this procedure Musical Therapy. Although the physicians might -well say to these musicians that therapeutics is definitely not within -the province of musicians, it is unlikely that a musician would at this -time have the courage to ask physicians, “Is this your field?” - -A thorough search of the history of medicine will show that almost all -phenomena and substances have at one time or another been tried in an -attempt to combat disease. Many of these agents were abandoned when -they became unfashionable to a more sophisticated civilization, or were -recognized as unwholesome by a more educated generation. The fact that -few were given up merely because of their ineffectiveness can be seen -in the great number of quack nostrums which still enjoy an active sale -among the ignorant, and by the impossible claims of highly organized -cults which continue to gain in numbers and followers in this country. -Healing schemes based upon the use of herbs because they are delivered -right from nature’s womb, or the fanciful notion that all diseases -arise from the imaginary displacements of the spinal bones, are still -in their ascendency. The liberal system we call democracy has not only -permitted their growth but has rewarded their ingenuous and ingenious -development. Exposure of the fraudulent methods involved serves little -purpose because the mentality which is so susceptible to warped -reasoning responds poorly or even antagonistically to enlightening -guidance. - -There are, however, certain valuable features in herb and spinal -doctrines which have been partially ignored by reputable physicians -because of the intimate relation of these ideas to cult practice. - -In spite of a spirited rebirth of the movement towards the -establishment of a system of healing based on music, there are many -valuable uses of music in medicine which might suffer a like fate -unless a critical analysis of the worth of music as a therapeutic agent -is effected before Musical Therapy reaches the dubious distinction of -classification as a healing cult. - -This book has been written with a view to preserving for medicine that -which is good for patients, and in an attempt to aid musicians under -medical guidance in using music to help the sick. - -Primitive peoples throughout the world still use music in association -with the healing arts. This of course is an indication that they have -probably used it for more centuries than are recorded in the pages of -written history. Ancient civilizations frequently associated music -with the divine, but placed diminished emphasis upon its association -with healing. Even so, the Hebrews accredited to music curative and -inspirational powers[7], as can be seen by the reference in Scripture: -“And it came to pass when the evil spirit from God was upon Saul that -David took a harp and played with his hand; so Saul was refreshed and -was well and the evil spirit departed from him.”[63] - -For the Greeks to whom we owe the origin of the word music, Apollo -served as the God of both medicine and music, and there were some among -them who suggested its use for both mental and physical disease. “Plato -and Aristotle claimed that the Dorian mode was regarded as virile, -energetic, and proper for the perfect citizen; the Phrygian made them -headstrong and the Lydian included effeminacy and slack morals. The -modes of Asiatic origin were considered suitable for banquets.” Five -hundred years before the birth of Christ, Pythagoras[I.] founded a -brotherhood “based on music as a means of life and moral uplift.”[70] -The influence of music was so great among the Greeks that it is not -surprising that they used it in all walks of life, including medical -treatment. The extent to which they and the peoples who followed them, -used music in this manner will be more fully discussed in the first -chapter. - -Nicholas Murray Butler once stated that “An expert is one who knows -more and more about less and less.” There is much truth in this -facetious definition. In ancient civilization the known facts were -so few that it was possible for some scholars to acquire all the -knowledge available. The professional thinkers or philosophers had a -comparatively complete familiarity with biology, law, music, medicine, -government and theology, and could easily write authoritatively about -most of them. Some of the important discoveries in the arts and -sciences were made by men equally well known in entirely unrelated -fields. As late as the Roman Era, Celsus wrote a series of books -on different subjects, each of which was so complete that it was -considered an authority in its field. To cite one example, the ten -volumes on medicine were accepted for the next thousand years as its -gospel text. Although specialization was known to ancient society, its -foundation was one of individual will rather than basic training in -facts. With the passage of time more and more knowledge developed till -the single volume could no longer hold all the known facts of a science -and what had been titles of chapters became the titles of books. -Knowledge may really be said to have progressed when books are written -on subjects about which only one sentence could have been written -previously, but knowledge progressed very slowly until the fifteenth -century. The Renaissance in art and science developed simultaneously -in a relatively small area. The Renaissance of both medicine and -music, was in Italy during the fifteenth and sixteenth centuries. -Here, instrumental music was asserting its importance over vocal -music, and accurate descriptions of human anatomy finally replaced -the old erroneous conceptions. Both of these changes were necessary -for progress in these fields, but progress was slow in each because -there is always a reluctance on the part of the people to accept new -concepts. Individuals may be intellectually progressive, but the people -find security and comfort in established folkways, whether it be of -music or medicine. Fortunately, individuals continued to write of new -discoveries and in new idioms, and that which was good was accepted by -a few in the same generation and by more in succeeding generations. -But each successive step was tedious and it was just as difficult to -influence the new generation as it had been the old. - -With the growth of knowledge came an increase in specialization and -men understood less of subjects unrelated to their own. As the rolling -mass of education grew, it threw off tangential bodies of information -which moved farther apart from each other, and it is only comparatively -recently that these diverging lines have begun to approach one another -and offer mutual assistance. Music, the art, found the need for -acoustics, the science. Industry has come to accept the importance of -color and form, and government has been forced to employ mathematics. -There was a time when such combinations would have been considered -fanciful; now they are indispensable. - -Music and medicine have had casual contacts through the ages, but -neither has cried out to the other for help. Musicians and physicians -are independent people, brooking no outside interference. There are -those on both sides who would protest their marriage, not so much -from a concern over connubial bliss as over the possible offspring -and undesirable relatives. Medicine has never refused to try anything -that might alleviate suffering or cure disease, but it has and -will continue to ignore unfounded claims or secret remedies. To be -acceptable, therapeutic measures must be applicable to all who suffer, -and the ingredients must be available to all qualified practitioners of -medicine. Physicians insist that therapeutic modalities be given under -their guidance and reserve for themselves the right to evaluate their -results. Very few physicians object to the use of music for and by -their patients, but many object to calling that use musical therapy. -If the musician is aflame with the desire to make music for patients -there is no need for insisting that it be labelled anything but music, -providing of course that it is music. Physicians do not discourage acts -of kindness or personal attention to their patients. They want them to -have clean bedding and fluffed pillows, but insist that such procedures -be called nursing care and not therapy, regardless of the amount of joy -it brings the patient. There are many uses to which music may be put -in medicine and especially in hospitals. When one considers the number -and variety of hospitals in this country, it is difficult to imagine a -kind of music which can not find a place in at least one of them, but, -for reasons which seem more obvious to musicians than physicians, music -has been used in the past almost exclusively for patients suffering -from mental illness. During the past few decades, hospitals have given -increasing attention to music, and in some instances have developed -impressive programs. - -In 1944 the National Music Council sent questionnaires to more than -three hundred hospitals which treated psychiatric disorders, and -received replies from two hundred of them. A summary of the survey was -published by them under the title of “The Use of Music in Hospitals for -Mental and Nervous Diseases,” and some of the information contained in -this pamphlet will be of interest to those who are considering this -aspect of music as a career. Almost all mental hospitals use music in -some form. In half of them, patients participate in music vocally or -instrumentally. In many hospitals the use of music is increasing and -in a few it is extensive. About one-quarter of the hospitals have some -budgetary appropriation for music, such appropriations are not great at -present. - -Most hospitals look for musical workers among the members of their -regular staff; but a few have consulted musical organizations. Trained -musicians might think that hospitals would turn more uniformly to -musical schools for this sort of assistance, but for the most part, few -schools of music have openly encouraged the study of this subject,--in -spite of the fact that one-half of all the hospitals questioned stated -that they could use additional qualified workers. - -Of greater interest perhaps to those who would like to become hospital -music aides are the opinions expressed by the hospital authorities on -the principal qualifications which they believed musical workers in -mental hospitals should have. It must be remembered, however, that -questionnaires submitted to hospitals are not answered in a uniform -manner, and any survey of this type must be interpreted with caution. -When questionnaires are sent to hospitals they usually pass first -through the hands of the director or superintendent, who reacts as -an individual and not according to a set pattern. One will turn the -paper over to his secretary for reply; another will pass it on to a -physician, nurse or occupational therapist. In many instances the -answers will be filled out by the hospital music worker, and sometimes, -if the superintendent is sufficiently interested, he may answer it -himself. Each person to whom the questionnaire is submitted may -transfer the burden of answering to a subordinate, if he is too busy -to fill it out himself. The signature which appears at the bottom of -the returned questionnaire is usually one of approval rather than of -authorship. Surveys should list the titles of respondents. This one -did not. Even if it did, the foregoing possibilities would have to -be considered. In spite of this, the qualifications listed will be -reviewed for the help they may offer the prospective hospital musician. - -A majority agreed that a knowledge of music was necessary, and not only -were all phases of music specified, but the ability to make intelligent -selections of music and to operate commercial sound equipment was -recommended by some. Experience in teaching music, particularly the -piano, was high on the list of desired accomplishments, and the faculty -of directing singing was even higher. - -Many hospitals stressed the importance of a “wholesome personality”, -but this is a term which defies suitable definition. However, the -following qualifications were named: emotional stability, patience, -refinement, congeniality, quietness, and a sense of humor. There are -further recommendations that the worker should possess: imagination, -tactfulness, consideration, energy, perseverance, sincerity, -co-operation, adaptability and understanding of human nature. In the -final chapter of this work a more realistic approach to this subject -will be offered. - -One final qualification is mentioned which is to be taken most -seriously, and that is that the musician who would work with mental -patients should have “a definite urge to help the mentally ill.” As a -supplement to this he should have or be given a working knowledge of -hospital procedure and the handling of the psychiatric patient. - -From these comments by hospital authorities and the recent trends in -institutions throughout the country, it is reasonable to assume that -the demand for adequately trained hospital music aides will increase. -Some hospitals will want one or more full-time workers, and others will -want a part-time worker. This means that some musicians may be able to -supplement their earnings by securing partial pay from hospitals in -their communities, the remuneration offered varying with the size of -the hospital, its endowment and income. It will never be a source of -wealth to a musician, but it can be a stop-gap in the hard early years -or a continuous position for those who seek the security of regular -employment. - -Some people fill positions for which their only qualification has been -influence; but in the majority of cases the people who have spent the -greatest effort in securing superior training will be the recipients of -the best positions. The student of hospital music should prepare for -his job as seriously as for any other aspect of music. Regardless of -his other qualifications, he must of course be a musician, and a degree -in music is valuable; in fact almost essential. The ability to play a -second instrument even moderately well is useful. The universal appeal -and advantages of the piano make a working knowledge of it important. -The music aide should be able either to play the piano at sight or -he should study one of the rapid systems of piano instruction for he -will be called upon not only to accompany group singing but to assist -visiting artists or talented patients. - -Although a foundation in classical music is part of any good musical -training, a musician who refuses to recognize the importance of popular -music in American life is not suited to this work. If he has a positive -dislike for popular music, he should look to other fields. It is not -necessary that he be able to play all the types of modern jazz, but -he should be familiar with the common jargon of jazz and should learn -the distinctions which exist between these so-called musical forms. -His musical tastes need not be catholic, but his attitude towards the -tastes of others must be broadminded. - -Advances in mechanical reproduction of music are progressing at a very -rapid rate, so the technological aspects of music should be cursorily -reviewed. A working knowledge of record players, record cutters, -needles, tone control and amplification is not difficult to acquire. -It may be part of the duties of a music aide to supervise record -cuttings and a public address system. In some hospitals the library -of musical recordings and literature may be large. A study of musical -librarianship will save much time, and the study of classification -systems and filing will become an additional part of the work of a -music aide. - -More often than not a musician approaches a problem with more emotion -than analysis, and this becomes of great importance when the problem is -a patient. There have always been and will continue to be physicians -who with honest conviction or for greater glory will anxiously ally -themselves with anything new or sensational, therefore musicians -impassioned with the belief that music is necessary to health will have -little difficulty in finding collaborators in the ranks of medicine. -Musicians must be cautioned to consider the fact that their sincere -efforts may result only in discrediting music, as a therapeutic agent. -As a result its acceptance as the basis of such merits as it may -possess may be undeservedly delayed because of antagonism aroused by -extravagant claims made in its behalf. - -Much has been written about music as a therapeutic agent, and recently -there have been entire schools and organizations devoted to Musical -Therapy. In spite of the great temptation to be in on a coming theory -few physicians have associated themselves with these efforts, and what -is more conclusive, no physicians of national repute have come forward -in approval of the term “musical therapy” as applied to the handling of -psychiatric patients. - -The use of music should not be limited to mental hospitals, however. -Those who have played music for mental patients are enthusiastic over -the individual responses they have witnessed. The nature of this -response is awakened interest or joy. Joy is a healthful symptom for -all patients to experience and this joy should be available to patients -in all hospitals. Many other phases of music are adaptable for hospital -use and this book is written to outline the many approaches possible -and delineate the scientific basis for some of them. - -Of the better known books on musical therapy some, like the work by -Hector Chomet, are built around the effects observed in individual -patients; others, like the writings of Eva Vescelius, are pure phantasy -which stem from unbridled emotion. For science was not applied until -the appearance of psychologic investigations when common sense -began to emerge from a chaos of wishful thinking. One of the first -dependable surveys of the subject was in the _Psychology of Music_ -by C. M. Diserens. Since the appearance of this excellent work the -passages stating his views have been often quoted--frequently without -acknowledgment. Its chapter on Musical Therapeutics is recommended for -its scholarly history and sober evaluations of facts and fancies. - -This book has been written for the musicians who wish to learn how they -may work with physicians for patients. Technical terminology has been -reduced to simple terms wherever possible for a better understanding, -but co-operation can be secured only if the musician is willing to -forget his preconceived ideas and abide by the decisions of the -physician, who may not be too familiar with music but is familiar with -hospitals and patients. - -The unemotional approach to this subject is of recent origin. Little -has been written in that vein, and this book will lay no claim to -originality or perfection. It is hoped that it will act as a guide to -further study and an aid to those who wish to engage in this as yet -uncharted venture. - -Realizing that few sources of information are available in this field -to musicians, and that some musicians may one day feel the urge or -experience the need to participate in such work, the New England -Conservatory of Music invited the author to give a series of lectures -to its students on this subject. At the conclusion of the course they -decided to offer this outline to those who might later wish to refer to -its contents. - -In preparing this work the author had the good fortune of personal -interviews with some of the leading musicians, musicologists and -musical psychologists in the country. Although no statements which -appear in this volume are to be construed as the opinions of any of -them, an expression of thanks is offered to the following for their -willingness to exchange ideas with the author: Dr. Serge Koussevitsky, -Mr. Igor Stravinsky, Dr. Harold Spivacke, Dr. James Mursell, and Dr. -Carroll Pratt. - -The author wishes to express his thanks to Mrs. Margaret E. Gurney -and Miss Ida Evans for their assistance in the preparation of the -manuscript. - -The author wishes to express his deep gratitude to Mr. Clifton Joseph -Furness, Director of Academic Subjects at the New England Conservatory -of Music for his supervision in the editing of this book. - - S. L. - - -FOOTNOTES: - -[I.] _Pythagoras passed a black-smith shop one day and was struck -with the beauty of the two sounds he heard coming from it. He entered -the shop, studied the sounds closely and found that the two notes -were an octave apart. This observation stimulated him to a detailed -study of music which led to his musical philosophy. He believed that -all nature and knowledge were contained in harmonic numbers, and that -the world had been made in a musical harmonic accord. He invented a -sacred quartenary of harmonic numbers to explain the phenomena of life. -But Roussier believed that Pythagoras adapted his system from the -Chinese._[70] - - - - -_CHAPTER ONE_ - -HISTORY OF MUSIC IN MEDICINE - - “Music exalts each joy, allays each grief, - Expels Diseases, softens ev’ry pain, - Subdues the rage of poison and the plague, - And hence the wise of ancient days ador’d - One pow’r of Physic, Melody and Song.” - - “_The Art of Preserving Health_” - by John Armstrong (1709-1779) - - -In many fields of endeavor a scholar occasionally appears who not only -makes a personal contribution to the knowledge and advancement of his -subject but summarizes previously gained information so well that -his work becomes at once a milestone and a beacon. In the field of -music, such a man was Charles Burney, who began to publish a _General -History of Music_ in 1776. This book was so thorough and scientifically -critical that his conception is as modern as tomorrow. After listing -all the instances of music as a therapeutic agent, he concludes: - - “Yet men delight in the marvellous; and many bigoted admirers - of antiquity, forgetting that most of the extraordinary effects - attributed to the music of the ancients had their origins in poetical - inventions, and mythological allegories, have given way to credulity - so far as to believe, or pretend to believe, these fabulous accounts, - in order to play them off against modern music, which according to - them, must remain in a state far inferior to the ancient, till it can - operate all the effects that have been attributed to the music of - Orpheus, Amphion and such wonder-working bards.”[15] - -It is well to begin a study of music in medicine with Burney’s -restrained enthusiasm lest we fall into the error of building -impossible temples of healing on the thin ice of untested claims. We -shall begin with prehistoric times. - -The use of music against disease is as old as music itself. In -fact, early history of music is intimately associated with healing. -The wishful thinking of primitive peoples called upon magic for -assistance, and magic is almost universally associated with words, -chanted words, in rhythmic incantation. Chateaubriand believed that -the chant was the offspring of prayers. Among primitive peoples, the -medicine-man combined the offices of priest, physician and magician, -and although all three functions were closely related, their functions -were dissociated on occasion. For instance, there were special songs -for the invocation of natural phenomena, for group activities, and -for accompaniment of healing rituals. “The belief in the efficacy of -musical magic is one of the most important facts in the history of -civilization.”[19] - -Although no records exist, it is fair to assume that the truly -primitive peoples of today have not changed markedly from their -ancient customs, and that they resemble to some extent the status of -prehistoric men. The universality of certain folkways among widely -scattered tribes of primitive peoples today lends validity to this -theory. - -For such studies we need look no further than our own continent. Even -though certain magical practices have been banned by law, the American -Indians number amongst their tribesmen, those who remember and to some -extent still use music in healing. Several investigators have become -interested in this study, but chief among them is Frances Densmore who -has analyzed and recorded the songs of many Indian tribes. Among the -Teton Sioux she found[21] that the sick appealed to the tribal medicine -man who gave the case some thought and claimed to find the cure in -dreams. “All treatment of the sick was in accordance with dreams.” The -patient was then placed in a dark tent and the medicine man sang his -dream song, as well as songs addressed to the sacred stones. The use of -herbs of the agency of magic might accompany the song. An example of -one of the songs used to cure wounds has the following text: - - “Behold all these things - something elk-like - you behold - you will live” - -Words like these have a certain sophistication which we may assume -constitutes a more recent development. - -For many centuries primitive peoples have had different concepts of -the exact nature of disease, but for many of them it connotes some -connection between a demoniacal spirit and counter-spirits. There were -a great many methods employed to drive out the evil spirits. The idea -that music was efficacious in these cases persisted for centuries. -Martin Luther said, “The devil is a saturnine spirit and music is -hateful to him and drives him away from it.” - -Densmore points out that among the Iriquois[22] the word _orenda_ is -used to designate the universal indwelling spirit. Nothing was regarded -by the Indian as supernatural, in our use of the term, but many Indians -desired an _orenda_ stronger than their own. When a medicine man began -to treat a sick person the result depended upon the power of his -_orenda_. _Orenda_ could be put forth in song. Those who possessed -_orenda_ strong enough to do wonderful things were called medicine men. -They were consecrated to their work, and the safety, success and health -of their people depended on their efforts. - -In completing her analysis of Indian medicine songs, Densmore concludes -that they suggest “the confidence which the medicine man felt in his -own power, and which he wished to impress on the mind of his patients.” - -Wallaschek[79] lists many examples of the healing use of music among -primitive tribes. Among the Wasambara in East Africa, the doctor -arrives with a small bell in his hand which he rings from time to -time. The patient sits before him on the ground and the doctor begins -speaking in a singing tone: “Dabre, dabre.” He repeats this several -times and the patient sings a simple response. In Australia, Wallaschek -found a tribal doctor shaking a bundle of reeds, an action otherwise -used during a song to mark time. In Borneo, the natives perform -recitatives and songs in order to catch the soul of the patient which -is supposed to have run away before the evil spirit. The Wallawalla -Indians in this country believe that song influences the cure of a -patient, and all the convalescents are directed to sing for several -hours daily. In British Columbia the doctor sings when he visits the -patient, while a chorus of people intones a song outside the house. - -With the dawn of civilization, intellectual activity became more -progressive but folkways die hard. - - “The ancient Egyptians called music ‘physic for the soul,’ and had - faith in its remedial virtues. We may presume that the incantations - presented in the medical papyri were likewise to be emitted with the - proper voice and therefore contain an element of music. The Persians - regarded music as an expression of the good principle Ahura-Mazda - and are said to have cured various maladies by the sound of the - lute”[24]. “The Lacedemonians agreed with the Egyptians and confined - the possessors of music to one family, and their priests like those - of Egypt were taught medicine and music, and initiated into religious - mysteries”[28]. - -The martial and moral values of music were appreciated by most of the -early civilizations. Both Confucius and Plato believed that music -was the most certain means of reforming public mores and sustaining -them at a high level.[25] Although many histories on effects of music -quote the scripture as evidence of the Hebrew use of music in healing, -the passage quoted[63] is subject to various interpretations. It -simply says that after listening to David play on the harp, Saul was -“refreshed and well,” this could refer more to loss of fatigue than -cure of a disease. - -The great poets have always sung the praises of their beloved sister -muse. In Homer there is a story relating how the flow of blood from -Ulysses’s wound was stopped, charmed by the use of music.[13] Now it -is very possible that the blood of the famed warrior coagulated in its -wound during a musical interlude, but then, all wounds except those -involving a large artery will cease bleeding in about twenty minutes. -Homer also stressed good music and song as a means of elevating the -spirit and of overcoming depression of the soul or mind, agony, -anguish, anger and sorrow. He gives as an example the story in which -Chiron heals the sick with melody.[57] Cato[13] spoke of luxated -joints which were eased by the harmony of sound. We cannot be sure -of the diagnostic acumen of the observer, but for active people the -most common traumatic joint trouble is a “locked” knee. Most knees -which contain disturbed cartilage will unlock after a relatively short -period of rest. In each of these instances, music was an environmental -coincidence. Such observations would only begin to assume scientific -medical value if they could be repeated many times under identical or -similar conditions. They were not. - -We may now return to the episodes related by Burney in his commentary. -Martianus Capella, an ancient author on music, assures us that “I have -often cured disorders of the mind as well as the body with music”[58]. -He also claimed that the Aesclepiades, the state-recognized priests -of medicine, cured deafness by the sound of the trumpet. “Wonderful, -indeed!”, says Burney, “that the same noise which would occasion -deafness in some should be a specific for it in another.” In Plutarch’s -book _De Musica_ it is related that Thaletas the Cretan delivered the -Lacedemonians from the pestilence by the sweetness of his lyre. - - “Thaletas, a famous lyric poet, appeared by command of an oracle and - all the songs he sang were prayers to the Gods. The disease probably - reached its highest pitch of malignity before he came, and began to - subside with his coming; but its disappearance was attributed to the - music of Thaletas.” - -Many other cures are cited. Xenocrates employed the sound of -instruments in the cure of maniacs; and Appolonius Dyscolos claimed -that music was a sovereign remedy for dejection of the spirits and a -disordered mind, and that the sound of a flute would cure epilepsy and -sciatic gout. Athenaeus rendered the cure for gout more certain by -playing music in the Phrygian mode, while Aulus Gellius insisted that -the music be soft and gentle, the opposite of the furious Phrygian. -Coelius Aurelianus introduced a concept which reappeared at several -widely separated times. He called it _loca dolentia decantare_, -or enchanting the disordered places. He claimed that the pain -was relieved by causing a vibration in the fibres of the affected -part. There is little doubt that music causes a physical vibration -of the air, but the force that such vibrations could have on most -tissues is negligible. Other writers recommended that the instrument -be held against the part to be treated for direct transmission of -the vibrations, but if physical excitement is desired this can be -accomplished more uniformly by applications known as manipulation or -massage. Such manipulations are known to be helpful in some conditions, -but not curative in painful conditions such as sciatica. - -Nearchus, who accompanied Alexander the Great in his conquests, -reported that in India the only remedy against the bite of a serpent -was a chant[70]. Galen, one of the soundest physicians of ancient -Rome, recommended music as an antidote to the bite of vipers and -scorpions[7], and for centuries music was recommended for the bite of -a tarantula. In the seventeenth century three physicians named Mead, -Burette and Baglivi explained this use of music. They said that it -threw the patient into a violent fit of dancing which brought out a -plentiful perspiration, and with it the poison. Since perspiration -consists of water and a few simple salts, such activity would increase -the concentration of the poison in the circulating blood, and neither -the explanation nor the treatment is acceptable[28]. Music was -recommended not only for the bites of the reptiles and insects; Desault -recommended it in the treatment of hydrophobia[23]. Not all bites -are poisonous, and it is likely that in the case of the two patients -mentioned the cure was more for fright than bite. - -The effects of music on the mind were too obvious to escape the -ancients. When the armies of Greece took the field, they were -accompanied by the best musicians, who by their martial strains -inspired the soldiers with a kind of mechanical courage never -experienced by their enemies. - -The distinction between mental health and disease was not advanced -among the ancients, but they did recognize varieties of insanity such -as delirium, melancholy and mania. Many physicians recommended music in -the treatment of mental disease, and Quarin spoke of a single case of -epilepsy cured by music. With the exception of severe epilepsy, many -patients who suffer from the symptoms which bear this name have only -occasional attacks and these disappear spontaneously, making the music -simply another coincidence. - - * * * * * - -Celsus, who was a great medical authority not only in his own time -but in subsequent centuries wrote of the mentally ill, “We must quiet -their demoniacal laughter ... and sooth their sadness by harmony, the -sound of cymbals and other noisy instruments”[16]. Areteus, another -great physician of ancient Rome, prescribed music for “corybantism, -a disease of the imagination”[24]. The great Dutch physician, -Boerhaave[11], said, “I do not know if all that one tells us of the -charms and enchantments could not be attributed to the effects of -music, in which the ancient physicians were well versed.” References -continued to appear concerning the magical relationship between music -and healing. Robert Grosseteste (1175-1253 A.D.) said that disease and -even wounds and deafness could be cured by music based upon a knowledge -of astrology and mathematics[75]. - - * * * * * - -During the early part of the Christian Era, most of the arts were -sustained by the Church, and as a result the finest works in painting -and music were available to the average man only within places of -worship. Not until the Renaissance did serious music take on a secular -character. Music until then was largely identified with religion, and -as such was considered to have an influence on the soul. Bacon advanced -as a rule of health that people “recreate their spirits every day -with a piece of good music.”[13] He went a step further in his _Sylva -Sylvarum_. - - “Seeing then the mind is so powerful an agent in particular disease, - I see no reason why the efficacy of music should not be tried in many - disorders which arise in the animal constitution; for music composes - the irregular motion of the animal spirits and more especially allays - the inordinate passion of grief and sorrow.”[7] - -The restful and joyful qualities of music were praised by Shakespeare: - - “But sweet music can minister to minds diseased - Pluck from the memory a rooted sorrow - Raze out the written troubles of the brain - And with its sweet oblivious antidote - Cleanses the full bosom of all perilous stuff - Which weighs upon the heart.” - -Henry Beacham wrote in his “_The Compleat Gentleman_” in 1634 that - - “the exercise of music is a great lengthner of life, by stirring and - reviving the spirits, holding a secret sympathy with them; besides - the exercise of singing opens the breast and pipes; it is an enemy - to melancholy and dejection of the mind, which St. Chrysostome - truly called ‘Devil’s Bath’. Besides the aforementioned benefit of - singing, it is a most ready help for a bad pronunciation, and distinct - speaking, which I have heard confirmed by many great Divines; yea, in - myself have known many children to have been aided in their stammering - in speech by it alone.” - -In the dark ages there was very little added to the knowledge of -medicine, but during the Renaissance physicians became more progressive -and articulate. Among these was the famous Willis who said that - - “Music not only is a delightful phantasy, but dispels sadness from - the grieving heart; and it also allays fevered passions and excessive - commotion of the breast.”[81] - -Characteristic of the use of music as an aid to healing is an anecdote -quoted by Burney. Farinelli was one of the great operatic singers of -his day and his fame was equally great in all of western Europe and -England. One of the countries he visited was Spain. “It has often been -related, and generally believed, that Philip V. King of Spain, being -seized with a total _dejection_ of spirits which made him refuse to be -shaved, and rendered him incapable of attending council or transacting -affairs of state; the Queen who had in vain tried every common remedy -that was likely to contribute to his recovery, determined that an -experiment should be made of the effects of music upon the King, who -was extremely sensible to its charms. Farinelli was summoned and on his -arrival her Majesty contrived that there should be a concert in the -room adjoining the King’s apartment, in which the singer performed one -of his most captivating songs. Philip appeared at first surprised, then -moved; and at the end of the second air, made the virtuoso enter the -royal apartment. He plied him with compliments and caresses and asked -him how he could sufficiently reward such talents, assuring him that -he could refuse him nothing. Farinelli, previously instructed, only -begged that his majesty would permit his attendants to shave and dress -him, and that he would endeavor to appear in council as usual. From -this time the King’s disease gave way to _medicine_, and the singer -had all the honor of the cure. “The King,” according to the _London -Daily Post_ of September 26, 1736, “settled a pension of 3,150 pounds -sterling, per annum, on Signor Farinelli, to engage him to stay at -court.” - -A great number of references during the sixteenth and seventeenth -centuries attests to the wondrous workings of music against mental -disturbances. Wilhelm Albrecht[1] reported a patient who was suffering -from melancholia. Many remedies had been tried, when as a last resort -the physician requested that a certain _ritournello_ be played. As -soon as the patient heard it, he began to laugh with all his might -and hopped out of his bed completely cured. More interesting is the -observation of Champlain[17] who wrote on his return from America, “It -is the custom in America when one is sick, to divert them with loud -music, to prevent brooding about the condition and thus help restore -health.” - -Mozart was not the first to call the flute “magic.” To Democritus was -attributed the story of abolishing plague with its music. Jean-Baptiste -Porta claimed that one could cure all disease with music, provided -that one used a flute made of the wood of the plant which was a known -specific for the disease to be treated. Thus one could cure mental -disease with flutes made of hellebore stems. One could return some -vigor to the impotent with flutes made of orchid stems, and fainting -could be cured by playing on a flute made of cinnamon wood.[67] - -Philippe Pinel, the physician credited with being the first to accord -the mentally ill humane treatment reported at least one instance of the -use of music in the treatment of epilepsy. - - “During the attacks, the sense of hearing, far from being deadened, - seemed to have acquired more keenness. A skilful musician played on - the violin at the patient’s side during her paroxysm. Although she - then appeared insensible to the charm of music, she was so strongly - effected by it, that she admitted after having recovered entire - consciousness, that the music had thrown her into a state of rapturous - delight.” - -Literature abounds with many accounts of the use of music by lesser -medical lights. Sauvages[18] mentioned a young man who had attacks of -intermittent fever accompanied by violent headaches which could be -soothed only by the sound of a drum played loudly. This same patient -did not like music when in good health. Instances of this nature may be -explained on the basis of counter-irritation, wherein a new disturbance -superimposed upon an old one may counteract it. - -In the eighteenth century, Brocklesby[13] summarized the known -literature of music in relation to health and disease and, considering -the status of medicine in his day, made a fair appraisal of its value. - -During the last century Hector Chomet[18], a Parisian physician, became -interested in music and its application to disease. He wrote a short -article setting forth his views, which he was to deliver to a group of -medical men in Paris, but was put off time and again by his colleagues -and by political upheavals. Each time, before replacing his paper on -the shelf, Chomet made additions. This work grew to be the important -thing in his life, and when he could contain himself no longer, he -published a book on the subject which showed considerable research -but which unfortunately contained as much invention as fact. Not -content with the known and proved existence of blood and lymph as the -chief body fluids, he added another--the “sonorous fluid,” which was -influenced for the good or bad by the vibrations of musical sounds. - -At about the turn of the century Eva Vescelius, a woman of great charm, -beauty and perseverance, reintroduced the use of music for mental -disease under the guidance of a physician. There is little doubt that -she gave great joy to many patients, but a differentiation must be made -between personal attention and therapeutics. In her works[78] on the -subject one can read enthusiastic accounts of past performances, but -unfortunately her explanations and claims are pure phantasy, to wit: - - “For fever, high pulse, hysteria, arrest the attention, play softly - and rhythmically to bring pulse and respiration to normal. Tests - with instruments will prove that music will do this. Do not change - too abruptly from one key to another; modulate and pause and let the - musical impression be absorbed. Select songs that depict green fields - and pastures new, the cool running brook, the flight of birds, the - blue sky, the sea. - - “Fear is dissipated by music awakening in the listener the - consciousness of the all enveloping Good. A high nervous tension is - relieved and nerves are relaxed under the spell of a composition that - swings the body into normal rhythmic movement. Sluggish conditions - of body and mind are eliminated by the rhythmic waltz, polka or - mazurka--music affecting the motor system. Insomnia is cured by the - slumber-song, the nocturne, or the spiritual song that assures one of - the Divine protection.” - -The use of music in hospitals is by no means limited to the application -to mental disease. Recreation is needed to avoid boredom, for as -Shakespeare said: - - “Sweet recreation barr’d, what doth ensue - But moody moping and dull melancholy - Akin to grim and comfortless despair - And at her heels a huge infection troops - Of pale distemperatures and foes to life.” - -The use of music as a diversion in hospitals received a great impetus -in the First World War but made its greatest leap forward with the -introduction of the portable bedside radio. - -The use of music as an exercise for poorly moving joints and weakened -muscles is recent and may be said to have received its great impetus in -the Second World War (described in the Boston Sunday Post, February 11, -1945; A-5). - - - - -_CHAPTER TWO_ - -PHILOSOPHY AND PSYCHOLOGY OF MUSIC - - -I - -In the realm of thought, opinions and theories sometimes find credence -long after they have been proved incorrect. In the field of the arts, -opinions may become so strongly rooted that there is occasional -resistance to any analytical attempts designed to disprove them, and -even after they have been exposed, there will be a significant number -of people who will continue to believe in them. The artist who would -make music for patients must approach such an endeavor with a full -knowledge of the elements involved, and should be willing to recognize -those prejudices, customs and thoughts concerning the effects of -music on the human body which have been fostered by well-meaning, but -misguided, enthusiasts. We must differentiate between the philosophy of -esthetics and the proved psychology of music. Musicians who refuse to -accept those results of scientific research which disagree with their -personal views will fall into the same difficulties which have beset so -many musicians in the past who have desired to help patients. - -Before the advent of laboratory psychology, there was no satisfactory -test for the theories which dealt with music and the mind, and the -number and variety of theories advanced were great. Some of the most -unreasonable were the most attractive, and it is easy to understand -why they were accepted. But if any of these theories is used as a means -of attaining a scientific end it cannot succeed with any dependability -if it is unsound. - -The psychologic effects of sound may be physiologic or intellectual. -They may be related to intensity, quality or direction on the one -hand, or to past or present mental associations on the other. To the -primitive man thunder, which seems to come from everywhere and is -louder than anything he can produce, is terrifying and supernatural; -the rustling of leaves is frequently caused by the wind, but from his -past experience may also instil the fear of the approaching enemy. -Sound is often frightening from its qualities or implications. - -The psychologic reaction to the type of sound known as music may vary -from the reflex panic produced by the air-raid siren to the soothing -effect of a softly sung lullaby. For some people, certain musical -selections elicit almost no response, while in still others a truly -amazing chain of mental images results. The latter reaction is the -result of centuries of evolution in the development of music and -knowledge, and will be discussed later. - -During the modern evolution of musical composition, many new forms -were devised bearing descriptive names. Some of these forms by their -distinctive tempo, dynamics, or title conditioned the informed -listener to a mental attitude consistent with the intention of the -composer. Some selections by the very nature of their execution cause -stimulation or assist repose. Superficially it might seem, therefore, -that the controlled administration of music could evoke desired moods -in listeners at will, and some practitioners declared that music is a -specific treatment for mental disease. It is undoubtedly possible to -influence the mood of healthy, trained musicians by the use of selected -compositions but to assume that all listeners will react in similar -fashion, or that the moods of the mentally deranged can be changed at -will by prescribed music, is to ignore the nature of mental disease and -the scientific finding of psychologists. - -Music is many things, but physically it consists of sounds or notes -which have pitch, intensity, timbre and duration. These notes are -combined in patterns which have rhythm, tempo, melody and harmony and -these in turn are related to key, mode and form. Each of these elements -has been the subject of philosophic interpretation, and more recently -of psychologic investigations. Although the effect of music on the -human mind depends upon the reaction to the entire composition, it is -important to review the existing data in order to understand more fully -the effects of music, in spite of the difficulties; for as Ortman[71] -has said “the problem of analyzing and classifying responses of music -into types is at the same time intensely interesting and notoriously -difficult. The history of the problem is rich in unco-ordinated data -and poor in clear-cut conclusion.” - - -II - -ELEMENTS OF MUSIC - -_Pitch._ Heinlein[45] found that the same chords which called forth a -happy and bright feeling when played in high pitch were characterized -as gloomy or melancholy when played in low pitch. The voice of youth -and laughter is higher pitched than the grumbling of old age and may -be a conditioning factor. Beaunis[8] felt that the reaction to pitch -is the effect of experience and custom and cited a reversal among -Orientals in whom low pitched sounds effect joyous reactions and the -high, sadness and sorrow. - -_Intensity._ Heinlein found that loud chords are rarely soothing, and -soft chords are almost always soothing. Beaunis stresses the fatiguing -quality of great intensity over a long period, and contrasts it with -“Very soft sounds as in Schumann’s ‘Danse des Sylphes’ ... which holds -you under the charm of delightful emotion.” - -_Timbre_ is the quality of sound which identifies it with the -instrument of its production. Although many instruments can be -convincingly gay or subdued, most authors are agreed that some -instruments emit prejudicing tones. Chomet[18] considered the bassoon -mournful, the flute tender, and the trombone harrowing. He found that -the clarinet expresses grief, the oboe suggests reverie, but that the -violin “seems suited to express all sentiments common to humanity.” -Mursell[60] finds consistent tactile values in tone. Low tones are dull -and high tones cutting. He speaks of the French horn as smooth, the -piccolo sharp, the oboe as stringent, the cello velvety and the bassoon -rough. - -Gundlach[38] believes that the timbre of an instrument is significant -in mood response. He finds the brasses triumphant and grotesque, -never melancholy or tranquil, delicate or sentimental; the woodwinds -mournful, awkward, uneasy, never brilliant or glad. The human voice -also has timbre, and distinctive values. There is the dramatic quality -of Marian Anderson and the syrupy flow of Bing Crosby; the virility of -the basso and the sparkle of the coloratura. - -_Duration._ The sounding of a single note will attract attention, -but if the note continues for a sufficient period without changing -its characteristics it will become monotonous, annoying and finally -exasperating. If the sound is interrupted at equal intervals, this -reaction will take longer to develop, but if the intervals between them -are irregular, interest is sustained, especially if these variations -occur periodically; that is, with a certain rhythm.[8] - -_Rhythm._ It is possible to have music without rhythm, but as -Rameau[68] pointed out long ago, “Music without rhythm loses all its -grace.” Since percussion instruments probably preceded all others, -rhythm was the first stage in the evolution of music. The proponents of -the motor theory of rhythm feel that muscular response to music with -pronounced rhythm is a physiological reflex. They point out that it is -difficult to walk deliberately out of time to a well accentuated march, -and Dunlap[26] has shown that in reclining subjects “With the utmost -possible relaxation of the entire body, good rhythmic grouping of an -auditory series can be obtained.” With the aid of the electromyograph -Jacobson[50] has shown that in complete relaxation mental activity -results in fleeting but specific muscle contractions invisible to the -eye and unknown to the subject. - -Rhythm perception is a mental stimulant. Reade[69] observed that -African negroes when ordered to row a boat always began to sing as an -aid to overcome their natural laziness. Bücher[14] believed that rhythm -as exemplified in working songs facilitates the synchronous expenditure -of energy by individuals engaged in a common task. - -Although rhythmic song will not necessarily elicit obvious motor -responses in all subjects, the wide-spread use of work songs among -groups of people engaged at hard work on land or sea throughout the -world is indicative of the value of background rhythm for communal -effort. Mursell[60] believes that “any notion that pure or ‘naked’ -rhythm is more effective than rhythm clothed in tone is open to very -serious doubt.” But the chief effect of marked rhythm is the feeling of -excitement and happiness which it can arouse. Rhythm gives us a certain -pleasure because of its orderliness to which the mind is sensible. - -_Melody_ as a musical element contributes chiefly to restfulness.[71] -If it is simple and recognizable it will recall other times and rest -the mind from the thoughts of present problems. If it is complex and -new it will distract the more musical but have a less desirable effect -on the uninterested. - -_Mode._ The term _mode_ is applied to the arrangement of whole and -half-tones in the musical scale construction. Of the many possible -modes only two are used in our present system of music, the _major_ -and the _minor_. There is only one form of the major mode, and it is -the one most people recall when they think of the scale. There are -three forms of the minor mode, but of these the _harmonic_ is the most -frequently used. It is formed by lowering the third and sixth notes by -a half-tone.[80] - -When an author pioneers convincingly in a field which has long needed -clarification, it is likely that even his questionable remarks will -be accepted with the same degree of authority as his scientific -statements. In 1722, Rameau[68] published a treatise on harmony which -received wide acceptance because of its excellence and comprehension, -but in that work he prejudiced many of the writers who followed into -believing that the major triad was more pleasing and beautiful than the -minor. This concept was not only adopted but embroidered. Hauptman[44] -likened the minor triad to the branches of the weeping willow and -hence attributed to it a mournful downward drawing power. To the major -triad he assigned the property of an upward driving force. (When this -is taken literally, as it was, and applied to the patient, we can see -clearly why remarkable attributes were claimed for music.) - -Now there is little doubt that if the triad of C minor is struck on a -piano after that of C major, most people will describe the sensation -elicited by the sound of the minor chord as melancholy. Helmholtz[46] -attributed the veiled or sad effect of a minor chord to certain notes -foreign to the chord which physical reasoning expects. - - “The foreign element thus introduced is not sufficiently distinct to - destroy the harmony, but it is enough to give a mysterious obscure - effect to the musical character and meaning of these chords, an - effect for which the hearer is unable to account, because the weak - combinational tones on which it depends are concealed by other louder - tones, and are audible only to a practiced ear.” - -But Gurney[40] refuses to admit to a sense of melancholy in this slight -dissonance, for as he points out - - “the same slight degree of dissonance as exists in the minor triad - may be made to supervene on a major triad, by adding to it a certain - extremely faint amount of discordant elements: it would seem then - that the major triad thus slightly dimmed or confused ought to sound - melancholy, but it does not in the least. Another argument may be - found in the following fact. The minor triads of D and A are of - perpetual occurrence among the harmonies of C major; and yet they do - not seem then to convey the distinctly pathetic impression, instantly - produced by the appearance of the C minor triad. - - “Music in a major key may be profoundly mournful; and it would - often be impossible for any description to touch the musically felt - difference between such music and mournful minor music. The minor mode - has a somewhat more constant range of effect.” - -Such discussions continued until Valentine[76] decided to test the -mood effect of the modes on a group of listeners. He found that -“major intervals are described as sad or plaintive twice as often -as the minor.” Heinlein[45] not only substantiated this but found -that intensity was the dominant modifier of feeling. He reviewed -more than twenty-five hundred compositions for beginners and among -them found only seven per cent written in the minor mode. “It is a -difficult matter to obtain a composition in the minor mode written -for children that does not have a title which relates to the weird, -the mysterious, the sad and the gloomy. Apparently composers in their -attempts to differentiate the modes for children fall victim to the -method of introducing titles opposite to feeling content. To children, -the title of a composition is a very outstanding feature. It may be, -after all, that reaction to the modes is largely a question of the -extent to which association with descriptive titles of a specific -variety first establishes the affective impressions in the mind of -the beginner.” Thus it can be seen that composers have been nurturing -an old philosophy by titles rather than music. Beaunis has shown that -although among European composers, the major mode has been used for -bright and restful passages and the minor mode has been used for uneasy -and stirring selections, a study of the music of other races will -uncover an entirely opposite use. Hevner[47], in an elaborate series of -controlled studies, concluded that “all of the historically affirmed -characteristics of the two modes have been confirmed” but admits that -“in producing its effect on the listener, the mode is never the sole -factor.” - -In a later study Hevner[48] continues to maintain that modality is -effective in the dimensions of sadness and happiness but quite useless -in the dimensions of vigor, excitement and dignity. - -The reaction to mode is influenced by what has been heard immediately -previously, and by musical training. The reaction to mode is not -physiologic but offers one key to music for patients in that those who -identify the minor mode with sadness should not be given such music -when gay music is indicated. - -_Key._ There was a time when particular keys were credited with -emotional powers. Lest such thoughts still persist, the following -quotation from Gurney[40] is offered. - - “Particular keys are sometimes credited with definite emotional - powers. That certain faint differences exist between them on certain - instruments is undeniable, though it is a difference which only - exceptional ears detect. The relations between the notes of every key - being identical, every series of relations presenting every sort of - describable or indescribable character will of course be accepted by - the ear in any key, or if it is a series which modulates through a set - of several keys, in any set of similarly related keys. But as it must - have a highest and a lowest note it will be important, especially in - writing for a particular instrument, to choose such a key that these - notes shall not be inconvenient or impossible; and also the mechanical - difficulties of an instrument may make certain keys preferable for - certain passages. Subject to corrections from considerations of this - sort, the composer probably generally chooses the key in which the - gem of his work first flashes across his mind’s eye: and when the - music has once been seen and known, written in a certain key, the - very look of it becomes so associated with itself, that the idea of - changing the key may produce a certain shock. But the cases are few - indeed where, had the music been first presented to any one’s ears in - a key differing by a semitone from that in which it actually stands, - he would have perceived the slightest necessity for alteration; and - as a matter of fact when a bit of music is thought over, or hummed - or whistled, unless by a person of exceptionally gifted ear it is - naturally far oftener than not in some different key to that in which - it has been written and heard. Even the difference most commonly - alleged, between C major as bright and strong and D flat as soft and - veiled, comes to almost nothing when a bright piece is played in D - flat or a dreamy one in C. - - “That a variety of emotional characters can be definitely attributed - to various keys is a notion so glaringly absurd that I would not - mention it, were it not that it is commonly held; and that such - doctrines are really harmful by making humble and genuine lovers of - music believe that there are regions of musical feeling absolutely - beyond their powers of conception.” - -In an unnamed manual the following statements occur: - - “C major expresses feeling in a pure, certain and decisive manner. - It is furthermore expressive of innocence, of a powerful resolve, of - manly earnestness, and deep religious feeling. - - “G minor expresses sometimes sadness, sometimes, on the other hand, - quiet and sedate joy--a gentle grace with a slight touch of dreamy - melancholy--and occasionally it rises to romantic elevation. It - effectively portrays the sentimental, etc. Another author, quoted by - Schumann, found in G minor discontent, discomfort, worrying anxiety - about an unsuccessful plan, ill tempered gnawing at the bit. ‘Now - compare this idea,’ says Schumann, ‘with Mozart’s Symphony in G minor, - that floating Grecian Grace.’ He quotes from the same writer that E - minor is a girl dressed in white with a rose-colored breastknot. - - “These are but abstracts, and a good deal of the humor is lost by - selection. For the ‘characters’ of several of his keys the author - gives a list of examples the choice of which, inasmuch as every - possible character might be exemplified from compositions in every - single key, cannot have been very difficult. It is something like - proving that Monday is a day ‘especially full of melancholy,’ on - the ground that some individual lost a relative on it, or that the - characteristic of Thursday is ‘confidence and hope,’ on the ground - that on it an individual came in for a fortune. - - “These thoughts are similar to that of the Chinese philosopher who - traced the five tones of the old Chinese scale to the five elements, - water, fire, wood, metal and earth.” - -_Tempo._ “The idea of forcing emotional characteristics on tempo is not -less preposterous than those on key. (Gurney quotes further ideas of -the same writer.) - - “The common time expresses the quiet life of the soul, an inward peace - but also strength, energy and courage. - - “The three-eight time expresses joy and sincere pleasure; but its best - characteristic is simplicity and innocence. - - “The three-four time is expressive of longing, sincere hope and love. - - “It would be interesting to hear from this writer what happens when - any one composes a piece in common time, which expresses the quiet - life of the soul and ‘inward peace’ and in the key of E minor, which - represents grief, mournfulness, and restlessness of spirit.” - -Gundlach[38] found that speed was by far the most important factor in -distinguishing among several pieces played to a group. And Hevner[48] -found that for excitement the most important element was tempo, which -must be swift. “Dreamy sentimental moods follow slow tempo. Sheer -happiness demands a faster tempo.” - -Hanson[42] believes that “everything else being equal, the further -the tempo is accelerated above _tempo moderato_ (which is about the -same speed as the human pulse rate) the greater becomes the emotional -tension.” He goes on to state that “as long as the subdivisions of the -metric units are regular and the accents remain in conformity with -the basic pattern, the effect may be exhilarating but not disturbing. -Rhythmic tension is heightened by the extent to which the dynamic -accent is misplaced in terms of metric accent, and the emotional -effect of ‘off-balance’ accents is greatly heightened by an increase -in dynamic power.” He is unduly alarmed by the effect “Boogie-Woogie” -may have on the younger generation because rhythm irregularity finds -its most fertile field in this jazz form characterized by “a repeated -figure in the bass (which) continues indefinitely in regular rhythm.” - -_Sonority._ Hanson[41] has traced the development of music from the -highly consonant music of the Roman Catholic Church at about the time -of Palestrina to the dissonant music of certain modern composers. He -describes the early hymns as “calm, serene and in a sense impersonal.” -For him, “the expression of personal feeling in music seems inevitably -to be associated with the use of dissonance. Indeed the expression -of emotion in music seems to be bound up in the contrast between -dissonance and consonance, the former producing a sense of tension and -conflict to be either heightened by progression to a sonority of still -greater tension or resolved by a succeeding consonance.” It may be easy -for a musician to believe that the increased use of dissonance creates -an increase of emotional tension, but to the musically uncultured -listener dissonance may just as often create boredom or annoyance. - -_Composition._ Although musical factors such as pitch, intensity and -melody can contribute to mood effect when isolated, the reaction to an -entire composition is quite different from reaction to tones of chords. -It may depend upon environment or association with the situation in -which the selection was first heard or is being heard. It may be -altered by the length of the composition or unanticipated contrasts of -intensity or the use of unusual patterns, rhythm or tempo. In listening -to music, expectation plays an important role. A sudden change or -interruption is apt to excite surprise. “The mere meeting of the -expectation in all its details affords pleasure of a kind. But great -as is the aesthetic pleasure, a far greater degree of enjoyment may at -times be attained by a carefully planned surprise, the appropriateness -and artistic skill of which is recognized and approved”[10]. - -Much has been written on the images or stories which musical -compositions evoke. Some musicians have tacitly implied that ability -to appreciate these stories results in greater pleasure, but -Gehring[34] wisely insists that “musical enjoyment does not depend on -interpretations, but it may also be reaped by those who abstain from -making them.” There are some people who can interpret any musical -selection, and others who find no story. Between these extremes is a -group who can get more pleasure from music if listening is preceded by -such preparation. As Damon[20] has pointed out, “A musical selection is -thought to be more beautiful and more colorful when the usual program -notes are supplied before hearing it.” - -There are those who see specific color in sound. It was Isaac Newton -who first compared the diatonic scale with the seven colors of the -spectrum from red to violet beginning with C as red. Katz[71] reported -on strong color association of two case studies. For the first, C major -was jet black and for the other C major was brilliant white. But this -could be expected inasmuch as the scale of notes presents intervals -and proportions of the most definite kind whereas those of the color -spectrum are confluent and have no mathematic relation. Spectrum -analogy was discredited by de Marian in 1737[70]. “No two people -agree or hardly ever do, as to the color they associate with the same -sound”[30]. - -But color is only one element in a mental image; what about the others? -Is it possible for two people listening to a new, unnamed musical -selection for the first time to envisage the same story or picture? - -T. Kawarski and H. Odbert[52] found no direct relationship between -color and music which held for more than a few individuals but certain -general relationships of photoism to special aspects of music were -found to recur constantly. Thus increase in brightness tends to -accompany rise in pitch or quickening of tempo. Whereas some one factor -like strong visual imagery or cultural influences or suggestions may be -dominant in some individuals and a totally different factor in another, -none of those factors operate in any pure and simple fashion. - -Too often musical interpreters will see too much in a given selection. -Some will try to rhapsodize in words the theme as announced by the -title of the selection. Some enthusiasts will grasp at straws of -suggestion from the original source. Gurney cites an amusing instance -in connection with a sonata of Beethoven, of which the three movements -are entitled: _Les Adieux_, _L’Absence_, and _Le Retour_. These titles -were so inviting that some gushing comments were published about the -portrayal of passages from the life of two lovers. However, on the -manuscript, Beethoven wrote: “Farewell on the departure of His Imperial -Highness, the Archduke Rudolph, the 4th of May 1809.” and “Arrival of -his Imperial Highness, the Archduke Rudolph, the 30th of January 1810.” - -The insistence by some of the specific images evoked by certain -selections can be disheartening to those lovers of music who accept -such interpretations as fact and are disappointed in their inability to -experience the same reaction as others, especially if the others are -recognized musicians. - - “It is obvious that the power of music to depict objects, situations - or ideas is extremely indefinite. No matter how specific a pictorial - or dramatic program the composer may have in mind to present through - his music, the listener will never get that program from the music - itself. If the hearer is told what the music is supposed to depict - he will imagine the incidents and fit them into the music. Or if he - is given a title it will suggest to him a train of imagery which he - will read into the composition. And if he is given neither title nor - program his fancy might take him on a mental journey, the direction - of which will depend upon his mood, his mental set, his physical - condition, his past experience, and numerous other subjective factors, - for which music serves as a stimulus, but all of which lies outside of - the music itself.”[35] - -Thus when Rubinstein read into the “Second Ballade” of Chopin the -story of a wild flower caught by a gust of wind, the struggles of the -flower and its final breaking, he confused the issue by adding a second -interpretation to the music which was inspired by Mickiewicz’s poem, -“Switez Lake,” the story of which is totally different. When Gilman -played this same song for his students there were many interpretations -which ran the gamut from “meaningless” to “creeping assassins.”[35] - - * * * * * - -Beethoven’s complaints of his interpreters and expounders were frequent -and bitter, but we must turn to the writings of the more literary -musicians, Mendelssohn and Schumann, for coherent expressions on the -subject. Mendelssohn wrote, - - “What any music I like expresses for me is not thoughts too indefinite - to clothe in words, but too definite. If you asked me what I thought - on the occasion in question, I say, the song itself precisely as it - stands.” - -Schumann’s position as regards verbal readings of music may be gathered -from the following passage: - - “Critics always wish to know what the composer himself cannot tell - them; and critics sometimes hardly understand the tenth part of what - they talk about. Good heavens! will the day ever come when people will - cease to ask us what we mean by our divine compositions? Pick out the - fifths, but leave us in peace.”[40] - -Some musical selections have been written to accompany a subject. Those -who know the story of _The Barber of Seville_ may associate the aria -“Largo al Factotum” with the despair of an over-worked barber, but -the same song might have been written to accompany almost any lively -subject and for people who have never heard the story and who do not -understand Italian, it is just a bright song, possibly humorous. As -Gurney says: - - “The verbal titles which aim at summing up the expression of certain - compositions, however interesting, are so adventitious that they have - often been suggested by instead of suggesting the music; and a hundred - auditors, if left to guess the title for themselves, would originate a - hundred new ones.”[40] - -Music can evoke specific emotions only when people have been -conditioned to it. The “Horst Wessel” song would not stir Americans -to hatred unless they could identify the title with the song and its -significance. Even then, the degree of hatred or contempt for the music -would be variable. - -Edwin Franko Goldman’s “On the Farm” can leave little doubt in any -one’s mind as to its subject matter, but with the exception of such -very obvious music, or music to which we have been emotionally -conditioned, music cannot paint blue skies or green pastures. - -What then are the feelings most frequently excited by music? According -to Schoen[72]: - - “The data show that rest, sadness, joy, love, longing and reverence - appear most frequently as the effects produced. Vocal music has a - tendency to arouse well-defined emotional effects far more often than - instrumental, the probability being that the specific emotional effect - is due in the main to the words.” - -The conclusions of Schoen on mood changes in a tested group sum up the -relationship between mood changes and enjoyment. Thus for practical -purposes we want to know not only whether a musical composition -produces a mood change in the listener, but also what is of greater -significance, whether the induced mood is also enjoyed, and to what -degree this enjoyment might depend on such factors as the type of -mood induced. The listener’s familiarity with the selection, and his -judgment of the quality of the selection, are also important. - -The results of a large series of observations show as a rule, that -music produced a mood change in every listener, or that an existing -mood was intensified when it conformed with the mood of the music. -The tendency of the same composition to produce the same mood in -every listener was very marked. The degree of enjoyment derived from -the musical composition was in direct proportion to the intensity of -the mood effect produced, provided this effect was not due to the -conditions of the performance, such as a poor intonation or faulty -interpretation. - - “No greater amount of enjoyment was derived from one type of mood than - from another type, unless the mood was due to dislike of the specific - type of music or to a poor performance. But when the mood change was - from joyful to serious, the enjoyment seemed to be slightly less than - when the change was from serious to joyful, provided the hearer was - not hampered by a knowledge of the critical estimate of the music to - which he was listening or by faulty interpretation. The evaluation of - the quality of the musical composition was in direct proportion to the - intensity of enjoyment.” - - -III - -OTHER CONDITIONING FACTORS - -In addition to the physical elements of music previously discussed -there are other factors which enter into the type of response of mind -and body to music. Mention has been made above of the value of program -notes. People who hear new music for the first time may or may not -develop a visual or emotional response, but if prepared by descriptive -writing they may “understand” or at least enjoy the music more. - - “Program notes, oral comments, and the general setting of the - presentation are important because they concentrate and reinforce the - mood response. Indeed it has been shown that in a verbal introduction - offered before a composition is presented, what is said does not - matter much, and that almost any kind of comment will enhance the - listener’s enjoyment if it serves to cue him into appropriate - effective states of mind.”[60] - -Music aides should take this finding seriously and preface the playing -of musical selections with verbal commentary. Even popular dance music -may be prefaced by remarks about the solo instrument featured or the -personalities involved. - -With the exception of the effects of rhythm, all other reactions -thus far cited have been largely psychologic. Before leaving the -discussion of response, one bit of evidence demonstrating possible -physiologic action will be presented. Gundlach[39] studied the songs -of six different American Indian tribes. Now the language, customs -and music of neighboring European countries frequently have something -in common, but the absence of the wheel in transportation made the -scattered people of the Western Hemisphere strangers to each other. -The speech and songs of the different Indian nations are entirely -unrelated, yet the songs representing the same types of ceremonials -show considerable agreement. From this Gundlach concludes that “music -has some conventions grounded on a firm basis of physiologic structure -and behavioral similarity of human beings.” - -_A_--_Live Music._ Most people will turn to the source of sound. Even -the most phlegmatic will turn if the sound is sudden and loud enough. -It is a protective mechanism because identification of the source may -prevent personal injury. There is also a sense of satisfaction in the -corroboration of the auditory and visual images. When the sound is -musical the desire to see its production is greatly increased. For -those who cannot make music themselves, it is like watching a conjurer -from behind. For musicians it offers the opportunity of inspection, -improvement or criticism. One of the most important psychologic -components of music is the physical presence of the music maker. About -twenty years ago a manufacturer produced piano-player rolls which -reproduced the manipulation of well known artists so well that experts -could not differentiate between the sounds produced on the piano by a -live pianist and the automatic player. Yet this method of reproduction -was a failure financially; it had every quality of the live musician -except the physical presence. - -We demand far less in quality of music from a live band than from a -mechanical reproduction of band music. Groups of people who assemble to -dance will pay relatively high prices for inexperienced players with a -monotonous repertoire for the sake of having live music. The dancers -may complain of the poor musical execution, but will suffer a return -engagement in preference to the playing of recorded music. - -There are cinema stars whose singing voices are harsh to most ears, -yet listeners will applaud them into an encore, not so much for the -sake of a beautiful experience, but to prolong the human contact. We -react not only to the sound, but to the motions and very presence of -music-makers. We listen to people as well as their music. Live music -stimulates, sustains and focuses attention. It should be used as often -as possible for patients. The “live” musician can get patients to -listen to musical forms which would be entirely ignored otherwise. If -musicians wish to spread the appreciation of “good” music and music -appreciation, one method is to be found in personal appearances at -hospitals. - -_B_--_The Human Voice._ Of all the sounds of given pitch and intensity -the one which best attracts and maintains interest is the human voice. -We habitually turn to the human voice. Sometimes we do it as a matter -of courtesy. Again, we may do it for better understanding, or even out -of curiosity. The spoken language is understood by far more people than -is the so-called language of music. When words are set to music they -command greater attention than when they are spoken. They are usually -compact and in rhyme. We strain to hear each word to gather the full -meaning and humor or cleverness of the lyricist. Yet, we willingly -lower our literary standards when words are put to music. The verses -of many songs sound vacuous and repetitious without accompaniment. But -the words are made interesting by the melody, and melody takes on -additional meaning from words. “Vocal music has greater power to arouse -a definite emotional response than has instrumental music. Rest results -about equally from instrumental and vocal music.”[71] - -Songs with words are ideally suited for arousing patient interest. -Community singing is the most valuable form of music for maximum group -response. - - -LISTENING - -Violet Paget[55] sent questionnaires to one hundred and fifty people in -different parts of the world to obtain a global sampling of reactions -to music. From an analysis of their answers she found - - “two different modes of responding to music, each of which was claimed - to be the only one in those in whom it was habitual. One may be called - ‘listening’ to music; the other ‘hearing’ ... with lapses into merely - overhearing it. Listening implied the most active attention.... - Hearing is a lesser degree of the same mental activity where active - attention occurs in moments like islands continuously washed over by a - shallow tide of other thoughts.” - -This is very similar to Gurney’s classification of musical perception -as “definite” and “indefinite.” Vernon[77] lists the varieties of -response to indefinite listening as: - - a. Reflex or physiological; soothing or stimulating. - - b. General euphoria. - - c. Stimulation of thought and wandering of attention. - - d. Emotional moods of interpretation of the so-called “meaning” of - music. - - e. Dramatic visual images of day-dreams. - - f. Awareness that sounds are going on, but no further response. - - g. Lapsing of this awareness into the “margin” of consciousness. - -He found reactions a. and b. among primitives and infants; and -reactions c. f. and g. among the untrained. - -Schoen[71] found that response to music is related to the psychologic -levels at which they occur, and to sensation, perception, and -imagination. The sensorial response is physiologic and possessed by -all. It is the source upon which all other musical development depends. -It requires a minimum amount of mental effort, and its effects are -within the easy reason of the intellectually inferior and superior -alike. As a sensation, music is either pleasant or unpleasant. Training -and experience may lead to higher types of response, depending upon -individual desire and ability to develop musical taste and education. -The next higher response is perceptual and its distribution level adds -excitement or repose. The highest level of response is imaginal. - - “Much of the music we hear we have heard before, and because of this - fact we have associated it with a host of memories with pleasant or - unpleasant coloring. The hearer may not recall the exact time or - occasion on which he heard the selection before and yet he may have a - group of images which are definitely referred to his own past.” - -Meyer[71] summarizes the appeal that music might have for listeners as -1. Emotional response, 2. Suggested associations, 3. Personification of -a subject, 4. Its value as an object. - - -IV - -MUSICAL TASTE - -The selection of music for patients can be handled in many ways. The -easiest and least reliable is to use the music best loved by the -musician guiding the program. Such programming will undoubtedly meet -with the approval of some of the patients but it is unlikely that it -will meet with the approval of all. Non-psychiatric patients should be -given the music _they_ want. - -Much has been written concerning specific music for certain groups -of patients. There has been considerable prejudice in favor of “good -music”; that is “good” in its relation to intellectual values. -But music in itself can be neither good nor bad. Its execution or -appropriateness for the occasion or the individual may be open to -question, but the answer must come from the patient. We must keep -uppermost in our minds the goal of music for bed-ridden or chronically -hospitalized patients. They look to music as a morale-booster and a -source of enjoyment. Most people have favorite songs, but the degree -of desire for them or for any music will fluctuate with the time of -day, the kind of day, and many other considerations. The taste of -the patient will vary not only with age, training, nationality and -home back-ground, but with such intrinsic and unfathomable things as -personality and thinking habits. - - “Musical taste is a folkway, a convention which behaves exactly as do - folkways in other realms of activity. Accompanying this taste is the - conventional ‘conscience’ which dictates what is ‘right’ and what is - ‘beautiful.’ It is more or less impervious to contradiction and is - disturbed at the prospect of change”[59]. - -The music of any given composer does not change but the audience will -change as a result of the appearance of new forms of music and living. -The works of the eighteenth century, with few exceptions, were loved by -its contemporaries but find a small audience to-day. - -The musical taste of an individual changes noticeably from childhood -to maturity but the change is gradual, and except for those studying -music intensively, during any one year of life the change is hardly -appreciable. Even established favorites will become less desirable to -the individual. - - “After a certain number of repetitions, varying with both the founded - experience of the listener and the complexity of the item, the - enjoyment is diminished. One might here propose the hypothesis that - the rate of ascent to popularity is directly in proportion to the rate - of the decline ... as illustrated by the sharp rise to popular acclaim - of the ephemeral popular hits and their subsequent precipitous decline - into oblivion.”[59] - -Among the many factors which sometimes have a great effect on musical -taste, contemporary events are outstanding. During a war, the people -welcome songs which sing of their prowess, impending victory, or -derision of the enemy. Such songs become popular because of their -literary rather than their musical content, but they affect taste -indirectly, since the only test of taste lies in the songs to which -people will freely listen. - -Soldiers pick up foreign songs and marching songs and bring them home -as souvenirs and favorites. It is now well recognized how great and -prolonged such an influence can be. - -Whatever the musical taste of the patient may be, and regardless of how -he came by it, it should be satisfied. As soon as an individual attains -the status of being a patient, there is an immediate mental depression -which may continue to increase if not checked. The patient may develop -anxiety, fear, self pity or boredom. There may be sensory depression -from pain, unpleasant sight or disability. In addition to these -saddening factors there may be undesirable response to environment, -personnel, and the monotony of medical or nursing routines. All efforts -should be directed at substituting joyful experiences for saddening -introspection. The formula for joy is very personal. Although most -people will laugh at some comic situations, the response to music -cannot be predicted except upon the basis of individual desire. The -person who becomes a patient may not have a fundamental change in -musical taste but his appetite may be altered by variations in mood, -and this is of prime importance. - - “More people express a wish for music dynamically similar to the - existing mood than for music of the opposite effect. The amount of - enjoyment is slightly affected by the kind of mood change taking - place.”[71] - -It is possible for sad music to be more enjoyable to those who are -receptive to it, than gay music. Nevertheless, other things being -equal, gay music is apt to give a greater degree of pleasure to those -who wish to hear it than sad music gives to its devotees. - -The enjoyment of music depends not only upon its pleasantness, but also -upon its familiarity. This recognition may be one of identity or of -idiom. Most people like popular music because they are familiar with -its form or tempo; or because they can hum or name it. - -The musical taste of the patient can readily be determined by offering -him a check-list with the names of fifty or more selections including -the entire gamut of musical forms. A general idea of the popularity -of classical selections can be determined from the sales records of -recordings and the frequency with which certain pieces are performed -by the better symphonic orchestras. The popularity of contemporary -offerings can be learned from surveys published in such magazines as -_Variety_ and _Down Beat_ or by listening to radio shows such as “The -Hit Parade.” - -Musical taste is closely allied to performance. If chosen selections -are played improperly or without regard to certain elementary -considerations, the use of music will lose its value to the patient. A -brief consideration must include the effects of arrangement, tempo and -volume with which the selections are played, since these have been seen -to influence the effects of the selection. Many people when asked to -name their favorite music will name a performer or a band rather than -a specific piece because they have come to desire the characteristic -style of the artists preferred, and style in an orchestra is closely -related to these factors. Some listeners prefer loud music, but it must -be remembered that even though sound does not become painful until -the level of 125 decibels is reached, there are some people for whom -the painful level is much lower, and hypersensitivity to sound is an -important source of irritation. Others may be disturbed by music which -is too fast, which must be taken into consideration. - -The role of expectation plays an important part in taste. Most people -who have been conditioned to expect the classic use of the scale and -traditional harmony cannot find joy in the unusual tonal structure -of the moderns as exemplified in Schönberg or even Stravinsky. -Hospitalization is not the proper period of life for indoctrination in -the beauties of innovations. - -Musical taste is acquired and always relative, and is based as -Diserens[24] has pointed out, on the “habit of hearing.” An historical -illustration of this is the evolution of the consonances. The -Greeks regarded the octave as the only genuine consonance. In the -fifth century, the fifth and fourth intervals were admitted to this -classification. In the eleventh century, the major third was accepted -as such, but the minor third had to wait until the twelfth century. “In -music the habit of hearing is the Law, and through it, the exception of -yesterday becomes the rule of today.” - -The best analysis of musical appetite can be found in the statement -of St. Thomas Aquinas, “Bonum est in quod tendit appetitus”--the good -is that toward which the appetite tends. We repeat there is no such -thing as good music or bad music. Music may be played poorly, but the -evaluation of the good in music is personal. “Pleasure, and pleasure -alone, is the proper purpose of art,” said Walter Sickert. Musicians -will do well to remember that since taste results from the gradual -blending of emotion, experience, and education, it is better to enjoy -wholeheartedly “a waltz of Lehar than to be able to make a thematic -analysis of a Beethoven sonata and yet remain unmoved by it.”[36] - - -V - -SUMMARY - -For non-psychiatric patients, musical programming should be based upon -patient requests. For stimulation the important factors are rapid -tempo, accentuated rhythm, and elevated volume. For sedation, slow -tempo and reduced volume are indicated, as well as simple recognizable -melodies. Some discussion of the selection to follow is a valuable aid -to the enjoyment of listening. Live musicians should be used as often -as possible. - - - - -_CHAPTER THREE_ - -MUSIC AS OCCUPATIONAL THERAPY - - -Until the latter part of the eighteenth century the institutional -treatment of mentally diseased people consisted of custodial care. -This meant shelter, food and restraint. The quality of the shelter -varied in most instances from very bad to poor. The quality of the -food was not as varied--it was just bad. The quality of the restraint -was excellent. With few exceptions commitment meant life internment. -Violent patients were chained to the wall, for who could tell when -they might become violent again after a period of calm? The mentally -deranged were not considered as patients with a disease of the mind but -as inmates who had lost communal value and social desirability. Dr. -Philippe Pinel of the Salpêtrière Hospital in Paris thought otherwise -and began to consider these people as still human. Among the reforms he -introduced was the use of activities to keep the mind and body occupied -doing things. This concept grew slowly at first but eventually reached -universal acceptance, was considered of real therapeutic value and -named occupational therapy. - -During the first World War many military patients were confined to -hospitals for prolonged periods while awaiting complete recovery. -It was noted that those who busied themselves with such physical -activities as required the use of their wounded extremities regained -the use of these extremities sooner those who remained idle physically. -Thus was born a branch of Occupational Therapy which was known as -_functional_ to differentiate it from previous psychiatric use. - -Functional Occupational Therapy is used to increase three functions: -muscle power, joint mobility and co-ordination of movements. It finds -its greatest use in those patients who fall under the care of those -medical specialists known as orthopedic surgeons and neuro-surgeons. -Orthopedic patients are those who have disease or disability of one -or more joints or bones. The most common disease of joints is called -arthritis, of which there are several kinds of varieties. The most -common disability of bone during war-time is fracture. Arthritis -usually prevents complete joint motion. In some instances the joint -is put at rest to hasten healing. Almost all fractured bones are kept -fixed by plaster casts or traction and prevented from movement during -healing. The prolonged rest, necessitated by diseases of bones and -joints, permits muscles to become weakened or atrophied, and also -permits joints to lose some of their range of motion. When the course -of disease has reached that point where rest is no longer required, -the chief aim of medical treatment is to restore former function. This -means the restoration of power and mobility. This is accomplished by -means of physical and occupational therapy. Physical therapy includes -the use of heat, massage and guided exercise. Occupational therapy is -exercise through work--purposeful, productive work with an incentive. -The incentive is twofold--to produce something useful and to hasten -recovery. - -Patients who have had destruction or other disease of the nerves which -activate their muscles develop varying degrees of loss of muscle-power -known as palsy or paralysis. When a nerve is pressed or cut, it usually -heals in such fashion as to permit return of muscle-power. During -the period of its impairment, there is not only a loss of power, but -frequently concomitant disturbance in the skin, the joints and still -other functions. As a result of the nerve disturbance or the disuse -which follows, the portion of the body which is paralyzed loses the -ability to use its muscles with facility and maximum economy. There are -almost no motions performed by single muscles. Most activity results -from the contraction of a group of muscles and these are usually in -delicate balance with other groups of muscles which either assist or -prevent overaction. The delicate adjustment of muscle groups, which is -normally present, results in co-ordinated movements. Following nerve -disease or, for that matter, the immobilization of joints and muscles, -co-ordination is usually lost to more or less degree. Muscles must be -re-trained to work together. Such co-ordination can be accomplished by -special exercises, but even more rapidly and efficiently by imitating -the motions of life. This is the aim of functional occupational therapy. - -There are other disease conditions which can profit from the use of -occupational therapy. These include other disabilities which are -accompanied by loss of power, motion or co-ordination. When the skin -is burned, healing is usually accompanied by some degree of scarring. -If the scar includes a joint on its flexor surface (i.e. inside the -bend) there will result a deformity known as a flexion contracture. -If nothing is done about this, the crippling process will become -progressive and some day reach a stage beyond correction other than -that offered by plastic surgery. The early stretching of such joints -will not only prevent progressive disability but may result in some -improvement. - -Many other indications for the use of occupational exercise will be -met, but since this is not a text on medicine, the preceding types of -disabilities will serve as examples of the conditions commonly seen. - -The crafts first used in functional work were carry-overs of those -most beneficial in mental disease, and for the most part were restful -and simple, such as basketry, weaving and the graphic arts. More -recently, almost all the arts and crafts have been used, as well as -motorized tools. - -The results of occupational exercise will depend upon the -attractiveness of the objects which can be produced, the energy -required, the skill and patience of the occupational therapy worker and -patient, and the stage and extent of the disability. For those who are -not “handy”, or who have become increasingly clumsy with disability, -there may be impatience, tedium and fatigue. Occupational therapy is -always seeking new activities or modalities as they have become known -in practice. Music can be used as exercise in occupational therapy as -well as for background and interludes of relaxation. - -The fingers of professional pianists and violinists are very strong, -for instrumental manipulation requires and develops strength and -co-ordination. Music as an exercise can be used not only for its effect -on most of the joints and muscles of the body, but to increase the -use of the lungs and larynx. It focuses attention through the use of -visual, auditory and tactile senses and stimulates mental activity and -interest. - -Many instruments may be employed for the mobilization of joints and -muscles. When a musical instrument is prescribed as the occupational -therapy activity for a patient, there may be some resistance on the -part of the patient because of a lack of general or musical education, -or the fear of studying something new. The success with which this -resistance may be overcome will depend upon the skill of the musical -aide not only as a musician but as a teacher. The musical aide will -have to convince the patient that the fundamentals of music are far -less difficult to learn than is popularly supposed. Much of the -notoriety about music lessons is developed among children who dislike -regimentation, interference with their play periods, and the length of -time it takes the minute hand to circle the clock. The musical aide may -cite that observation and impress the patient with the greater ease of -adults in learning to play. Interest may be aroused by naming the other -patients who have recently learned to play and by demonstrating the -advantages in earlier recovery that music offers. - -Regardless of their initial attitude towards music lessons, most -patients will soon be pleased with their progress and ability to master -musical notation. Visits to the craft shop will usually be made on an -appointment basis and the patient will leave as soon as his “time” is -up. The knowledge newly acquired through instrumental instruction will -keep the patient at work longer and the musical aide will find him -returning for further practice without coaxing and for desirably longer -periods. - -_Piano._ Before considering the use of the piano in occupational -therapy, the work of Ortmann[64] should be reviewed. - -A joint is the point at which two bones connect. In any moveable joint -the essential feature is a sliding of one surface on another. Joined -to the sides of the two bones near their ends are ligaments which are -strong and inelastic and hold the joints within the joint cavity, and -which prevent the joint from exceeding its normal range of motion. -But the function of holding the bones together and keeping them in -different positions belongs to the controlling muscles. Bones are -usually activated by at least two sets of muscles which effect the -movements in opposite directions. Normally muscles are under a slight -but constant tension known as _tonus_, and the simultaneous pull of -muscles on both sides of the joint presses the bone surfaces closer, -and keeps the muscle in a state which makes immediate action possible. - -Joints move by virtue of the contractions of the muscles. Most -movements are made not by one muscle alone, but rather by the -co-ordinated contraction of various muscles and the simultaneous -relaxation of their antagonists. As a result of muscle contractions, -a chemical change takes place which produces substances in the muscle -that interfere with good muscle action. Ordinarily these waste -products are carried away by the circulating blood with sufficient -speed to prevent noticeable effects. If, however, the muscle produces -these deleterious chemicals faster than the blood stream can carry -them away, fatigue results. The earliest manifestation of fatigue is -inability to relax, and the second contraction may be initiated before -relaxation is complete. The second effect of fatigue is interference -with rate and quality of contraction. Only relatively brief periods of -relaxation are necessary for complete recovery, but these periods are -important. When normal muscles practice on the piano, the fatigue limit -is rarely reached, but for the weakened muscles of patients, fatigue -must be guarded against by limiting duration of continuous playing -and by proper interludes of rest. Ordinary piano-playing offers short -rest periods because there is a reflex relaxation after the sound is -produced and it requires less muscle energy to keep the key depressed -than to depress it. - -Muscles are excited into contraction by minute bio-electrical impulses -which enter through their motor nerves, but the property of contraction -is independent of the nerve and can also be accomplished by artificial -external stimuli of electricity or mechanical force. The quality of -contraction is a function governed by the health and nutrition of the -muscle. The nutrition of the muscle depends upon its blood supply, -which depends in part upon its warmth. Delicate motions are difficult -for cold muscles and artificial warming is advisable before exercise, a -fact which assumes greater importance in cold weather. - -From the viewpoint of patient interest and instruction, the piano is -the best instrument. When equipped with pianola fixtures, it is the -one instrument that gives the widest range of activities. Because the -piano is difficult to move, playing is restricted to the room in which -it is housed and there need be no concern about its interference with -other patients if the practice room is sound-proofed, or is situated -some distance from the other patients. The piano offers excellent -opportunity for flexion of the fingers and thumb, extension, abduction -and adduction of the wrist, as well as flexion and abduction of the -shoulders and exercise of the neck and back. - -The piano can be adapted for use by patients with extremities in -hanging casts, which can be supported by sling arrangements attached -to the piano or the patient’s neck. It can even be used satisfactorily -with a cumbersome airplane splint if a very low bench is substituted -for the usual piano chair. The height of the bench can be arranged so -that the key-board and hand are on the same level, and the challenge -of this position will make the patient try all the harder to use his -fingers. - -For the contractures resulting from burns of the hands, the piano -offers an excellent medium with which to increase joint motion. In -depressing the keys the fingers are forcibly flexed. The key surface is -much broader and easier to manage than that of the typewriter key. The -piano, therefore, offers less of a psychological deterrent to use than -does the typewriter. Mistakes at the piano are less annoying because -there is nothing to erase but a memory, and the memory of unpleasant -things is fortunately short-lived. By means of special musical -arrangements and additional notation written next to the printed notes, -some fingers can be exercised singly or in any combination desired. -The physical exercise or co-ordination of selected fingers can be -obtained more subtly by the use of marked music than is possible with -most crafts. Some instructors may prefer to mark the keys of the piano -with the letters to which they correspond, but this is not really -needed in the instruction of adults. A large diagram of the piano keys -placed above the musical scale for which they stand may be located to -advantage on the wall over the piano. - -It is recommended that the first piano lessons cover fifteen minutes -and that the time be increased five minutes daily until the lesson -fills a half hour period. Inasmuch as the strain of piano playing is -very slight, the first lesson may last thirty minutes if the physician -so decides. The patient should be encouraged to practice freely at -other times during the day as long as his interest can be sustained. -Chief attention must be placed on the use of the fingers requiring -exercise. As is true in all forms of functional occupational therapy, -the impatient patient will try to speed his work by using unaffected -joints or by improper use of muscles. The musical aide must guard -against this temptation. Although standard music for beginners should -be used, it is well for the teacher to use simple arrangements of -popular tunes at each session for the incentive that it will give the -patient. If the patient expresses the desire to play a certain melody, -the instructor should write his own arrangement if none is available. - -The keys of the piano can be reached effectively in many ways and -it is possible to exercise almost any of the muscles of the upper -extremity by playing from different levels. To exercise the muscles -of the shoulder girdle, loud notes may be played by holding the hands -fixed and raising and lowering the shoulders. The shoulder itself can -be abducted and adducted by wide lateral movements along the keyboard. -Flexion and extension of the wrist is accomplished by staccato -movements. Lateral motion of the wrists is partially restricted by the -bony structure but can be accomplished by arpeggio work. - -Thumb action plays a very important part in piano playing. The -_opponens_ action (touching the last finger with the thumb) is very -necessary in playing _arpeggios_, particularly with large intervals -played _legato_. In fact there is hardly any known purposeful activity -which is more useful for full exercise of the _opponens_ range than -this activity. The music must be fingered with numbers that will keep -the index finger on one note as the thumb passes under for the next -higher note at an interval of two or three tones. In order to depress -the key, flexion of the thumb is necessary. The thumb can be abducted -to almost any degree by the playing of chords or by playing _legato_ -passages. - -All motions of the fingers are possible. For active or passive -extension of the fingers much use should be made of the black keys. -If the hand is held in position to play the white notes in the normal -manner, the black keys can be played only by extension. Various degrees -of flexion of the joints are possible by ordinary playing. Spread of -the fingers which is a function of the dorsal interossei muscles can -be accomplished by practising chords, the span of which should be -increased as power and range improve. - -_Violin._ In most activities requiring the use of both hands, the -more delicate motions are performed by the right hand in right-handed -persons. For the violin family the situation is reversed, and these -stringed instruments are of greatest value for exercise of the left -fingers and right elbow. If the interest of the patient is great, there -is no reason why the normal positions cannot be interchanged so that -fingering is accomplished by the right hand on a violin with reversed -strings. - -The violin is recommended for flexion of the left fingers, but is of -greater value for flexion and extension of the right elbow. It is -secondarily valuable for the flexion and extension of the wrist and -abduction and adduction of the shoulder. The motion analysis for the -cello and bass viol are similar to that of the violin. The heavier -instruments require more motion at the shoulder. String instruments -are less popular than the piano because two fundamental techniques -must be learned simultaneously; correct fingering and correct bowing. -The vibration of the struck piano strings is relatively uniform with -variable pressures[II.], but the quality of the violin sound as -produced by the beginner can be discouragingly unpleasant. - -_Plectrum Instruments._ The plectrum instruments afford excellent -exercise of the wrist of the right hand and the fingers of the left. -The ukulele, when brushed by the fingers, offers better extension of -them than is found in most crafts. The guitar offers even stronger -flexion for the fingers which depress the strings than does the -violin. All these instruments require supination and pronation at -the wrist and some flexion and extension of the elbow. They are more -popular than bowed instruments and have the added advantage of being -so easy to learn that the performer will be able to play simple song -accompaniments in a relatively short period of time. The variety -of instruments in this category permits a wide range of energy -requirements. - -_Foot Instruments._ Although there are several instruments in which -the lower extremities are used, there are only two which are readily -adaptable to hospital use--the pianola and the parlor organ. For the -former, no knowledge or musical ability is required and its use is open -to all. The distance between the bench and the pedals will determine to -some extent the energy expended and the range of joint motion which can -be accomplished. The speed of playing is related to the energy which is -required. If the library of pianola rolls is large and inclusive enough -to meet the demands of the patient’s taste, an adequate amount of work -can be expected. - -The foot-pumped organ is also an excellent ankle exerciser. Even the -untrained will find some interest in the timbre of the notes and the -qualities of sound emitted with the pulling of different stops. The -lingering sounds and the novelty of playing an organ which is no longer -a commonplace in the home, are great incentives to playing. Instruction -on the organ, which has a smaller keyboard and slower manipulation -than the piano, is pleasant and simple. For combined upper and lower -extremity disabilities, the organ is an excellent instrument. Every -hospital music department should own one. There are enough unused -organs in the attics of this country to supply the needs of most -hospitals. - -The bass drum with foot pedal attached is obviously not a solo -instrument, but when used in ensemble or with a full set of traps and -snare drum, it can sustain some interest and result in some benefit to -those suffering with ankle disabilities. Its use is limited to activity -of the muscles and joints below the knee. It can be used by patients -wearing a leg-brace pivoted at the ankle. - -_“Pocket” Instruments._ Of all the wind instruments available for the -instruction of beginners, those which require no reed or lip knowledge -are most desirable. Easiest to play is the “kazoo”, or any other -instrument which embodies the principle of a membrane vibrating to the -sound of the human voice. Only the ability to hum is needed and it is -valuable for the patient who is difficult to teach because it permits -even the dullest to participate. The kazoo is especially useful for -children or psychiatric patients and can supply the melody for “rhythm -bands.” The ocarina, song-flute and related instruments are relatively -easy to master but the sound emitted is annoying to many. The recorder -is easy to play and produces a pleasant sound. The harmonica has been -developed into an instrument that is not unpleasant to listen to, -but the beginner’s efforts may not be too welcome. The fife requires -greater effort to operate and is harsh to the ears of some. The flute -is too difficult for hospital use and the beginner in his anxiety might -experience a “black-out” from sustained blowing. - -The reed and brass wind instruments are not suitable for functional -use. Their use is limited to chronic patients because of the large -amount of time required to learn to operate them satisfactorily. - -Wind instruments can be used for patients whose pulmonary pathology -has cleared to such an extent that the physician feels lung exercise -is indicated. The early use of lung exercise following atypical virus -pneumonia has been found especially beneficial. - -Wind instruments may also be used for exercising the facial muscles -during the recovery phase of facial palsy. Their possibilities in -stretching the scars about the mouth and cheeks should be considered. - -_Percussion Instruments._ The snare drum offers motion to the wrists, -elbows and shoulders. Few men or children can resist the temptation -to play the snare drum. The desire for prolonged playing is not too -great, but if recorded music is played during the exercise the duration -can be prolonged for an adequate period. The bass drum, as previously -mentioned, permits flexion and extension of the ankle when used with -the pedal, and this, too, can be made interesting if recorded music is -played simultaneously. - -Other percussion instruments may not be generally available in -hospitals but the possibilities offered by them will be listed. The -kettle drum offers rotation of the arms. The xylophone and marimba do -not evoke great ranges of motion but bring the muscles of the upper -extremities, neck, and back into play, and promote co-ordination. For -children, the toy xylophone is a welcome plaything and an excellent -form of occupational therapy for the upper extremities. A new toy, the -_Typatune_, operated like a typewriter affords opportunity for finger -exercise. - -There are still other instruments which may be classed as musical that -offer opportunities for exercise. It is just possible that a portable -hand organ may be available. The novelty of operating one of these -is not to be underestimated as an incentive to work, particularly in -younger people. Both the hurdy-gurdy and the hand-cranked victrola -offer exercise to the wrist, elbow and shoulder. By placing these -instruments at different distances from the floor or patient, many -ranges of motion can be obtained. - -The harp offers excellent exercise to the serratus muscles as well as -to the muscles and joints of the upper extremities, but its operation -is more complicated than that of most instruments, and even if -available, would require the instruction of a harpist, of whom there -are too few. - - -TECHNIQUE - -Assignment of patients to instrument-playing should be made in the -same manner as other assignments in functional occupational therapy. -The physician should prescribe the instrument which best meets the -convalescent’s needs. He should explain to the musical aide in the -presence of an occupational therapist the motions desired and the -precautions to be followed. He should set the time limits for the -first and succeeding lessons. In general, it may be said that the -first lesson should last about fifteen minutes, or until such time as -the patient shows signs of fatigue. This period should be extended -gradually to a half hour. The patient should be encouraged to return to -the instrument as often as is practicable for further study. When the -number of patients receiving lessons is large, a regular schedule for -additional practice periods will have to be posted. After a relatively -short period, the musical phase of occupational therapy will operate -smoothly and the physician will be able to delegate most of the details -to the occupational therapist, who should frequently supervise the -lessons to ensure desired joint motion and to note progress. The -occupational therapist should make progress measurements and notes. -When properly supervised, the use of music as functional occupational -therapy can be as scientific as any other branch of occupational -therapy and is the one use of music at this time which may properly be -termed “musical therapy”. - -The following table is offered as a reference for some of the motions -possible with a few of the instruments described. - - +----------+-----------------------+-------------+ - | _Part_ | _Motion_ | _Instrument_ | - +----------+-----------------------+-------------+ - | Fingers | All | Piano | - | Fingers | Extension | Ukelele | - | Thumb | All but adduction | Piano | - | Wrists | Flexion--Extension | Piano | - | Elbow | Pronation--Supination | Guitar | - | Elbow | Flexion--Extension | Violin | - | Shoulder | Abduction--Adduction | Piano | - | Neck | All Motions | Xylophone | - | Back | All Motions | Bass Viol | - | Hips | Abduction--Adduction | Organ | - | Knees | Flexion--Extension | Pianola | - | Ankles | Flexion--Extension | Parlor Organ | - +-----------+-------------------------------------+ - - -VOICE - -Singing has long been used for the treatment of stammering and other -speech impediments. Singing can also be used to exercise the jaws, -larynx, lungs and diaphragm. With proper instruction, singing can be -an excellent exercise for the muscles of the chest and abdomen as well -as a breathing exercise. - -For the patient with a recently wired fractured jaw, singing gives -gentle joint motion and restores confidence in the ability to use -the jaw again. The same thing applies to patients with recovering -tempero-mandibular joint pathology. A patient with poor jaw motion -cannot articulate well, but can sing more nearly like the well patient -than he can talk. Singing can begin at the level of humming and -progress through scale practice to actual song instruction. - -When several patients are available for vocal exercises, a trio, -quartet or other group arrangement will create greater interest. Except -in hospitals devoted to the treatment of chronic disease, the turn-over -in patients will make group singing uncertain. - - -FOOTNOTES: - -[II.] “_a discussion took place in 1913 on the physical significance of -that mystic quality called “touch” by which a player attempts to vary -the quality of the notes ... but it was concluded that the velocity of -striking was all that could be varied by the player._” - - _Richardson, E. G.--Sound, p. 106_ - - - - -_CHAPTER FOUR_ - -PSYCHIATRY AND MUSIC - - “His music mads me, let it sound no more, - For though it helps madmen to their wits, - To me it seems it will make wise men mad.” - - _Richard III_, Shakespeare - - -Gaston[31] believes that - - “The basic reason for the arts throughout the history of mankind has - been the resultant mental hygiene benefits. The common creative urge, - desire for diversion, and search for satisfactory expression exist in - all people. Music--above all arts--guarantees the fulfillment of these - elemental urges, and therein lies its greatest value.” - -The suggestive power of music has given rise to a series of legends -which go back to the very origin of civilization. But the methods of -experimental physiology, so precise in the study of organic function, -lead to no clear and easy picture in the presence of reactions as -complex and subjective as those of esthetic emotion and artistic -pleasures. The task of evaluating the effect of music on the mind is -made increasingly difficult by the personal equation, and when to this -is added the distortion of mental disease, great caution must be used -in the approach, technique, and recommendations to be followed in the -use of music as applied to psychiatry[27]. Altschuler[3] finds that -music stimulates the libido, which he defines as - - “the great amorphous power, the vital spark, out of which the will to - pleasure, the longing for love or passion for procreation take their - origin.” - -He believes that music is the only “medicine” which helps to convert -instinctual forces into socially acceptable forms. - - “Stimulated by music, man can still offer his lowly instincts free - expressions, camouflaged by jitter-bugging and boogie-woogieing.... - Indeed there is therapeutic acumen to an agent which is capable of - reconciling the instinctual with the social, and the sensual with the - spiritual.” - -The relationship between music and the mind is obvious, but the nature -of the relationship which has led some musicians to facile claims -of artistry remains for most psychiatrists a tempting but obscure -field. Most of the writing on this subject has been done by musicians -and so-called results obtained with music in mental patients have -been evaluated without medical guidance or the use of scientific -method. Physicians are hesitant to accept new ideas which are not -founded on unquestionable evidence. Enthusiastic laymen might call -this reactionary, and they would not be entirely wrong. It is the -reaction to the too rapid spread of folklore, cults, and nostrums which -physicians have had to combat to keep medicine on the highest possible -plane. It is the only tool with which they can protect the sick from -unscrupulous or even well-meaning people who, for personal gain or with -ill-founded conviction, promise cures by the citation of accidental or -falsified results. By custom, ethics, and state laws the treatment of -disease is the province of the licensed physician. - -The term “musical therapy” has been applied almost exclusively to the -treatment of mental disease with music. The term “therapy” is derived -from a Greek verb which means _to cure_. A cure can be practiced and -determined only by a qualified physician, or under his direction. -Claims can be made by anyone. To establish the curative value of any -procedure, certain criteria must be observed. In the first place, the -disease must be accurately classified so that the affliction of a -series of patients can be scientifically grouped for study. Next, the -therapeutic agent must possess qualities of constancy which permit -controlled dosage. Last, the proper administration of the agent in -the same disease condition must show a reasonably high percentage -of results which can be proved to be of value in the control or -elimination of symptoms or disease. - -Until a relatively short time ago, the causes of most disease -conditions were unknown and illnesses were named according to their -superficial characteristics. Most newly named diseases are designated -by the agents which cause them or by the variations from normal found -in the tissues of the body they affect (pathology). In psychiatry, most -diseases bear the names applied to their outward appearances. - -A simplification of terms places mental disease into three general -classes. Psychoses, Psychoneuroses, and Behavior Disorders. The -subdivisions of these classes are not universally accepted and the -musician who works in a mental hospital will soon become acquainted -with the locally practiced terminology. - -As a guide to vocabulary rather than an introduction to psychiatry, a -brief review of some of the prominent symptoms of mental disease will -be enumerated. The scientific material is based on Noyes’[62] excellent -text. - -The following list of the more common mental diseases is based upon the -classification offered by the National Committee for Mental Hygiene. - - _Psychoses_ - General Paresis - Alcoholic - Hardening of the Brain Arteries - Senility - Involutional Melancholia - Manic-Depressive - Schizophrenia - - _Psychoneuroses_ - Hysteria--anxiety, conversion - Hypochondriasis - - _Mental Deficiency_ - - _Behavior Disorders_ - Maladjustment - Habit or conduct disturbance - - _Psychopathic Personality_ - Amoral, immoral, emotional - -Detailed descriptions are confusing to the layman because within one -disease subclass, the variations possible as a result of duration, time -of onset, mental background, etc. are very great. Only generalizations -will be mentioned. - -The two major divisions of mental disease--psychosis and -psychoneurosis--are not always readily differentiated. In the -psychotic, the personality is usually distorted, whereas in the -psychoneurotic the personality remains normal in relation to the -realities of the world and social life. The psychotic is the more -obviously deranged, the psychoneurotic usually passes for almost normal. - -_General Paresis_ is a late result of syphilis. The patient becomes -increasingly forgetful and disinterested in his surroundings and -social relations. There is a gradual loss of judgment and other mental -faculties. The facial expression becomes empty and the speech slurred. -This is the disease in which the knee reflex disappears, an indication -popularly associated with “crazy people”. It is a progressive disease -which becomes more difficult to treat as it progresses. The treatment -at this writing consists of the use of drugs containing arsenic and the -production of fever in the patient. The results are not remarkable, -ordinarily. Return to normal is unusual. Music for such patients could -in no manner be conceived as curative or even helpful. - -_Alcoholic Psychosis_ results from continued excesses of drinking. The -patient usually resents criticism because he is convinced that his -reverses have driven him to drink. The prolonged use of alcohol relaxes -inhibitions, produces anti-social actions, and results in more sorrows -to drown in more alcohol. Alcoholic psychosis usually begins suddenly -with mental confusion, muscle twitches known as tremors, and vivid, -visual imaginary thought known as hallucinations. The treatment for -such patients includes withdrawal of alcohol and the use of sedative -measures. One of these measures is a prolonged bath in a tub of water -just below body temperature. Once the patient has recuperated to the -convalescent stage, music may be employed. Some alcoholics like to join -in group singing, especially if the group is made up exclusively of -fellow inebriates. Any encouragement to join non-alcoholics in group -singing, or any use of music which may stimulate a permanent interest -in a new instrument or diversion would be valuable. These patients lack -self-imposed discipline. If music can be used as a discipline, it might -lead to decreased drinking. - -_Arteriosclerotic Psychosis._ As its name implies this is a condition -of the aged and is probably related to hardening of the brain arteries. -The symptoms may include emotional instability, mental fatigue, -disinterestedness, and some loss of memory. The patient begins to -look and act old. The treatment consists of custodial care, physical -rest, and mental occupation. Music is well suited to this combination. -Oldtime favorites played softly for several periods daily is indicated. -Obviously, where specific musical numbers are requested they should be -played. - -There is another disease which resembles this called senile psychosis. -Usually it can be handled in the home, and is. - -_Involutional Melancholia_ occurs at an age when certain important -biologic functions of the body begin to regress or involute. For women -this age is usually forty-five, but for men it can be ten or more -years later. The condition is seen especially in those who did not -lead an average life previously. A study of the personality of such -patients usually shows them to have been uninterested and uninteresting -people, with few close friends. An unfavorable experience may bring on -worry and unrest. They become saddened and exaggerate the minor sins -of their past. They develop false beliefs known as delusions about -their surroundings or themselves. At least half of them never recover -completely. - -There is little that can be done for them, except to encourage -healthful diets and hygienic regimes to keep them physically well. -Some physicians might encourage the use of music for such patients -to distract their attention from themselves. Familiar melodies are -recommended, because of the age group, old time favorites will be the -most suitable. - -_Manic-Depressive_ psychosis is a relatively common condition in most -large mental hospitals. It is so called because the same patient -may have periods of excitement or depression separated by phases of -apparent well-being. The stage of excitement begins with arrogance, -assurance, exuberance and energy, and may superficially resemble the -pleasantly boisterous drunk seen at a national convention. The patient -talks rapidly, histrionically, and with a play on words called “flight -of ideas” because each new phrase suggests new ideas on which the -patient will embark, leaving the main thought-stream. This excitement -may continue to the point where the fatigueless drive is remarkably -great. This may or may not be followed by an opposite reaction. - -In the depressive phase patients may feel gloomy, speak slowly, and -look worried. A feeling of inadequacy may lead to self-punishment and -suicidal intent. The symptoms may progress to the complete inactivity -known as stupor. - -The first manifestation of this disease is usually manic with the first -depressive state years later. Attacks last about six months or longer -and although they usually recur at a future date, may not. In the time -between attacks the patient may appear quite normal and return to his -previous activities. - -In the manic phase, sedatives are frequently administered. Stimulating -music would only tend to increase the disturbance. If the physician -prescribes music it should be of the restful type, preferably a -selection which will attract the patient’s attention by its familiarity. - -In the depressive phase, patients should not hear cheerful and gay -music. Entertainment often deepens the depressive state because of -the contrast, and the awareness of their own problem, which prevents -enjoyment. - -_Schizophrenia_ literally means splitting of the mind. It is a group -of conditions in which the usual harmonious blending of emotions, -intellect, and drive are disorganized into a seeming inactivity and -resultant apathy. In the _simple_ type the patient becomes uninterested -in his environment and responsibilities. This result is seen in the -vagrant and the delinquent. - -In the type known as _catatonic_ there are phases of excitement or -stupor. In the stuporous state the attitude of the patient resembles -that of an automaton. In this state it is difficult to make any contact -with the patient who refuses to co-operate or even move. Catatonic -excitement sometimes follows the stupor and is evidenced by the same -purposeless absence of emotion, but may include unexpected acts of -destructiveness. - -There is another type called _paranoid_ in which the patient develops -false beliefs of persecution, and a hebephrenic type in which the -patient becomes even more inaccessible and inattentive. - -Schizophrenia, once thought incurable, is now considered amenable to -treatment and about one fourth of the stricken recover completely after -the first attack. - -In treating these patients an attempt is often made to promote an -interest in real things and social consciousness. It is necessary to -stimulate attention and redirect it to things outside the patient. -Music has a more important place in this disease than in any other -mental condition, and this disease may account for more than half the -population of many mental hospitals. - -Altshuler and Shebesta[4] tried music in the treatment of four excited -female schizophrenics in conjunction with hydrotherapy. To have some -basis for evaluation of effect, the amount of vocal productions -and head movements were recorded for thirty minute periods. This -combination is referred to as “output”. Observations were made for a -six week period, five days a week for two to three hours a day. Two -patients were given continuous baths and two were given cold wet sheet -packs during the observation periods. A violinist played behind a -screen for the first thirty minutes. During the first ten to twenty -minutes of playing no changes were noted, and the patients seemed more -or less inattentive to the music. Soon it was found that familiar tunes -were most effective in centering and keeping their attention. Thus, -very noisy and upset patients might begin to sing a familiar song -with the violin, keeping their output of energy at the same level but -changing from irrelevant purposeless activity to the directed activity -of singing or humming a tune. It was also noted that the effect of -familiar tunes extended far beyond the termination of the music, as -manifested by continued singing after the music stopped. Familiar -waltzes were found to be the best type of music to use in quieting the -patients, but these were more effective when preceded by more lively -tunes which secured their attention. - -As a control, patients were placed in dry sheets and after twenty to -thirty minutes of music the output diminished in the same degree (50%) -that was observed with patients in wet packs. This showed that possibly -the music alone may have been responsible for the quieting effect. - -These authors conclude that musical accompaniment tends to prevent -the feeling that hydriatic measures are punitive and that the return -of real memories is a natural substitute for states of phantasy and -excitement. - -Julia Eby[29] feels that - - “If in the development of a person’s talent for music, stress is laid - upon the enjoyment it will give further listeners, he is being made - conscious of the social significance of his own accomplishments and - this helps the development of the personality as a contributing member - of the community. - - “Music contributes emotional energy needed to turn dissatisfaction - into mental reconstruction. The playing of music arouses associations - which stimulate the intellect and if this is sufficient it gives - satisfaction and enhances self respect.” But “We must be careful to - excite only those activities that will be followed by a feeling of - success”. - - “The intellectual stimuli of music bring the expenditure of emotional - energy from unconscious levels to conscious and intellectually - controlled levels ... a concentration on environment stimuli instead - of intrapsychic impulses, a perseverance in effort to adjust one’s own - conduct to group standards.” - -Altshuler[2] points out that the seat of all sensation, emotion, and -esthetic feeling (the thalamus) is not involved in mental illness, and -is directly attacked by music. The musical stimulation of the thalamus -automatically transfers from this “below awareness” level to the brain -cortex. - - “Little constructive therapy is possible as long as the patient is - acutely disturbed; therefore anything which may lessen disturbance and - bring about association familiar to the patient and which will revive - thoughts to a real level will be desirable.” - -_Psychoneurosis_ differs from psychosis in that the patient recognizes -that he is ill and wants to get well, although his more powerful -subconscious desire does not. Several types are recognized. - -_Hysteria_ is an unconscious reaction on the part of an individual -to solve a personal problem by the acquisition of some symptom or -symptoms. If this is done consciously it is called _malingering_. -Any and every physical or mental symptom is possible. Examples of -physical involvement are blindness, paralysis, aches and pains. -Mental manifestations may include loss of memory, delirium, etc. -Hysteria permits the patient to achieve his purpose and maintain his -self-respect. It is an escape mechanism to evade responsibility, excuse -failure, or gain attention. - -Many forms of treatment have been used and each physician uses his own -approach. The more commonly accepted methods include psychotherapy, -persuasion, suggestion, and psycho-analysis. Psychotherapy encourages -the patient to talk about his condition and with the guidance of the -psychiatrist discover the basis of his difficulties. Logical persuasion -is used but is not considered effective by most. Suggestion under -hypnosis is used by some who are expert in hypnotism. Psychoanalysis -attempts to discover the subconscious thoughts and experiences which -have caused the disturbance. - -Music may be of some value for this group. Levine[56] believes that - - “Many individuals achieve a feeling of self-confidence if they develop - hobbies such as music. Learning to play musical instruments may - compensate a feeling of inferiority, especially when the individual - has ability which he underestimates.” - -Listening to music may stimulate the patient to talk about his -condition or about things that trouble him. Altshuler[3] feels that -where large groups of patients must be treated with limited personnel, -such as exists in hospitals which handle cases of war neuroses, -group treatment is the only solution, and that when there is group -psychotherapy music is indispensable, for it not only can “turn any -aggregation of people into an ‘organic’ group. It is one of the -mightiest socializing agents.” - -Harrington[43] believes that music has an important place in the mental -hospital although he regards technical instruction for heterogeneous -groups unworthy of the effort. He is convinced that, “Mass singing has -therapeutic value, and that subdued instrumental music during mealtimes -is desirable.” - -According to Kraines[54] - - “Recreation and hobbies are also extremely important energy release - techniques. The apparently passive listening to music may accomplish - release of energy. The passivity is only seeming. The person following - the music tends by identification to swing muscularly with the music, - nodding his head, tapping his feet; and even when there is no manifest - movement, there is often a non-observable but yet definite movement. - In many forms of music such rhythmic movements can be performed only - by relaxed muscles; and tense persons who are influenced by harmonious - music are perforce relaxed. Some sanatariums very effectively utilize - dancing to music as a means of relaxing patients. Moreover in this - general relaxation and harmonious appeal to the senses, the person - “feels” that peace and harmony do exist outside himself and will - continue to exist despite his own troubles; and by such general - “feeling tone”, the person puts aside his conflicts for the while. - On the other hand some types of music will stimulate persons into - increased activity (e.g. martial music, dance music) by reason of the - tendency to make rapid and staccato rhythmic movement in time with - the music. The rhythmic muscle movement can, under the influence of - a skillful composer, increase to such a pitch as to make the person - excited, exhilarated, etc. Outlets for energy release should be - selected which will give enjoyment to the patient.” - -In chronic mental institutions the patient band has been found most -valuable. Pierce[66] believes that - - “Music can be a co-operative effort for a wholesome discipline. - It tends to break down the sense of isolation so common to mental - disease. It assists in adaptation to the mental state. - - “First, playing must be made a pleasure to the members. This means - there must be no severity of discipline and great tact must be - exercised in correcting errors--preferably privately so as not to be - humiliating to the patient. - - “Second, have some easy numbers: otherwise the results may discourage - the patients. - - “Public appearances away from the hospital have the advantages of - enhancing self respect and pride. - - “Admit a small number of hospital personnel to the band--but not - those of great ability. The more varied the instrumentation, the more - gratifying the result to the participants.” - -_Mental deficiency_ means the incomplete development of the mind which -makes independent living impossible for the victims. The degrees -of deficiency are classified according to the results obtained in -intelligence tests: 1. Idiot--mental age of less than three years. 2. -Imbecile--age of three to seven. 3. Moron--above the age of eight, but -deficient. The treatment for these groups consists of custodial and -hygienic care plus any education which can be attained, and of course -music will play its part in this in a purely academic manner. - - -SUMMARY - -Music can be used in psychiatry for its value in listening, group -participation, and creation of sound, as follows: - - 1. _By listening_ - - A. To improve attention. - B. To maintain interest. - C. To influence mood (to produce exhilaration, etc.). - D. To produce sedation. - E. To release energy (by tapping of foot, etc.). - - 2. _By participation_ (in group singing, bands, etc.) - - A. To bring about communal co-operation. - B. To release energy. - C. To arouse interest. - - 3. _By creation of sound_ (playing of instruments) - - A. To increase self respect by accomplishment and success. - B. To increase personal happiness by ability to please others. - C. To release energy. - - - - -_CHAPTER FIVE_ - -BACKGROUND MUSIC - - -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: - - “1084 ... Other means of allaying pain: 3. Agreeable music, especially - if it inclines one to sleep. 4. Being occupied with something very - engrossing removes the severity of pain.” - -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: - - “I wish you were well enough to come to us tomorrow.... I would divert - your pain with good music[12].” - -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 - - “if the fingers are completely fatigued, either by voluntary effort - or by electric excitation, music has the power of making fatigue - disappear.”[74] - -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. - - -FOOTNOTES: - -[III.] _The use of industrial music is not to be confused with working -songs. Working songs are those sung by groups performing tedious or -strenuous work to help them maintain good rhythm and spirit. Bücher -(Bücher, K., Arbeit und Rhythmus, Leipzig, 1909) analyzed a long list -of working songs and concluded that: 1. Through rhythm they facilitate -the synchronous expenditures of energy by individuals engaged in -a common task. 2. They spur the worker on through jest, abuse, or -reference to the spectators’ opinions. 3. They mention the work, its -progress, pleasures, vexations, difficulties and rewards. 4. They -inform everyone of the wishes and aspirations of the workers. These -slow rhythmic songs are entirely unsuited to the machine age where the -machine sets the inelastic rhythm for the worker._ - - - - -_CHAPTER SIX_ - -MEALTIME MUSIC - - -Patients who are confined to bed, or for that matter, to a hospital, -find meals progressively monotonous in spite of the fact that there is -a greater variety offered them than was theirs at home. This monotony -results in part from the color and nature of the environment, the -personnel, the general atmosphere of the hospital, and the constraining -nature of institutional restriction. While dining at home some of these -factors are subconsciously dissipated by trivial intimate conversation, -friendly faces, individual attention and the security of the things for -which “home” stands. - -There are only a few things which can be done to make hospital meals -more enjoyable, aside from those features best handled by the chef -and menu planner; but it is possible to increase the pleasure of meal -periods through the manipulation of certain environmental factors. One -of these is the use of color and _decor_ in hospital dining halls to -simulate home surroundings. In the ward this is most difficult where -little can be done, except by introducing attractive hangings which are -less hospital-like, or by the application of paint in cheerful colors. -The latter method is sanitary and practical. - -Since ancient times music has been used as an accompaniment to meals. -The instruments used by the ancients for this purpose were usually -those which emitted soft sounds. Voltaire said that our purpose in -going to the opera was to promote digestion. During the preceding -century, dinner music became stylized and consisted largely of -semi-classical pieces or waltzes played softly in slow tempo by string -ensembles. During the past twenty-five years there has evolved a form -of dinner music which is not only a marked departure from the old, but -has come to be used as a source for dancing between and during courses. -Whether the physiologic and psychologic effects of dancing during -a meal are harmful, beneficial, or of no moment remains undecided. -Certainly there seems to have been little interest in analyzing its -effects. During the period when dinner-dance music was available only -in a few places, the number of those who could be affected by it was -very small. But, with the more recent installations of “juke” boxes, -and other forms of mechanically reproduced music, into all varieties of -dining places, the problem is worthy of investigation. - -Most people derive pleasure from the consumption of appetizing food. -Most people derive pleasure from music played to their taste. Although -the logic of the following thought is subject to criticism, it does -sound reasonable to state that two pleasurable experiences enjoyed -simultaneously, should add up to a greater happiness than that afforded -by either individually. Food has received thorough study with respect -to preservation, preparation, serving, and the time of day when each -item is most satisfying. Some of the conclusions have been arbitrary, -but for the most part, people eat the food that agrees with them -physiologically and psychologically. There is no especially good -reason why cereals should be eaten by adults only in the morning. It -has become a matter of custom or advertising, and the minds of the -masses have become conditioned to feel that cereal is especially good -at breakfast time. A generation ago the breakfast menu in some homes -differed little from the present day dinner fare. Eating habits have -become set in the minds of most people and there is little that can be -done to change them rapidly. Daily routines have given rise to certain -music conventions as well. Until recently, music at breakfast was -uncommon. Bernard Shaw[65] wrote, “Music after dinner is pleasant: -Music before breakfast is so unpleasant as to be clearly unnatural.” -With the advent of radio this has changed even if Shaw has not. Lunch -rooms, barbershops and other public places where people spend time -inactively, are equipped with mechanisms for reproducing music. The -practice of reading or even studying school work at home with the radio -on has become increasingly prevalent. The tempo of living has stepped -up to the point where most people, especially the younger, like to do -two things at once, especially if one of these is to listen to music. - -The effect of different foods upon digestion and health is known, and -most persons eat with a regularity which is related to capacity and -needs. They are usually able to select the items they desire, the time -at which they will eat, and the period for consumption. - -The ideal attitude while eating is one of mental serenity and physical -repose. If certain criteria are observed music can be relaxing. The -elements which increase relaxation are melody, rhythm, and softness. -If the music which accompanies meals is carefully selected it can make -eating more pleasurable, and this is desirable for patients in the -hospital. - -Mealtime music must be unobtrusive. It must lack stimulating qualities -which attract attention. If the diner can promptly name the selection -played five minutes earlier, that piece was too impressive in score or -performance. Perhaps the most suitable form of dinner music is that -played by a small string ensemble. The piano and harp are also very -satisfactory, alone or in combination with the ensemble. When the -piano is played in the hesitant legato style of Eddie Duchin it is -particularly desirable. The shrill sounds of the flute or the brassy -sound of the trumpet must be omitted. The music must be soft and slow. -Avoid vocals and strange instruments. - -The volume of the music should be maintained at as nearly the same -level as is consistent with the source of the music. It should begin -without fanfare or any attempt to attract attention. The level of -intensity should not interfere with conversation, for, if the loudness -of the music demands an increased volume of voice to carry on normal -conversation, it defeats the purpose of relaxation by evoking increased -energy on the part of the speaker. When possible the end of the -selection should fade out. There should be nothing abrupt about the -selection, and unusual sequences or novelties should be avoided. The -music should be fluent and entirely unexciting. The interval between -pieces should be brief in order to sustain auditory reception at -a fairly continuous level. Five to ten seconds between numbers is -recommended, and this coincides approximately with the time required -to change discs on an automatic or manually controlled record player. -Musical selections should be played in groups. The groups should last -a total of about fifteen minutes with rest intervals of about three -minutes. This simulates the requirements and performance of the live -ensemble and has become a part of stylized dinner music. The music -should last as long as the meal. - -Ideally, the source of the music should not be obvious, and to this -end a concealed loud speaker has an advantage over the live ensemble, -which through its motions or the physical appearance or mannerisms of -its members may distract diners. There should be no vocal announcements -between selections. Occasionally a listener will want to know the name -of the song being played because it is familiar, reminiscent, or sweet. -When the budget will permit, printed or mimeographed programs are most -welcome to those whose interest is aroused. - -The music recommended, is the music which has been played by dinner -ensembles for years. Their repertoires usually include waltzes by -Strauss and his contemporaries; selections from operettas by Herbert, -Friml, and Romberg, and the popular favorites of the past decade, -such as selections from the musical comedies of Kern, Cole Porter and -Gershwin, or the songs of Carmichael and Berlin. - -It cannot be emphasized too strongly that mealtime music must be -physiologically non-stimulating, and noisy music is to be avoided. -“Douglas Jerrold declared that he hated to dine amidst the strains of a -military band; he said he could taste the brass in his soup.” (Hadden, -J., “_Music as Medicine_,” 1895, 9:369). A foreman of a shop in which -music was played during mealtime begged that raucous music be omitted -“to give the digestion a break”[9]. - -Some orchestra leaders habitually use arrangements which approximate -the qualities desirable for mealtime music. Among these are: Wayne -King, Marek Weber, Andre Kostelanetz, David Rose, Frankie Carle, Carmen -Cavallaro, Eddie Duchin, Guy Lombardo, and the following orchestras: -Boston “Pops”, New Mayfair, Percy Faith, Anton and Paramount, Victor -Salon, Victor Continental, Palmer House Ensemble, Selinsky String -Ensemble. All these have been recorded and a sample list of their -recordings follows as a nucleus of a mealtime music library. - - _Victor Recordings_ - - Southern Roses 26322 B - Sweetheart Waltz 26322 A - Black Eyes 20037 B - Our Waltz 27853 B - Holiday for Strings 27853 B - Frühlingstimmen 4387 A and B - Dream Waltz V 214 - None But The Lonely Heart 4413 B - Song of The Islands 27224 B - La Golondrina 27451 B - Lover, Come Back To Me 27397 A - Indian Love Call 27397 B - Le Secret 20416 A - Pirouette 20416 B - Wine, Women And Song 6647 A - A Shepherd’s Tale 9479 A - Narcissus 9479 B - Come Back To Sorrento 27917 A - Gavotte from Mignon 27917 B - Zigeuner 24609 B - Tales of Hoffman 20011 B - Badinage 12591 A - Air de Ballet 12591 B - Gold and Silver 25199 B - Blue Danube 25199 A - - _Columbia Recordings_ - - Begin the Beguine 4265 M - Easter Parade 4292 M - With A Song In My Heart 4292 M - The Touch Of Your Hand 4291 M - Somebody Loves Me 4291 M - Falling In Love 4266 M - Tea For Two 4266 M - Josephine 36692 - Louise 36692 - Estrellita 4236 M - London Again 69264 D - By The Tamarisk 69264 D - Swan Lake 69357 D - Rosalie 36543 - Speak To Me Of Love 35551 - Pavanne 7361 M - Clair De Lune 7361 M - - _Decca Recordings_ - - The Very Thought Of You 3110 B - Cocktails For Two 3110 A - Every Little Movement 18300 B - Minute Waltz 18466 A - Blue September 15050 A - Valse Bluette 15049 B - Sleepy Lagoon 18286 A - - - - -_CHAPTER SEVEN_ - -MUSIC IN BED - - -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. - - - - -_CHAPTER EIGHT_ - -DIVERSION AND ENTERTAINMENT - - -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. - - - - -_CHAPTER NINE_ - -PUBLIC ADDRESS SYSTEM - - -Many hospitals now have public address systems. Before long most -hospitals of one hundred or more beds will have public address systems, -if for no other reason than emergency calls and to lessen the load on -the intramural telephone network. - -The public address system originally installed as an emergency call -device may be used for music reproduction at relatively little -increase in expense. The same operator may be used for both forms of -transmission. Ideally, the system should include a loud speaker in -every ward and a “phone-jack” at every bedside. The central switchboard -should have a good radio and an automatic record player which may -transmit music to the patients by means of the public address systems. -The addition of a set of switches which can cut wards in or out at -will can prove most useful. If there are halls or buildings from -which programs of general interest emanate frequently, they should -be equipped with microphones which are connected with the central -switchboard so that musical programs from the assembly hall or the -church services from the chapel may be broadcast to the non-ambulatory -patients. - -The central switchboard should be housed in a relatively sound proof -room or booth. Additional equipment for it should include shelves for -recordings and a telephone for which the usual bell signal is replaced -by a light signal. An instantaneous record-cutter which permits the -operator to record programs from the radio or microphone will be found -of great value, but the expense involved may be too great for most -hospitals of fewer than 500 beds. - -It is most advisable that a full-time operator for the system be -employed. The operator should have a pleasant voice, but even more -important, a highly intelligible one. He will require some basic -training in the operation of the switchboard and its accessories and -this should be the obligation of the organization which installs the -equipment. The operator should be required to keep a written record -of everything that emanates from the studio. He should be responsible -for the routine care of the apparatus and know enough about its parts -to recognize defects early and to correct some of the simpler ones. He -must be prepared to live a lone life. There is always a temptation to -invite or permit guests in the studio, and the resultant diversion or -conversation might adversely affect the broadcast. - -If an instantaneous record cutter is available he should read “_How -to Make Good Recordings_” (Audak Co. of New York) which is not only -valuable for the recording of music but gives some excellent advice -concerning the use of the proper needle for music reproduction and the -use of the microphone. - - -PROGRAM - -_Music._ The public address system should be operated on a rigid -schedule in imitation of a commercial radio studio. This is necessary -because the patients will come to expect certain features at specified -times of the day and fluctuations may result in disappointment and -reduced morale. The program policy should be the direct concern of the -hospital superintendent and any service chiefs who are interested. -The hours of use will vary considerably with the individual hospital -from a few hours to a very full program. Because of the great number -of possible variations, some general applications will be considered -first and then a model program will be suggested. - -The hour of awakening for patients may vary from about six to seven. -At some time during that hour, a program of exhilarating music is -indicated to start the day off right and perhaps get better cooperation -between the patients and the nursing personnel in morning care. To this -end, military or other marches are suggested as well as gay melodies, -because as Seashore[73] has shown, “pronounced rhythm brings on a -feeling of elation,” and martial music is traditionally stirring. This -program should last from fifteen to thirty minutes, and should be -followed by silence for at least fifteen minutes before breakfast is -served. It is unwise to begin eating while too stimulated. - -During the breakfast, luncheon and supper periods, mealtime music -should be broadcast for the entire duration of the dining period. -The nature of mealtime music may be the same for all meals. This is -discussed in Chapter VII. - -The period between eight and ten in the morning is frequently reserved -for routine dressings or medical rounds and a period of silence should -be observed in the wards during the hours of maximum professional -services. Obviously, music should not be broadcast at any time during -the day when rounds are held. The operator should be supplied with a -schedule of ward rounds and cut out those wards which are concerned. - -The duration of rounds will vary from very brief periods on the -surgical wards to prolonged ones on the medical wards. Soon after -rounds the operator should broadcast to wards on which no regular -activity is taking place. A half hour program of request music in the -morning between ten and eleven is suggested. This should be followed by -the pre-meal period of silence. - -Where desired, luncheon music should be followed by restful or very -soft music. If the blinds are drawn and silence among patients is -maintained maximum benefit will result. Those patients who can fall -asleep readily at this time will do so. Those who find it impossible to -nap in the afternoon will be grateful for the diversion of music which -will permit greater relaxation. It is more difficult for some people to -rest in absolute quiet than with soft background music. - -Another request program of music lasting one hour may be begun between -two and three o’clock. It is advisable to mention specific names of -patients who request music to stimulate patient interest in communal -participation and listening. During the evening hours following supper, -it is suggested that the most popular radio programs be transmitted -over the system. These should be chosen on the bases of Hooper or -Crossley ratings so that the greatest number of patients will be -satisfied. When more than one channel is available, the second program -selected should be of a different nature from the first. - -_Announcements._ Announcements should be kept to a minimum. Routine -announcements should be made at specified hours daily, such as after -breakfast, before lunch, and after supper. Emergency calls should -be limited to genuine emergencies or they will not be regarded as -compelling, as they should be. - -Newscasts are a much appreciated and desirable feature for patients -who, until their admission to the hospital, may have read or listened -to the news daily and will want to keep up with it. The newscast should -be given in an unsensational manner and news which is too depressing or -exciting should be deleted or reworded, for psychiatric patients. - -_Special Programs._ There should be a weekly religious program sent -out over the system for those in bed. The minister affiliated with the -hospital should be able to fit the hospital into his Sunday morning -schedule. If no minister is available, a regular radio program should -be rebroadcast, but a Sunday service of local origin will be more -personal, and therefore will be more appreciated. There are many -suitable religious recordings available for incidental service music, -particularly the series of albums pressed by Bibletone. - -Holidays should be observed by the reproduction of appropriate music or -radio rebroadcasts. - -For the small hospital with limited personnel a two-channel system -continuously tuned to the two most popular networks locally available, -should be used. - - - - -_CHAPTER TEN_ - -EQUIPMENT AND LIBRARY - - -A hospital which wishes to use music as an adjunct to medical practice -must be willing to offer the space required for its activities. The -extent to which music will be needed will depend upon the nature of the -illnesses treated and the average stay of the patients. For mental and -tuberculosis hospitals, music is a “must.” The chronic hospital usually -has an assembly or recreation hall for musical performance. This hall -will generally be adequate for band rehearsals, and may also be used at -other hours of the day for instrumental practice. Where funds and space -can be spared, additional rehearsal rooms should be built so that more -patients will be able to participate. Space can be saved by building -small cubicles sound-proofed with any of the sound absorbing fabricated -wall boards such as _Celotex_ or _Transite_. Cubicles should be built -with much glazing so that the patient will not feel the smallness of -the room. If there is only one music aide, there will be an advantage -in centralizing all music activities, but if more help is available, -music rehearsal rooms should be available in the different pavilions or -wings of the hospital so that newly convalescent patients will not have -to walk too far. - -If the age range of the patients runs the full gamut, seating and -instrumental provisions will have to include provisions for all. This -means adjustable piano benches, music stands, etc. Chairs should be -provided not only for musicians but spectators. Patients should be -encouraged to attend band and other group rehearsals as a method of -stimulating their interest in music and for the diversion which it will -afford. Music stands for the bands should be dressed up to resemble -those used by popular bands. These stands are colorful, collapsible, -and hence transportable for any outside performances which the patient -band may contract. - - -INSTRUMENTS - -_Participation._ The number and nature of instruments which a hospital -should have will depend only upon budget limitations and the interest -of the community. There is no limit except storage space to the number -and variety of instruments which a hospital should accept as gifts. -Ideally there should be at least one of each of the major instruments. -Each instrument should have its own case, and it is wise to engrave the -hospital name on each instrument to minimize loss. The initials of the -hospital may be cut into an inconspicuous part of the instrument such -as the inside of the brass bell or the under side of the wood body. All -the instruments should be locked in cabinets when not in use. - -In addition to regular band instruments, small instruments which can be -played in bed should be acquired. These can be divided into those of -normal construction such as the ukulele, mandolin, and autoharp and the -toneless instruments which can be made by removing the resonating body. -A toneless violin can be constructed from a donated violin in poor -condition by mounting the tailpiece, bridge, and fingering element on a -narrow strip of wood or plastic. A piece of rubber “kneeling” pad makes -a good practice drum head. - -For children toy instruments such as the Typatune, the toy-xylophone, -trumpet, maracas, etc. should be available. - -_Listening._ A room should be designated as a “Music Listening Room.” -For economy of use this may be a multi-purpose room. It may be a -combination of the music aide’s office and musical library used at -selected hours of the day for both practice and listening. It should -contain an instrument for playing recordings. The choice of record -player should depend upon the sound produced by the instrument rather -than its name. The record player for the listening room should have an -automatic changer and wide tone control if possible. Because of the -excellence of many musical broadcasts a combination radio-record player -is most desirable. - -Portable record players are also desirable for the bedside listening -of those who request it. In hospitals not equipped with public address -systems, the portable record player can act as an excellent substitute -for it. If the player is mounted on a cart fitted with shelves for -records and albums, it can be wheeled from one ward to another for -daily musical periods. If the hospital has small-sized lantern slides -with words to songs imprinted (such as those supplied Service groups -during the war by the USO), a small slide projector should be added to -the music cart to be used on the darkened ward for ward songs. - - -THE MUSIC LIBRARY - -The hospital music library may vary from a few recordings to a -composite collection of all forms of musical literature available. -General hospitals which treat all diseases and age groups will -require the most extensive and catholic varieties of all kinds of -music. Specialty hospitals can operate on a library tailored to their -individual needs. A hospital for the aged will not require too much -of contemporary popular music. For purposes of inclusiveness, the -ideal will be discussed in the hope that some hospitals will be able -to afford it and that others will be able to select those items which -become possible for them. - -_Recordings._ The choice of recordings will be determined by the usual -hospital population. In building up the record library the music aide -should submit check lists to every patient in the hospital on any -one day. The list should include ten specific titles in each of six -categories: symphony, opera, operetta, folk-songs, old-time favorites, -and the currently popular songs. These should be carefully tabulated -and should be used to form the nucleus of the permanent collection. A -space should be left for patients to write in other pieces than those -named. Records should be purchased in the order of their numerically -recorded popularity. A collection should begin with one record per -hospital bed. This method of starting a library is very tedious but -well worth the effort, because only by determining the musical tastes -of patients can you give the majority the music they want. The musical -tastes of the patients will not vary significantly after a complete -turn-over in patient census, since most hospitals derive their patient -population from the same geographic area, and the tabulation of musical -desires arrived at in this manner will correspond satisfactorily with -the tastes of the same age group in the community. If the budget will -not permit an original collection of this size, it might be reduced to -half of that recommended, but that is a minimum. - -The collection should be built up at a rate of approximately one record -for every ten new patient admissions. The choice of additional records -should be on a request basis, but the proportion of the six categories -as originally determined should remain relatively constant to keep the -collection balanced. - -Whenever there is a choice of two or more recordings of the same piece, -the discs to choose are those which are played softly or sweetly so -that they are adaptable for the additional purpose of mealtime or -restful music. - -In the library of recordings there should be included albums of -records for special occasions and holidays. Patients look forward to -hearing Irish songs on St. Patrick’s Day and appropriate songs on -other holidays. To accompany religious services the albums prepared by -Bibletone are valuable. A glance through any standard record catalogue -will readily permit the music aide to assemble a suitable collection. - -The following is a list of records suggested for Easter Sunday and St. -Patrick’s Day. - - Easter Recordings: - - I Want a Bunny for Easter Decca 18654 A - Easter Sunday With You Decca 18591 B - Easter Parade Decca 18425 B - Easter Sunday on the Prairie Decca 18654 B - Chorale for Easter Cantata Victor 15631 B - Requiem, by Gabriel Faure Victor 18301, 2, 3, and 4 - - St. Patrick’s Day: - - Molly Brannigan Columbia 35496 - That’s How I Spell Ireland Columbia 35496 - Come Back to Erin Victor 27770 B - Mother Machree Victor 27772 A - Eileen Columbia 36585 - A Little Bit of Heaven Sonora 1069 B - You’re Irish and You’re Beautiful Sonora 1068 A - Irish Lullaby Decca 18621 A - Same Old Shellalagh Columbia 354986 - Macushla Victor 27770 A - I’ll Take You Home Again Kathleen Sonora 1067 B - Little Town in Old County Down Sonora 1070 B - -All recordings should be kept in their albums or jackets. Because -jackets have a way of getting lost or torn, there should be a stock of -unused jackets on hand. Each jacket should be labelled according to its -contents. In addition a cross-index catalogue file should be maintained -by the music aide for all records in the hospital collection. Three -cards should be filled out for each face of each record: one card for -composer, one for title, and one for performer. This seems like a lot -of work but is worth the effort because it is only in this manner that -a program can be rapidly assembled from the record library. Any filing -system will suffice, but if the collection is large, an elaborate -system will be found worth the effort. Cards of three different colors -may be used to separate classical, popular and miscellaneous. Tabs may -be placed on those cards which list music for occasions. Tabs in one -corner may refer to meal-time music and tabs in another holiday music, -etc. - -It is well to have the entire record collection in one room, and -shelves for holding records should be built of very heavy lumber -because recordings when closely packed are very heavy. It is best -to add records to shelves with continuous accession numbers in each -category and to rely on the file for alphabetic listing. If there -are duplicates, they can form the nucleus for a second or lending -library. Broken, cracked, or defective discs should be placed in a -separate section of the shelves for replacement when budget permits and -popularity demands. - -_Instantaneous Recordings._ A few hospitals will have the good fortune -to acquire a record-cutter for hospital recording of radio music. -When this is possible, the record collection can be augmented most -satisfactorily. The music aide should study all radio programs to -determine the hours during which the best performances of desired -music are played. By listening to several carefully selected programs -each week he will soon discover which programs use music employed in a -manner most desirable for hospital reproduction. The orchestrations of -Kostelanetz and Lombardo are especially suitable for easy listening in -the field of popular music. The broadcasts of the Metropolitan Opera -Association include passages not commercially recorded or at least not -recorded with the most popular singers. There are many other radio -features which are worth recording for the hospital record library. - -It is relatively easy to operate a record-cutter, but there are many -minor details which must be known for maximum efficiency. An excellent -book for beginners is that published by the Audak Company of New York, -_How to Make Good Recordings_. - -_Sheet Music._ A library of sheet music will once more depend upon -the local needs. It may include orchestral, instrumental, vocal, and -band music. In the hospital for the chronically ill, a large number of -varieties will be needed. Inasmuch as the simplest group performance -will be vocal, music for group singing should head the list. The music -should include old-time favorites, hymns, spirituals and any other -items which the aide can determine from the intellectual and musical -qualifications and desires of the patients. This type of music can be -purchased individually and increased according to the interest shown. - -If there is a patient band, the musical scores should include a few -marches which may be used at the beginning and end of its concerts. -The perennial favorites most desirable for community singing should -constitute a major portion of the orchestral literature. The readily -available medleys of Victor Herbert melodies and similar stand-bys can -complete the initial group. - -Sheet music should be catalogued and filed in cabinets. A simple system -of shelving consists of grouping music according to use: one shelf -for group playing, one for solo and beginners instrumental books, and -another for vocal selections. The numbers most commonly and currently -used by the band can be placed in folders according to the accepted -usage among bands, and if there are daily rehearsals they can remain on -the band stands at all times. - -The library should also contain books, printed forms, or mimeographed -collections of songs for distribution to patients during community -singing. - -_Books About Music._ The average hospital library will have relatively -few books about musical appreciation or history. This will depend -first on the budget and second on the demand. The addition of a music -aide to a hospital staff will usually increase the demand. The music -aide should be consulted concerning the books he thinks will appeal to -patients. Books on music should also be available to help the music -aide in preparing commentaries on the music he plays for the patients. - -The following are some books suggested for inclusion in the hospital -patient library: - - Copland, Aaron--_What to Listen for in Music_, 1939. - Goss, Madeline--_Unfinished Symphony_, 1941. - Elson, Arthur--_Music Club Programs From All Nations_. - Erskine, John--_What Is Music_, 1944. - Ewen, David--_Tales From The Vienna Woods_, 1944. - Ewen, David--_Gershwin’s Life_, 1944. - Ewen, David--_Men of Popular Music_, 1944. - Gronowicz, Antoni--_Chopin_, 1943. - O’Connell, Charles--_Victor Book of Opera_, 1936. - Taylor, Deems--_Of Men and Music_, 1945. - Taylor, Deems--_The Well Tempered Listener_, 1944. - Siegmeister, Elie--_Music Lover’s Handbook_, 1943. - Spaeth, Sigmund--_At Home With Music_, 1945. - -For young patients there are the new series of colorfully illustrated -lives of composers from Bach to Gershwin by Waldo Mayo, as well as a -great number of old and good titles. - - - - -_CHAPTER ELEVEN_ - -DIRECTION - - -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: - - _First Year_ - - Piano 8 Credits - Solfège 5 Credits - Counterpoint 2 Credits - Harmony 2 Credits - English 6 Credits - History of Medicine 1 Credit - - _Second Year_ - - Piano 4 Credits - Solfège 2 Credits - Harmony 2 Credits - Counterpoint 2 Credits - History of Music 4 Credits - Nursing anatomy 6 Credits - - _Third Year_ - - Violin 4 Credits - Harmony 4 Credits - Musical Form 4 Credits - Physics 6 Credits - Physiology 2 Credits - Kinesiology 2 Credits - Psychology 4 Credits - Conducting 2 Credits - Piano Sight Playing 4 Credits - Ensemble 2 Credits - - _Fourth Year_ - - Violin 4 Credits - Choral Class 0 Credits - Conducting 2 Credits - Contemporary Music 4 Credits - Occupational Therapy 4 Credits - Music in Medicine 6 Credits - Abnormal Psychology 6 Credits - Orchestra Reading 2 Credits - -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. - - - - -BIBLIOGRAPHY - -[1] Albrecht, W., De effect. mus., Sect. 314, _in Roger, J. L._ - -[2] Altschuler, I., _Occ. Ther. Rehab._, 1941, 20:75. - -[3] Altschuler, I., _Proc. Mus. Teach. Nat. Assoc._, 1944, p. 154. - -[4] Altschuler, I., and Shebesta, B., _Journ. Nerv. Ment. Dis._ 1941, -94:179. - -[5] Ayers, I., _Am. Phys. Ed Rev._, 1912, 16:321. - -[6] Barker, L., _Psychotherapy_, New York, 1940. - -[7] Bauer, M., and Peyser, E., _Music Through the Ages_, New York, 1932. - -[8] Beaunis, B., “L’Emotion Musicale”, _Rev. Phil._, 1918, 86:353. - -[9] Beckett, W., _Music in War Plants_, Washington, 1943. - -[10] Bissell, A. D., The Role of Expectation in Music, New Haven, 1921. - -[11] Boerhaave, H., Impetum Faciens, _in Roger, J. L._ - -[12] Bowers, C. G., _The Young Jefferson_, New York, 1945. - -[13] Brocklesby, R., _Reflections on Antient and Modern Musick_, -London, 1749. - -[14] Bücher, K., Arbeit und Rhythmus, _in Diserens, C. M._ - -[15] Burney, Charles, _A General History of Music_, Ed., by Mercer, -F., New York, 1937. - -[16] Celsus, A. C., _Of Medicine_, Trans. by J. Grieve, London, 1838. - -[17] Champlain, Voyages de l’Amerique, _in Roger, J. L._ - -[18] Chomet, H., _Influence of Music in Health and Life_, New York, -1875. - -[19] Combarieu, J., _La Musique, Ses Lois, Son Evolution_, Paris, 1907. - -[20] Damon, K. F., Program Notes for the Listener to music, New York, -1933. - -[21] Densmore, Frances, _American Indians and Their Music_, New York, -1926. - -[22] Densmore, Frances, _Teton Sioux Music_, Bull. 61, Smithsonian -Inst., Washington, D. C. - -[23] Desault, P., Method pour preserver de la rage, _in Roger, J. L._ - -[24] Diserens, C. M., _Influence of Music on Behaviour_, Princeton, -1926. - -[25] D’Olivet, F., _La Musique_, Paris, 1896. - -[26] Dunlap, K., Rhythm and the Specious Present, _J. Phil. Psychol. -and Sci. Method_, 1911, 8:348. - -[27] Dupre, E., and Nathan, M., _Le Language Musical_, Paris, 1911. - -[28] Eastcott, Richard, Sketches of the Origin, Progress and Effects of -Music, Bath, 1748. - -[29] Eby, J., _Occ. Ther. Rehab._, 1943, 22:31. - -[30] Galton, F., Inquiries Into Human Faculty and Its Development, -London, 1883. - -[31] Gaston, E., _Music Educ._, 1945, 31:24. - -[32] Gatewood, E., _Am. J. Surg._, 1921, 35:47. - -[33] Gatewood, E., _J. App. Psychol._, 1921, 5:350. - -[34] Gehring, A., _Basis of Musical Pleasure_, New York, 1910. - -[35] Gilman, B., Report on an Experimental Test of Musical -Expressiveness, _Amer. J. Psychol._, 1892, 4:42. - -[36] Gray, C., Contingencies, _The Music Review_, Nov. 1944. - -[37] Gruner, O. C., _The Canon of Medicine of Avicenna_, London, 1930. - -[38] Gundlach, R., An Analysis of Some Musical Factors Determining the -Mood Characteristics of Music, _Psychol. Bull._, 1934, 31:592. - -[39] Gundlach, R., A Quantitave Analysis of Indian Music, _Am. J. -Psychol._, 1932, 44:133. - -[40] Gurney, E., _The Power of Sound_, London, 1880. - -[41] Hanson, H., Some Objective Studies of Rhythm in Music, _Am. J. -Psychiatry_, Nov. 1944, 101:364. - -[42] Hanson, H., Musician’s Point of View Toward Emotional Expression, -_Am. J. Psychiatry_, Nov. 1942, 99:317. - -[43] Harrington, A., Ment. Hyg., 1939, 23:601. - -[44] Hauptman, M., Die Natur de Harmonik, _in Helmholtz, H. L. F._ - -[45] Heinlein, C. P., The Affective Characters of the Major and Minor -Mode in Music, _J. Comp. Psychol._, 1928, 8:101. - -[46] Helmholtz, H. L. F., _The Sensations of Tone_, London, 1875. - -[47] Hevner, K., The Affective Character of the Major and Minor Modes -in Music, _Am. J. Psychol._, 1935, 47:103. - -[48] Hevner, K., The Affective Value of Pitch and Tempo in Music, -_Amer. J. Psychol._, 1937, 49:621. - -[49] Hulbert, H., _Eurthym._, London, 1921. - -[50] Jacobson, E., Electrophysiology of Mental Activities, _Am. J. -Psychol._, 1932, 44:677. - -[51] Johnson, M., _Nat. Ed. Ass. Journ._, 1905, 45:940. - -[52] Kawarski, T., and Odbert, H., Color Music, _Psychol. Monographs_, -1938, no. 50. - -[53] Kirschner, M., Musik und Operation, _Der Chirurg_, 1936, 11:429. - -[54] Kraines, S., _The Therapy of Neuroses and Psychoses_, Phila., 1943. - -[55] Lee, V., _Music and Its Lovers_, London, 1930. - -[56] Levine, M., _Psychotherapy in Medical Practice_, New York, 1942. - -[57] Ligeros, K. A., _How Ancient Healing Governs Modern Therapeutics_, -New York, 1937. - -[58] Meibomius, M., _Antiquae Musicae Auctores_, Lib. IX, Amstelodami, -1652. - -[59] Mueller, J., and Hevner, K., Trends in Musical Taste, _Indiana U. -Public._, 1942, no. 8. - -[60] Mursell, J. L., _Psychology of Music_, New York, 1937. - -[61] Nollet, J. A., _Recherches sur les Causes Particulieres des -Phenomènes Electriques_, Paris, 1749, p. 33. - -[62] Noyes, A. P., _Modern Clinical Psychiatry_, Phila., 1944. - -[63] _The Old Testament_, I Samuel, Chap. 16, verse 23. - -[64] Ortmann, Otto, _The Physiologic Mechanics of Piano Technique_, -London, 1929. - -[65] Pearson, Hesketh, _G. B. S._, New York, 1942. - -[66] Pierce, A., _Med. Bull. Vet. Adm._, 1934, 21:142. - -[67] Porta, J. B., Magia natural., _in Roger, J. L._ - -[68] Rameau, J. P., _Traité de l’harmonie_, Paris, 1722. - -[69] Reade, W., African Sketch Book, _in Diserens._ - -[70] Roger, J. L., _Effects de le Musique_, Paris, 1803. - -[71] Schoen, M., _The Effects of Music_, London, 1927. - -[72] Schoen, M., _The Psychology of Music_, New York, 1940. - -[73] Seashore, K., _Psychology of Music_, New York, 1938. - -[74] Tarchanoff, I, _Arch. 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XVII, -Amstelodami, 1664. - - - - -INDEX - - - Aesclepiades, 6 - - Aide, duties of, xvii, 121 - - Aide, qualifications of, xvi, 120 - - Albrecht, Wilhelm, 11 - - Alcoholic psychosis, 63 - - Altschuler, I., 60, 66, 68, 69 - - Amateur shows, 101 - - Amphion, 2 - - Analysis, instrumental, 57 - - Anesthesia, use with, 75 - - Ankle exercise, 54 - - Appetite, musical, 42 - - Apollo, xi - - Aquinas, St. Thomas, 42 - - Areteus, 8 - - Aristotle, xi - - Armstrong, John, 1 - - Arteriosclerotic psychosis, 64 - - Atheneus, 6 - - Aurelianus, 6 - - Avicenna, 74 - - - Background music, 73 - - Bacon, 8 - - Band, patient, 70 - - Beacham, H., 9 - - Beaunis, B., 17 - - Beckett, W., 79 - - Bedside instruction, 95 - - Beethoven, L., 29 - - Bites, treatment of animal, 7 - - Boerhaave, H., 8 - - Books about music, 117 - - Brocklesby, R., 12 - - Bücher, K., 19 - - Butler, Nicholas M., xii - - - Calisthenics, music for, 76 - - Capella, M., 6 - - Carle, F., 86 - - Cart, music, 94, 112 - - Catatonic schizophrenia, 66 - - Cato, 5 - - Cavallero, C., 86 - - Celsus, A. C., xii, 8 - - Champlain, S., 11 - - Chateaubriand, 2 - - Children, music for, 90 - - Chiron, 5 - - Chomet, Hector, xix, 12 - - Chopin, F. F., 30 - - Chronically ill, music for, 98 - - Color in sound, 28 - - Community sing, 69, 101 - - Confucius, 5 - - Counter-irritation, 74 - - Criteria of therapy, xiii, 61 - - Crosby, Bing, 18, 91 - - Curriculum for aides, 123 - - - Dalcroze, J., 76 - - Damon, K. F., 28 - - Dancing as exercise, 78 - - David’s Harp, xi, 5 - - De Marian, 28 - - Democritus, 11 - - Densmore, F., 3 - - Dentistry, music in, 75 - - Desault, P., 7 - - Direction of hospital music, 118 - - Diserens, C. M., 42 - - Dorian mode, xi - - Duchin, E., 84, 86 - - Duration, effect of, 18 - - Dunlap, K., 19 - - - Easter music recordings, 114 - - Eby, Julia, 67 - - Egyptian use of music, 4 - - Emotional response to music, 32 - - Enjoyment of music, 32, 39 - - Epilepsy, music in, 8, 11 - - Eurhythmics, 77 - - Exercise, effect of music on, 75 - - Exercise through music, 50 - - Expectation, role of, 27 - - - Factory, use of music in, 79 - - Faith, Percy, 86 - - Farinelli and Philip V, 10 - - Fatigue, effect on, 76 - - Flute, the magic, 11 - - Functional Occupational Therapy, 45 - - - Galen, 7 - - Gaston, E., 59 - - Gatewood, E., 79 - - Gehring, A., 28 - - Gellius, A., 6 - - General paresis, 63 - - Gilman, B., 30 - - Goldman, Edwin Franko, 31 - - Good music, 38 - - Grosseteste, R., 8 - - Group singing, 69, 101 - - Gundlach, R., 18, 26, 34 - - Gurney, E., 21, 25, 31 - - - Hanson, Howard, 26, 27 - - Harrington, A., 69 - - Hauptmann, M., 20 - - Head-phones vs. loud-speakers, 93 - - Hebrew use of music, xi, 5 - - Heinlein, C. P., 17, 22 - - Helmholtz, H. L. F., 20 - - Hevner, K., 22 - - Homer, 5 - - Hulbert, H., 77 - - Hydrotherapy, music and, 66 - - Hysteria, 68 - - - Imaginal response to music, 37 - - Indian, American, 2, 34 - - Industrial music, 79 - - Instantaneous recordings, 106 - - Instrumental analysis, 57 - - Instrumental instruction, 103 - - Iriquois practice, 3 - - Intensity, effect of, 17, 22 - - - Jacobson, E., 19 - - Jaw fracture, music in, 58 - - Jerrold, D., 86 - - Johnson, M., 77 - - - Karwarski, T., 28 - - Key, effect of, 23 - - Kostelanetz, A., 86 - - Kraines, S., 69 - - - Lacedemonian music, 5 - - Lantern slide preparation, 102 - - Levine, M., 69 - - Library of music, 116 - - Listening to music, 36 - - Live music, 34, 96, 99 - - _Loca dolentia decantare_, 6 - - Lombardo, Guy, 86 - - Lower extremity exercises, 53 - - Luther, Martin, 3 - - Lydian mode, xi - - - Manic-depressive psychosis, 64 - - Mealtime music, 82 - - Medical direction, 119 - - Medicine man, 3, 4 - - Melancholy, involutional, 64 - - Melody, effect of, 19 - - Mendelssohn, F., 30 - - Mental deficiency, 71 - - Mental disease, 9 - - Mental disease classification, 62 - - Mode, effect of, 20 - - Mood effects, 17, 22, 32, 40 - - Morale, effect on, 7 - - Mozart, W., 11 - - Mursell, James, 18 - - Music aide, training for, 123 - - Musical therapy, ix, xviii, 57, 61 - - - National Music Council, xiv - - Nearchus, 6 - - Newton, Isaac, 28 - - Noyes, A. P., 61 - - - Occupational Therapy, 44 - - _Orenda_, 3 - - Orpheus, 2 - - Ortmann, Otto, 17 - - Operating room, music in, 75 - - Opponens action, 52 - - - Paget, V., 36 - - Painful level of sound, 41 - - Palmer House Ensemble, 86 - - Paresis, general, 63 - - Parlor organ as foot exercise, 54 - - Patient band, 70 - - Pediatric ward, music in, 90 - - Percussion instruments, 55 - - Persian use of music, 5 - - Philip V of Spain, 10 - - Photoism in music, 28 - - Phrygian mode, xi, 6 - - Physical therapy, 45 - - Physiologic effects of music, 34 - - Piano; analysis of motions, 52 - - Piano playing for exercise, 50 - - Pianola, value of, 52 - - Pierce, A., 70 - - Pinel, P., 11, 44 - - Pitch, effect of, 17 - - Plato, 5, 76 - - Plectrum instruments, 53 - - Plutarch, 6 - - Pocket instruments, 54 - - Porta, J. B., 11 - - Primitive people, music among, xi, 2 - - Production, effects of music on, 80 - - Program distribution system, 93 - - Program notes, effect of, 33 - - Psychiatry, value in, 72 - - Psychologic effects of music, 36 - - Psychosis, alcoholic, 63 - - Psychosis, arteriosclerotic, 64 - - Psychosis, manic-depressive, 64 - - Public address system, 93 - - Pythagoras, xi - - - Quarin, 8 - - Quintillian, 76 - - - Radio, bedside, 91 - - Rameau, J. P., 18, 20 - - Reade, W., 19 - - Record library, 115 - - Remedial exercise, 78 - - Renaissance of art forms, xii - - Response to music, 36 - - Rhythm, effect of, 18 - - Room, listening, 111 - - Rose, D., 86 - - Rubinstein, A., 30 - - - Sauvages, G., 12 - - St. Chrysostome, 9 - - St. Patrick’s Day music, 114 - - St. Thomas Aquinas, 42 - - Schizophrenia, 65 - - Schoen, M., 32, 37 - - Schönberg, A., 41 - - Schumann, R., 30 - - Scorpion bites, music for, 7 - - Seashore, C., 107 - - Secret remedies, xiii - - Selinsky String Ensemble, 86 - - Shakespeare, W., 9, 13, 59 - - Shaw, G. B., 84 - - Shopwork, music in, 79 - - Sickert, W., 42 - - Sioux Indian practice, 3 - - Slumber music, 90 - - Sonorous fluid, 12 - - Stravinsky, Igor, 42 - - Surgery, music in, 75 - - - Tarantula bites, music in, 7 - - Tarchanoff, I., 76 - - Taste, musical, 38 - - Templeton, Alec, 91 - - Tempo, effect of, 25 - - Thalamus, role of, 68 - - Thaletas, 6 - - Timbre, effect of, 18 - - Toneless instruments, 95 - - Tuberculosis ward, music in, 92 - - - Ulysses’ wound, 5 - - Upper extremity exercise, 51 - - - Valentine, C., 21 - - Vernon, P. E., 36 - - Vescelius, Eva, xix, 12 - - Vibration, effect of, 7 - - Victor Salon Orchestra, 86 - - Violin as exercise, 52 - - Viper bite, music in, 7 - - Vocal music, 32, 35 - - Voice, human, 35 - - Voltaire, 82 - - Volume, effect of, 80 - - Volunteers, hospital, 97, 99 - - - Wallaschek, R., 4 - - Wallawalla practice, 4 - - Waltzes, effects of, 81 - - War, music in, 7 - - War songs, 7 - - Ward sings, 96 - - Wasambara practice, 4 - - Weber, Marek, 86 - - Willis, T., 10 - - Words, effect of, 35 - - Working songs, 79 - - - - -Transcriber’s Notes - -In a few cases, obvious errors or omissions in punctuation have been -fixed. - -Page ii: “nervous insistance,” changed to “nervous insistence,” - -Table of Contents and Index: “Eurthymics” changed to “Eurhythmics” - -Page xvi: “of human ature” changed to “of human nature” - -Page xix: “forget his preconcieved” changed to “forget his preconceived” - -Page 8: “delerium, melancholy and mania” changed to “delirium, -melancholy and mania” - -Page 12: “she admitted after after having” changed to “she admitted -after having” - -Page 25: “in every singly key” changed to “in every single key” - -Page 31: “Largo al Factotem” changed to “Largo al Factotum” - -Page 41: “Most people have been conditioned” changed to “Most people -who have been conditioned” - -Page 44: “sooner those who remained” changed to “sooner than those who -remained” - -Page 53: “are readily adpatable” changed to “are readily adaptable” - -Page 60: “which has lead some musicians” changed to “which has led some -musicians” - -Page 65: “may appear quiet normal” changed to “may appear quite normal” - -Page 68: “more powerful subconcious” changed to “more powerful -subconscious” - -Page 69: “for heterogenious groups” changed to “for heterogeneous -groups” - -Page 77: “preferable the piano” changed to “preferably the piano” - -Page 78: “places of assemble” changed to “places of assembly” - -Page 84: “barbershop and other public” changed to “barbershops and -other public” - -Page 92: “alloting certain periods” changed to “allotting certain -periods” - -Page 94: “musical programs and hospital announcement,” changed to -“musical programs and hospital announcements,” - -Page 110: “age range of the patient” changed to “age range of the -patients” - -Page 115: “with continuous acession” changed to “with continuous -accession” - -Page 120: “the appelation “music aide”” changed to “the appellation -“music aide”” - -Page 122: “programing for concerts” changed to “programming for -concerts” - -In the bibliography, “Electrophsiology of Mental Activities” was -changed to “Electrophysiology of Mental Activities”; there is no -anchor for reference [6] Barker. L., in the text. - -In the index, “Mental disease classication” changed to “Mental disease -classification” and “Cavotte from Mignon” changed to “Gavotte from -Mignon” - -The original index had T located after W. This has been fixed. - -There are numerous probable mistakes in the French and German -references in the footnotes; these have been intentionally left as per -the original. - -The spellings of “Philippe Pinel” and “Richard Wallaschek” have been -corrected. - -*** END OF THE PROJECT GUTENBERG EBOOK MUSIC IN MEDICINE *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online -at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you -are not located in the United States, you will have to check the laws of the -country where you are located before using this eBook. -</div> - -<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: Music in Medicine</p> -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: Sidney Licht</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: March 2, 2022 [eBook #67545]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>Produced by: Tim Lindell and the Online Distributed Proofreading Team at https://www.pgdp.net (This book was produced from images made available by the HathiTrust Digital Library.)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK MUSIC IN MEDICINE ***</div> - - - - - -<h1> MUSIC IN MEDICINE</h1> - -<p class="center p0 p2"> by</p> - -<p class="center p0 big"> SIDNEY LICHT, M.D.</p> - -<p class="center p0"> <i>Fellow, New York Academy of Medicine</i></p> - -<p class="center p0 p4"> NEW ENGLAND CONSERVATORY OF MUSIC<br /> - BOSTON, MASSACHUSETTS -</p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p class="center p0"> <i>Copyright, 1946, By</i></p> - -<p class="center p0"> SIDNEY LICHT, M.D.</p> - -<p class="center p0 p2"> All rights reserved, including - the right to reproduce this book - or portions thereof in any form.</p> - -<p class="center p0 p2"> <i>First Edition</i></p> - -<p class="center p0 p2"> PRINTED IN THE UNITED STATES OF AMERICA -</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h2 class="nobreak" id="FOREWORD">FOREWORD</h2> -</div> - - -<p>In presenting a musician’s point of view on so specific a subject as -“Music in Medicine”, it seems to me necessary at the outset to clarify -the status of music as an independent aesthetic art, and its practical -adaptation for definite utilitarian purposes. We must clearly separate -the active individual process of artistic creation from the elements -of passive perception and from effects such perception may have when -applied for different realistic reasons.</p> - -<p>Taken aesthetically, as an art, music is a social “superstructure”, -which, as far as the individual creative act is concerned, remains -an abstract manifestation of the human mind and imagination. -Its existence as a creative art is possible only as long as the -practical “possibilities” and potentialities of its effects in the -phase of passive perception, do not intrude into and interfere -with its character as an absolute non-utilitarian phenomenon in -the processes of the creative art. Art, by its very nature is a -product of individuality. As opposed to the anonymous craft, the -main requirement of an aesthetically artistic product assuming the -presence of professional skill and knowledge is that it be the work -of a human organism, which possesses acceptable qualifications of -vocation and expression. To this attribute we have given such names -as talent, genius, imagination, and many others. This phenomenon of -specific predestination must also be accompanied by a characteristic -property which has received such names as personality, individuality or -originality. It is obvious that these fundamentals of artistic creation -prevent any general or universal approach to the creative processes -which, with the exception of purely technical<span class="pagenum" id="Page_ii">[Pg ii]</span> and formal elements of -craftsmanship and common expression of specific style, exclude the -pattern and definite utilitarian aims. All these factors are obviously -concerned only with the living moment of the musical art in the essence -and genesis of the individual creation.</p> - -<p>Although music as a creative manifestation of the human mind does not -aim at social or utilitarian function, its materialized results may yet -find wide application in the manifold use of this aspect of passive -perception. This passive perception stimulates an active participation -by the listener in whom it may provoke definite emotional reactions -and mental modulations. If we think of music as the completed creation -of one mind, we can understand how its perception may have a genuine -influence on the listener’s mood and that it may be channeled into -desired directions which takes the forms of adaptation and adjustment. -This, in spite of the variety of tastes and reactions, can certainly be -generalized within limits by scientific methods.</p> - -<p>Although I do not believe that music should be written for purely -utilitarian reasons (and I am speaking not of the material advantages -it may bring the artist, but of the aesthetics of creative art) I see -no reason for not using any composition to such practical advantage as -its application may offer. Music as an <i xml:lang="fr" lang="fr">art appliqué</i> has been -known since ancient times in many different roles, not all as laudable -and noble as its use in healing. Its property of melodical expansion, -propulsive character, rhythmical vitality, nervous insistence, harmonic -intricacy, development in time rather than space, its wealth of moods -(which extend from static calmness to wild exuberance with an enormous -range of intermediary impressions, even in its abstract character -of pure organized sound) provokes in listeners a response which is -primarily psychological and emotional, but which frequently influences -physiology and the nervous system.</p> - -<p><span class="pagenum" id="Page_iii">[Pg iii]</span></p> - -<p>The use of music for work, marches, the stimulation of mass sentiment -or emotional impact (patriotism, war, etc.), for entertainment, -oblivion, mood change, mood creation, and background music for motion -pictures, evokes realistic responses, where music is applied for -its effect, rather than for its intrinsic value. It is therefore no -surprise that the applied use of music (which has nothing to do with -the active process of artistic creation) should be used in the care -and treatment of the sick mind and body. I do not know what subjective -responses result from such purely physical phenomena as vibration -and harmonics but I am convinced that listeners are physiologically -and psychically effected by such musical characteristics as mood, -intensity, pitch and rhythmical outline. It seems to me that the -right music should provoke remembrance and association of thoughts -and situations more easily in a mental patient than methods using -factual persuasion. Music can avoid the realistic approach and by its -absolute progression abstractly recreate a familiarity of situation -which may prove most useful in handling mental patients. By eliciting -a desired mood it may offer the physician a method of handling disease -as important as shock, and a result obtainable in no other way. To a -musician, completely unfamiliar with medicine and pathology this use -seems obvious and undeniable. Dr. Licht has made a thorough study -of this subject and has indicated some of the many uses of music -in mental and physical pathology. The work which has been based on -scientific research and clinical experience is most impressive and -encouraging. If we, as musicians, can bring our contribution to such a -wonderful purpose as healing, it would certainly be our most glorious -accomplishment for mankind, and the noblest use of our art.</p> - -<p>But, as I have said, aesthetically it should not be the aim but the -effect of art which should be considered. If <em>applied use</em> rather -than creation were to assume greater importance, art would lose<span class="pagenum" id="Page_iv">[Pg iv]</span> its -essential characteristics and would become a social manifestation -of mass production instead of an abstract phenomenon. It might work -out usefully, perhaps for a time, but in losing those primordial -elements which condition its own existence, it would also lose the -<em>effects</em> which its use provoke not only in medicine but in other -important directions. The effects of music will progress satisfactorily -to the advantage of mankind only as long as it is permitted its normal -development regardless of motivations and their justifications. In -the long run it will find a greater and better use in the practical -sense, if its creation continues along traditional lines, and is not -diverted into the fallacious channel of anonymous mass production with -consequent loss of proper utility and aesthetic <i xml:lang="fr" lang="fr">raison d’etre</i>.</p> - -<p>It is likely that scientific research and clinical experience will -motivate the production of musical compositions which are designed -for certain classes of patients. This will require much skill, -craftsmanship, gift of adaptation and assimilation of established -patterns as well as disciplined imagination, but the creation of -such planned utilitarian works would not be possible without the -continuation of music as a self sufficient art activated by its own -emotional and spiritual reaction and enjoyment. No derivative may -exist and progress by suppression of the source which must aliment it -continuously by its own growth and through the conservation of its -individual characteristics.</p> - -<p>Music as an art has its own internal laws of creation and traditional -development. These laws are not casual but organic and they can not -be violated without self destruction. Consequently, the beneficial -effects of music can be applied for utilitarian purposes only if its -integrity is safe from external intervention, even if only temporarily, -and if the element of social usefulness does not influence the creative -process.</p> - -<p>The criteria of artistic and practical values do not necessarily<span class="pagenum" id="Page_v">[Pg v]</span> -coincide. Artistic value is defined only by time, the practical value -is a matter of present usefulness. Works of great artistic value may be -useful, whereas facile “hits” which fall into oblivion within a brief -period may prove extremely useful, and that is why the two conceptions -must be differentiated. Michelangelo’s <i>Medici Tomb</i>, or a Bach -<i>Mass</i> are completely useless in the practical sense of the work, -and most successful “hit-songs” are completely devoid of any artistic -value or originality. Yet both kinds supply the specific wants of those -who would lament the absence of either of them. This resolves itself -into a question of taste, educational background, musical culture and -other factors which I presume are of importance in the clinical use of -music. Patients will show preferential response to the music they like -regardless of the elements of mood, tempo, rhythm and pitch.</p> - -<p>But classifications are always dangerous. Good music is not necessarily -useless, and useful music is not necessarily bad music. The eternal -principal of <i xml:lang="la" lang="la">suum cuique</i> is the principle of individual human -taste which can be placed into approximate categories, but cannot be -standardized without the artificial interference of external factors. -The same principle certainly applies to music as a weapon of healing, -where selection should be determined by science but at the same time -we must strive to adapt the results of research of the individual -preferences of normal subjects.</p> - -<p class="right p0"> -Alexandre Tansman<br /> -Los Angeles, January 1946<br /> -</p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_vi">[Pg vi]</span></p> -<h2 class="nobreak" id="CONTENTS">CONTENTS</h2> -</div> -<table class="autotable"> -<tr> -<td colspan="2"> -<a href="#INTRODUCTION"><i>Introduction</i></a> -</td> -<td class="tdr page"> -<a href="#Page_ix">ix</a> -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_ONE">Chapter I</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>History of Music in Medicine</i> -</td> -<td class="tdr page"> -<a href="#Page_1">1</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> - Primitive use and the medicine man. Ancient - civilizations. Music against animal bites and mental - disease. Magic and the Middle Ages. The magic - flute. Recent developments. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_TWO">Chapter II</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Philosophy and Psychology of Music</i> -</td> -<td class="tdr page"> -<a href="#Page_15">15</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> - Physiology of musical elements—pitch, intensity, - timbre, duration, rhythm, melody, mode, key. Color - in sound. Music interpretation. Live music and the - human voice. Listening and appreciation. Musical - taste and appetite. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_THREE">Chapter III</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Music as Occupational Therapy</i> -</td> -<td class="tdr page"> -<a href="#Page_44">44</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Origins of occupational therapy. Advantages of - music as a modality. Analysis of motion in piano - playing. Analysis of string, plectrum, foot, wind - and percussion instruments. Use of voice as exercise.<span class="pagenum" id="Page_vii">[Pg vii]</span> -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_FOUR">Chapter IV</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Psychiatry and Music</i> -</td> -<td class="tdr page"> -<a href="#Page_59">59</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Criteria of therapeutics. Classification of mental - diseases. Description of diseases and indications for - music. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_FIVE">Chapter V</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Background Music</i> -</td> -<td class="tdr page"> -<a href="#Page_73">73</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Counter-irritation. Music in the operating room. - Effect on physical exercise. Use with calisthenics. - Eurhythmics. Remedial exercise. Industrial music. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_SIX">Chapter VI</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Mealtime Music</i> -</td> -<td class="tdr page"> -<a href="#Page_82">82</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Criteria for mealtime music. Examples of orchestras - and songs most suitable. List of suggested - recordings. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_SEVEN">Chapter VII</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Music in Bed</i> -</td> -<td class="tdr page"> -<a href="#Page_89">89</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Needs of children. Slumber music. Bedside - radio. Program distribution systems. Head phones - versus loud speakers. Personalized music. Instruction - in bed. Toneless instruments. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_EIGHT">Chapter VIII</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Diversion and Entertainment</i> -</td> -<td class="tdr page"> -<a href="#Page_98">98</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> - Need for entertainment in hospitals. Programming - for patient groups. Amateur show. Group - singing. Music instruction.<span class="pagenum" id="Page_viii">[Pg viii]</span> -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_NINE">Chapter IX</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Public Address System</i> -</td> -<td class="tdr page"> -<a href="#Page_105">105</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Basic equipment and personnel. Programming. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_TEN">Chapter X</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Equipment and Library</i> -</td> -<td class="tdr page"> -<a href="#Page_110">110</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Patient band. Instruments and rooms. Record - library. Holiday music. -</td> -</tr> -<tr> -<td colspan="3" class="tdc"> -<a href="#CHAPTER_ELEVEN">Chapter XI</a> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Direction</i> -</td> -<td class="tdr page"> -<a href="#Page_118">118</a> -</td> -</tr> -<tr> -<td colspan="3" class="indent"> -Medical direction. Qualifications and duties of - the hospital musician. Training program and curriculum - for music aides. -</td> -</tr> -<tr> -<td colspan="2"> -<a href="#BIBLIOGRAPHY"><i>Bibliography</i></a> -</td> -<td class="tdr page"> -<a href="#Page_125">125</a> -</td> -</tr> -<tr> -<td colspan="2"> -<a href="#INDEX"><i>Index</i></a> -</td> -<td class="tdr page"> -<a href="#Page_129">129</a> -</td> -</tr> -</table> - - -<p><span class="pagenum" id="Page_ix">[Pg ix]</span></p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h2 class="nobreak" id="INTRODUCTION">INTRODUCTION</h2> -</div> - - -<p>In the middle of the eighteenth century there were two prominent men -in Paris whose conflict was typical of the controversial nature of the -subject known as Musical Therapy. The Abbé Nollet was not only one -of the most prominent clerics in France during his time but was in -addition the most famous of its physicists. He had constructed some -excellent models of machines which produced static electricity, but -he had had no medical training. At about this time throughout western -Europe, the subject of static electricity had become very popular. -Several physicians claimed that it was of great use in the treatment -of many diseases. Particularly did they say that it cured paralysis. -The Abbé Nollet wrote a book about static electricity and in it told -of the cases he had cured with it. The most prominent physician in -Paris was Doctor Louis, who was the chief physician at the Salpêtrière -Hospital, the largest and best known hospital in France. <abbr title="doctor">Dr.</abbr> Louis -tried to repeat the cures promised by Nollet but was unable to secure -success in any of the patients whom he exposed to static electricity. -He published the story of his failure to do so, which so excited Abbé -Nollet that he wrote an entire volume condemning <abbr title="doctor">Dr.</abbr> Louis. Instead of -refuting the ability of <abbr title="doctor">Dr.</abbr> Louis to diagnose paralysis and evaluate a -cure, he climaxed his remarks with the classical question addressed to -the doctor, “Is electricity your field?”<span class="fnanchor" id="fna61"><a href="#fn61">[61]</a></span></p> - -<p>For many centuries philosophers and musicians have claimed the ability -to cure mental illness through the use of music, and have at times -called this procedure Musical Therapy. Although the physicians might -well say to these musicians that therapeutics<span class="pagenum" id="Page_x">[Pg x]</span> is definitely not within -the province of musicians, it is unlikely that a musician would at this -time have the courage to ask physicians, “Is this your field?”</p> - -<p>A thorough search of the history of medicine will show that almost all -phenomena and substances have at one time or another been tried in an -attempt to combat disease. Many of these agents were abandoned when -they became unfashionable to a more sophisticated civilization, or were -recognized as unwholesome by a more educated generation. The fact that -few were given up merely because of their ineffectiveness can be seen -in the great number of quack nostrums which still enjoy an active sale -among the ignorant, and by the impossible claims of highly organized -cults which continue to gain in numbers and followers in this country. -Healing schemes based upon the use of herbs because they are delivered -right from nature’s womb, or the fanciful notion that all diseases -arise from the imaginary displacements of the spinal bones, are still -in their ascendency. The liberal system we call democracy has not only -permitted their growth but has rewarded their ingenuous and ingenious -development. Exposure of the fraudulent methods involved serves little -purpose because the mentality which is so susceptible to warped -reasoning responds poorly or even antagonistically to enlightening -guidance.</p> - -<p>There are, however, certain valuable features in herb and spinal -doctrines which have been partially ignored by reputable physicians -because of the intimate relation of these ideas to cult practice.</p> - -<p>In spite of a spirited rebirth of the movement towards the -establishment of a system of healing based on music, there are many -valuable uses of music in medicine which might suffer a like fate -unless a critical analysis of the worth of music as a therapeutic agent -is effected before Musical Therapy reaches the dubious distinction of -classification as a healing cult.</p> - -<p>This book has been written with a view to preserving for<span class="pagenum" id="Page_xi">[Pg xi]</span> medicine that -which is good for patients, and in an attempt to aid musicians under -medical guidance in using music to help the sick.</p> - -<p>Primitive peoples throughout the world still use music in association -with the healing arts. This of course is an indication that they have -probably used it for more centuries than are recorded in the pages of -written history. Ancient civilizations frequently associated music -with the divine, but placed diminished emphasis upon its association -with healing. Even so, the Hebrews accredited to music curative and -inspirational powers<span class="fnanchor" id="fna7"><a href="#fn7">[7]</a></span>, as can be seen by the reference in Scripture: -“And it came to pass when the evil spirit from God was upon Saul that -David took a harp and played with his hand; so Saul was refreshed and -was well and the evil spirit departed from him.”<span class="fnanchor" id="fna63"><a href="#fn63">[63]</a></span></p> - -<p>For the Greeks to whom we owe the origin of the word music, Apollo -served as the God of both medicine and music, and there were some among -them who suggested its use for both mental and physical disease. “Plato -and Aristotle claimed that the Dorian mode was regarded as virile, -energetic, and proper for the perfect citizen; the Phrygian made them -headstrong and the Lydian included effeminacy and slack morals. The -modes of Asiatic origin were considered suitable for banquets.” Five -hundred years before the birth of Christ, Pythagoras<span class="fnanchor" id="fnaI"><a href="#fnI">[I.]</a></span> founded a -brotherhood “based on music as a means of life and moral uplift.”<span class="fnanchor" id="fna70"><a href="#fn70">[70]</a></span> -The influence of music was so great among the Greeks that it is not -surprising that they used it in all walks of life, including medical -treatment. The extent to which they and the peoples who followed them,<span class="pagenum" id="Page_xii">[Pg xii]</span> -used music in this manner will be more fully discussed in the first -chapter.</p> - -<p>Nicholas Murray Butler once stated that “An expert is one who knows -more and more about less and less.” There is much truth in this -facetious definition. In ancient civilization the known facts were -so few that it was possible for some scholars to acquire all the -knowledge available. The professional thinkers or philosophers had a -comparatively complete familiarity with biology, law, music, medicine, -government and theology, and could easily write authoritatively about -most of them. Some of the important discoveries in the arts and -sciences were made by men equally well known in entirely unrelated -fields. As late as the Roman Era, Celsus wrote a series of books -on different subjects, each of which was so complete that it was -considered an authority in its field. To cite one example, the ten -volumes on medicine were accepted for the next thousand years as its -gospel text. Although specialization was known to ancient society, its -foundation was one of individual will rather than basic training in -facts. With the passage of time more and more knowledge developed till -the single volume could no longer hold all the known facts of a science -and what had been titles of chapters became the titles of books. -Knowledge may really be said to have progressed when books are written -on subjects about which only one sentence could have been written -previously, but knowledge progressed very slowly until the fifteenth -century. The Renaissance in art and science developed simultaneously -in a relatively small area. The Renaissance of both medicine and -music, was in Italy during the fifteenth and sixteenth centuries. -Here, instrumental music was asserting its importance over vocal -music, and accurate descriptions of human anatomy finally replaced -the old erroneous conceptions. Both of these changes were necessary -for progress in these fields, but progress was slow in each because -there is always a reluctance on<span class="pagenum" id="Page_xiii">[Pg xiii]</span> the part of the people to accept new -concepts. Individuals may be intellectually progressive, but the people -find security and comfort in established folkways, whether it be of -music or medicine. Fortunately, individuals continued to write of new -discoveries and in new idioms, and that which was good was accepted by -a few in the same generation and by more in succeeding generations. -But each successive step was tedious and it was just as difficult to -influence the new generation as it had been the old.</p> - -<p>With the growth of knowledge came an increase in specialization and -men understood less of subjects unrelated to their own. As the rolling -mass of education grew, it threw off tangential bodies of information -which moved farther apart from each other, and it is only comparatively -recently that these diverging lines have begun to approach one another -and offer mutual assistance. Music, the art, found the need for -acoustics, the science. Industry has come to accept the importance of -color and form, and government has been forced to employ mathematics. -There was a time when such combinations would have been considered -fanciful; now they are indispensable.</p> - -<p>Music and medicine have had casual contacts through the ages, but -neither has cried out to the other for help. Musicians and physicians -are independent people, brooking no outside interference. There are -those on both sides who would protest their marriage, not so much -from a concern over connubial bliss as over the possible offspring -and undesirable relatives. Medicine has never refused to try anything -that might alleviate suffering or cure disease, but it has and -will continue to ignore unfounded claims or secret remedies. To be -acceptable, therapeutic measures must be applicable to all who suffer, -and the ingredients must be available to all qualified practitioners of -medicine. Physicians insist that therapeutic modalities be given under -their guidance and reserve for themselves the right to evaluate their -results. Very<span class="pagenum" id="Page_xiv">[Pg xiv]</span> few physicians object to the use of music for and by -their patients, but many object to calling that use musical therapy. -If the musician is aflame with the desire to make music for patients -there is no need for insisting that it be labelled anything but music, -providing of course that it is music. Physicians do not discourage acts -of kindness or personal attention to their patients. They want them to -have clean bedding and fluffed pillows, but insist that such procedures -be called nursing care and not therapy, regardless of the amount of joy -it brings the patient. There are many uses to which music may be put -in medicine and especially in hospitals. When one considers the number -and variety of hospitals in this country, it is difficult to imagine a -kind of music which can not find a place in at least one of them, but, -for reasons which seem more obvious to musicians than physicians, music -has been used in the past almost exclusively for patients suffering -from mental illness. During the past few decades, hospitals have given -increasing attention to music, and in some instances have developed -impressive programs.</p> - -<p>In 1944 the National Music Council sent questionnaires to more than -three hundred hospitals which treated psychiatric disorders, and -received replies from two hundred of them. A summary of the survey was -published by them under the title of “The Use of Music in Hospitals for -Mental and Nervous Diseases,” and some of the information contained in -this pamphlet will be of interest to those who are considering this -aspect of music as a career. Almost all mental hospitals use music in -some form. In half of them, patients participate in music vocally or -instrumentally. In many hospitals the use of music is increasing and -in a few it is extensive. About one-quarter of the hospitals have some -budgetary appropriation for music, such appropriations are not great at -present.</p> - -<p>Most hospitals look for musical workers among the members of their -regular staff; but a few have consulted musical organizations.<span class="pagenum" id="Page_xv">[Pg xv]</span> Trained -musicians might think that hospitals would turn more uniformly to -musical schools for this sort of assistance, but for the most part, few -schools of music have openly encouraged the study of this subject,—in -spite of the fact that one-half of all the hospitals questioned stated -that they could use additional qualified workers.</p> - -<p>Of greater interest perhaps to those who would like to become hospital -music aides are the opinions expressed by the hospital authorities on -the principal qualifications which they believed musical workers in -mental hospitals should have. It must be remembered, however, that -questionnaires submitted to hospitals are not answered in a uniform -manner, and any survey of this type must be interpreted with caution. -When questionnaires are sent to hospitals they usually pass first -through the hands of the director or superintendent, who reacts as -an individual and not according to a set pattern. One will turn the -paper over to his secretary for reply; another will pass it on to a -physician, nurse or occupational therapist. In many instances the -answers will be filled out by the hospital music worker, and sometimes, -if the superintendent is sufficiently interested, he may answer it -himself. Each person to whom the questionnaire is submitted may -transfer the burden of answering to a subordinate, if he is too busy -to fill it out himself. The signature which appears at the bottom of -the returned questionnaire is usually one of approval rather than of -authorship. Surveys should list the titles of respondents. This one -did not. Even if it did, the foregoing possibilities would have to -be considered. In spite of this, the qualifications listed will be -reviewed for the help they may offer the prospective hospital musician.</p> - -<p>A majority agreed that a knowledge of music was necessary, and not only -were all phases of music specified, but the ability to make intelligent -selections of music and to operate commercial<span class="pagenum" id="Page_xvi">[Pg xvi]</span> sound equipment was -recommended by some. Experience in teaching music, particularly the -piano, was high on the list of desired accomplishments, and the faculty -of directing singing was even higher.</p> - -<p>Many hospitals stressed the importance of a “wholesome personality”, -but this is a term which defies suitable definition. However, the -following qualifications were named: emotional stability, patience, -refinement, congeniality, quietness, and a sense of humor. There are -further recommendations that the worker should possess: imagination, -tactfulness, consideration, energy, perseverance, sincerity, -co-operation, adaptability and understanding of human nature. In the -final chapter of this work a more realistic approach to this subject -will be offered.</p> - -<p>One final qualification is mentioned which is to be taken most -seriously, and that is that the musician who would work with mental -patients should have “a definite urge to help the mentally ill.” As a -supplement to this he should have or be given a working knowledge of -hospital procedure and the handling of the psychiatric patient.</p> - -<p>From these comments by hospital authorities and the recent trends in -institutions throughout the country, it is reasonable to assume that -the demand for adequately trained hospital music aides will increase. -Some hospitals will want one or more full-time workers, and others will -want a part-time worker. This means that some musicians may be able to -supplement their earnings by securing partial pay from hospitals in -their communities, the remuneration offered varying with the size of -the hospital, its endowment and income. It will never be a source of -wealth to a musician, but it can be a stop-gap in the hard early years -or a continuous position for those who seek the security of regular -employment.</p> - -<p>Some people fill positions for which their only qualification has<span class="pagenum" id="Page_xvii">[Pg xvii]</span> been -influence; but in the majority of cases the people who have spent the -greatest effort in securing superior training will be the recipients of -the best positions. The student of hospital music should prepare for -his job as seriously as for any other aspect of music. Regardless of -his other qualifications, he must of course be a musician, and a degree -in music is valuable; in fact almost essential. The ability to play a -second instrument even moderately well is useful. The universal appeal -and advantages of the piano make a working knowledge of it important. -The music aide should be able either to play the piano at sight or -he should study one of the rapid systems of piano instruction for he -will be called upon not only to accompany group singing but to assist -visiting artists or talented patients.</p> - -<p>Although a foundation in classical music is part of any good musical -training, a musician who refuses to recognize the importance of popular -music in American life is not suited to this work. If he has a positive -dislike for popular music, he should look to other fields. It is not -necessary that he be able to play all the types of modern jazz, but -he should be familiar with the common jargon of jazz and should learn -the distinctions which exist between these so-called musical forms. -His musical tastes need not be catholic, but his attitude towards the -tastes of others must be broadminded.</p> - -<p>Advances in mechanical reproduction of music are progressing at a very -rapid rate, so the technological aspects of music should be cursorily -reviewed. A working knowledge of record players, record cutters, -needles, tone control and amplification is not difficult to acquire. -It may be part of the duties of a music aide to supervise record -cuttings and a public address system. In some hospitals the library -of musical recordings and literature may be large. A study of musical -librarianship will save much time, and<span class="pagenum" id="Page_xviii">[Pg xviii]</span> the study of classification -systems and filing will become an additional part of the work of a -music aide.</p> - -<p>More often than not a musician approaches a problem with more emotion -than analysis, and this becomes of great importance when the problem is -a patient. There have always been and will continue to be physicians -who with honest conviction or for greater glory will anxiously ally -themselves with anything new or sensational, therefore musicians -impassioned with the belief that music is necessary to health will have -little difficulty in finding collaborators in the ranks of medicine. -Musicians must be cautioned to consider the fact that their sincere -efforts may result only in discrediting music, as a therapeutic agent. -As a result its acceptance as the basis of such merits as it may -possess may be undeservedly delayed because of antagonism aroused by -extravagant claims made in its behalf.</p> - -<p>Much has been written about music as a therapeutic agent, and recently -there have been entire schools and organizations devoted to Musical -Therapy. In spite of the great temptation to be in on a coming theory -few physicians have associated themselves with these efforts, and what -is more conclusive, no physicians of national repute have come forward -in approval of the term “musical therapy” as applied to the handling of -psychiatric patients.</p> - -<p>The use of music should not be limited to mental hospitals, however. -Those who have played music for mental patients are enthusiastic over -the individual responses they have witnessed. The nature of this -response is awakened interest or joy. Joy is a healthful symptom for -all patients to experience and this joy should be available to patients -in all hospitals. Many other phases of music are adaptable for hospital -use and this book is written to outline the many approaches possible -and delineate the scientific basis for some of them.</p> - -<p>Of the better known books on musical therapy some, like the<span class="pagenum" id="Page_xix">[Pg xix]</span> work by -Hector Chomet, are built around the effects observed in individual -patients; others, like the writings of Eva Vescelius, are pure phantasy -which stem from unbridled emotion. For science was not applied until -the appearance of psychologic investigations when common sense -began to emerge from a chaos of wishful thinking. One of the first -dependable surveys of the subject was in the <i>Psychology of Music</i> -by C. M. Diserens. Since the appearance of this excellent work the -passages stating his views have been often quoted—frequently without -acknowledgment. Its chapter on Musical Therapeutics is recommended for -its scholarly history and sober evaluations of facts and fancies.</p> - -<p>This book has been written for the musicians who wish to learn how they -may work with physicians for patients. Technical terminology has been -reduced to simple terms wherever possible for a better understanding, -but co-operation can be secured only if the musician is willing to -forget his preconceived ideas and abide by the decisions of the -physician, who may not be too familiar with music but is familiar with -hospitals and patients.</p> - -<p>The unemotional approach to this subject is of recent origin. Little -has been written in that vein, and this book will lay no claim to -originality or perfection. It is hoped that it will act as a guide to -further study and an aid to those who wish to engage in this as yet -uncharted venture.</p> - -<p>Realizing that few sources of information are available in this field -to musicians, and that some musicians may one day feel the urge or -experience the need to participate in such work, the New England -Conservatory of Music invited the author to give a series of lectures -to its students on this subject. At the conclusion of the course they -decided to offer this outline to those who might later wish to refer to -its contents.</p> - -<p>In preparing this work the author had the good fortune of personal -interviews with some of the leading musicians, musicologists<span class="pagenum" id="Page_xx">[Pg xx]</span> and -musical psychologists in the country. Although no statements which -appear in this volume are to be construed as the opinions of any of -them, an expression of thanks is offered to the following for their -willingness to exchange ideas with the author: <abbr title="doctor">Dr.</abbr> Serge Koussevitsky, -<abbr title="mister">Mr.</abbr> Igor Stravinsky, <abbr title="doctor">Dr.</abbr> Harold Spivacke, <abbr title="doctor">Dr.</abbr> James Mursell, and <abbr title="doctor">Dr.</abbr> -Carroll Pratt.</p> - -<p>The author wishes to express his thanks to Mrs. Margaret E. Gurney -and Miss Ida Evans for their assistance in the preparation of the -manuscript.</p> - -<p>The author wishes to express his deep gratitude to <abbr title="mister">Mr.</abbr> Clifton Joseph -Furness, Director of Academic Subjects at the New England Conservatory -of Music for his supervision in the editing of this book.</p> - -<p class="right p0"> -S. L.<br /> -</p> - - -<div class="footnotes"><h3>FOOTNOTES:</h3> - -<p><span class="pagenum" id="Page_1">[Pg 1]</span></p> - -<p class="footnote" id="fnI"><a href="#fnaI">[I.]</a> <i>Pythagoras passed a black-smith shop one day and was struck -with the beauty of the two sounds he heard coming from it. He entered -the shop, studied the sounds closely and found that the two notes -were an octave apart. This observation stimulated him to a detailed -study of music which led to his musical philosophy. He believed that -all nature and knowledge were contained in harmonic numbers, and that -the world had been made in a musical harmonic accord. He invented a -sacred quartenary of harmonic numbers to explain the phenomena of life. -But Roussier believed that Pythagoras adapted his system from the -Chinese.</i><span class="fnanchor" id="fna70a"><a href="#fn70">[70]</a></span></p></div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h2 class="nobreak" id="CHAPTER_ONE"><i>CHAPTER ONE</i><br /> -HISTORY OF MUSIC IN MEDICINE</h2> -</div> - -<p class="poetry p0"> -“Music exalts each joy, allays each grief,<br /> -Expels Diseases, softens ev’ry pain,<br /> -Subdues the rage of poison and the plague,<br /> -And hence the wise of ancient days ador’d<br /> -One pow’r of Physic, Melody and Song.”<br /> -<br /> -<span style="margin-left: 2em;">“<i>The Art of Preserving Health</i>”</span><br /> -<span style="margin-left: 2em;">by John Armstrong (1709-1779)</span><br /> -</p> - - -<p>In many fields of endeavor a scholar occasionally appears who not -only makes a personal contribution to the knowledge and advancement -of his subject but summarizes previously gained information so well -that his work becomes at once a milestone and a beacon. In the field -of music, such a man was Charles Burney, who began to publish a -<i>General History of Music</i> in 1776. This book was so thorough and -scientifically critical that his conception is as modern as tomorrow. -After listing all the instances of music as a therapeutic agent, he -concludes:</p> - -<div class="blockquot"> - -<p>“Yet men delight in the marvellous; and many bigoted admirers -of antiquity, forgetting that most of the extraordinary effects -attributed to the music of the ancients had their origins in poetical -inventions, and mythological allegories, have given way to credulity -so far as to believe, or pretend to believe, these fabulous accounts, -in order<span class="pagenum" id="Page_2">[Pg 2]</span> to play them off against modern music, which according to -them, must remain in a state far inferior to the ancient, till it can -operate all the effects that have been attributed to the music of -Orpheus, Amphion and such wonder-working bards.”<span class="fnanchor" id="fna15"><a href="#fn15">[15]</a></span></p> -</div> - -<p>It is well to begin a study of music in medicine with Burney’s -restrained enthusiasm lest we fall into the error of building -impossible temples of healing on the thin ice of untested claims. We -shall begin with prehistoric times.</p> - -<p>The use of music against disease is as old as music itself. In -fact, early history of music is intimately associated with healing. -The wishful thinking of primitive peoples called upon magic for -assistance, and magic is almost universally associated with words, -chanted words, in rhythmic incantation. Chateaubriand believed that -the chant was the offspring of prayers. Among primitive peoples, the -medicine-man combined the offices of priest, physician and magician, -and although all three functions were closely related, their functions -were dissociated on occasion. For instance, there were special songs -for the invocation of natural phenomena, for group activities, and -for accompaniment of healing rituals. “The belief in the efficacy of -musical magic is one of the most important facts in the history of -civilization.”<span class="fnanchor" id="fna19"><a href="#fn19">[19]</a></span></p> - -<p>Although no records exist, it is fair to assume that the truly -primitive peoples of today have not changed markedly from their -ancient customs, and that they resemble to some extent the status of -prehistoric men. The universality of certain folkways among widely -scattered tribes of primitive peoples today lends validity to this -theory.</p> - -<p>For such studies we need look no further than our own continent. Even -though certain magical practices have been banned by law, the American -Indians number amongst their tribesmen, those<span class="pagenum" id="Page_3">[Pg 3]</span> who remember and to some -extent still use music in healing. Several investigators have become -interested in this study, but chief among them is Frances Densmore who -has analyzed and recorded the songs of many Indian tribes. Among the -Teton Sioux she found<span class="fnanchor" id="fna21"><a href="#fn21">[21]</a></span> that the sick appealed to the tribal medicine -man who gave the case some thought and claimed to find the cure in -dreams. “All treatment of the sick was in accordance with dreams.” The -patient was then placed in a dark tent and the medicine man sang his -dream song, as well as songs addressed to the sacred stones. The use of -herbs of the agency of magic might accompany the song. An example of -one of the songs used to cure wounds has the following text:</p> - -<p class="poetry p0"> -“Behold all these things<br /> -something elk-like<br /> -you behold<br /> -you will live”<br /> -</p> - -<p>Words like these have a certain sophistication which we may assume -constitutes a more recent development.</p> - -<p>For many centuries primitive peoples have had different concepts of -the exact nature of disease, but for many of them it connotes some -connection between a demoniacal spirit and counter-spirits. There were -a great many methods employed to drive out the evil spirits. The idea -that music was efficacious in these cases persisted for centuries. -Martin Luther said, “The devil is a saturnine spirit and music is -hateful to him and drives him away from it.”</p> - -<p>Densmore points out that among the Iriquois<span class="fnanchor" id="fna22"><a href="#fn22">[22]</a></span> the word <i>orenda</i> -is used to designate the universal indwelling spirit. Nothing was -regarded by the Indian as supernatural, in our use of the term, but -many Indians desired an <i>orenda</i> stronger than their own. When a -medicine man began to treat a sick person the result<span class="pagenum" id="Page_4">[Pg 4]</span> depended upon the -power of his <i>orenda</i>. <i>Orenda</i> could be put forth in song. -Those who possessed <i>orenda</i> strong enough to do wonderful things -were called medicine men. They were consecrated to their work, and the -safety, success and health of their people depended on their efforts.</p> - -<p>In completing her analysis of Indian medicine songs, Densmore concludes -that they suggest “the confidence which the medicine man felt in his -own power, and which he wished to impress on the mind of his patients.”</p> - -<p>Wallaschek<span class="fnanchor" id="fna79"><a href="#fn79">[79]</a></span> lists many examples of the healing use of music among -primitive tribes. Among the Wasambara in East Africa, the doctor -arrives with a small bell in his hand which he rings from time to -time. The patient sits before him on the ground and the doctor begins -speaking in a singing tone: “Dabre, dabre.” He repeats this several -times and the patient sings a simple response. In Australia, Wallaschek -found a tribal doctor shaking a bundle of reeds, an action otherwise -used during a song to mark time. In Borneo, the natives perform -recitatives and songs in order to catch the soul of the patient which -is supposed to have run away before the evil spirit. The Wallawalla -Indians in this country believe that song influences the cure of a -patient, and all the convalescents are directed to sing for several -hours daily. In British Columbia the doctor sings when he visits the -patient, while a chorus of people intones a song outside the house.</p> - -<p>With the dawn of civilization, intellectual activity became more -progressive but folkways die hard.</p> - -<div class="blockquot"> - -<p>“The ancient Egyptians called music ‘physic for the soul,’ and had -faith in its remedial virtues. We may presume that the incantations -presented in the medical papyri were likewise to be emitted with the -proper voice and therefore contain an element of<span class="pagenum" id="Page_5">[Pg 5]</span> music. The Persians -regarded music as an expression of the good principle Ahura-Mazda -and are said to have cured various maladies by the sound of the -lute”<span class="fnanchor" id="fna24"><a href="#fn24">[24]</a></span>. “The Lacedemonians agreed with the Egyptians and confined -the possessors of music to one family, and their priests like those -of Egypt were taught medicine and music, and initiated into religious -mysteries”<span class="fnanchor" id="fna28"><a href="#fn28">[28]</a></span>.</p> -</div> - -<p>The martial and moral values of music were appreciated by most of the -early civilizations. Both Confucius and Plato believed that music -was the most certain means of reforming public mores and sustaining -them at a high level.<span class="fnanchor" id="fna25"><a href="#fn25">[25]</a></span> Although many histories on effects of music -quote the scripture as evidence of the Hebrew use of music in healing, -the passage quoted<span class="fnanchor" id="fna63a"><a href="#fn63">[63]</a></span> is subject to various interpretations. It -simply says that after listening to David play on the harp, Saul was -“refreshed and well,” this could refer more to loss of fatigue than -cure of a disease.</p> - -<p>The great poets have always sung the praises of their beloved sister -muse. In Homer there is a story relating how the flow of blood from -Ulysses’s wound was stopped, charmed by the use of music.<span class="fnanchor" id="fna13a"><a href="#fn13">[13]</a></span> Now it -is very possible that the blood of the famed warrior coagulated in its -wound during a musical interlude, but then, all wounds except those -involving a large artery will cease bleeding in about twenty minutes. -Homer also stressed good music and song as a means of elevating the -spirit and of overcoming depression of the soul or mind, agony, -anguish, anger and sorrow. He gives as an example the story in which -Chiron heals the sick with melody.<span class="fnanchor" id="fna57"><a href="#fn57">[57]</a></span> Cato<span class="fnanchor" id="fna13"><a href="#fn13">[13]</a></span> spoke of luxated -joints which were eased by the harmony of sound. We cannot be sure -of the diagnostic acumen of the observer, but for active people the -most common traumatic joint trouble is a “locked” knee. Most<span class="pagenum" id="Page_6">[Pg 6]</span> knees -which contain disturbed cartilage will unlock after a relatively short -period of rest. In each of these instances, music was an environmental -coincidence. Such observations would only begin to assume scientific -medical value if they could be repeated many times under identical or -similar conditions. They were not.</p> - -<p>We may now return to the episodes related by Burney in his commentary. -Martianus Capella, an ancient author on music, assures us that “I have -often cured disorders of the mind as well as the body with music”<span class="fnanchor" id="fna58"><a href="#fn58">[58]</a></span>. -He also claimed that the Aesclepiades, the state-recognized priests -of medicine, cured deafness by the sound of the trumpet. “Wonderful, -indeed!”, says Burney, “that the same noise which would occasion -deafness in some should be a specific for it in another.” In Plutarch’s -book <i xml:lang="la" lang="la">De Musica</i> it is related that Thaletas the Cretan delivered -the Lacedemonians from the pestilence by the sweetness of his lyre.</p> - -<div class="blockquot"> - -<p>“Thaletas, a famous lyric poet, appeared by command of an oracle and -all the songs he sang were prayers to the Gods. The disease probably -reached its highest pitch of malignity before he came, and began to -subside with his coming; but its disappearance was attributed to the -music of Thaletas.”</p> -</div> - -<p>Many other cures are cited. Xenocrates employed the sound of -instruments in the cure of maniacs; and Appolonius Dyscolos claimed -that music was a sovereign remedy for dejection of the spirits and a -disordered mind, and that the sound of a flute would cure epilepsy and -sciatic gout. Athenaeus rendered the cure for gout more certain by -playing music in the Phrygian mode, while Aulus Gellius insisted that -the music be soft and gentle, the opposite of the furious Phrygian. -Coelius Aurelianus introduced a concept which reappeared at several -widely separated times. He called it <i xml:lang="la" lang="la">loca dolentia decantare</i>, -or enchanting the disordered<span class="pagenum" id="Page_7">[Pg 7]</span> places. He claimed that the pain -was relieved by causing a vibration in the fibres of the affected -part. There is little doubt that music causes a physical vibration -of the air, but the force that such vibrations could have on most -tissues is negligible. Other writers recommended that the instrument -be held against the part to be treated for direct transmission of -the vibrations, but if physical excitement is desired this can be -accomplished more uniformly by applications known as manipulation or -massage. Such manipulations are known to be helpful in some conditions, -but not curative in painful conditions such as sciatica.</p> - -<p>Nearchus, who accompanied Alexander the Great in his conquests, -reported that in India the only remedy against the bite of a serpent -was a chant<span class="fnanchor" id="fna70b"><a href="#fn70">[70]</a></span>. Galen, one of the soundest physicians of ancient -Rome, recommended music as an antidote to the bite of vipers and -scorpions<span class="fnanchor" id="fna7a"><a href="#fn7">[7]</a></span>, and for centuries music was recommended for the bite of -a tarantula. In the seventeenth century three physicians named Mead, -Burette and Baglivi explained this use of music. They said that it -threw the patient into a violent fit of dancing which brought out a -plentiful perspiration, and with it the poison. Since perspiration -consists of water and a few simple salts, such activity would increase -the concentration of the poison in the circulating blood, and neither -the explanation nor the treatment is acceptable<span class="fnanchor" id="fna28a"><a href="#fn28">[28]</a></span>. Music was -recommended not only for the bites of the reptiles and insects; Desault -recommended it in the treatment of hydrophobia<span class="fnanchor" id="fna23"><a href="#fn23">[23]</a></span>. Not all bites -are poisonous, and it is likely that in the case of the two patients -mentioned the cure was more for fright than bite.</p> - -<p>The effects of music on the mind were too obvious to escape the -ancients. When the armies of Greece took the field, they were -accompanied by the best musicians, who by their martial strains -inspired the soldiers with a kind of mechanical courage never -experienced by their enemies.</p> - -<p><span class="pagenum" id="Page_8">[Pg 8]</span></p> - -<p>The distinction between mental health and disease was not advanced -among the ancients, but they did recognize varieties of insanity such -as delirium, melancholy and mania. Many physicians recommended music in -the treatment of mental disease, and Quarin spoke of a single case of -epilepsy cured by music. With the exception of severe epilepsy, many -patients who suffer from the symptoms which bear this name have only -occasional attacks and these disappear spontaneously, making the music -simply another coincidence.</p> - -<hr class="tb" /> - -<p>Celsus, who was a great medical authority not only in his own time -but in subsequent centuries wrote of the mentally ill, “We must quiet -their demoniacal laughter ... and sooth their sadness by harmony, the -sound of cymbals and other noisy instruments”<span class="fnanchor" id="fna16"><a href="#fn16">[16]</a></span>. Areteus, another -great physician of ancient Rome, prescribed music for “corybantism, -a disease of the imagination”<span class="fnanchor" id="fna24a"><a href="#fn24">[24]</a></span>. The great Dutch physician, -Boerhaave<span class="fnanchor" id="fna11"><a href="#fn11">[11]</a></span>, said, “I do not know if all that one tells us of the -charms and enchantments could not be attributed to the effects of -music, in which the ancient physicians were well versed.” References -continued to appear concerning the magical relationship between music -and healing. Robert Grosseteste (1175-1253 A.D.) said that disease and -even wounds and deafness could be cured by music based upon a knowledge -of astrology and mathematics<span class="fnanchor" id="fna75"><a href="#fn75">[75]</a></span>.</p> - -<hr class="tb" /> - -<p>During the early part of the Christian Era, most of the arts were -sustained by the Church, and as a result the finest works in painting -and music were available to the average man only within places of -worship. Not until the Renaissance did serious music take on a secular -character. Music until then was largely identified with religion, and -as such was considered to have an influence on the soul. Bacon advanced -as a rule of health that people “recreate<span class="pagenum" id="Page_9">[Pg 9]</span> their spirits every day with -a piece of good music.”<span class="fnanchor" id="fna13b"><a href="#fn13">[13]</a></span> He went a step further in his <i xml:lang="la" lang="la">Sylva -Sylvarum</i>.</p> - -<div class="blockquot"> - -<p>“Seeing then the mind is so powerful an agent in particular disease, -I see no reason why the efficacy of music should not be tried in many -disorders which arise in the animal constitution; for music composes -the irregular motion of the animal spirits and more especially allays -the inordinate passion of grief and sorrow.”<span class="fnanchor" id="fna7b"><a href="#fn7">[7]</a></span></p> -</div> - -<p>The restful and joyful qualities of music were praised by Shakespeare:</p> - -<p class="poetry p0"> -“But sweet music can minister to minds diseased<br /> -Pluck from the memory a rooted sorrow<br /> -Raze out the written troubles of the brain<br /> -And with its sweet oblivious antidote<br /> -Cleanses the full bosom of all perilous stuff<br /> -Which weighs upon the heart.”<br /> -</p> - -<p>Henry Beacham wrote in his “<i>The Compleat Gentleman</i>” in 1634 that</p> - -<div class="blockquot"> - -<p>“the exercise of music is a great lengthner of life, by stirring and -reviving the spirits, holding a secret sympathy with them; besides -the exercise of singing opens the breast and pipes; it is an enemy -to melancholy and dejection of the mind, which <abbr title="saint">St.</abbr> Chrysostome -truly called ‘Devil’s Bath’. Besides the aforementioned benefit of -singing, it is a most ready help for a bad pronunciation, and distinct -speaking, which I have heard confirmed by many great Divines; yea, in -myself have known many children to have been aided in their stammering -in speech by it alone.”</p> -</div> - -<p><span class="pagenum" id="Page_10">[Pg 10]</span></p> - -<p>In the dark ages there was very little added to the knowledge of -medicine, but during the Renaissance physicians became more progressive -and articulate. Among these was the famous Willis who said that</p> - -<div class="blockquot"> - -<p>“Music not only is a delightful phantasy, but dispels sadness from -the grieving heart; and it also allays fevered passions and excessive -commotion of the breast.”<span class="fnanchor" id="fna81"><a href="#fn81">[81]</a></span></p> -</div> - -<p>Characteristic of the use of music as an aid to healing is an anecdote -quoted by Burney. Farinelli was one of the great operatic singers of -his day and his fame was equally great in all of western Europe and -England. One of the countries he visited was Spain. “It has often -been related, and generally believed, that Philip V. King of Spain, -being seized with a total <em>dejection</em> of spirits which made him -refuse to be shaved, and rendered him incapable of attending council -or transacting affairs of state; the Queen who had in vain tried -every common remedy that was likely to contribute to his recovery, -determined that an experiment should be made of the effects of music -upon the King, who was extremely sensible to its charms. Farinelli was -summoned and on his arrival her Majesty contrived that there should -be a concert in the room adjoining the King’s apartment, in which the -singer performed one of his most captivating songs. Philip appeared at -first surprised, then moved; and at the end of the second air, made the -virtuoso enter the royal apartment. He plied him with compliments and -caresses and asked him how he could sufficiently reward such talents, -assuring him that he could refuse him nothing. Farinelli, previously -instructed, only begged that his majesty would permit his attendants to -shave and dress him, and that he would endeavor to appear in council as -usual. From this time the King’s disease gave way to <em>medicine</em>, -and the singer had all the honor<span class="pagenum" id="Page_11">[Pg 11]</span> of the cure. “The King,” according to -the <i>London Daily Post</i> of September 26, 1736, “settled a pension -of 3,150 pounds sterling, per annum, on Signor Farinelli, to engage him -to stay at court.”</p> - -<p>A great number of references during the sixteenth and seventeenth -centuries attests to the wondrous workings of music against mental -disturbances. Wilhelm Albrecht<span class="fnanchor" id="fna1"><a href="#fn1">[1]</a></span> reported a patient who was suffering -from melancholia. Many remedies had been tried, when as a last resort -the physician requested that a certain <i xml:lang="fr" lang="fr">ritournello</i> be played. -As soon as the patient heard it, he began to laugh with all his might -and hopped out of his bed completely cured. More interesting is the -observation of Champlain<span class="fnanchor" id="fna17"><a href="#fn17">[17]</a></span> who wrote on his return from America, “It -is the custom in America when one is sick, to divert them with loud -music, to prevent brooding about the condition and thus help restore -health.”</p> - -<p>Mozart was not the first to call the flute “magic.” To Democritus was -attributed the story of abolishing plague with its music. Jean-Baptiste -Porta claimed that one could cure all disease with music, provided -that one used a flute made of the wood of the plant which was a known -specific for the disease to be treated. Thus one could cure mental -disease with flutes made of hellebore stems. One could return some -vigor to the impotent with flutes made of orchid stems, and fainting -could be cured by playing on a flute made of cinnamon wood.<span class="fnanchor" id="fna67"><a href="#fn67">[67]</a></span></p> - -<p>Philippe Pinel, the physician credited with being the first to accord -the mentally ill humane treatment reported at least one instance of the -use of music in the treatment of epilepsy.</p> - -<div class="blockquot"> - -<p>“During the attacks, the sense of hearing, far from being deadened, -seemed to have acquired more keenness. A skilful musician played on -the violin at the patient’s side during her paroxysm. Although she -then appeared insensible to the charm of music, she<span class="pagenum" id="Page_12">[Pg 12]</span> was so strongly -effected by it, that she admitted after having recovered entire -consciousness, that the music had thrown her into a state of rapturous -delight.”</p> -</div> - -<p>Literature abounds with many accounts of the use of music by lesser -medical lights. Sauvages<span class="fnanchor" id="fna18"><a href="#fn18">[18]</a></span> mentioned a young man who had attacks of -intermittent fever accompanied by violent headaches which could be -soothed only by the sound of a drum played loudly. This same patient -did not like music when in good health. Instances of this nature may be -explained on the basis of counter-irritation, wherein a new disturbance -superimposed upon an old one may counteract it.</p> - -<p>In the eighteenth century, Brocklesby<span class="fnanchor" id="fna13c"><a href="#fn13">[13]</a></span> summarized the known -literature of music in relation to health and disease and, considering -the status of medicine in his day, made a fair appraisal of its value.</p> - -<p>During the last century Hector Chomet<span class="fnanchor" id="fna18a"><a href="#fn18">[18]</a></span>, a Parisian physician, became -interested in music and its application to disease. He wrote a short -article setting forth his views, which he was to deliver to a group of -medical men in Paris, but was put off time and again by his colleagues -and by political upheavals. Each time, before replacing his paper on -the shelf, Chomet made additions. This work grew to be the important -thing in his life, and when he could contain himself no longer, he -published a book on the subject which showed considerable research -but which unfortunately contained as much invention as fact. Not -content with the known and proved existence of blood and lymph as the -chief body fluids, he added another—the “sonorous fluid,” which was -influenced for the good or bad by the vibrations of musical sounds.</p> - -<p>At about the turn of the century Eva Vescelius, a woman of great charm, -beauty and perseverance, reintroduced the use of<span class="pagenum" id="Page_13">[Pg 13]</span> music for mental -disease under the guidance of a physician. There is little doubt that -she gave great joy to many patients, but a differentiation must be made -between personal attention and therapeutics. In her works<span class="fnanchor" id="fna78"><a href="#fn78">[78]</a></span> on the -subject one can read enthusiastic accounts of past performances, but -unfortunately her explanations and claims are pure phantasy, to wit:</p> - -<div class="blockquot"> - -<p>“For fever, high pulse, hysteria, arrest the attention, play softly -and rhythmically to bring pulse and respiration to normal. Tests -with instruments will prove that music will do this. Do not change -too abruptly from one key to another; modulate and pause and let the -musical impression be absorbed. Select songs that depict green fields -and pastures new, the cool running brook, the flight of birds, the -blue sky, the sea.</p> - -<p>“Fear is dissipated by music awakening in the listener the -consciousness of the all enveloping Good. A high nervous tension is -relieved and nerves are relaxed under the spell of a composition that -swings the body into normal rhythmic movement. Sluggish conditions -of body and mind are eliminated by the rhythmic waltz, polka or -mazurka—music affecting the motor system. Insomnia is cured by the -slumber-song, the nocturne, or the spiritual song that assures one of -the Divine protection.”</p> -</div> - -<p>The use of music in hospitals is by no means limited to the application -to mental disease. Recreation is needed to avoid boredom, for as -Shakespeare said:</p> - -<p><span class="pagenum" id="Page_14">[Pg 14]</span></p> - -<p class="poetry p0"> -“Sweet recreation barr’d, what doth ensue<br /> -But moody moping and dull melancholy<br /> -Akin to grim and comfortless despair<br /> -And at her heels a huge infection troops<br /> -Of pale distemperatures and foes to life.”<br /> -</p> - -<p>The use of music as a diversion in hospitals received a great impetus -in the First World War but made its greatest leap forward with the -introduction of the portable bedside radio.</p> - -<p>The use of music as an exercise for poorly moving joints and weakened -muscles is recent and may be said to have received its great impetus in -the Second World War (described in the Boston Sunday Post, February 11, -1945; A-5).</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_15">[Pg 15]</span></p> - -<h2 class="nobreak" id="CHAPTER_TWO"><i>CHAPTER TWO</i><br /> -PHILOSOPHY AND PSYCHOLOGY OF MUSIC</h2> -</div> - -<h3>I</h3> - -<p>In the realm of thought, opinions and theories sometimes find credence -long after they have been proved incorrect. In the field of the arts, -opinions may become so strongly rooted that there is occasional -resistance to any analytical attempts designed to disprove them, and -even after they have been exposed, there will be a significant number -of people who will continue to believe in them. The artist who would -make music for patients must approach such an endeavor with a full -knowledge of the elements involved, and should be willing to recognize -those prejudices, customs and thoughts concerning the effects of -music on the human body which have been fostered by well-meaning, but -misguided, enthusiasts. We must differentiate between the philosophy of -esthetics and the proved psychology of music. Musicians who refuse to -accept those results of scientific research which disagree with their -personal views will fall into the same difficulties which have beset so -many musicians in the past who have desired to help patients.</p> - -<p>Before the advent of laboratory psychology, there was no satisfactory -test for the theories which dealt with music and the mind, and the -number and variety of theories advanced were great. Some of the most -unreasonable were the most attractive,<span class="pagenum" id="Page_16">[Pg 16]</span> and it is easy to understand -why they were accepted. But if any of these theories is used as a means -of attaining a scientific end it cannot succeed with any dependability -if it is unsound.</p> - -<p>The psychologic effects of sound may be physiologic or intellectual. -They may be related to intensity, quality or direction on the one -hand, or to past or present mental associations on the other. To the -primitive man thunder, which seems to come from everywhere and is -louder than anything he can produce, is terrifying and supernatural; -the rustling of leaves is frequently caused by the wind, but from his -past experience may also instil the fear of the approaching enemy. -Sound is often frightening from its qualities or implications.</p> - -<p>The psychologic reaction to the type of sound known as music may vary -from the reflex panic produced by the air-raid siren to the soothing -effect of a softly sung lullaby. For some people, certain musical -selections elicit almost no response, while in still others a truly -amazing chain of mental images results. The latter reaction is the -result of centuries of evolution in the development of music and -knowledge, and will be discussed later.</p> - -<p>During the modern evolution of musical composition, many new forms -were devised bearing descriptive names. Some of these forms by their -distinctive tempo, dynamics, or title conditioned the informed -listener to a mental attitude consistent with the intention of the -composer. Some selections by the very nature of their execution cause -stimulation or assist repose. Superficially it might seem, therefore, -that the controlled administration of music could evoke desired moods -in listeners at will, and some practitioners declared that music is a -specific treatment for mental disease. It is undoubtedly possible to -influence the mood of healthy, trained musicians by the use of selected -compositions but to assume that all listeners will react in similar -fashion, or that<span class="pagenum" id="Page_17">[Pg 17]</span> the moods of the mentally deranged can be changed at -will by prescribed music, is to ignore the nature of mental disease and -the scientific finding of psychologists.</p> - -<p>Music is many things, but physically it consists of sounds or notes -which have pitch, intensity, timbre and duration. These notes are -combined in patterns which have rhythm, tempo, melody and harmony and -these in turn are related to key, mode and form. Each of these elements -has been the subject of philosophic interpretation, and more recently -of psychologic investigations. Although the effect of music on the -human mind depends upon the reaction to the entire composition, it is -important to review the existing data in order to understand more fully -the effects of music, in spite of the difficulties; for as Ortman<span class="fnanchor" id="fna71"><a href="#fn71">[71]</a></span> -has said “the problem of analyzing and classifying responses of music -into types is at the same time intensely interesting and notoriously -difficult. The history of the problem is rich in unco-ordinated data -and poor in clear-cut conclusion.”</p> - - -<h3>II<br /> -<span class="smcap">Elements of Music</span></h3> - -<p><em>Pitch.</em> Heinlein<span class="fnanchor" id="fna45"><a href="#fn45">[45]</a></span> found that the same chords which called -forth a happy and bright feeling when played in high pitch were -characterized as gloomy or melancholy when played in low pitch. The -voice of youth and laughter is higher pitched than the grumbling of old -age and may be a conditioning factor. Beaunis<span class="fnanchor" id="fna8"><a href="#fn8">[8]</a></span> felt that the reaction -to pitch is the effect of experience and custom and cited a reversal -among Orientals in whom low pitched sounds effect joyous reactions and -the high, sadness and sorrow.</p> - -<p><em>Intensity.</em> Heinlein found that loud chords are rarely soothing, -and soft chords are almost always soothing. Beaunis stresses the -fatiguing quality of great intensity over a long period, and contrasts<span class="pagenum" id="Page_18">[Pg 18]</span> -it with “Very soft sounds as in Schumann’s ‘Danse des Sylphes’ ... -which holds you under the charm of delightful emotion.”</p> - -<p><em>Timbre</em> is the quality of sound which identifies it with -the instrument of its production. Although many instruments can -be convincingly gay or subdued, most authors are agreed that some -instruments emit prejudicing tones. Chomet<span class="fnanchor" id="fna18b"><a href="#fn18">[18]</a></span> considered the bassoon -mournful, the flute tender, and the trombone harrowing. He found that -the clarinet expresses grief, the oboe suggests reverie, but that the -violin “seems suited to express all sentiments common to humanity.” -Mursell<span class="fnanchor" id="fna60"><a href="#fn60">[60]</a></span> finds consistent tactile values in tone. Low tones are dull -and high tones cutting. He speaks of the French horn as smooth, the -piccolo sharp, the oboe as stringent, the cello velvety and the bassoon -rough.</p> - -<p>Gundlach<span class="fnanchor" id="fna38"><a href="#fn38">[38]</a></span> believes that the timbre of an instrument is significant -in mood response. He finds the brasses triumphant and grotesque, -never melancholy or tranquil, delicate or sentimental; the woodwinds -mournful, awkward, uneasy, never brilliant or glad. The human voice -also has timbre, and distinctive values. There is the dramatic quality -of Marian Anderson and the syrupy flow of Bing Crosby; the virility of -the basso and the sparkle of the coloratura.</p> - -<p><em>Duration.</em> The sounding of a single note will attract attention, -but if the note continues for a sufficient period without changing -its characteristics it will become monotonous, annoying and finally -exasperating. If the sound is interrupted at equal intervals, this -reaction will take longer to develop, but if the intervals between them -are irregular, interest is sustained, especially if these variations -occur periodically; that is, with a certain rhythm.<span class="fnanchor" id="fna8a"><a href="#fn8">[8]</a></span></p> - -<p><em>Rhythm.</em> It is possible to have music without rhythm, but as -Rameau<span class="fnanchor" id="fna68"><a href="#fn68">[68]</a></span> pointed out long ago, “Music without rhythm loses<span class="pagenum" id="Page_19">[Pg 19]</span> all its -grace.” Since percussion instruments probably preceded all others, -rhythm was the first stage in the evolution of music. The proponents of -the motor theory of rhythm feel that muscular response to music with -pronounced rhythm is a physiological reflex. They point out that it is -difficult to walk deliberately out of time to a well accentuated march, -and Dunlap<span class="fnanchor" id="fna26"><a href="#fn26">[26]</a></span> has shown that in reclining subjects “With the utmost -possible relaxation of the entire body, good rhythmic grouping of an -auditory series can be obtained.” With the aid of the electromyograph -Jacobson<span class="fnanchor" id="fna50"><a href="#fn50">[50]</a></span> has shown that in complete relaxation mental activity -results in fleeting but specific muscle contractions invisible to the -eye and unknown to the subject.</p> - -<p>Rhythm perception is a mental stimulant. Reade<span class="fnanchor" id="fna69"><a href="#fn69">[69]</a></span> observed that -African negroes when ordered to row a boat always began to sing as an -aid to overcome their natural laziness. Bücher<span class="fnanchor" id="fna14"><a href="#fn14">[14]</a></span> believed that rhythm -as exemplified in working songs facilitates the synchronous expenditure -of energy by individuals engaged in a common task.</p> - -<p>Although rhythmic song will not necessarily elicit obvious motor -responses in all subjects, the wide-spread use of work songs among -groups of people engaged at hard work on land or sea throughout the -world is indicative of the value of background rhythm for communal -effort. Mursell<span class="fnanchor" id="fna60a"><a href="#fn60">[60]</a></span> believes that “any notion that pure or ‘naked’ -rhythm is more effective than rhythm clothed in tone is open to very -serious doubt.” But the chief effect of marked rhythm is the feeling of -excitement and happiness which it can arouse. Rhythm gives us a certain -pleasure because of its orderliness to which the mind is sensible.</p> - -<p><em>Melody</em> as a musical element contributes chiefly to -restfulness.<span class="fnanchor" id="fna71a"><a href="#fn71">[71]</a></span> If it is simple and recognizable it will recall other -times and rest the mind from the thoughts of present problems. If it<span class="pagenum" id="Page_20">[Pg 20]</span> -is complex and new it will distract the more musical but have a less -desirable effect on the uninterested.</p> - -<p><em>Mode.</em> The term <em>mode</em> is applied to the arrangement of -whole and half-tones in the musical scale construction. Of the many -possible modes only two are used in our present system of music, the -<em>major</em> and the <em>minor</em>. There is only one form of the -major mode, and it is the one most people recall when they think of -the scale. There are three forms of the minor mode, but of these the -<em>harmonic</em> is the most frequently used. It is formed by lowering -the third and sixth notes by a half-tone.<span class="fnanchor" id="fna80"><a href="#fn80">[80]</a></span></p> - -<p>When an author pioneers convincingly in a field which has long needed -clarification, it is likely that even his questionable remarks will -be accepted with the same degree of authority as his scientific -statements. In 1722, Rameau<span class="fnanchor" id="fna68a"><a href="#fn68">[68]</a></span> published a treatise on harmony which -received wide acceptance because of its excellence and comprehension, -but in that work he prejudiced many of the writers who followed into -believing that the major triad was more pleasing and beautiful than the -minor. This concept was not only adopted but embroidered. Hauptman<span class="fnanchor" id="fna44"><a href="#fn44">[44]</a></span> -likened the minor triad to the branches of the weeping willow and -hence attributed to it a mournful downward drawing power. To the major -triad he assigned the property of an upward driving force. (When this -is taken literally, as it was, and applied to the patient, we can see -clearly why remarkable attributes were claimed for music.)</p> - -<p>Now there is little doubt that if the triad of C minor is struck on a -piano after that of C major, most people will describe the sensation -elicited by the sound of the minor chord as melancholy. Helmholtz<span class="fnanchor" id="fna46"><a href="#fn46">[46]</a></span> -attributed the veiled or sad effect of a minor chord to certain notes -foreign to the chord which physical reasoning expects.</p> - -<p><span class="pagenum" id="Page_21">[Pg 21]</span></p> - -<div class="blockquot"> - -<p>“The foreign element thus introduced is not sufficiently distinct to -destroy the harmony, but it is enough to give a mysterious obscure -effect to the musical character and meaning of these chords, an -effect for which the hearer is unable to account, because the weak -combinational tones on which it depends are concealed by other louder -tones, and are audible only to a practiced ear.”</p> -</div> - -<p>But Gurney<span class="fnanchor" id="fna40"><a href="#fn40">[40]</a></span> refuses to admit to a sense of melancholy in this slight -dissonance, for as he points out</p> - -<div class="blockquot"> - -<p>“the same slight degree of dissonance as exists in the minor triad -may be made to supervene on a major triad, by adding to it a certain -extremely faint amount of discordant elements: it would seem then -that the major triad thus slightly dimmed or confused ought to sound -melancholy, but it does not in the least. Another argument may be -found in the following fact. The minor triads of D and A are of -perpetual occurrence among the harmonies of C major; and yet they do -not seem then to convey the distinctly pathetic impression, instantly -produced by the appearance of the C minor triad.</p> - -<p>“Music in a major key may be profoundly mournful; and it would -often be impossible for any description to touch the musically felt -difference between such music and mournful minor music. The minor mode -has a somewhat more constant range of effect.”</p> -</div> - -<p>Such discussions continued until Valentine<span class="fnanchor" id="fna76"><a href="#fn76">[76]</a></span> decided to test the -mood effect of the modes on a group of listeners. He found that -“major intervals are described as sad or plaintive twice<span class="pagenum" id="Page_22">[Pg 22]</span> as often -as the minor.” Heinlein<span class="fnanchor" id="fna45a"><a href="#fn45">[45]</a></span> not only substantiated this but found -that intensity was the dominant modifier of feeling. He reviewed -more than twenty-five hundred compositions for beginners and among -them found only seven per cent written in the minor mode. “It is a -difficult matter to obtain a composition in the minor mode written -for children that does not have a title which relates to the weird, -the mysterious, the sad and the gloomy. Apparently composers in their -attempts to differentiate the modes for children fall victim to the -method of introducing titles opposite to feeling content. To children, -the title of a composition is a very outstanding feature. It may be, -after all, that reaction to the modes is largely a question of the -extent to which association with descriptive titles of a specific -variety first establishes the affective impressions in the mind of -the beginner.” Thus it can be seen that composers have been nurturing -an old philosophy by titles rather than music. Beaunis has shown that -although among European composers, the major mode has been used for -bright and restful passages and the minor mode has been used for uneasy -and stirring selections, a study of the music of other races will -uncover an entirely opposite use. Hevner<span class="fnanchor" id="fna47"><a href="#fn47">[47]</a></span>, in an elaborate series of -controlled studies, concluded that “all of the historically affirmed -characteristics of the two modes have been confirmed” but admits that -“in producing its effect on the listener, the mode is never the sole -factor.”</p> - -<p>In a later study Hevner<span class="fnanchor" id="fna48"><a href="#fn48">[48]</a></span> continues to maintain that modality is -effective in the dimensions of sadness and happiness but quite useless -in the dimensions of vigor, excitement and dignity.</p> - -<p>The reaction to mode is influenced by what has been heard immediately -previously, and by musical training. The reaction to mode is not -physiologic but offers one key to music for patients<span class="pagenum" id="Page_23">[Pg 23]</span> in that those who -identify the minor mode with sadness should not be given such music -when gay music is indicated.</p> - -<p><em>Key.</em> There was a time when particular keys were credited with -emotional powers. Lest such thoughts still persist, the following -quotation from Gurney<span class="fnanchor" id="fna40a"><a href="#fn40">[40]</a></span> is offered.</p> - -<div class="blockquot"> - -<p>“Particular keys are sometimes credited with definite emotional -powers. That certain faint differences exist between them on certain -instruments is undeniable, though it is a difference which only -exceptional ears detect. The relations between the notes of every key -being identical, every series of relations presenting every sort of -describable or indescribable character will of course be accepted by -the ear in any key, or if it is a series which modulates through a set -of several keys, in any set of similarly related keys. But as it must -have a highest and a lowest note it will be important, especially in -writing for a particular instrument, to choose such a key that these -notes shall not be inconvenient or impossible; and also the mechanical -difficulties of an instrument may make certain keys preferable for -certain passages. Subject to corrections from considerations of this -sort, the composer probably generally chooses the key in which the -gem of his work first flashes across his mind’s eye: and when the -music has once been seen and known, written in a certain key, the -very look of it becomes so associated with itself, that the idea of -changing the key may produce a certain shock. But the cases are few -indeed where, had the music been first presented to any one’s ears in -a key differing by a semitone from<span class="pagenum" id="Page_24">[Pg 24]</span> that in which it actually stands, -he would have perceived the slightest necessity for alteration; and -as a matter of fact when a bit of music is thought over, or hummed -or whistled, unless by a person of exceptionally gifted ear it is -naturally far oftener than not in some different key to that in which -it has been written and heard. Even the difference most commonly -alleged, between C major as bright and strong and D flat as soft and -veiled, comes to almost nothing when a bright piece is played in D -flat or a dreamy one in C.</p> - -<p>“That a variety of emotional characters can be definitely attributed -to various keys is a notion so glaringly absurd that I would not -mention it, were it not that it is commonly held; and that such -doctrines are really harmful by making humble and genuine lovers of -music believe that there are regions of musical feeling absolutely -beyond their powers of conception.”</p> -</div> - -<p>In an unnamed manual the following statements occur:</p> - -<div class="blockquot"> - -<p>“C major expresses feeling in a pure, certain and decisive manner. -It is furthermore expressive of innocence, of a powerful resolve, of -manly earnestness, and deep religious feeling.</p> - -<p>“G minor expresses sometimes sadness, sometimes, on the other hand, -quiet and sedate joy—a gentle grace with a slight touch of dreamy -melancholy—and occasionally it rises to romantic elevation. It -effectively portrays the sentimental, etc. Another author, quoted by -Schumann, found in G minor<span class="pagenum" id="Page_25">[Pg 25]</span> discontent, discomfort, worrying anxiety -about an unsuccessful plan, ill tempered gnawing at the bit. ‘Now -compare this idea,’ says Schumann, ‘with Mozart’s Symphony in G minor, -that floating Grecian Grace.’ He quotes from the same writer that E -minor is a girl dressed in white with a rose-colored breastknot.</p> - -<p>“These are but abstracts, and a good deal of the humor is lost by -selection. For the ‘characters’ of several of his keys the author -gives a list of examples the choice of which, inasmuch as every -possible character might be exemplified from compositions in every -single key, cannot have been very difficult. It is something like -proving that Monday is a day ‘especially full of melancholy,’ on -the ground that some individual lost a relative on it, or that the -characteristic of Thursday is ‘confidence and hope,’ on the ground -that on it an individual came in for a fortune.</p> - -<p>“These thoughts are similar to that of the Chinese philosopher who -traced the five tones of the old Chinese scale to the five elements, -water, fire, wood, metal and earth.”</p> -</div> - -<p><em>Tempo.</em> “The idea of forcing emotional characteristics on tempo -is not less preposterous than those on key. (Gurney quotes further -ideas of the same writer.)</p> - -<div class="blockquot"> - -<p>“The common time expresses the quiet life of the soul, an inward peace -but also strength, energy and courage.</p> - -<p><span class="pagenum" id="Page_26">[Pg 26]</span></p> - -<p>“The three-eight time expresses joy and sincere pleasure; but its best -characteristic is simplicity and innocence.</p> - -<p>“The three-four time is expressive of longing, sincere hope and love.</p> - -<p>“It would be interesting to hear from this writer what happens when -any one composes a piece in common time, which expresses the quiet -life of the soul and ‘inward peace’ and in the key of E minor, which -represents grief, mournfulness, and restlessness of spirit.”</p> -</div> - -<p>Gundlach<span class="fnanchor" id="fna38a"><a href="#fn38">[38]</a></span> found that speed was by far the most important factor in -distinguishing among several pieces played to a group. And Hevner<span class="fnanchor" id="fna48a"><a href="#fn48">[48]</a></span> -found that for excitement the most important element was tempo, which -must be swift. “Dreamy sentimental moods follow slow tempo. Sheer -happiness demands a faster tempo.”</p> - -<p>Hanson<span class="fnanchor" id="fna42"><a href="#fn42">[42]</a></span> believes that “everything else being equal, the further the -tempo is accelerated above <i xml:lang="it" lang="it">tempo moderato</i> (which is about the -same speed as the human pulse rate) the greater becomes the emotional -tension.” He goes on to state that “as long as the subdivisions of the -metric units are regular and the accents remain in conformity with -the basic pattern, the effect may be exhilarating but not disturbing. -Rhythmic tension is heightened by the extent to which the dynamic -accent is misplaced in terms of metric accent, and the emotional -effect of ‘off-balance’ accents is greatly heightened by an increase -in dynamic power.” He is unduly alarmed by the effect “Boogie-Woogie” -may have on the younger generation because rhythm irregularity finds -its most fertile field in this jazz form characterized by “a repeated<span class="pagenum" id="Page_27">[Pg 27]</span> -figure in the bass (which) continues indefinitely in regular rhythm.”</p> - -<p><em>Sonority.</em> Hanson<span class="fnanchor" id="fna41"><a href="#fn41">[41]</a></span> has traced the development of music from -the highly consonant music of the Roman Catholic Church at about -the time of Palestrina to the dissonant music of certain modern -composers. He describes the early hymns as “calm, serene and in a -sense impersonal.” For him, “the expression of personal feeling in -music seems inevitably to be associated with the use of dissonance. -Indeed the expression of emotion in music seems to be bound up in the -contrast between dissonance and consonance, the former producing a -sense of tension and conflict to be either heightened by progression -to a sonority of still greater tension or resolved by a succeeding -consonance.” It may be easy for a musician to believe that the -increased use of dissonance creates an increase of emotional tension, -but to the musically uncultured listener dissonance may just as often -create boredom or annoyance.</p> - -<p><em>Composition.</em> Although musical factors such as pitch, intensity -and melody can contribute to mood effect when isolated, the reaction -to an entire composition is quite different from reaction to tones -of chords. It may depend upon environment or association with the -situation in which the selection was first heard or is being heard. -It may be altered by the length of the composition or unanticipated -contrasts of intensity or the use of unusual patterns, rhythm or -tempo. In listening to music, expectation plays an important role. A -sudden change or interruption is apt to excite surprise. “The mere -meeting of the expectation in all its details affords pleasure of a -kind. But great as is the aesthetic pleasure, a far greater degree of -enjoyment may at times be attained by a carefully planned surprise, -the appropriateness and artistic skill of which is recognized and -approved”<span class="fnanchor" id="fna10"><a href="#fn10">[10]</a></span>.</p> - -<p><span class="pagenum" id="Page_28">[Pg 28]</span></p> - -<p>Much has been written on the images or stories which musical -compositions evoke. Some musicians have tacitly implied that ability -to appreciate these stories results in greater pleasure, but -Gehring<span class="fnanchor" id="fna34"><a href="#fn34">[34]</a></span> wisely insists that “musical enjoyment does not depend on -interpretations, but it may also be reaped by those who abstain from -making them.” There are some people who can interpret any musical -selection, and others who find no story. Between these extremes is a -group who can get more pleasure from music if listening is preceded by -such preparation. As Damon<span class="fnanchor" id="fna20"><a href="#fn20">[20]</a></span> has pointed out, “A musical selection is -thought to be more beautiful and more colorful when the usual program -notes are supplied before hearing it.”</p> - -<p>There are those who see specific color in sound. It was Isaac Newton -who first compared the diatonic scale with the seven colors of the -spectrum from red to violet beginning with C as red. Katz<span class="fnanchor" id="fna71c"><a href="#fn71">[71]</a></span> reported -on strong color association of two case studies. For the first, C major -was jet black and for the other C major was brilliant white. But this -could be expected inasmuch as the scale of notes presents intervals -and proportions of the most definite kind whereas those of the color -spectrum are confluent and have no mathematic relation. Spectrum -analogy was discredited by de Marian in 1737<span class="fnanchor" id="fna70e"><a href="#fn70">[70]</a></span>. “No two people -agree or hardly ever do, as to the color they associate with the same -sound”<span class="fnanchor" id="fna30"><a href="#fn30">[30]</a></span>.</p> - -<p>But color is only one element in a mental image; what about the others? -Is it possible for two people listening to a new, unnamed musical -selection for the first time to envisage the same story or picture?</p> - -<p>T. Kawarski and H. Odbert<span class="fnanchor" id="fna52"><a href="#fn52">[52]</a></span> found no direct relationship between -color and music which held for more than a few individuals but certain -general relationships of photoism to special<span class="pagenum" id="Page_29">[Pg 29]</span> aspects of music were -found to recur constantly. Thus increase in brightness tends to -accompany rise in pitch or quickening of tempo. Whereas some one factor -like strong visual imagery or cultural influences or suggestions may be -dominant in some individuals and a totally different factor in another, -none of those factors operate in any pure and simple fashion.</p> - -<p>Too often musical interpreters will see too much in a given selection. -Some will try to rhapsodize in words the theme as announced by -the title of the selection. Some enthusiasts will grasp at straws -of suggestion from the original source. Gurney cites an amusing -instance in connection with a sonata of Beethoven, of which the three -movements are entitled: <i xml:lang="fr" lang="fr">Les Adieux</i>, <i xml:lang="fr" lang="fr">L’Absence</i>, and <i xml:lang="fr" lang="fr">Le -Retour</i>. These titles were so inviting that some gushing comments -were published about the portrayal of passages from the life of two -lovers. However, on the manuscript, Beethoven wrote: “Farewell on the -departure of His Imperial Highness, the Archduke Rudolph, the 4th of -May 1809.” and “Arrival of his Imperial Highness, the Archduke Rudolph, -the 30th of January 1810.”</p> - -<p>The insistence by some of the specific images evoked by certain -selections can be disheartening to those lovers of music who accept -such interpretations as fact and are disappointed in their inability to -experience the same reaction as others, especially if the others are -recognized musicians.</p> - -<div class="blockquot"> - -<p>“It is obvious that the power of music to depict objects, situations -or ideas is extremely indefinite. No matter how specific a pictorial -or dramatic program the composer may have in mind to present through -his music, the listener will never get that program from the music -itself. If the hearer is told what the music is supposed to depict -he will imagine<span class="pagenum" id="Page_30">[Pg 30]</span> the incidents and fit them into the music. Or if he -is given a title it will suggest to him a train of imagery which he -will read into the composition. And if he is given neither title nor -program his fancy might take him on a mental journey, the direction -of which will depend upon his mood, his mental set, his physical -condition, his past experience, and numerous other subjective factors, -for which music serves as a stimulus, but all of which lies outside of -the music itself.”<span class="fnanchor" id="fna35"><a href="#fn35">[35]</a></span></p> -</div> - -<p>Thus when Rubinstein read into the “Second Ballade” of Chopin the -story of a wild flower caught by a gust of wind, the struggles of the -flower and its final breaking, he confused the issue by adding a second -interpretation to the music which was inspired by Mickiewicz’s poem, -“Switez Lake,” the story of which is totally different. When Gilman -played this same song for his students there were many interpretations -which ran the gamut from “meaningless” to “creeping assassins.”<span class="fnanchor" id="fna35a"><a href="#fn35">[35]</a></span></p> - -<hr class="tb" /> - -<p>Beethoven’s complaints of his interpreters and expounders were frequent -and bitter, but we must turn to the writings of the more literary -musicians, Mendelssohn and Schumann, for coherent expressions on the -subject. Mendelssohn wrote,</p> - -<div class="blockquot"> - -<p>“What any music I like expresses for me is not thoughts too indefinite -to clothe in words, but too definite. If you asked me what I thought -on the occasion in question, I say, the song itself precisely as it -stands.”</p> -</div> - -<p>Schumann’s position as regards verbal readings of music may be gathered -from the following passage:</p> - -<p><span class="pagenum" id="Page_31">[Pg 31]</span></p> - -<div class="blockquot"> - -<p>“Critics always wish to know what the composer himself cannot tell -them; and critics sometimes hardly understand the tenth part of what -they talk about. Good heavens! will the day ever come when people will -cease to ask us what we mean by our divine compositions? Pick out the -fifths, but leave us in peace.”<span class="fnanchor" id="fna40b"><a href="#fn40">[40]</a></span></p> -</div> - -<p>Some musical selections have been written to accompany a subject. Those -who know the story of <i>The Barber of Seville</i> may associate the -aria “Largo al Factotum” with the despair of an over-worked barber, but -the same song might have been written to accompany almost any lively -subject and for people who have never heard the story and who do not -understand Italian, it is just a bright song, possibly humorous. As -Gurney says:</p> - -<div class="blockquot"> - -<p>“The verbal titles which aim at summing up the expression of certain -compositions, however interesting, are so adventitious that they have -often been suggested by instead of suggesting the music; and a hundred -auditors, if left to guess the title for themselves, would originate a -hundred new ones.”<span class="fnanchor" id="fna40c"><a href="#fn40">[40]</a></span></p> -</div> - -<p>Music can evoke specific emotions only when people have been -conditioned to it. The “Horst Wessel” song would not stir Americans -to hatred unless they could identify the title with the song and its -significance. Even then, the degree of hatred or contempt for the music -would be variable.</p> - -<p>Edwin Franko Goldman’s “On the Farm” can leave little doubt in any -one’s mind as to its subject matter, but with the exception of such -very obvious music, or music to which we have been emotionally -conditioned, music cannot paint blue skies or green pastures.</p> - -<p><span class="pagenum" id="Page_32">[Pg 32]</span></p> - -<p>What then are the feelings most frequently excited by music? According -to Schoen<span class="fnanchor" id="fna72"><a href="#fn72">[72]</a></span>:</p> - -<div class="blockquot"> - -<p>“The data show that rest, sadness, joy, love, longing and reverence -appear most frequently as the effects produced. Vocal music has a -tendency to arouse well-defined emotional effects far more often than -instrumental, the probability being that the specific emotional effect -is due in the main to the words.”</p> -</div> - -<p>The conclusions of Schoen on mood changes in a tested group sum up the -relationship between mood changes and enjoyment. Thus for practical -purposes we want to know not only whether a musical composition -produces a mood change in the listener, but also what is of greater -significance, whether the induced mood is also enjoyed, and to what -degree this enjoyment might depend on such factors as the type of -mood induced. The listener’s familiarity with the selection, and his -judgment of the quality of the selection, are also important.</p> - -<p>The results of a large series of observations show as a rule, that -music produced a mood change in every listener, or that an existing -mood was intensified when it conformed with the mood of the music. -The tendency of the same composition to produce the same mood in -every listener was very marked. The degree of enjoyment derived from -the musical composition was in direct proportion to the intensity of -the mood effect produced, provided this effect was not due to the -conditions of the performance, such as a poor intonation or faulty -interpretation.</p> - -<div class="blockquot"> - -<p>“No greater amount of enjoyment was derived from one type of mood than -from another type, unless the mood was due to dislike of the specific -type of music or to a poor performance. But when the mood change was -from joyful to serious, the enjoyment<span class="pagenum" id="Page_33">[Pg 33]</span> seemed to be slightly less than -when the change was from serious to joyful, provided the hearer was -not hampered by a knowledge of the critical estimate of the music to -which he was listening or by faulty interpretation. The evaluation of -the quality of the musical composition was in direct proportion to the -intensity of enjoyment.”</p> -</div> - - -<h3>III<br /> -<span class="smcap">Other Conditioning Factors</span></h3> - - -<p>In addition to the physical elements of music previously discussed -there are other factors which enter into the type of response of mind -and body to music. Mention has been made above of the value of program -notes. People who hear new music for the first time may or may not -develop a visual or emotional response, but if prepared by descriptive -writing they may “understand” or at least enjoy the music more.</p> - -<div class="blockquot"> - -<p>“Program notes, oral comments, and the general setting of the -presentation are important because they concentrate and reinforce the -mood response. Indeed it has been shown that in a verbal introduction -offered before a composition is presented, what is said does not -matter much, and that almost any kind of comment will enhance the -listener’s enjoyment if it serves to cue him into appropriate -effective states of mind.”<span class="fnanchor" id="fna60b"><a href="#fn60">[60]</a></span></p> -</div> - -<p>Music aides should take this finding seriously and preface the playing -of musical selections with verbal commentary. Even popular dance music -may be prefaced by remarks about the solo instrument featured or the -personalities involved.</p> - -<p><span class="pagenum" id="Page_34">[Pg 34]</span></p> - -<p>With the exception of the effects of rhythm, all other reactions -thus far cited have been largely psychologic. Before leaving the -discussion of response, one bit of evidence demonstrating possible -physiologic action will be presented. Gundlach<span class="fnanchor" id="fna39"><a href="#fn39">[39]</a></span> studied the songs -of six different American Indian tribes. Now the language, customs -and music of neighboring European countries frequently have something -in common, but the absence of the wheel in transportation made the -scattered people of the Western Hemisphere strangers to each other. -The speech and songs of the different Indian nations are entirely -unrelated, yet the songs representing the same types of ceremonials -show considerable agreement. From this Gundlach concludes that “music -has some conventions grounded on a firm basis of physiologic structure -and behavioral similarity of human beings.”</p> - -<p><em>A</em>—<em>Live Music.</em> Most people will turn to the source of -sound. Even the most phlegmatic will turn if the sound is sudden and -loud enough. It is a protective mechanism because identification -of the source may prevent personal injury. There is also a sense -of satisfaction in the corroboration of the auditory and visual -images. When the sound is musical the desire to see its production -is greatly increased. For those who cannot make music themselves, it -is like watching a conjurer from behind. For musicians it offers the -opportunity of inspection, improvement or criticism. One of the most -important psychologic components of music is the physical presence -of the music maker. About twenty years ago a manufacturer produced -piano-player rolls which reproduced the manipulation of well known -artists so well that experts could not differentiate between the sounds -produced on the piano by a live pianist and the automatic player. Yet -this method of reproduction was a failure financially; it had every -quality of the live musician except the physical presence.</p> - -<p><span class="pagenum" id="Page_35">[Pg 35]</span></p> - -<p>We demand far less in quality of music from a live band than from a -mechanical reproduction of band music. Groups of people who assemble to -dance will pay relatively high prices for inexperienced players with a -monotonous repertoire for the sake of having live music. The dancers -may complain of the poor musical execution, but will suffer a return -engagement in preference to the playing of recorded music.</p> - -<p>There are cinema stars whose singing voices are harsh to most ears, -yet listeners will applaud them into an encore, not so much for the -sake of a beautiful experience, but to prolong the human contact. We -react not only to the sound, but to the motions and very presence of -music-makers. We listen to people as well as their music. Live music -stimulates, sustains and focuses attention. It should be used as often -as possible for patients. The “live” musician can get patients to -listen to musical forms which would be entirely ignored otherwise. If -musicians wish to spread the appreciation of “good” music and music -appreciation, one method is to be found in personal appearances at -hospitals.</p> - -<p><em>B</em>—<em>The Human Voice.</em> Of all the sounds of given pitch and -intensity the one which best attracts and maintains interest is the -human voice. We habitually turn to the human voice. Sometimes we do it -as a matter of courtesy. Again, we may do it for better understanding, -or even out of curiosity. The spoken language is understood by far -more people than is the so-called language of music. When words are -set to music they command greater attention than when they are spoken. -They are usually compact and in rhyme. We strain to hear each word -to gather the full meaning and humor or cleverness of the lyricist. -Yet, we willingly lower our literary standards when words are put to -music. The verses of many songs sound vacuous and repetitious without -accompaniment. But the words are made interesting by<span class="pagenum" id="Page_36">[Pg 36]</span> the melody, and -melody takes on additional meaning from words. “Vocal music has greater -power to arouse a definite emotional response than has instrumental -music. Rest results about equally from instrumental and vocal -music.”<span class="fnanchor" id="fna71d"><a href="#fn71">[71]</a></span></p> - -<p>Songs with words are ideally suited for arousing patient interest. -Community singing is the most valuable form of music for maximum group -response.</p> - - -<h4>LISTENING</h4> - -<p>Violet Paget<span class="fnanchor" id="fna55"><a href="#fn55">[55]</a></span> sent questionnaires to one hundred and fifty people in -different parts of the world to obtain a global sampling of reactions -to music. From an analysis of their answers she found</p> - -<div class="blockquot"> - -<p>“two different modes of responding to music, each of which was claimed -to be the only one in those in whom it was habitual. One may be called -‘listening’ to music; the other ‘hearing’ ... with lapses into merely -overhearing it. Listening implied the most active attention.... -Hearing is a lesser degree of the same mental activity where active -attention occurs in moments like islands continuously washed over by a -shallow tide of other thoughts.”</p> -</div> - -<p>This is very similar to Gurney’s classification of musical perception -as “definite” and “indefinite.” Vernon<span class="fnanchor" id="fna77"><a href="#fn77">[77]</a></span> lists the varieties of -response to indefinite listening as:</p> - -<div class="blockquot"> - -<p>a. Reflex or physiological; soothing or stimulating.</p> - -<p>b. General euphoria.</p> - -<p>c. Stimulation of thought and wandering of attention.</p> - -<p><span class="pagenum" id="Page_37">[Pg 37]</span></p> - -<p>d. Emotional moods of interpretation of the so-called “meaning” of -music.</p> - -<p>e. Dramatic visual images of day-dreams.</p> - -<p>f. Awareness that sounds are going on, but no further response.</p> - -<p>g. Lapsing of this awareness into the “margin” of consciousness.</p> -</div> - -<p>He found reactions a. and b. among primitives and infants; and -reactions c. f. and g. among the untrained.</p> - -<p>Schoen<span class="fnanchor" id="fna71b"><a href="#fn71">[71]</a></span> found that response to music is related to the psychologic -levels at which they occur, and to sensation, perception, and -imagination. The sensorial response is physiologic and possessed by -all. It is the source upon which all other musical development depends. -It requires a minimum amount of mental effort, and its effects are -within the easy reason of the intellectually inferior and superior -alike. As a sensation, music is either pleasant or unpleasant. Training -and experience may lead to higher types of response, depending upon -individual desire and ability to develop musical taste and education. -The next higher response is perceptual and its distribution level adds -excitement or repose. The highest level of response is imaginal.</p> - -<div class="blockquot"> - -<p>“Much of the music we hear we have heard before, and because of this -fact we have associated it with a host of memories with pleasant or -unpleasant coloring. The hearer may not recall the exact time or -occasion on which he heard the selection before and yet he may have a -group of images which are definitely referred to his own past.”</p> -</div> - -<p>Meyer<span class="fnanchor" id="fna71e"><a href="#fn71">[71]</a></span> summarizes the appeal that music might have<span class="pagenum" id="Page_38">[Pg 38]</span> for listeners as -1. Emotional response, 2. Suggested associations, 3. Personification of -a subject, 4. Its value as an object.</p> - - -<h3>IV<br /> -<span class="smcap">Musical Taste</span></h3> - - -<p>The selection of music for patients can be handled in many ways. The -easiest and least reliable is to use the music best loved by the -musician guiding the program. Such programming will undoubtedly meet -with the approval of some of the patients but it is unlikely that it -will meet with the approval of all. Non-psychiatric patients should be -given the music <em>they</em> want.</p> - -<p>Much has been written concerning specific music for certain groups -of patients. There has been considerable prejudice in favor of “good -music”; that is “good” in its relation to intellectual values. -But music in itself can be neither good nor bad. Its execution or -appropriateness for the occasion or the individual may be open to -question, but the answer must come from the patient. We must keep -uppermost in our minds the goal of music for bed-ridden or chronically -hospitalized patients. They look to music as a morale-booster and a -source of enjoyment. Most people have favorite songs, but the degree -of desire for them or for any music will fluctuate with the time of -day, the kind of day, and many other considerations. The taste of -the patient will vary not only with age, training, nationality and -home back-ground, but with such intrinsic and unfathomable things as -personality and thinking habits.</p> - -<div class="blockquot"> - -<p>“Musical taste is a folkway, a convention which behaves exactly as do -folkways in other realms of activity. Accompanying this taste is the -conventional ‘conscience’ which dictates what is ‘right’ and what is<span class="pagenum" id="Page_39">[Pg 39]</span> -‘beautiful.’ It is more or less impervious to contradiction and is -disturbed at the prospect of change”<span class="fnanchor" id="fna59"><a href="#fn59">[59]</a></span>.</p> -</div> - -<p>The music of any given composer does not change but the audience will -change as a result of the appearance of new forms of music and living. -The works of the eighteenth century, with few exceptions, were loved by -its contemporaries but find a small audience to-day.</p> - -<p>The musical taste of an individual changes noticeably from childhood -to maturity but the change is gradual, and except for those studying -music intensively, during any one year of life the change is hardly -appreciable. Even established favorites will become less desirable to -the individual.</p> - -<div class="blockquot"> - -<p>“After a certain number of repetitions, varying with both the founded -experience of the listener and the complexity of the item, the -enjoyment is diminished. One might here propose the hypothesis that -the rate of ascent to popularity is directly in proportion to the rate -of the decline ... as illustrated by the sharp rise to popular acclaim -of the ephemeral popular hits and their subsequent precipitous decline -into oblivion.”<span class="fnanchor" id="fna59a"><a href="#fn59">[59]</a></span></p> -</div> - -<p>Among the many factors which sometimes have a great effect on musical -taste, contemporary events are outstanding. During a war, the people -welcome songs which sing of their prowess, impending victory, or -derision of the enemy. Such songs become popular because of their -literary rather than their musical content, but they affect taste -indirectly, since the only test of taste lies in the songs to which -people will freely listen.</p> - -<p>Soldiers pick up foreign songs and marching songs and bring<span class="pagenum" id="Page_40">[Pg 40]</span> them home -as souvenirs and favorites. It is now well recognized how great and -prolonged such an influence can be.</p> - -<p>Whatever the musical taste of the patient may be, and regardless of how -he came by it, it should be satisfied. As soon as an individual attains -the status of being a patient, there is an immediate mental depression -which may continue to increase if not checked. The patient may develop -anxiety, fear, self pity or boredom. There may be sensory depression -from pain, unpleasant sight or disability. In addition to these -saddening factors there may be undesirable response to environment, -personnel, and the monotony of medical or nursing routines. All efforts -should be directed at substituting joyful experiences for saddening -introspection. The formula for joy is very personal. Although most -people will laugh at some comic situations, the response to music -cannot be predicted except upon the basis of individual desire. The -person who becomes a patient may not have a fundamental change in -musical taste but his appetite may be altered by variations in mood, -and this is of prime importance.</p> - -<div class="blockquot"> - -<p>“More people express a wish for music dynamically similar to the -existing mood than for music of the opposite effect. The amount of -enjoyment is slightly affected by the kind of mood change taking -place.”<span class="fnanchor" id="fna71f"><a href="#fn71">[71]</a></span></p> -</div> - -<p>It is possible for sad music to be more enjoyable to those who are -receptive to it, than gay music. Nevertheless, other things being -equal, gay music is apt to give a greater degree of pleasure to those -who wish to hear it than sad music gives to its devotees.</p> - -<p>The enjoyment of music depends not only upon its pleasantness, but also -upon its familiarity. This recognition may be one of identity or of -idiom. Most people like popular music because<span class="pagenum" id="Page_41">[Pg 41]</span> they are familiar with -its form or tempo; or because they can hum or name it.</p> - -<p>The musical taste of the patient can readily be determined by offering -him a check-list with the names of fifty or more selections including -the entire gamut of musical forms. A general idea of the popularity -of classical selections can be determined from the sales records of -recordings and the frequency with which certain pieces are performed -by the better symphonic orchestras. The popularity of contemporary -offerings can be learned from surveys published in such magazines as -<i>Variety</i> and <i>Down Beat</i> or by listening to radio shows such -as “The Hit Parade.”</p> - -<p>Musical taste is closely allied to performance. If chosen selections -are played improperly or without regard to certain elementary -considerations, the use of music will lose its value to the patient. A -brief consideration must include the effects of arrangement, tempo and -volume with which the selections are played, since these have been seen -to influence the effects of the selection. Many people when asked to -name their favorite music will name a performer or a band rather than -a specific piece because they have come to desire the characteristic -style of the artists preferred, and style in an orchestra is closely -related to these factors. Some listeners prefer loud music, but it must -be remembered that even though sound does not become painful until -the level of 125 decibels is reached, there are some people for whom -the painful level is much lower, and hypersensitivity to sound is an -important source of irritation. Others may be disturbed by music which -is too fast, which must be taken into consideration.</p> - -<p>The role of expectation plays an important part in taste. Most people -who have been conditioned to expect the classic use of the scale and -traditional harmony cannot find joy in the unusual tonal structure -of the moderns as exemplified in Schönberg or<span class="pagenum" id="Page_42">[Pg 42]</span> even Stravinsky. -Hospitalization is not the proper period of life for indoctrination in -the beauties of innovations.</p> - -<p>Musical taste is acquired and always relative, and is based as -Diserens<span class="fnanchor" id="fna24b"><a href="#fn24">[24]</a></span> has pointed out, on the “habit of hearing.” An historical -illustration of this is the evolution of the consonances. The -Greeks regarded the octave as the only genuine consonance. In the -fifth century, the fifth and fourth intervals were admitted to this -classification. In the eleventh century, the major third was accepted -as such, but the minor third had to wait until the twelfth century. “In -music the habit of hearing is the Law, and through it, the exception of -yesterday becomes the rule of today.”</p> - -<p>The best analysis of musical appetite can be found in the statement -of <abbr title="saint">St.</abbr> Thomas Aquinas, “Bonum est in quod tendit appetitus”—the good -is that toward which the appetite tends. We repeat there is no such -thing as good music or bad music. Music may be played poorly, but the -evaluation of the good in music is personal. “Pleasure, and pleasure -alone, is the proper purpose of art,” said Walter Sickert. Musicians -will do well to remember that since taste results from the gradual -blending of emotion, experience, and education, it is better to enjoy -wholeheartedly “a waltz of Lehar than to be able to make a thematic -analysis of a Beethoven sonata and yet remain unmoved by it.”<span class="fnanchor" id="fna36"><a href="#fn36">[36]</a></span></p> - - -<h3>V<br /> -<span class="smcap">Summary</span></h3> - - -<p>For non-psychiatric patients, musical programming should be based upon -patient requests. For stimulation the important factors are rapid -tempo, accentuated rhythm, and elevated volume. For sedation, slow -tempo and reduced volume are indicated, as well<span class="pagenum" id="Page_43">[Pg 43]</span> as simple recognizable -melodies. Some discussion of the selection to follow is a valuable aid -to the enjoyment of listening. Live musicians should be used as often -as possible.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_44">[Pg 44]</span></p> - -<h2 class="nobreak" id="CHAPTER_THREE"><i>CHAPTER THREE</i><br /> -MUSIC AS OCCUPATIONAL THERAPY</h2> -</div> - - - -<p>Until the latter part of the eighteenth century the institutional -treatment of mentally diseased people consisted of custodial care. -This meant shelter, food and restraint. The quality of the shelter -varied in most instances from very bad to poor. The quality of the -food was not as varied—it was just bad. The quality of the restraint -was excellent. With few exceptions commitment meant life internment. -Violent patients were chained to the wall, for who could tell when -they might become violent again after a period of calm? The mentally -deranged were not considered as patients with a disease of the mind but -as inmates who had lost communal value and social desirability. <abbr title="doctor">Dr.</abbr> -Philippe Pinel of the Salpêtrière Hospital in Paris thought otherwise -and began to consider these people as still human. Among the reforms he -introduced was the use of activities to keep the mind and body occupied -doing things. This concept grew slowly at first but eventually reached -universal acceptance, was considered of real therapeutic value and -named occupational therapy.</p> - -<p>During the first World War many military patients were confined to -hospitals for prolonged periods while awaiting complete recovery. -It was noted that those who busied themselves with such physical -activities as required the use of their wounded extremities regained -the use of these extremities sooner those who remained idle physically. -Thus was born a branch of Occupational<span class="pagenum" id="Page_45">[Pg 45]</span> Therapy which was known as -<em>functional</em> to differentiate it from previous psychiatric use.</p> - -<p>Functional Occupational Therapy is used to increase three functions: -muscle power, joint mobility and co-ordination of movements. It finds -its greatest use in those patients who fall under the care of those -medical specialists known as orthopedic surgeons and neuro-surgeons. -Orthopedic patients are those who have disease or disability of one -or more joints or bones. The most common disease of joints is called -arthritis, of which there are several kinds of varieties. The most -common disability of bone during war-time is fracture. Arthritis -usually prevents complete joint motion. In some instances the joint -is put at rest to hasten healing. Almost all fractured bones are kept -fixed by plaster casts or traction and prevented from movement during -healing. The prolonged rest, necessitated by diseases of bones and -joints, permits muscles to become weakened or atrophied, and also -permits joints to lose some of their range of motion. When the course -of disease has reached that point where rest is no longer required, -the chief aim of medical treatment is to restore former function. This -means the restoration of power and mobility. This is accomplished by -means of physical and occupational therapy. Physical therapy includes -the use of heat, massage and guided exercise. Occupational therapy is -exercise through work—purposeful, productive work with an incentive. -The incentive is twofold—to produce something useful and to hasten -recovery.</p> - -<p>Patients who have had destruction or other disease of the nerves which -activate their muscles develop varying degrees of loss of muscle-power -known as palsy or paralysis. When a nerve is pressed or cut, it usually -heals in such fashion as to permit return of muscle-power. During -the period of its impairment, there is not only a loss of power, but -frequently concomitant disturbance<span class="pagenum" id="Page_46">[Pg 46]</span> in the skin, the joints and still -other functions. As a result of the nerve disturbance or the disuse -which follows, the portion of the body which is paralyzed loses the -ability to use its muscles with facility and maximum economy. There are -almost no motions performed by single muscles. Most activity results -from the contraction of a group of muscles and these are usually in -delicate balance with other groups of muscles which either assist or -prevent overaction. The delicate adjustment of muscle groups, which is -normally present, results in co-ordinated movements. Following nerve -disease or, for that matter, the immobilization of joints and muscles, -co-ordination is usually lost to more or less degree. Muscles must be -re-trained to work together. Such co-ordination can be accomplished by -special exercises, but even more rapidly and efficiently by imitating -the motions of life. This is the aim of functional occupational therapy.</p> - -<p>There are other disease conditions which can profit from the use of -occupational therapy. These include other disabilities which are -accompanied by loss of power, motion or co-ordination. When the skin -is burned, healing is usually accompanied by some degree of scarring. -If the scar includes a joint on its flexor surface (i.e. inside the -bend) there will result a deformity known as a flexion contracture. -If nothing is done about this, the crippling process will become -progressive and some day reach a stage beyond correction other than -that offered by plastic surgery. The early stretching of such joints -will not only prevent progressive disability but may result in some -improvement.</p> - -<p>Many other indications for the use of occupational exercise will be -met, but since this is not a text on medicine, the preceding types of -disabilities will serve as examples of the conditions commonly seen.</p> - -<p>The crafts first used in functional work were carry-overs of<span class="pagenum" id="Page_47">[Pg 47]</span> those -most beneficial in mental disease, and for the most part were restful -and simple, such as basketry, weaving and the graphic arts. More -recently, almost all the arts and crafts have been used, as well as -motorized tools.</p> - -<p>The results of occupational exercise will depend upon the -attractiveness of the objects which can be produced, the energy -required, the skill and patience of the occupational therapy worker and -patient, and the stage and extent of the disability. For those who are -not “handy”, or who have become increasingly clumsy with disability, -there may be impatience, tedium and fatigue. Occupational therapy is -always seeking new activities or modalities as they have become known -in practice. Music can be used as exercise in occupational therapy as -well as for background and interludes of relaxation.</p> - -<p>The fingers of professional pianists and violinists are very strong, -for instrumental manipulation requires and develops strength and -co-ordination. Music as an exercise can be used not only for its effect -on most of the joints and muscles of the body, but to increase the -use of the lungs and larynx. It focuses attention through the use of -visual, auditory and tactile senses and stimulates mental activity and -interest.</p> - -<p>Many instruments may be employed for the mobilization of joints and -muscles. When a musical instrument is prescribed as the occupational -therapy activity for a patient, there may be some resistance on the -part of the patient because of a lack of general or musical education, -or the fear of studying something new. The success with which this -resistance may be overcome will depend upon the skill of the musical -aide not only as a musician but as a teacher. The musical aide will -have to convince the patient that the fundamentals of music are far -less difficult to learn than is popularly supposed. Much of the -notoriety about music lessons<span class="pagenum" id="Page_48">[Pg 48]</span> is developed among children who dislike -regimentation, interference with their play periods, and the length of -time it takes the minute hand to circle the clock. The musical aide may -cite that observation and impress the patient with the greater ease of -adults in learning to play. Interest may be aroused by naming the other -patients who have recently learned to play and by demonstrating the -advantages in earlier recovery that music offers.</p> - -<p>Regardless of their initial attitude towards music lessons, most -patients will soon be pleased with their progress and ability to master -musical notation. Visits to the craft shop will usually be made on an -appointment basis and the patient will leave as soon as his “time” is -up. The knowledge newly acquired through instrumental instruction will -keep the patient at work longer and the musical aide will find him -returning for further practice without coaxing and for desirably longer -periods.</p> - -<p><em>Piano.</em> Before considering the use of the piano in occupational -therapy, the work of Ortmann<span class="fnanchor" id="fna64"><a href="#fn64">[64]</a></span> should be reviewed.</p> - -<p>A joint is the point at which two bones connect. In any moveable joint -the essential feature is a sliding of one surface on another. Joined -to the sides of the two bones near their ends are ligaments which are -strong and inelastic and hold the joints within the joint cavity, and -which prevent the joint from exceeding its normal range of motion. -But the function of holding the bones together and keeping them in -different positions belongs to the controlling muscles. Bones are -usually activated by at least two sets of muscles which effect the -movements in opposite directions. Normally muscles are under a slight -but constant tension known as <em>tonus</em>, and the simultaneous pull -of muscles on both sides of the joint presses the bone surfaces closer, -and keeps the muscle in a state which makes immediate action possible.</p> - -<p>Joints move by virtue of the contractions of the muscles. Most<span class="pagenum" id="Page_49">[Pg 49]</span> -movements are made not by one muscle alone, but rather by the -co-ordinated contraction of various muscles and the simultaneous -relaxation of their antagonists. As a result of muscle contractions, -a chemical change takes place which produces substances in the muscle -that interfere with good muscle action. Ordinarily these waste -products are carried away by the circulating blood with sufficient -speed to prevent noticeable effects. If, however, the muscle produces -these deleterious chemicals faster than the blood stream can carry -them away, fatigue results. The earliest manifestation of fatigue is -inability to relax, and the second contraction may be initiated before -relaxation is complete. The second effect of fatigue is interference -with rate and quality of contraction. Only relatively brief periods of -relaxation are necessary for complete recovery, but these periods are -important. When normal muscles practice on the piano, the fatigue limit -is rarely reached, but for the weakened muscles of patients, fatigue -must be guarded against by limiting duration of continuous playing -and by proper interludes of rest. Ordinary piano-playing offers short -rest periods because there is a reflex relaxation after the sound is -produced and it requires less muscle energy to keep the key depressed -than to depress it.</p> - -<p>Muscles are excited into contraction by minute bio-electrical impulses -which enter through their motor nerves, but the property of contraction -is independent of the nerve and can also be accomplished by artificial -external stimuli of electricity or mechanical force. The quality of -contraction is a function governed by the health and nutrition of the -muscle. The nutrition of the muscle depends upon its blood supply, -which depends in part upon its warmth. Delicate motions are difficult -for cold muscles and artificial warming is advisable before exercise, a -fact which assumes greater importance in cold weather.</p> - -<p><span class="pagenum" id="Page_50">[Pg 50]</span></p> - -<p>From the viewpoint of patient interest and instruction, the piano is -the best instrument. When equipped with pianola fixtures, it is the -one instrument that gives the widest range of activities. Because the -piano is difficult to move, playing is restricted to the room in which -it is housed and there need be no concern about its interference with -other patients if the practice room is sound-proofed, or is situated -some distance from the other patients. The piano offers excellent -opportunity for flexion of the fingers and thumb, extension, abduction -and adduction of the wrist, as well as flexion and abduction of the -shoulders and exercise of the neck and back.</p> - -<p>The piano can be adapted for use by patients with extremities in -hanging casts, which can be supported by sling arrangements attached -to the piano or the patient’s neck. It can even be used satisfactorily -with a cumbersome airplane splint if a very low bench is substituted -for the usual piano chair. The height of the bench can be arranged so -that the key-board and hand are on the same level, and the challenge -of this position will make the patient try all the harder to use his -fingers.</p> - -<p>For the contractures resulting from burns of the hands, the piano -offers an excellent medium with which to increase joint motion. In -depressing the keys the fingers are forcibly flexed. The key surface is -much broader and easier to manage than that of the typewriter key. The -piano, therefore, offers less of a psychological deterrent to use than -does the typewriter. Mistakes at the piano are less annoying because -there is nothing to erase but a memory, and the memory of unpleasant -things is fortunately short-lived. By means of special musical -arrangements and additional notation written next to the printed notes, -some fingers can be exercised singly or in any combination desired. -The physical exercise or co-ordination of selected fingers can be -obtained more<span class="pagenum" id="Page_51">[Pg 51]</span> subtly by the use of marked music than is possible with -most crafts. Some instructors may prefer to mark the keys of the piano -with the letters to which they correspond, but this is not really -needed in the instruction of adults. A large diagram of the piano keys -placed above the musical scale for which they stand may be located to -advantage on the wall over the piano.</p> - -<p>It is recommended that the first piano lessons cover fifteen minutes -and that the time be increased five minutes daily until the lesson -fills a half hour period. Inasmuch as the strain of piano playing is -very slight, the first lesson may last thirty minutes if the physician -so decides. The patient should be encouraged to practice freely at -other times during the day as long as his interest can be sustained. -Chief attention must be placed on the use of the fingers requiring -exercise. As is true in all forms of functional occupational therapy, -the impatient patient will try to speed his work by using unaffected -joints or by improper use of muscles. The musical aide must guard -against this temptation. Although standard music for beginners should -be used, it is well for the teacher to use simple arrangements of -popular tunes at each session for the incentive that it will give the -patient. If the patient expresses the desire to play a certain melody, -the instructor should write his own arrangement if none is available.</p> - -<p>The keys of the piano can be reached effectively in many ways and -it is possible to exercise almost any of the muscles of the upper -extremity by playing from different levels. To exercise the muscles -of the shoulder girdle, loud notes may be played by holding the hands -fixed and raising and lowering the shoulders. The shoulder itself can -be abducted and adducted by wide lateral movements along the keyboard. -Flexion and extension of the wrist is accomplished by staccato -movements. Lateral motion of the wrists is partially restricted by the -bony structure but can be accomplished by arpeggio work.</p> - -<p><span class="pagenum" id="Page_52">[Pg 52]</span></p> - -<p>Thumb action plays a very important part in piano playing. The -<em>opponens</em> action (touching the last finger with the thumb) is -very necessary in playing <i xml:lang="it" lang="it">arpeggios</i>, particularly with large -intervals played <i xml:lang="it" lang="it">legato</i>. In fact there is hardly any known -purposeful activity which is more useful for full exercise of the -<em>opponens</em> range than this activity. The music must be fingered -with numbers that will keep the index finger on one note as the thumb -passes under for the next higher note at an interval of two or three -tones. In order to depress the key, flexion of the thumb is necessary. -The thumb can be abducted to almost any degree by the playing of chords -or by playing <i xml:lang="it" lang="it">legato</i> passages.</p> - -<p>All motions of the fingers are possible. For active or passive -extension of the fingers much use should be made of the black keys. -If the hand is held in position to play the white notes in the normal -manner, the black keys can be played only by extension. Various degrees -of flexion of the joints are possible by ordinary playing. Spread of -the fingers which is a function of the dorsal interossei muscles can -be accomplished by practising chords, the span of which should be -increased as power and range improve.</p> - -<p><em>Violin.</em> In most activities requiring the use of both hands, the -more delicate motions are performed by the right hand in right-handed -persons. For the violin family the situation is reversed, and these -stringed instruments are of greatest value for exercise of the left -fingers and right elbow. If the interest of the patient is great, there -is no reason why the normal positions cannot be interchanged so that -fingering is accomplished by the right hand on a violin with reversed -strings.</p> - -<p>The violin is recommended for flexion of the left fingers, but is of -greater value for flexion and extension of the right elbow. It is -secondarily valuable for the flexion and extension of the wrist and -abduction and adduction of the shoulder. The motion<span class="pagenum" id="Page_53">[Pg 53]</span> analysis for the -cello and bass viol are similar to that of the violin. The heavier -instruments require more motion at the shoulder. String instruments -are less popular than the piano because two fundamental techniques -must be learned simultaneously; correct fingering and correct bowing. -The vibration of the struck piano strings is relatively uniform with -variable pressures<span class="fnanchor" id="fnaII"><a href="#fnII">[II.]</a></span>, but the quality of the violin sound as -produced by the beginner can be discouragingly unpleasant.</p> - -<p><em>Plectrum Instruments.</em> The plectrum instruments afford excellent -exercise of the wrist of the right hand and the fingers of the left. -The ukulele, when brushed by the fingers, offers better extension of -them than is found in most crafts. The guitar offers even stronger -flexion for the fingers which depress the strings than does the -violin. All these instruments require supination and pronation at -the wrist and some flexion and extension of the elbow. They are more -popular than bowed instruments and have the added advantage of being -so easy to learn that the performer will be able to play simple song -accompaniments in a relatively short period of time. The variety -of instruments in this category permits a wide range of energy -requirements.</p> - -<p><em>Foot Instruments.</em> Although there are several instruments in -which the lower extremities are used, there are only two which are -readily adaptable to hospital use—the pianola and the parlor organ. -For the former, no knowledge or musical ability is required and its -use is open to all. The distance between the bench and the pedals will -determine to some extent the energy expended and the range of joint -motion which can be accomplished. The speed of playing is related to -the energy which is required. If<span class="pagenum" id="Page_54">[Pg 54]</span> the library of pianola rolls is large and inclusive enough to meet -the demands of the patient’s taste, an adequate amount of work can be -expected.</p> - -<p>The foot-pumped organ is also an excellent ankle exerciser. Even the -untrained will find some interest in the timbre of the notes and the -qualities of sound emitted with the pulling of different stops. The -lingering sounds and the novelty of playing an organ which is no longer -a commonplace in the home, are great incentives to playing. Instruction -on the organ, which has a smaller keyboard and slower manipulation -than the piano, is pleasant and simple. For combined upper and lower -extremity disabilities, the organ is an excellent instrument. Every -hospital music department should own one. There are enough unused -organs in the attics of this country to supply the needs of most -hospitals.</p> - -<p>The bass drum with foot pedal attached is obviously not a solo -instrument, but when used in ensemble or with a full set of traps and -snare drum, it can sustain some interest and result in some benefit to -those suffering with ankle disabilities. Its use is limited to activity -of the muscles and joints below the knee. It can be used by patients -wearing a leg-brace pivoted at the ankle.</p> - -<p><em>“Pocket” Instruments.</em> Of all the wind instruments available -for the instruction of beginners, those which require no reed or lip -knowledge are most desirable. Easiest to play is the “kazoo”, or any -other instrument which embodies the principle of a membrane vibrating -to the sound of the human voice. Only the ability to hum is needed -and it is valuable for the patient who is difficult to teach because -it permits even the dullest to participate. The kazoo is especially -useful for children or psychiatric patients and can supply the melody -for “rhythm bands.” The ocarina, song-flute and related instruments -are relatively easy to master but the<span class="pagenum" id="Page_55">[Pg 55]</span> sound emitted is annoying to -many. The recorder is easy to play and produces a pleasant sound. The -harmonica has been developed into an instrument that is not unpleasant -to listen to, but the beginner’s efforts may not be too welcome. The -fife requires greater effort to operate and is harsh to the ears of -some. The flute is too difficult for hospital use and the beginner in -his anxiety might experience a “black-out” from sustained blowing.</p> - -<p>The reed and brass wind instruments are not suitable for functional -use. Their use is limited to chronic patients because of the large -amount of time required to learn to operate them satisfactorily.</p> - -<p>Wind instruments can be used for patients whose pulmonary pathology -has cleared to such an extent that the physician feels lung exercise -is indicated. The early use of lung exercise following atypical virus -pneumonia has been found especially beneficial.</p> - -<p>Wind instruments may also be used for exercising the facial muscles -during the recovery phase of facial palsy. Their possibilities in -stretching the scars about the mouth and cheeks should be considered.</p> - -<p><em>Percussion Instruments.</em> The snare drum offers motion to the -wrists, elbows and shoulders. Few men or children can resist the -temptation to play the snare drum. The desire for prolonged playing is -not too great, but if recorded music is played during the exercise the -duration can be prolonged for an adequate period. The bass drum, as -previously mentioned, permits flexion and extension of the ankle when -used with the pedal, and this, too, can be made interesting if recorded -music is played simultaneously.</p> - -<p>Other percussion instruments may not be generally available in -hospitals but the possibilities offered by them will be listed. The -kettle drum offers rotation of the arms. The xylophone and marimba do -not evoke great ranges of motion but bring the muscles<span class="pagenum" id="Page_56">[Pg 56]</span> of the upper -extremities, neck, and back into play, and promote co-ordination. For -children, the toy xylophone is a welcome plaything and an excellent -form of occupational therapy for the upper extremities. A new toy, the -<em>Typatune</em>, operated like a typewriter affords opportunity for -finger exercise.</p> - -<p>There are still other instruments which may be classed as musical that -offer opportunities for exercise. It is just possible that a portable -hand organ may be available. The novelty of operating one of these -is not to be underestimated as an incentive to work, particularly in -younger people. Both the hurdy-gurdy and the hand-cranked victrola -offer exercise to the wrist, elbow and shoulder. By placing these -instruments at different distances from the floor or patient, many -ranges of motion can be obtained.</p> - -<p>The harp offers excellent exercise to the serratus muscles as well as -to the muscles and joints of the upper extremities, but its operation -is more complicated than that of most instruments, and even if -available, would require the instruction of a harpist, of whom there -are too few.</p> - - -<h3><span class="smcap">Technique</span></h3> - -<p>Assignment of patients to instrument-playing should be made in the -same manner as other assignments in functional occupational therapy. -The physician should prescribe the instrument which best meets the -convalescent’s needs. He should explain to the musical aide in the -presence of an occupational therapist the motions desired and the -precautions to be followed. He should set the time limits for the -first and succeeding lessons. In general, it may be said that the -first lesson should last about fifteen minutes, or until such time as -the patient shows signs of fatigue. This period should be extended -gradually to a half hour. The patient should be encouraged to return to -the instrument as often as is practicable for further study. When the -number of patients receiving<span class="pagenum" id="Page_57">[Pg 57]</span> lessons is large, a regular schedule for -additional practice periods will have to be posted. After a relatively -short period, the musical phase of occupational therapy will operate -smoothly and the physician will be able to delegate most of the details -to the occupational therapist, who should frequently supervise the -lessons to ensure desired joint motion and to note progress. The -occupational therapist should make progress measurements and notes. -When properly supervised, the use of music as functional occupational -therapy can be as scientific as any other branch of occupational -therapy and is the one use of music at this time which may properly be -termed “musical therapy”.</p> - -<p>The following table is offered as a reference for some of the motions -possible with a few of the instruments described.</p> - -<table class="autotable"> -<tr> -<th class="tdc"> -<i>Part</i> -</th> -<th class="tdc"> -<i>Motion</i> -</th> -<th class="tdc"> -<i>Instrument</i> -</th> -</tr> -<tr> -<td> -Fingers -</td> -<td> -All -</td> -<td>Piano -</td> -</tr> -<tr> -<td> -Fingers -</td> -<td>Extension -</td> -<td>Ukelele -</td> -</tr> -<tr> -<td> -Thumb -</td> -<td>All but adduction -</td> -<td>Piano -</td> -</tr> -<tr> -<td> -Wrists -</td> -<td>Flexion—Extension -</td> -<td>Piano -</td> -</tr> -<tr> -<td> -Elbow -</td> -<td>Pronation—Supination -</td> -<td>Guitar -</td> -</tr> -<tr> -<td> -Elbow -</td> -<td>Flexion—Extension -</td> -<td>Violin -</td> -</tr> -<tr> -<td> -Shoulder -</td> -<td>Abduction—Adduction -</td> -<td>Piano -</td> -</tr> -<tr> -<td> -Neck -</td> -<td>All Motions -</td> -<td>Xylophone -</td> -</tr> -<tr> -<td> -Back -</td> -<td>All Motions -</td> -<td>Bass Viol -</td> -</tr> -<tr> -<td> -Hips -</td> -<td>Abduction—Adduction -</td> -<td>Organ -</td> -</tr> -<tr> -<td> -Knees -</td> -<td>Flexion—Extension -</td> -<td>Pianola -</td> -</tr> -<tr> -<td> -Ankles -</td> -<td>Flexion—Extension -</td> -<td>Parlor Organ -</td> -</tr> -</table> - - -<h3><span class="smcap">Voice</span></h3> - -<p>Singing has long been used for the treatment of stammering and other -speech impediments. Singing can also be used to exercise the jaws, -larynx, lungs and diaphragm. With proper instruction,<span class="pagenum" id="Page_58">[Pg 58]</span> singing can be -an excellent exercise for the muscles of the chest and abdomen as well -as a breathing exercise.</p> - -<p>For the patient with a recently wired fractured jaw, singing gives -gentle joint motion and restores confidence in the ability to use -the jaw again. The same thing applies to patients with recovering -tempero-mandibular joint pathology. A patient with poor jaw motion -cannot articulate well, but can sing more nearly like the well patient -than he can talk. Singing can begin at the level of humming and -progress through scale practice to actual song instruction.</p> - -<p>When several patients are available for vocal exercises, a trio, -quartet or other group arrangement will create greater interest. Except -in hospitals devoted to the treatment of chronic disease, the turn-over -in patients will make group singing uncertain.</p> - - -<div class="footnotes"><h3>FOOTNOTES:</h3> - -<p class="footnote" id="fnII"><a href="#fnaII">[II.]</a> “<i>a discussion took place in 1913 on the physical significance -of that mystic quality called “touch” by which a player attempts -to vary the quality of the notes ... but it was concluded that the -velocity of striking was all that could be varied by the player.</i>”</p> -<p class="footnote right"> -<i>Richardson, E. G.—Sound, <abbr title="page">p.</abbr> 106</i><br /> -</p> -</div> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_59">[Pg 59]</span></p> -<h2 class="nobreak" id="CHAPTER_FOUR"><i>CHAPTER FOUR</i><br /> -PSYCHIATRY AND MUSIC</h2> -</div> - - -<p class="poetry p0"> -“His music mads me, let it sound no more,<br /> -For though it helps madmen to their wits,<br /> -To me it seems it will make wise men mad.”<br /> -<span style="margin-left: 2em;"><i>Richard III</i>, Shakespeare</span><br /> -</p> - - -<p>Gaston<span class="fnanchor" id="fna31"><a href="#fn31">[31]</a></span> believes that</p> - -<div class="blockquot"> - -<p>“The basic reason for the arts throughout the history of mankind has -been the resultant mental hygiene benefits. The common creative urge, -desire for diversion, and search for satisfactory expression exist in -all people. Music—above all arts—guarantees the fulfillment of these -elemental urges, and therein lies its greatest value.”</p> -</div> - -<p>The suggestive power of music has given rise to a series of legends -which go back to the very origin of civilization. But the methods of -experimental physiology, so precise in the study of organic function, -lead to no clear and easy picture in the presence of reactions as -complex and subjective as those of esthetic emotion and artistic -pleasures. The task of evaluating the effect of music on the mind is -made increasingly difficult by the personal equation, and when to this -is added the distortion of mental disease, great caution must be used -in the approach, technique, and recommendations to be followed in the -use of music as applied to psychiatry<span class="fnanchor" id="fna27"><a href="#fn27">[27]</a></span>.<span class="pagenum" id="Page_60">[Pg 60]</span> Altschuler<span class="fnanchor" id="fna3"><a href="#fn3">[3]</a></span> finds that -music stimulates the libido, which he defines as</p> - -<div class="blockquot"> - -<p>“the great amorphous power, the vital spark, out of which the will to -pleasure, the longing for love or passion for procreation take their -origin.”</p> -</div> - -<p>He believes that music is the only “medicine” which helps to convert -instinctual forces into socially acceptable forms.</p> - -<div class="blockquot"> - -<p>“Stimulated by music, man can still offer his lowly instincts free -expressions, camouflaged by jitter-bugging and boogie-woogieing.... -Indeed there is therapeutic acumen to an agent which is capable of -reconciling the instinctual with the social, and the sensual with the -spiritual.”</p> -</div> - -<p>The relationship between music and the mind is obvious, but the nature -of the relationship which has led some musicians to facile claims -of artistry remains for most psychiatrists a tempting but obscure -field. Most of the writing on this subject has been done by musicians -and so-called results obtained with music in mental patients have -been evaluated without medical guidance or the use of scientific -method. Physicians are hesitant to accept new ideas which are not -founded on unquestionable evidence. Enthusiastic laymen might call -this reactionary, and they would not be entirely wrong. It is the -reaction to the too rapid spread of folklore, cults, and nostrums which -physicians have had to combat to keep medicine on the highest possible -plane. It is the only tool with which they can protect the sick from -unscrupulous or even well-meaning people who, for personal gain or with -ill-founded conviction, promise cures by the citation of accidental or -falsified results. By custom, ethics, and state laws the treatment of -disease is the province of the licensed physician.</p> - -<p><span class="pagenum" id="Page_61">[Pg 61]</span></p> - -<p>The term “musical therapy” has been applied almost exclusively to the -treatment of mental disease with music. The term “therapy” is derived -from a Greek verb which means <em>to cure</em>. A cure can be practiced -and determined only by a qualified physician, or under his direction. -Claims can be made by anyone. To establish the curative value of any -procedure, certain criteria must be observed. In the first place, the -disease must be accurately classified so that the affliction of a -series of patients can be scientifically grouped for study. Next, the -therapeutic agent must possess qualities of constancy which permit -controlled dosage. Last, the proper administration of the agent in -the same disease condition must show a reasonably high percentage -of results which can be proved to be of value in the control or -elimination of symptoms or disease.</p> - -<p>Until a relatively short time ago, the causes of most disease -conditions were unknown and illnesses were named according to their -superficial characteristics. Most newly named diseases are designated -by the agents which cause them or by the variations from normal found -in the tissues of the body they affect (pathology). In psychiatry, most -diseases bear the names applied to their outward appearances.</p> - -<p>A simplification of terms places mental disease into three general -classes. Psychoses, Psychoneuroses, and Behavior Disorders. The -subdivisions of these classes are not universally accepted and the -musician who works in a mental hospital will soon become acquainted -with the locally practiced terminology.</p> - -<p>As a guide to vocabulary rather than an introduction to psychiatry, a -brief review of some of the prominent symptoms of mental disease will -be enumerated. The scientific material is based on Noyes’<span class="fnanchor" id="fna62"><a href="#fn62">[62]</a></span> excellent -text.</p> - -<p><span class="pagenum" id="Page_62">[Pg 62]</span></p> - -<p>The following list of the more common mental diseases is based upon the -classification offered by the National Committee for Mental Hygiene.</p> -<div class="blockquot"> -<i>Psychoses</i><br /> -<ul class="index"> -<li class="isuba">General Paresis</li> -<li class="isuba">Alcoholic</li> -<li class="isuba">Hardening of the Brain Arteries</li> -<li class="isuba">Senility</li> -<li class="isuba">Involutional Melancholia</li> -<li class="isuba">Manic-Depressive</li> -<li class="isuba">Schizophrenia</li> -</ul> -<i>Psychoneuroses</i> -<ul class="index"> -<li class="isuba">Hysteria—anxiety, conversion</li> -<li class="isuba">Hypochondriasis</li> -</ul> -<i>Mental Deficiency</i> -<br /><br /> -<i>Behavior Disorders</i> -<ul class="index"> -<li class="isuba">Maladjustment</li> -<li class="isuba">Habit or conduct disturbance</li> -</ul> -<i>Psychopathic Personality</i> -<ul class="index"> -<li class="isuba">Amoral, immoral, emotional</li> -</ul> -</div> -<p>Detailed descriptions are confusing to the layman because within one -disease subclass, the variations possible as a result of duration, time -of onset, mental background, etc. are very great. Only generalizations -will be mentioned.</p> - -<p>The two major divisions of mental disease—psychosis and -psychoneurosis—are not always readily differentiated. In the -psychotic, the personality is usually distorted, whereas in the -psychoneurotic the personality remains normal in relation to the -realities of the world and social life. The psychotic is the more<span class="pagenum" id="Page_63">[Pg 63]</span> -obviously deranged, the psychoneurotic usually passes for almost normal.</p> - -<p><em>General Paresis</em> is a late result of syphilis. The patient -becomes increasingly forgetful and disinterested in his surroundings -and social relations. There is a gradual loss of judgment and other -mental faculties. The facial expression becomes empty and the speech -slurred. This is the disease in which the knee reflex disappears, -an indication popularly associated with “crazy people”. It is a -progressive disease which becomes more difficult to treat as it -progresses. The treatment at this writing consists of the use of drugs -containing arsenic and the production of fever in the patient. The -results are not remarkable, ordinarily. Return to normal is unusual. -Music for such patients could in no manner be conceived as curative or -even helpful.</p> - -<p><em>Alcoholic Psychosis</em> results from continued excesses of drinking. -The patient usually resents criticism because he is convinced that his -reverses have driven him to drink. The prolonged use of alcohol relaxes -inhibitions, produces anti-social actions, and results in more sorrows -to drown in more alcohol. Alcoholic psychosis usually begins suddenly -with mental confusion, muscle twitches known as tremors, and vivid, -visual imaginary thought known as hallucinations. The treatment for -such patients includes withdrawal of alcohol and the use of sedative -measures. One of these measures is a prolonged bath in a tub of water -just below body temperature. Once the patient has recuperated to the -convalescent stage, music may be employed. Some alcoholics like to join -in group singing, especially if the group is made up exclusively of -fellow inebriates. Any encouragement to join non-alcoholics in group -singing, or any use of music which may stimulate a permanent interest -in a new instrument or diversion would be valuable. These patients lack -self-imposed discipline. If music can be used as a discipline, it might -lead to decreased drinking.</p> - -<p><span class="pagenum" id="Page_64">[Pg 64]</span></p> - -<p><em>Arteriosclerotic Psychosis.</em> As its name implies this is a -condition of the aged and is probably related to hardening of the -brain arteries. The symptoms may include emotional instability, mental -fatigue, disinterestedness, and some loss of memory. The patient begins -to look and act old. The treatment consists of custodial care, physical -rest, and mental occupation. Music is well suited to this combination. -Oldtime favorites played softly for several periods daily is indicated. -Obviously, where specific musical numbers are requested they should be -played.</p> - -<p>There is another disease which resembles this called senile psychosis. -Usually it can be handled in the home, and is.</p> - -<p><em>Involutional Melancholia</em> occurs at an age when certain important -biologic functions of the body begin to regress or involute. For women -this age is usually forty-five, but for men it can be ten or more -years later. The condition is seen especially in those who did not -lead an average life previously. A study of the personality of such -patients usually shows them to have been uninterested and uninteresting -people, with few close friends. An unfavorable experience may bring on -worry and unrest. They become saddened and exaggerate the minor sins -of their past. They develop false beliefs known as delusions about -their surroundings or themselves. At least half of them never recover -completely.</p> - -<p>There is little that can be done for them, except to encourage -healthful diets and hygienic regimes to keep them physically well. -Some physicians might encourage the use of music for such patients -to distract their attention from themselves. Familiar melodies are -recommended, because of the age group, old time favorites will be the -most suitable.</p> - -<p><em>Manic-Depressive</em> psychosis is a relatively common condition in -most large mental hospitals. It is so called because the same patient -may have periods of excitement or depression separated by phases of -apparent well-being. The stage of excitement begins<span class="pagenum" id="Page_65">[Pg 65]</span> with arrogance, -assurance, exuberance and energy, and may superficially resemble the -pleasantly boisterous drunk seen at a national convention. The patient -talks rapidly, histrionically, and with a play on words called “flight -of ideas” because each new phrase suggests new ideas on which the -patient will embark, leaving the main thought-stream. This excitement -may continue to the point where the fatigueless drive is remarkably -great. This may or may not be followed by an opposite reaction.</p> - -<p>In the depressive phase patients may feel gloomy, speak slowly, and -look worried. A feeling of inadequacy may lead to self-punishment and -suicidal intent. The symptoms may progress to the complete inactivity -known as stupor.</p> - -<p>The first manifestation of this disease is usually manic with the first -depressive state years later. Attacks last about six months or longer -and although they usually recur at a future date, may not. In the time -between attacks the patient may appear quite normal and return to his -previous activities.</p> - -<p>In the manic phase, sedatives are frequently administered. Stimulating -music would only tend to increase the disturbance. If the physician -prescribes music it should be of the restful type, preferably a -selection which will attract the patient’s attention by its familiarity.</p> - -<p>In the depressive phase, patients should not hear cheerful and gay -music. Entertainment often deepens the depressive state because of -the contrast, and the awareness of their own problem, which prevents -enjoyment.</p> - -<p><em>Schizophrenia</em> literally means splitting of the mind. It is a -group of conditions in which the usual harmonious blending of emotions, -intellect, and drive are disorganized into a seeming inactivity and -resultant apathy. In the <em>simple</em> type the patient becomes -uninterested in his environment and responsibilities. This result is -seen in the vagrant and the delinquent.</p> - -<p><span class="pagenum" id="Page_66">[Pg 66]</span></p> - -<p>In the type known as <em>catatonic</em> there are phases of excitement or -stupor. In the stuporous state the attitude of the patient resembles -that of an automaton. In this state it is difficult to make any contact -with the patient who refuses to co-operate or even move. Catatonic -excitement sometimes follows the stupor and is evidenced by the same -purposeless absence of emotion, but may include unexpected acts of -destructiveness.</p> - -<p>There is another type called <em>paranoid</em> in which the patient -develops false beliefs of persecution, and a hebephrenic type in which -the patient becomes even more inaccessible and inattentive.</p> - -<p>Schizophrenia, once thought incurable, is now considered amenable to -treatment and about one fourth of the stricken recover completely after -the first attack.</p> - -<p>In treating these patients an attempt is often made to promote an -interest in real things and social consciousness. It is necessary to -stimulate attention and redirect it to things outside the patient. -Music has a more important place in this disease than in any other -mental condition, and this disease may account for more than half the -population of many mental hospitals.</p> - -<p>Altshuler and Shebesta<span class="fnanchor" id="fna4"><a href="#fn4">[4]</a></span> tried music in the treatment of four excited -female schizophrenics in conjunction with hydrotherapy. To have some -basis for evaluation of effect, the amount of vocal productions -and head movements were recorded for thirty minute periods. This -combination is referred to as “output”. Observations were made for a -six week period, five days a week for two to three hours a day. Two -patients were given continuous baths and two were given cold wet sheet -packs during the observation periods. A violinist played behind a -screen for the first thirty minutes. During the first ten to twenty -minutes of playing no changes were noted, and the patients seemed more -or less inattentive to the music. Soon it was found that familiar tunes -were most effective in centering and keeping their attention. Thus, -very<span class="pagenum" id="Page_67">[Pg 67]</span> noisy and upset patients might begin to sing a familiar song -with the violin, keeping their output of energy at the same level but -changing from irrelevant purposeless activity to the directed activity -of singing or humming a tune. It was also noted that the effect of -familiar tunes extended far beyond the termination of the music, as -manifested by continued singing after the music stopped. Familiar -waltzes were found to be the best type of music to use in quieting the -patients, but these were more effective when preceded by more lively -tunes which secured their attention.</p> - -<p>As a control, patients were placed in dry sheets and after twenty to -thirty minutes of music the output diminished in the same degree (50%) -that was observed with patients in wet packs. This showed that possibly -the music alone may have been responsible for the quieting effect.</p> - -<p>These authors conclude that musical accompaniment tends to prevent -the feeling that hydriatic measures are punitive and that the return -of real memories is a natural substitute for states of phantasy and -excitement.</p> - -<p>Julia Eby<span class="fnanchor" id="fna29"><a href="#fn29">[29]</a></span> feels that</p> - -<div class="blockquot"> - -<p>“If in the development of a person’s talent for music, stress is laid -upon the enjoyment it will give further listeners, he is being made -conscious of the social significance of his own accomplishments and -this helps the development of the personality as a contributing member -of the community.</p> - -<p>“Music contributes emotional energy needed to turn dissatisfaction -into mental reconstruction. The playing of music arouses associations -which stimulate the intellect and if this is sufficient it gives -satisfaction and enhances self respect.” But “We must<span class="pagenum" id="Page_68">[Pg 68]</span> be careful to -excite only those activities that will be followed by a feeling of -success”.</p> - -<p>“The intellectual stimuli of music bring the expenditure of emotional -energy from unconscious levels to conscious and intellectually -controlled levels ... a concentration on environment stimuli instead -of intrapsychic impulses, a perseverance in effort to adjust one’s own -conduct to group standards.”</p> -</div> - -<p>Altshuler<span class="fnanchor" id="fna2"><a href="#fn2">[2]</a></span> points out that the seat of all sensation, emotion, and -esthetic feeling (the thalamus) is not involved in mental illness, and -is directly attacked by music. The musical stimulation of the thalamus -automatically transfers from this “below awareness” level to the brain -cortex.</p> - -<div class="blockquot"> - -<p>“Little constructive therapy is possible as long as the patient is -acutely disturbed; therefore anything which may lessen disturbance and -bring about association familiar to the patient and which will revive -thoughts to a real level will be desirable.”</p> -</div> - -<p><em>Psychoneurosis</em> differs from psychosis in that the patient -recognizes that he is ill and wants to get well, although his more -powerful subconscious desire does not. Several types are recognized.</p> - -<p><em>Hysteria</em> is an unconscious reaction on the part of an individual -to solve a personal problem by the acquisition of some symptom or -symptoms. If this is done consciously it is called <em>malingering</em>. -Any and every physical or mental symptom is possible. Examples of -physical involvement are blindness, paralysis, aches and pains. -Mental manifestations may include loss of memory, delirium, etc. -Hysteria permits the patient to achieve his purpose and maintain his -self-respect. It is an escape mechanism to evade responsibility, excuse -failure, or gain attention.</p> - -<p><span class="pagenum" id="Page_69">[Pg 69]</span></p> - -<p>Many forms of treatment have been used and each physician uses his own -approach. The more commonly accepted methods include psychotherapy, -persuasion, suggestion, and psycho-analysis. Psychotherapy encourages -the patient to talk about his condition and with the guidance of the -psychiatrist discover the basis of his difficulties. Logical persuasion -is used but is not considered effective by most. Suggestion under -hypnosis is used by some who are expert in hypnotism. Psychoanalysis -attempts to discover the subconscious thoughts and experiences which -have caused the disturbance.</p> - -<p>Music may be of some value for this group. Levine<span class="fnanchor" id="fna56"><a href="#fn56">[56]</a></span> believes that</p> - -<div class="blockquot"> - -<p>“Many individuals achieve a feeling of self-confidence if they develop -hobbies such as music. Learning to play musical instruments may -compensate a feeling of inferiority, especially when the individual -has ability which he underestimates.”</p> -</div> - -<p>Listening to music may stimulate the patient to talk about his -condition or about things that trouble him. Altshuler<span class="fnanchor" id="fna3a"><a href="#fn3">[3]</a></span> feels that -where large groups of patients must be treated with limited personnel, -such as exists in hospitals which handle cases of war neuroses, -group treatment is the only solution, and that when there is group -psychotherapy music is indispensable, for it not only can “turn any -aggregation of people into an ‘organic’ group. It is one of the -mightiest socializing agents.”</p> - -<p>Harrington<span class="fnanchor" id="fna43"><a href="#fn43">[43]</a></span> believes that music has an important place in the mental -hospital although he regards technical instruction for heterogeneous -groups unworthy of the effort. He is convinced that, “Mass singing has -therapeutic value, and that subdued instrumental music during mealtimes -is desirable.”</p> - -<p>According to Kraines<span class="fnanchor" id="fna54"><a href="#fn54">[54]</a></span></p> - -<p><span class="pagenum" id="Page_70">[Pg 70]</span></p> - -<div class="blockquot"> - -<p>“Recreation and hobbies are also extremely important energy release -techniques. The apparently passive listening to music may accomplish -release of energy. The passivity is only seeming. The person following -the music tends by identification to swing muscularly with the music, -nodding his head, tapping his feet; and even when there is no manifest -movement, there is often a non-observable but yet definite movement. -In many forms of music such rhythmic movements can be performed only -by relaxed muscles; and tense persons who are influenced by harmonious -music are perforce relaxed. Some sanatariums very effectively utilize -dancing to music as a means of relaxing patients. Moreover in this -general relaxation and harmonious appeal to the senses, the person -“feels” that peace and harmony do exist outside himself and will -continue to exist despite his own troubles; and by such general -“feeling tone”, the person puts aside his conflicts for the while. -On the other hand some types of music will stimulate persons into -increased activity (e.g. martial music, dance music) by reason of the -tendency to make rapid and staccato rhythmic movement in time with -the music. The rhythmic muscle movement can, under the influence of -a skillful composer, increase to such a pitch as to make the person -excited, exhilarated, etc. Outlets for energy release should be -selected which will give enjoyment to the patient.”</p> -</div> - -<p>In chronic mental institutions the patient band has been found most -valuable. Pierce<span class="fnanchor" id="fna66"><a href="#fn66">[66]</a></span> believes that</p> - -<p><span class="pagenum" id="Page_71">[Pg 71]</span></p><div class="blockquot"> - -<p>“Music can be a co-operative effort for a wholesome discipline. -It tends to break down the sense of isolation so common to mental -disease. It assists in adaptation to the mental state.</p> - -<p>“First, playing must be made a pleasure to the members. This means -there must be no severity of discipline and great tact must be -exercised in correcting errors—preferably privately so as not to be -humiliating to the patient.</p> - -<p>“Second, have some easy numbers: otherwise the results may discourage -the patients.</p> - -<p>“Public appearances away from the hospital have the advantages of -enhancing self respect and pride.</p> - -<p>“Admit a small number of hospital personnel to the band—but not -those of great ability. The more varied the instrumentation, the more -gratifying the result to the participants.”</p> -</div> - -<p><em>Mental deficiency</em> means the incomplete development of the mind -which makes independent living impossible for the victims. The degrees -of deficiency are classified according to the results obtained in -intelligence tests: 1. Idiot—mental age of less than three years. 2. -Imbecile—age of three to seven. 3. Moron—above the age of eight, but -deficient. The treatment for these groups consists of custodial and -hygienic care plus any education which can be attained, and of course -music will play its part in this in a purely academic manner.</p> - - -<h3><span class="smcap">Summary</span></h3> - -<p>Music can be used in psychiatry for its value in listening, group -participation, and creation of sound, as follows:</p> - -<p><span class="pagenum" id="Page_72">[Pg 72]</span></p> - -<ul><li class="ifrst none">1. <i>By listening</i></li> -<li class="none"><ul class="index"> -<li class="none"><span class="allsmcap">A.</span> To improve attention.</li> -<li class="none"><span class="allsmcap">B.</span> To maintain interest.</li> -<li class="none"><span class="allsmcap">C.</span> To influence mood (to produce exhilaration, etc.).</li> -<li class="none"><span class="allsmcap">D.</span> To produce sedation.</li> -<li class="none"><span class="allsmcap">E.</span> To release energy (by tapping of foot, etc.).</li> -</ul></li> -<li class="ifrst none">2. <i>By participation</i> (in group singing, bands, etc.)</li> -<li class="none"><ul class="index"> -<li class="none"><span class="allsmcap">A.</span> To bring about communal co-operation.</li> -<li class="none"><span class="allsmcap">B.</span> To release energy.</li> -<li class="none"><span class="allsmcap">C.</span> To arouse interest.</li> -</ul></li> -<li class="ifrst none">3. <i>By creation of sound</i> (playing of instruments)</li> -<li class="none"><ul class="index"> -<li class="none"><span class="allsmcap">A.</span> To increase self respect by accomplishment and success.</li> -<li class="none"><span class="allsmcap">B.</span> To increase personal happiness by ability to please others.</li> -<li class="none"><span class="allsmcap">C.</span> To release energy.</li> -</ul></li> -</ul> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_73">[Pg 73]</span></p> -<h2 class="nobreak" id="CHAPTER_FIVE"><i>CHAPTER FIVE</i><br /> -BACKGROUND MUSIC</h2> -</div> - - - - -<p>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.</p> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_74">[Pg 74]</span> -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.</p> - -<p>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<span class="fnanchor" id="fna37"><a href="#fn37">[37]</a></span> the following -suggestions:</p> - -<div class="blockquot"> - -<p>“1084 ... Other means of allaying pain: 3. Agreeable music, especially -if it inclines one to sleep. 4. Being occupied with something very -engrossing removes the severity of pain.”</p> -</div> - -<p>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:</p> - -<div class="blockquot"> - -<p>“I wish you were well enough to come to us tomorrow.... I would divert -your pain with good music<span class="fnanchor" id="fna12"><a href="#fn12">[12]</a></span>.”</p> -</div> - -<p>In 1915 two surgeons named Burdick and Kane used music as<span class="pagenum" id="Page_75">[Pg 75]</span> 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<span class="fnanchor" id="fna32"><a href="#fn32">[32]</a></span>. 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.</p> - -<p>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”<span class="fnanchor" id="fna53"><a href="#fn53">[53]</a></span>.</p> - -<p>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.</p> - -<p>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.</p> - - -<h3><span class="smcap">Physical Exercise</span></h3> - -<p>Some forms of physical exercise are carried out most successfully<span class="pagenum" id="Page_76">[Pg 76]</span> -when accompanied by music. Plato recommended such a practice in his -<i>Republic</i>. 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<span class="fnanchor" id="fna15a"><a href="#fn15">[15]</a></span>.</p> - -<p>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<span class="fnanchor" id="fna5"><a href="#fn5">[5]</a></span>.</p> - -<p>Tarchanoff found that</p> - -<div class="blockquot"> - -<p>“if the fingers are completely fatigued, either by voluntary effort -or by electric excitation, music has the power of making fatigue -disappear.”<span class="fnanchor" id="fna74"><a href="#fn74">[74]</a></span></p> -</div> - -<p>Such an observation leaves little doubt that physical endeavor is more -productive when done to music.</p> - -<p><em>Calisthenics.</em> 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<span class="pagenum" id="Page_77">[Pg 77]</span> esthetics called “Eurhythmics” based upon the -relationship between body motion and music.</p> - -<p>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.</p> - -<p>Johnson<span class="fnanchor" id="fna51"><a href="#fn51">[51]</a></span> 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.</p> - -<p>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<span class="fnanchor" id="fna49"><a href="#fn49">[49]</a></span> 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.</p> - -<p>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<span class="pagenum" id="Page_78">[Pg 78]</span> 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.</p> - -<p>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.</p> - - -<h3><span class="smcap">Remedial Exercise and Dancing</span></h3> - -<p>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.</p> - -<p>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.</p> - -<p><span class="pagenum" id="Page_79">[Pg 79]</span></p> - - -<h3><span class="smcap">Shop Work</span></h3> - -<p>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.</p> - -<p>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<span class="fnanchor" id="fna33"><a href="#fn33">[33]</a></span> 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.</p> - -<p>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.”<span class="fnanchor" id="fnaIII"><a href="#fnIII">[III.]</a></span> 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.</p> - -<p>Beckett<span class="fnanchor" id="fna9"><a href="#fn9">[9]</a></span> 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 <span class="pagenum" id="Page_80">[Pg 80]</span>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.</p> - -<p>“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.<span class="pagenum" id="Page_81">[Pg 81]</span> It requires not one but a number of questionnaires -over a period of time to keep up with changing tastes.”</p> - -<p>“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.”</p> - -<p>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.</p> - - -<div class="footnotes"><h3>FOOTNOTES:</h3> - -<p><span class="pagenum" id="Page_82">[Pg 82]</span></p> - -<p class="footnote" id="fnIII"><a href="#fnaIII">[III.]</a> <i>The use of industrial music is not to be confused with -working songs. Working songs are those sung by groups performing -tedious or strenuous work to help them maintain good rhythm and spirit. -Bücher (Bücher, K., <span xml:lang="de" lang="de">Arbeit und Rhythmus</span>, Leipzig, 1909) analyzed a -long list of working songs and concluded that: 1. Through rhythm they -facilitate the synchronous expenditures of energy by individuals -engaged in a common task. 2. They spur the worker on through jest, -abuse, or reference to the spectators’ opinions. 3. They mention the -work, its progress, pleasures, vexations, difficulties and rewards. -4. They inform everyone of the wishes and aspirations of the workers. -These slow rhythmic songs are entirely unsuited to the machine age -where the machine sets the inelastic rhythm for the worker.</i></p> -</div> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h2 class="nobreak" id="CHAPTER_SIX"><i>CHAPTER SIX</i><br /> -MEALTIME MUSIC</h2> -</div> - - - -<p>Patients who are confined to bed, or for that matter, to a hospital, -find meals progressively monotonous in spite of the fact that there is -a greater variety offered them than was theirs at home. This monotony -results in part from the color and nature of the environment, the -personnel, the general atmosphere of the hospital, and the constraining -nature of institutional restriction. While dining at home some of these -factors are subconsciously dissipated by trivial intimate conversation, -friendly faces, individual attention and the security of the things for -which “home” stands.</p> - -<p>There are only a few things which can be done to make hospital meals -more enjoyable, aside from those features best handled by the chef -and menu planner; but it is possible to increase the pleasure of meal -periods through the manipulation of certain environmental factors. One -of these is the use of color and <i xml:lang="it" lang="it">decor</i> in hospital dining halls -to simulate home surroundings. In the ward this is most difficult where -little can be done, except by introducing attractive hangings which are -less hospital-like, or by the application of paint in cheerful colors. -The latter method is sanitary and practical.</p> - -<p>Since ancient times music has been used as an accompaniment to meals. -The instruments used by the ancients for this purpose were usually -those which emitted soft sounds. Voltaire said that our purpose in -going to the opera was to promote digestion. During the preceding -century, dinner music became stylized and consisted<span class="pagenum" id="Page_83">[Pg 83]</span> largely of -semi-classical pieces or waltzes played softly in slow tempo by string -ensembles. During the past twenty-five years there has evolved a form -of dinner music which is not only a marked departure from the old, but -has come to be used as a source for dancing between and during courses. -Whether the physiologic and psychologic effects of dancing during -a meal are harmful, beneficial, or of no moment remains undecided. -Certainly there seems to have been little interest in analyzing its -effects. During the period when dinner-dance music was available only -in a few places, the number of those who could be affected by it was -very small. But, with the more recent installations of “juke” boxes, -and other forms of mechanically reproduced music, into all varieties of -dining places, the problem is worthy of investigation.</p> - -<p>Most people derive pleasure from the consumption of appetizing food. -Most people derive pleasure from music played to their taste. Although -the logic of the following thought is subject to criticism, it does -sound reasonable to state that two pleasurable experiences enjoyed -simultaneously, should add up to a greater happiness than that afforded -by either individually. Food has received thorough study with respect -to preservation, preparation, serving, and the time of day when each -item is most satisfying. Some of the conclusions have been arbitrary, -but for the most part, people eat the food that agrees with them -physiologically and psychologically. There is no especially good -reason why cereals should be eaten by adults only in the morning. It -has become a matter of custom or advertising, and the minds of the -masses have become conditioned to feel that cereal is especially good -at breakfast time. A generation ago the breakfast menu in some homes -differed little from the present day dinner fare. Eating habits have -become set in the minds of most people and there is little that can be -done to change them rapidly. Daily routines have given rise to certain -music conventions as well. Until recently,<span class="pagenum" id="Page_84">[Pg 84]</span> music at breakfast was -uncommon. Bernard Shaw<span class="fnanchor" id="fna65"><a href="#fn65">[65]</a></span> wrote, “Music after dinner is pleasant: -Music before breakfast is so unpleasant as to be clearly unnatural.” -With the advent of radio this has changed even if Shaw has not. Lunch -rooms, barbershops and other public places where people spend time -inactively, are equipped with mechanisms for reproducing music. The -practice of reading or even studying school work at home with the radio -on has become increasingly prevalent. The tempo of living has stepped -up to the point where most people, especially the younger, like to do -two things at once, especially if one of these is to listen to music.</p> - -<p>The effect of different foods upon digestion and health is known, and -most persons eat with a regularity which is related to capacity and -needs. They are usually able to select the items they desire, the time -at which they will eat, and the period for consumption.</p> - -<p>The ideal attitude while eating is one of mental serenity and physical -repose. If certain criteria are observed music can be relaxing. The -elements which increase relaxation are melody, rhythm, and softness. -If the music which accompanies meals is carefully selected it can make -eating more pleasurable, and this is desirable for patients in the -hospital.</p> - -<p>Mealtime music must be unobtrusive. It must lack stimulating qualities -which attract attention. If the diner can promptly name the selection -played five minutes earlier, that piece was too impressive in score or -performance. Perhaps the most suitable form of dinner music is that -played by a small string ensemble. The piano and harp are also very -satisfactory, alone or in combination with the ensemble. When the -piano is played in the hesitant legato style of Eddie Duchin it is -particularly desirable. The shrill sounds of the flute or the brassy -sound of the trumpet must be<span class="pagenum" id="Page_85">[Pg 85]</span> omitted. The music must be soft and slow. -Avoid vocals and strange instruments.</p> - -<p>The volume of the music should be maintained at as nearly the same -level as is consistent with the source of the music. It should begin -without fanfare or any attempt to attract attention. The level of -intensity should not interfere with conversation, for, if the loudness -of the music demands an increased volume of voice to carry on normal -conversation, it defeats the purpose of relaxation by evoking increased -energy on the part of the speaker. When possible the end of the -selection should fade out. There should be nothing abrupt about the -selection, and unusual sequences or novelties should be avoided. The -music should be fluent and entirely unexciting. The interval between -pieces should be brief in order to sustain auditory reception at -a fairly continuous level. Five to ten seconds between numbers is -recommended, and this coincides approximately with the time required -to change discs on an automatic or manually controlled record player. -Musical selections should be played in groups. The groups should last -a total of about fifteen minutes with rest intervals of about three -minutes. This simulates the requirements and performance of the live -ensemble and has become a part of stylized dinner music. The music -should last as long as the meal.</p> - -<p>Ideally, the source of the music should not be obvious, and to this -end a concealed loud speaker has an advantage over the live ensemble, -which through its motions or the physical appearance or mannerisms of -its members may distract diners. There should be no vocal announcements -between selections. Occasionally a listener will want to know the name -of the song being played because it is familiar, reminiscent, or sweet. -When the budget will permit, printed or mimeographed programs are most -welcome to those whose interest is aroused.</p> - -<p>The music recommended, is the music which has been played<span class="pagenum" id="Page_86">[Pg 86]</span> by dinner -ensembles for years. Their repertoires usually include waltzes by -Strauss and his contemporaries; selections from operettas by Herbert, -Friml, and Romberg, and the popular favorites of the past decade, -such as selections from the musical comedies of Kern, Cole Porter and -Gershwin, or the songs of Carmichael and Berlin.</p> - -<p>It cannot be emphasized too strongly that mealtime music must be -physiologically non-stimulating, and noisy music is to be avoided. -“Douglas Jerrold declared that he hated to dine amidst the strains of a -military band; he said he could taste the brass in his soup.” (Hadden, -J., “<i>Music as Medicine</i>,” 1895, 9:369). A foreman of a shop in -which music was played during mealtime begged that raucous music be -omitted “to give the digestion a break”<span class="fnanchor" id="fna9a"><a href="#fn9">[9]</a></span>.</p> - -<p>Some orchestra leaders habitually use arrangements which approximate -the qualities desirable for mealtime music. Among these are: Wayne -King, Marek Weber, Andre Kostelanetz, David Rose, Frankie Carle, Carmen -Cavallaro, Eddie Duchin, Guy Lombardo, and the following orchestras: -Boston “Pops”, New Mayfair, Percy Faith, Anton and Paramount, Victor -Salon, Victor Continental, Palmer House Ensemble, Selinsky String -Ensemble. All these have been recorded and a sample list of their -recordings follows as a nucleus of a mealtime music library.</p> - -<table class="autotable"> -<tr> -<td colspan="2"> -<i>Victor Recordings</i> -</td> -</tr> -<tr> -<td> - Southern Roses -</td> -<td class="tdr"> -26322 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Sweetheart Waltz -</td> -<td class="tdr"> -26322 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Black Eyes -</td> -<td class="tdr"> -20037 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Our Waltz -</td> -<td class="tdr"> -27853 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Holiday for Strings -</td> -<td class="tdr"> -27853 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Frühlingstimmen -</td> -<td class="tdr"> -4387 <span class="allsmcap">A</span> and <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - <span class="pagenum" id="Page_87">[Pg 87]</span>Dream Waltz -</td> -<td class="tdr"> -<span class="allsmcap">V</span> 214 -</td> -</tr> -<tr> -<td> - None But The Lonely Heart -</td> -<td class="tdr"> -4413 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Song of The Islands -</td> -<td class="tdr"> -27224 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - La Golondrina -</td> -<td class="tdr"> -27451 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Lover, Come Back To Me -</td> -<td class="tdr"> -27397 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Indian Love Call -</td> -<td class="tdr"> -27397 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Le Secret -</td> -<td class="tdr"> -20416 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Pirouette -</td> -<td class="tdr"> -20416 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Wine, Women And Song -</td> -<td class="tdr"> -6647 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - A Shepherd’s Tale -</td> -<td class="tdr"> -9479 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Narcissus -</td> -<td class="tdr"> -9479 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Come Back To Sorrento -</td> -<td class="tdr"> -27917 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Gavotte from Mignon -</td> -<td class="tdr"> -27917 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Zigeuner -</td> -<td class="tdr"> -24609 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Tales of Hoffman -</td> -<td class="tdr"> -20011 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Badinage -</td> -<td class="tdr"> -12591 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Air de Ballet -</td> -<td class="tdr"> -12591 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Gold and Silver -</td> -<td class="tdr"> -25199 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Blue Danube -</td> -<td class="tdr"> -25199 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Columbia Recordings</i> -</td> -</tr> -<tr> -<td> - Begin the Beguine -</td> -<td class="tdr"> -4265 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - Easter Parade -</td> -<td class="tdr">4292 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - With A Song In My Heart -</td> -<td class="tdr">4292 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - The Touch Of Your Hand -</td> -<td class="tdr">4291 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - Somebody Loves Me -</td> -<td class="tdr">4291 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - Falling In Love -</td> -<td class="tdr">4266 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - Tea For Two -</td> -<td class="tdr">4266 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - Josephine -</td> -<td class="tdr">36692 -</td> -</tr> -<tr> -<td> - Louise -</td> -<td class="tdr">36692 -</td> -</tr> -<tr> -<td> - Estrellita -</td> -<td class="tdr">4236 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - London Again -</td> -<td class="tdr">69264 <span class="allsmcap">D</span> -</td> -</tr> -<tr> -<td> - By The Tamarisk -</td> -<td class="tdr">69264 <span class="allsmcap">D</span> -</td> -</tr> -<tr> -<td> - <span class="pagenum" id="Page_88">[Pg 88]</span>Swan Lake -</td> -<td class="tdr">69357 <span class="allsmcap">D</span> -</td> -</tr> -<tr> -<td> - Rosalie -</td> -<td class="tdr">36543 -</td> -</tr> -<tr> -<td> - Speak To Me Of Love -</td> -<td class="tdr">35551 -</td> -</tr> -<tr> -<td> - Pavanne -</td> -<td class="tdr">7361 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td> - Clair De Lune -</td> -<td class="tdr">7361 <span class="allsmcap">M</span> -</td> -</tr> -<tr> -<td colspan="2"> -<i>Decca Recordings</i> -</td> -</tr> -<tr> -<td> - The Very Thought Of You -</td> -<td class="tdr">3110 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Cocktails For Two -</td> -<td class="tdr">3110 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Every Little Movement -</td> -<td class="tdr">18300 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Minute Waltz -</td> -<td class="tdr">18466 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Blue September -</td> -<td class="tdr">15050 <span class="allsmcap">A</span> -</td> -</tr> -<tr> -<td> - Valse Bluette -</td> -<td class="tdr">15049 <span class="allsmcap">B</span> -</td> -</tr> -<tr> -<td> - Sleepy Lagoon -</td> -<td class="tdr">18286 <span class="allsmcap">A</span> -</td> -</tr> -</table> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_89">[Pg 89]</span></p> -<h2 class="nobreak" id="CHAPTER_SEVEN"><i>CHAPTER SEVEN</i><br /> -MUSIC IN BED</h2> -</div> - - - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_90">[Pg 90]</span> to deprive the ward of music for the sake of the -few who should not have it.</p> - -<p>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.</p> - -<p>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.</p> - -<p><span class="pagenum" id="Page_91">[Pg 91]</span></p> - -<p>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.</p> - -<p>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.</p> - -<p>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 <a href="#CHAPTER_SIX">Chapter -VI</a>) 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.<span class="fnanchor" id="fna24c"><a href="#fn24">[24]</a></span></p> - - -<h3><span class="smcap">The Bedside Radio</span></h3> - -<p>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<span class="pagenum" id="Page_92">[Pg 92]</span> 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.</p> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_93">[Pg 93]</span> 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.</p> - - -<h3><span class="smcap">Public Address System</span></h3> - -<p>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.</p> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_94">[Pg 94]</span> 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.</p> - -<p>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.</p> - -<p>Each hospital will have to weigh these and other arguments of -the speaker-phone dilemma and choose according to its individual -requirements.</p> - -<p>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.</p> - -<p>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.</p> - - -<h3><span class="smcap">Personalized Music</span></h3> - -<p>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<span class="pagenum" id="Page_95">[Pg 95]</span> 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.</p> - -<p><em>Instruction.</em> 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.</p> - -<p>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.</p> - -<p><em>Diversion.</em> 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<span class="pagenum" id="Page_96">[Pg 96]</span> -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.</p> - -<p><em>Entertainment.</em> 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.</p> - -<p>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<span class="pagenum" id="Page_97">[Pg 97]</span> 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.</p> - -<p><em>Volunteers.</em> 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.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_98">[Pg 98]</span></p> - -<h2 class="nobreak" id="CHAPTER_EIGHT"><i>CHAPTER EIGHT</i><br /> -DIVERSION AND ENTERTAINMENT</h2> -</div> - - - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_99">[Pg 99]</span> -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.</p> - -<p>“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.</p> - -<p>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.</p> - -<p>In hospitals for the chronically ill there is usually an assembly -hall or recreational building, where entertainment may be given<span class="pagenum" id="Page_100">[Pg 100]</span> 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.</p> - -<p>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.</p> - -<p>Amateur programs have been present on the American scene for a long -time but the efforts of Major Bowes have made them<span class="pagenum" id="Page_101">[Pg 101]</span> 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.</p> - -<p>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<span class="pagenum" id="Page_102">[Pg 102]</span> 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.</p> - -<p>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.</p> - - -<h3><span class="smcap">Choir</span></h3> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_103">[Pg 103]</span> to a large extent on -the size of the hospital and the predominant age group.</p> - - -<h3><span class="smcap">Diversion</span></h3> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_104">[Pg 104]</span> 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.</p> - -<p>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.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_105">[Pg 105]</span></p> - -<h2 class="nobreak" id="CHAPTER_NINE"><i>CHAPTER NINE</i><br /> -PUBLIC ADDRESS SYSTEM</h2> -</div> - - -<p>Many hospitals now have public address systems. Before long most -hospitals of one hundred or more beds will have public address systems, -if for no other reason than emergency calls and to lessen the load on -the intramural telephone network.</p> - -<p>The public address system originally installed as an emergency call -device may be used for music reproduction at relatively little -increase in expense. The same operator may be used for both forms of -transmission. Ideally, the system should include a loud speaker in -every ward and a “phone-jack” at every bedside. The central switchboard -should have a good radio and an automatic record player which may -transmit music to the patients by means of the public address systems. -The addition of a set of switches which can cut wards in or out at -will can prove most useful. If there are halls or buildings from -which programs of general interest emanate frequently, they should -be equipped with microphones which are connected with the central -switchboard so that musical programs from the assembly hall or the -church services from the chapel may be broadcast to the non-ambulatory -patients.</p> - -<p>The central switchboard should be housed in a relatively sound proof -room or booth. Additional equipment for it should include shelves for -recordings and a telephone for which the usual bell signal is replaced -by a light signal. An instantaneous record-cutter which permits the -operator to record programs from the radio<span class="pagenum" id="Page_106">[Pg 106]</span> or microphone will be found -of great value, but the expense involved may be too great for most -hospitals of fewer than 500 beds.</p> - -<p>It is most advisable that a full-time operator for the system be -employed. The operator should have a pleasant voice, but even more -important, a highly intelligible one. He will require some basic -training in the operation of the switchboard and its accessories and -this should be the obligation of the organization which installs the -equipment. The operator should be required to keep a written record -of everything that emanates from the studio. He should be responsible -for the routine care of the apparatus and know enough about its parts -to recognize defects early and to correct some of the simpler ones. He -must be prepared to live a lone life. There is always a temptation to -invite or permit guests in the studio, and the resultant diversion or -conversation might adversely affect the broadcast.</p> - -<p>If an instantaneous record cutter is available he should read “<i>How -to Make Good Recordings</i>” (Audak <abbr title="company">Co.</abbr> of New York) which is not only -valuable for the recording of music but gives some excellent advice -concerning the use of the proper needle for music reproduction and the -use of the microphone.</p> - - -<h3><span class="smcap">Program</span></h3> - -<p><em>Music.</em> The public address system should be operated on a rigid -schedule in imitation of a commercial radio studio. This is necessary -because the patients will come to expect certain features at specified -times of the day and fluctuations may result in disappointment and -reduced morale. The program policy should be the direct concern of the -hospital superintendent and any service chiefs who are interested. -The hours of use will vary considerably with the individual hospital -from a few hours to a very full program. Because of the great number -of possible variations, some<span class="pagenum" id="Page_107">[Pg 107]</span> general applications will be considered -first and then a model program will be suggested.</p> - -<p>The hour of awakening for patients may vary from about six to seven. -At some time during that hour, a program of exhilarating music is -indicated to start the day off right and perhaps get better cooperation -between the patients and the nursing personnel in morning care. To this -end, military or other marches are suggested as well as gay melodies, -because as Seashore<span class="fnanchor" id="fna73"><a href="#fn73">[73]</a></span> has shown, “pronounced rhythm brings on a -feeling of elation,” and martial music is traditionally stirring. This -program should last from fifteen to thirty minutes, and should be -followed by silence for at least fifteen minutes before breakfast is -served. It is unwise to begin eating while too stimulated.</p> - -<p>During the breakfast, luncheon and supper periods, mealtime music -should be broadcast for the entire duration of the dining period. -The nature of mealtime music may be the same for all meals. This is -discussed in <a href="#CHAPTER_SEVEN">Chapter VII</a>.</p> - -<p>The period between eight and ten in the morning is frequently reserved -for routine dressings or medical rounds and a period of silence should -be observed in the wards during the hours of maximum professional -services. Obviously, music should not be broadcast at any time during -the day when rounds are held. The operator should be supplied with a -schedule of ward rounds and cut out those wards which are concerned.</p> - -<p>The duration of rounds will vary from very brief periods on the -surgical wards to prolonged ones on the medical wards. Soon after -rounds the operator should broadcast to wards on which no regular -activity is taking place. A half hour program of request music in the -morning between ten and eleven is suggested. This should be followed by -the pre-meal period of silence.</p> - -<p>Where desired, luncheon music should be followed by restful or very -soft music. If the blinds are drawn and silence among patients<span class="pagenum" id="Page_108">[Pg 108]</span> is -maintained maximum benefit will result. Those patients who can fall -asleep readily at this time will do so. Those who find it impossible to -nap in the afternoon will be grateful for the diversion of music which -will permit greater relaxation. It is more difficult for some people to -rest in absolute quiet than with soft background music.</p> - -<p>Another request program of music lasting one hour may be begun between -two and three o’clock. It is advisable to mention specific names of -patients who request music to stimulate patient interest in communal -participation and listening. During the evening hours following supper, -it is suggested that the most popular radio programs be transmitted -over the system. These should be chosen on the bases of Hooper or -Crossley ratings so that the greatest number of patients will be -satisfied. When more than one channel is available, the second program -selected should be of a different nature from the first.</p> - -<p><em>Announcements.</em> Announcements should be kept to a minimum. -Routine announcements should be made at specified hours daily, such -as after breakfast, before lunch, and after supper. Emergency calls -should be limited to genuine emergencies or they will not be regarded -as compelling, as they should be.</p> - -<p>Newscasts are a much appreciated and desirable feature for patients -who, until their admission to the hospital, may have read or listened -to the news daily and will want to keep up with it. The newscast should -be given in an unsensational manner and news which is too depressing or -exciting should be deleted or reworded, for psychiatric patients.</p> - -<p><em>Special Programs.</em> There should be a weekly religious program -sent out over the system for those in bed. The minister affiliated -with the hospital should be able to fit the hospital into his Sunday -morning schedule. If no minister is available, a regular radio program -should be rebroadcast, but a Sunday service of local<span class="pagenum" id="Page_109">[Pg 109]</span> origin will be -more personal, and therefore will be more appreciated. There are many -suitable religious recordings available for incidental service music, -particularly the series of albums pressed by Bibletone.</p> - -<p>Holidays should be observed by the reproduction of appropriate music or -radio rebroadcasts.</p> - -<p>For the small hospital with limited personnel a two-channel system -continuously tuned to the two most popular networks locally available, -should be used.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_110">[Pg 110]</span></p> - -<h2 class="nobreak" id="CHAPTER_TEN"><i>CHAPTER TEN</i><br /> -EQUIPMENT AND LIBRARY</h2> -</div> - - - -<p>A hospital which wishes to use music as an adjunct to medical practice -must be willing to offer the space required for its activities. The -extent to which music will be needed will depend upon the nature of the -illnesses treated and the average stay of the patients. For mental and -tuberculosis hospitals, music is a “must.” The chronic hospital usually -has an assembly or recreation hall for musical performance. This hall -will generally be adequate for band rehearsals, and may also be used at -other hours of the day for instrumental practice. Where funds and space -can be spared, additional rehearsal rooms should be built so that more -patients will be able to participate. Space can be saved by building -small cubicles sound-proofed with any of the sound absorbing fabricated -wall boards such as <i>Celotex</i> or <i>Transite</i>. Cubicles should -be built with much glazing so that the patient will not feel the -smallness of the room. If there is only one music aide, there will be -an advantage in centralizing all music activities, but if more help is -available, music rehearsal rooms should be available in the different -pavilions or wings of the hospital so that newly convalescent patients -will not have to walk too far.</p> - -<p>If the age range of the patients runs the full gamut, seating and -instrumental provisions will have to include provisions for all. This -means adjustable piano benches, music stands, etc. Chairs should be -provided not only for musicians but spectators. Patients should be -encouraged to attend band and other group rehearsals<span class="pagenum" id="Page_111">[Pg 111]</span> as a method of -stimulating their interest in music and for the diversion which it will -afford. Music stands for the bands should be dressed up to resemble -those used by popular bands. These stands are colorful, collapsible, -and hence transportable for any outside performances which the patient -band may contract.</p> - - -<h3><span class="smcap">Instruments</span></h3> - -<p><em>Participation.</em> The number and nature of instruments which a -hospital should have will depend only upon budget limitations and the -interest of the community. There is no limit except storage space to -the number and variety of instruments which a hospital should accept -as gifts. Ideally there should be at least one of each of the major -instruments. Each instrument should have its own case, and it is wise -to engrave the hospital name on each instrument to minimize loss. The -initials of the hospital may be cut into an inconspicuous part of the -instrument such as the inside of the brass bell or the under side of -the wood body. All the instruments should be locked in cabinets when -not in use.</p> - -<p>In addition to regular band instruments, small instruments which can be -played in bed should be acquired. These can be divided into those of -normal construction such as the ukulele, mandolin, and autoharp and the -toneless instruments which can be made by removing the resonating body. -A toneless violin can be constructed from a donated violin in poor -condition by mounting the tailpiece, bridge, and fingering element on a -narrow strip of wood or plastic. A piece of rubber “kneeling” pad makes -a good practice drum head.</p> - -<p>For children toy instruments such as the Typatune, the toy-xylophone, -trumpet, maracas, etc. should be available.</p> - -<p><em>Listening.</em> A room should be designated as a “Music Listening -Room.” For economy of use this may be a multi-purpose room. It may be -a combination of the music aide’s office and musical<span class="pagenum" id="Page_112">[Pg 112]</span> library used at -selected hours of the day for both practice and listening. It should -contain an instrument for playing recordings. The choice of record -player should depend upon the sound produced by the instrument rather -than its name. The record player for the listening room should have an -automatic changer and wide tone control if possible. Because of the -excellence of many musical broadcasts a combination radio-record player -is most desirable.</p> - -<p>Portable record players are also desirable for the bedside listening -of those who request it. In hospitals not equipped with public address -systems, the portable record player can act as an excellent substitute -for it. If the player is mounted on a cart fitted with shelves for -records and albums, it can be wheeled from one ward to another for -daily musical periods. If the hospital has small-sized lantern slides -with words to songs imprinted (such as those supplied Service groups -during the war by the USO), a small slide projector should be added to -the music cart to be used on the darkened ward for ward songs.</p> - - -<h3><span class="smcap">The Music Library</span></h3> - -<p>The hospital music library may vary from a few recordings to a -composite collection of all forms of musical literature available. -General hospitals which treat all diseases and age groups will -require the most extensive and catholic varieties of all kinds of -music. Specialty hospitals can operate on a library tailored to their -individual needs. A hospital for the aged will not require too much -of contemporary popular music. For purposes of inclusiveness, the -ideal will be discussed in the hope that some hospitals will be able -to afford it and that others will be able to select those items which -become possible for them.</p> - -<p><em>Recordings.</em> The choice of recordings will be determined by the -usual hospital population. In building up the record library<span class="pagenum" id="Page_113">[Pg 113]</span> the music -aide should submit check lists to every patient in the hospital on any -one day. The list should include ten specific titles in each of six -categories: symphony, opera, operetta, folk-songs, old-time favorites, -and the currently popular songs. These should be carefully tabulated -and should be used to form the nucleus of the permanent collection. A -space should be left for patients to write in other pieces than those -named. Records should be purchased in the order of their numerically -recorded popularity. A collection should begin with one record per -hospital bed. This method of starting a library is very tedious but -well worth the effort, because only by determining the musical tastes -of patients can you give the majority the music they want. The musical -tastes of the patients will not vary significantly after a complete -turn-over in patient census, since most hospitals derive their patient -population from the same geographic area, and the tabulation of musical -desires arrived at in this manner will correspond satisfactorily with -the tastes of the same age group in the community. If the budget will -not permit an original collection of this size, it might be reduced to -half of that recommended, but that is a minimum.</p> - -<p>The collection should be built up at a rate of approximately one record -for every ten new patient admissions. The choice of additional records -should be on a request basis, but the proportion of the six categories -as originally determined should remain relatively constant to keep the -collection balanced.</p> - -<p>Whenever there is a choice of two or more recordings of the same piece, -the discs to choose are those which are played softly or sweetly so -that they are adaptable for the additional purpose of mealtime or -restful music.</p> - -<p>In the library of recordings there should be included albums of -records for special occasions and holidays. Patients look forward to -hearing Irish songs on <abbr title="saint">St.</abbr> Patrick’s Day and appropriate songs<span class="pagenum" id="Page_114">[Pg 114]</span> on -other holidays. To accompany religious services the albums prepared by -Bibletone are valuable. A glance through any standard record catalogue -will readily permit the music aide to assemble a suitable collection.</p> - -<p>The following is a list of records suggested for Easter Sunday and <abbr title="saint">St.</abbr> -Patrick’s Day.</p> -<table class="autotable"> -<tr> -<td colspan="2"> -Easter Recordings: -</td> -</tr> -<tr> -<td> - I Want a Bunny for Easter -</td> -<td class="tdr"> -Decca 18654 A -</td> -</tr> -<tr> -<td> - Easter Sunday With You -</td> -<td class="tdr">Decca 18591 B -</td> -</tr> -<tr> -<td> - Easter Parade -</td> -<td class="tdr">Decca 18425 B -</td> -</tr> -<tr> -<td> - Easter Sunday on the Prairie -</td> -<td class="tdr">Decca 18654 B -</td> -</tr> -<tr> -<td> - Chorale for Easter Cantata -</td> -<td class="tdr">Victor 15631 B -</td> -</tr> -<tr> -<td> - Requiem, by Gabriel Faure -</td> -<td class="tdr">Victor 18301, 2, 3, and 4 -</td> -</tr> -<tr> -<td colspan="2"> -</td> -</tr> -<tr> -<td colspan="2"> -<abbr title="saint">St.</abbr> Patrick’s Day: -</td> -</tr> -<tr> -<td> - Molly Brannigan -</td> -<td class="tdr">Columbia 35496 -</td> -</tr> -<tr> -<td> - That’s How I Spell Ireland -</td> -<td class="tdr">Columbia 35496 -</td> -</tr> -<tr> -<td> - Come Back to Erin -</td> -<td class="tdr">Victor 27770 B -</td> -</tr> -<tr> -<td> - Mother Machree -</td> -<td class="tdr">Victor 27772 A -</td> -</tr> -<tr> -<td> - Eileen -</td> -<td class="tdr">Columbia 36585 -</td> -</tr> -<tr> -<td> - A Little Bit of Heaven -</td> -<td class="tdr">Sonora 1069 B -</td> -</tr> -<tr> -<td> - You’re Irish and You’re Beautiful -</td> -<td class="tdr">Sonora 1068 A -</td> -</tr> -<tr> -<td> - Irish Lullaby -</td> -<td class="tdr">Decca 18621 A -</td> -</tr> -<tr> -<td> - Same Old Shellalagh -</td> -<td class="tdr">Columbia 354986 -</td> -</tr> -<tr> -<td> - Macushla -</td> -<td class="tdr">Victor 27770 A -</td> -</tr> -<tr> -<td> - I’ll Take You Home Again Kathleen -</td> -<td class="tdr">Sonora 1067 B -</td> -</tr> -<tr> -<td> - Little Town in Old County Down -</td> -<td class="tdr">Sonora 1070 B -</td> -</tr> -</table> - -<p>All recordings should be kept in their albums or jackets. Because -jackets have a way of getting lost or torn, there should be a stock of -unused jackets on hand. Each jacket should be labelled according to its -contents. In addition a cross-index catalogue file should be maintained -by the music aide for all records in the<span class="pagenum" id="Page_115">[Pg 115]</span> hospital collection. Three -cards should be filled out for each face of each record: one card for -composer, one for title, and one for performer. This seems like a lot -of work but is worth the effort because it is only in this manner that -a program can be rapidly assembled from the record library. Any filing -system will suffice, but if the collection is large, an elaborate -system will be found worth the effort. Cards of three different colors -may be used to separate classical, popular and miscellaneous. Tabs may -be placed on those cards which list music for occasions. Tabs in one -corner may refer to meal-time music and tabs in another holiday music, -etc.</p> - -<p>It is well to have the entire record collection in one room, and -shelves for holding records should be built of very heavy lumber -because recordings when closely packed are very heavy. It is best -to add records to shelves with continuous accession numbers in each -category and to rely on the file for alphabetic listing. If there -are duplicates, they can form the nucleus for a second or lending -library. Broken, cracked, or defective discs should be placed in a -separate section of the shelves for replacement when budget permits and -popularity demands.</p> - -<p><em>Instantaneous Recordings.</em> A few hospitals will have the good -fortune to acquire a record-cutter for hospital recording of radio -music. When this is possible, the record collection can be augmented -most satisfactorily. The music aide should study all radio programs -to determine the hours during which the best performances of desired -music are played. By listening to several carefully selected programs -each week he will soon discover which programs use music employed in a -manner most desirable for hospital reproduction. The orchestrations of -Kostelanetz and Lombardo are especially suitable for easy listening in -the field of popular music. The broadcasts of the Metropolitan Opera -Association include passages not commercially recorded or at least not<span class="pagenum" id="Page_116">[Pg 116]</span> -recorded with the most popular singers. There are many other radio -features which are worth recording for the hospital record library.</p> - -<p>It is relatively easy to operate a record-cutter, but there are many -minor details which must be known for maximum efficiency. An excellent -book for beginners is that published by the Audak Company of New York, -<i>How to Make Good Recordings</i>.</p> - -<p><em>Sheet Music.</em> A library of sheet music will once more depend upon -the local needs. It may include orchestral, instrumental, vocal, and -band music. In the hospital for the chronically ill, a large number of -varieties will be needed. Inasmuch as the simplest group performance -will be vocal, music for group singing should head the list. The music -should include old-time favorites, hymns, spirituals and any other -items which the aide can determine from the intellectual and musical -qualifications and desires of the patients. This type of music can be -purchased individually and increased according to the interest shown.</p> - -<p>If there is a patient band, the musical scores should include a few -marches which may be used at the beginning and end of its concerts. -The perennial favorites most desirable for community singing should -constitute a major portion of the orchestral literature. The readily -available medleys of Victor Herbert melodies and similar stand-bys can -complete the initial group.</p> - -<p>Sheet music should be catalogued and filed in cabinets. A simple system -of shelving consists of grouping music according to use: one shelf -for group playing, one for solo and beginners instrumental books, and -another for vocal selections. The numbers most commonly and currently -used by the band can be placed in folders according to the accepted -usage among bands, and if there are daily rehearsals they can remain on -the band stands at all times.</p> - -<p>The library should also contain books, printed forms, or mimeographed<span class="pagenum" id="Page_117">[Pg 117]</span> -collections of songs for distribution to patients during community -singing.</p> - -<p><em>Books About Music.</em> The average hospital library will have -relatively few books about musical appreciation or history. This will -depend first on the budget and second on the demand. The addition of a -music aide to a hospital staff will usually increase the demand. The -music aide should be consulted concerning the books he thinks will -appeal to patients. Books on music should also be available to help -the music aide in preparing commentaries on the music he plays for the -patients.</p> - -<p>The following are some books suggested for inclusion in the hospital -patient library:</p> - -<ul class="index"> -<li class="isuba">Copland, Aaron—<i>What to Listen for in Music</i>, 1939.</li> -<li class="isuba">Goss, Madeline—<i>Unfinished Symphony</i>, 1941.</li> -<li class="isuba"> -Elson, Arthur—<i>Music Club Programs From All Nations</i>.</li> -<li class="isuba"> -Erskine, John—<i>What Is Music</i>, 1944.</li> -<li class="isuba"> -Ewen, David—<i>Tales From The Vienna Woods</i>, 1944.</li> -<li class="isuba"> -Ewen, David—<i>Gershwin’s Life</i>, 1944.</li> -<li class="isuba"> -Ewen, David—<i>Men of Popular Music</i>, 1944.</li> -<li class="isuba"> -Gronowicz, Antoni—<i>Chopin</i>, 1943.</li> -<li class="isuba"> -O’Connell, Charles—<i>Victor Book of Opera</i>, 1936.</li> -<li class="isuba"> -Taylor, Deems—<i>Of Men and Music</i>, 1945.</li> -<li class="isuba"> -Taylor, Deems—<i>The Well Tempered Listener</i>, 1944.</li> -<li class="isuba"> -Siegmeister, Elie—<i>Music Lover’s Handbook</i>, 1943.</li> -<li class="isuba"> -Spaeth, Sigmund—<i>At Home With Music</i>, 1945.</li> -</ul> - -<p>For young patients there are the new series of colorfully illustrated -lives of composers from Bach to Gershwin by Waldo Mayo, as well as a -great number of old and good titles.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_118">[Pg 118]</span></p> - -<h2 class="nobreak" id="CHAPTER_ELEVEN"><i>CHAPTER ELEVEN</i><br /> -DIRECTION</h2> -</div> - - - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_119">[Pg 119]</span> specialization and a paid, trained -musician will usually be worth the salary in efficiency, dependability, -and control.</p> - - -<h3><span class="smcap">Director</span></h3> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_120">[Pg 120]</span> desired but should -observe the musician at work with patients.</p> - - -<h3><span class="smcap">Music Aide</span></h3> - -<p>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.</p> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_121">[Pg 121]</span> singing and be able to play -an instrument. Ability to play a second instrument, or to teach it is a -valuable asset.</p> - -<p>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.</p> - -<p>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.</p> - -<p>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.</p> - -<p>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,<span class="pagenum" id="Page_122">[Pg 122]</span> 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.</p> - -<p>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.</p> - - -<h3><span class="smcap">Training</span></h3> - -<p>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.</p> - -<p><span class="pagenum" id="Page_123">[Pg 123]</span></p> - -<p>Applicants should be interviewed by a representative of both the -medical and music schools. A projected curriculum is suggested as -follows:</p> -<table class="autotable"> -<tr> -<td colspan="2" class="tdc"> -<i>First Year</i> -</td> -</tr> -<tr> -<td> -Piano -</td> -<td class="tdr"> -8 Credits -</td> -</tr> -<tr> -<td>Solfège -</td> -<td class="tdr">5 Credits -</td> -</tr> -<tr> -<td>Counterpoint -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>Harmony -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>English -</td> -<td class="tdr">6 Credits -</td> -</tr> -<tr> -<td>History of Medicine -</td> -<td class="tdr">1 Credit -</td> -</tr> -<tr> -<td colspan="2" class="tdc"> -<i>Second Year</i> -</td> -</tr> -<tr> -<td>Piano -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Solfège -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>Harmony -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>Counterpoint -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>History of Music -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Nursing anatomy -</td> -<td class="tdr">6 Credits -</td> -</tr> -<tr> -<td colspan="2" class="tdc"> -<i>Third Year</i> -</td> -</tr> -<tr> -<td>Violin -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Harmony -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Musical Form -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Physics -</td> -<td class="tdr">6 Credits -</td> -</tr> -<tr> -<td>Physiology -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>Kinesiology -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>Psychology -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Conducting -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>Piano Sight Playing -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Ensemble -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td colspan="2" class="tdc"> -<i>Fourth Year</i> -</td> -</tr> -<tr> -<td>Violin -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Choral Class -</td> -<td class="tdr">0 Credits -</td> -</tr> -<tr> -<td>Conducting -</td> -<td class="tdr">2 Credits -</td> -</tr> -<tr> -<td>Contemporary Music -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Occupational Therapy -</td> -<td class="tdr">4 Credits -</td> -</tr> -<tr> -<td>Music in Medicine -</td> -<td class="tdr">6 Credits -</td> -</tr> -<tr> -<td>Abnormal Psychology -</td> -<td class="tdr">6 Credits -</td> -</tr> -<tr> -<td>Orchestra Reading -</td> -<td class="tdr">2 Credits -</td> -</tr> -</table> - -<p>A brief explanation of courses not normally found at music schools and -which should be given at medical or professional schools follows.</p> - -<p><span class="pagenum" id="Page_124">[Pg 124]</span></p> - -<p><i>Anatomy for Nurses.</i> 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.</p> - -<p><i>History of Medicine.</i> This would be an orientation course on the -development of medicine and hospitals.</p> - -<p><i>Physiology.</i> Especial attention should be drawn to the physiology -of the nervous system and the muscles.</p> - -<p><i>Psychology.</i> Normal psychology, including laboratory -experimentation in the psychology of music, would be the basis of this -course.</p> - -<p><i>Kinesiology.</i> The standard course as taught in schools of -physical and occupational therapy, and physical education, would be -sufficient.</p> - -<p><i>Occupational Therapy.</i> An introduction into craft analysis and -psychiatric occupational therapy is necessary.</p> - -<p><i>Abnormal Psychology.</i> An introduction to psychiatry is sufficient.</p> - -<p><i>Music in Medicine.</i> A course of lectures, including the subjects -discussed in this volume, should be offered.</p> - -<p>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.</p> - -<p>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.</p> - -<p><span class="pagenum" id="Page_125">[Pg 125]</span></p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_128">[Pg 128]</span></p> -<h2 class="nobreak" id="BIBLIOGRAPHY">BIBLIOGRAPHY</h2> -</div> - -<p class="footnote" id="fn1"><a href="#fna1">[1]</a> Albrecht, W., De effect. mus., Sect. 314, <i>in Roger, J. L.</i></p> - -<p class="footnote" id="fn2"><a href="#fna2">[2]</a> Altschuler, I., <i><abbr title="Occupational">Occ.</abbr> <abbr title="therapy">Ther.</abbr> <abbr title="rehabilitation">Rehab.</abbr></i>, 1941, 20:75.</p> - -<p class="footnote" id="fn3"><a href="#fna3">[3]</a> Altschuler, I., <i><abbr title="proceedings">Proc.</abbr> <abbr title="music">Mus.</abbr> <abbr title="teachers national association">Teach. Nat. Assoc.</abbr></i>, 1944, <abbr title="page">p.</abbr> 154.</p> - -<p class="footnote" id="fn4"><a href="#fna4">[4]</a> Altschuler, I., and Shebesta, B., <i><abbr title="journal">Journ.</abbr> <abbr title="nervous mental disorders">Nerv. Ment. Dis.</abbr></i> -1941, 94:179.</p> - -<p class="footnote" id="fn5"><a href="#fna5">[5]</a> Ayers, I., <i><abbr title="American">Am.</abbr> <abbr title="physical education">Phys. Ed</abbr> <abbr title="review">Rev.</abbr></i>, 1912, 16:321.</p> - -<p class="footnote" id="fn6"><a href="#Barker">[6]</a> Barker, L., <i>Psychotherapy</i>, New York, 1940.</p> - -<p class="footnote" id="fn7"><a href="#fna7">[7]</a> Bauer, M., and Peyser, E., <i>Music Through the Ages</i>, New York, -1932.</p> - -<p class="footnote" id="fn8"><a href="#fna8">[8]</a> Beaunis, B., <span xml:lang="fr" lang="fr">“L’Emotion Musicale”</span>, <i><abbr title="review">Rev.</abbr> Phil.</i>, 1918, 86:353.</p> - -<p class="footnote" id="fn9"><a href="#fna9">[9]</a> Beckett, W., <i>Music in War Plants</i>, Washington, 1943.</p> - -<p class="footnote" id="fn10"><a href="#fna10">[10]</a> Bissell, A. D., The Role of Expectation in Music, New Haven, 1921.</p> - -<p class="footnote" id="fn11"><a href="#fna11">[11]</a> Boerhaave, H., <span xml:lang="la" lang="la">Impetum Faciens</span>, <i>in Roger, J. L.</i></p> - -<p class="footnote" id="fn12"><a href="#fna12">[12]</a> Bowers, C. 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Method</i>, 1911, 8:348.</p> - -<p class="footnote" id="fn27"><a href="#fna27">[27]</a> Dupre, E., and Nathan, M., <i xml:lang="fr" lang="fr">Le Language Musical</i>, Paris, 1911.</p> - -<p class="footnote" id="fn28"><a href="#fna28">[28]</a> Eastcott, Richard, Sketches of the Origin, Progress and Effects of -Music, Bath, 1748.</p> - -<p class="footnote" id="fn29"><a href="#fna29">[29]</a> Eby, J., <i><abbr title="occupational">Occ.</abbr> <abbr title="therapy">Ther.</abbr> <abbr title="rehabilitation">Rehab.</abbr></i>, 1943, 22:31.</p> - -<p class="footnote" id="fn30"><a href="#fna30">[30]</a> Galton, F., Inquiries Into Human Faculty and Its Development, -London, 1883.</p> - -<p class="footnote" id="fn31"><a href="#fna31">[31]</a> Gaston, E., <i>Music <abbr title="education">Educ.</abbr></i>, 1945, 31:24.</p> - -<p class="footnote" id="fn32"><a href="#fna32">[32]</a> Gatewood, E., <i><abbr title="American">Am.</abbr> <abbr title="journal">J.</abbr> Surg.</i>, 1921, 35:47.</p> - -<p class="footnote" id="fn33"><a href="#fna33">[33]</a> Gatewood, E., <i><abbr title="journal">J.</abbr> App. <abbr title="Psychology">Psychol.</abbr></i>, 1921, 5:350.</p> - -<p class="footnote" id="fn34"><a href="#fna34">[34]</a> Gehring, A., <i>Basis of Musical Pleasure</i>, New York, 1910.</p> - -<p class="footnote" id="fn35"><a href="#fna35">[35]</a> Gilman, B., Report on an Experimental Test of Musical -Expressiveness, <i>Amer. <abbr title="journal">J.</abbr> <abbr title="Psychology">Psychol.</abbr></i>, 1892, 4:42.</p> - -<p class="footnote" id="fn36"><a href="#fna36">[36]</a> Gray, C., Contingencies, <i>The Music Review</i>, Nov. 1944.</p> - -<p class="footnote" id="fn37"><a href="#fna37">[37]</a> Gruner, O. C., <i>The Canon of Medicine of Avicenna</i>, London, -1930.</p> - -<p class="footnote" id="fn38"><a href="#fna38">[38]</a> Gundlach, R., An Analysis of Some Musical Factors Determining the -Mood Characteristics of Music, <i><abbr title="Psychology">Psychol.</abbr> Bull.</i>, 1934, 31:592.</p> - -<p class="footnote" id="fn39"><a href="#fna39">[39]</a> Gundlach, R., A Quantitave Analysis of Indian Music, <i><abbr title="American">Am.</abbr> <abbr title="journal">J.</abbr> -<abbr title="Psychology">Psychol.</abbr></i>, 1932, 44:133.</p> - -<p class="footnote" id="fn40"><a href="#fna40">[40]</a> Gurney, E., <i>The Power of Sound</i>, London, 1880.</p> - -<p class="footnote" id="fn41"><a href="#fna41">[41]</a> Hanson, H., Some Objective Studies of Rhythm in Music, <i><abbr title="American">Am.</abbr> <abbr title="journal">J.</abbr> -Psychiatry</i>, Nov. 1944, 101:364.</p> - -<p class="footnote" id="fn42"><a href="#fna42">[42]</a> Hanson, H., Musician’s Point of View Toward Emotional Expression, -<i><abbr title="American">Am.</abbr> <abbr title="journal">J.</abbr> Psychiatry</i>, Nov. 1942, 99:317.</p> - -<p class="footnote" id="fn43"><a href="#fna43">[43]</a> Harrington, A., <abbr title="mental hygiene">Ment. Hyg.</abbr>, 1939, 23:601.</p> - -<p class="footnote" id="fn44"><a href="#fna44">[44]</a> Hauptman, M., <span xml:lang="de" lang="de">Die Natur de Harmonik</span>, <i>in Helmholtz, H. L. F.</i></p> - -<p class="footnote" id="fn45"><a href="#fna45">[45]</a> Heinlein, C. P., The Affective Characters of the Major and Minor -Mode in Music, <i><abbr title="journal">J.</abbr> Comp. <abbr title="Psychology">Psychol.</abbr></i>, 1928, 8:101.</p> - -<p class="footnote" id="fn46"><a href="#fna46">[46]</a> Helmholtz, H. L. F., <i>The Sensations of Tone</i>, London, 1875.</p> - -<p class="footnote" id="fn47"><a href="#fna47">[47]</a> Hevner, K., The Affective Character of the Major and Minor Modes -in Music, <i><abbr title="American">Am.</abbr> <abbr title="journal">J.</abbr> <abbr title="Psychology">Psychol.</abbr></i>, 1935, 47:103.</p> - -<p class="footnote" id="fn48"><a href="#fna48">[48]</a> Hevner, K., The Affective Value of Pitch and Tempo in Music, -<i>Amer. <abbr title="journal">J.</abbr> <abbr title="Psychology">Psychol.</abbr></i>, 1937, 49:621.</p> - -<p class="footnote" id="fn49"><a href="#fna49">[49]</a> Hulbert, H., <i>Eurthym.</i>, London, 1921.</p> - -<p class="footnote" id="fn50"><a href="#fna50">[50]</a> Jacobson, E., Electrophysiology of Mental Activities, <i><abbr title="American">Am.</abbr> <abbr title="journal">J.</abbr> -<abbr title="Psychology">Psychol.</abbr></i>, 1932, 44:677.</p> - -<p class="footnote" id="fn51"><a href="#fna51">[51]</a> Johnson, M., <i><abbr title="national education association">Nat. Ed. Ass.</abbr> <abbr title="journal">Journ.</abbr></i>, 1905, 45:940.</p> - -<p class="footnote" id="fn52"><a href="#fna52">[52]</a> Kawarski, T., and Odbert, H., Color Music, <i><abbr title="Psychology">Psychol.</abbr> -Monographs</i>, 1938, no. 50.</p> - -<p class="footnote" id="fn53"><a href="#fna53">[53]</a> Kirschner, M., <span xml:lang="de" lang="de">Musik und Operation</span>, <i>Der Chirurg</i>, 1936, -11:429.</p> - -<p class="footnote" id="fn54"><a href="#fna54">[54]</a> Kraines, S., <i>The Therapy of Neuroses and Psychoses</i>, <abbr title="Philadelphia">Phila.</abbr>, -1943.</p> - -<p class="footnote" id="fn55"><a href="#fna55">[55]</a> Lee, V., <i>Music and Its Lovers</i>, London, 1930.</p> - -<p class="footnote" id="fn56"><a href="#fna56">[56]</a> Levine, M., <i>Psychotherapy in Medical Practice</i>, New York, -1942.</p> - -<p class="footnote" id="fn57"><a href="#fna57">[57]</a> Ligeros, K. A., <i>How Ancient Healing Governs Modern -Therapeutics</i>, New York, 1937.</p> - -<p class="footnote" id="fn58"><a href="#fna58">[58]</a> Meibomius, M., <i xml:lang="la" lang="la">Antiquae Musicae Auctores</i>, Lib. IX, -Amstelodami, 1652.</p> - -<p class="footnote" id="fn59"><a href="#fna59">[59]</a> Mueller, J., and Hevner, K., Trends in Musical Taste, <i>Indiana -U. Public.</i>, 1942, no. 8.</p> - -<p class="footnote" id="fn60"><a href="#fna60">[60]</a> Mursell, J. L., <i>Psychology of Music</i>, New York, 1937.</p> - -<p class="footnote" id="fn61"><a href="#fna61">[61]</a> Nollet, J. A., <i xml:lang="fr" lang="fr">Recherches sur les Causes Particulieres des -Phenomènes Electriques</i>, Paris, 1749, <abbr title="page">p.</abbr> 33.</p> - -<p class="footnote" id="fn62"><a href="#fna62">[62]</a> Noyes, A. P., <i>Modern Clinical Psychiatry</i>, <abbr title="Philadelphia">Phila.</abbr>, 1944.</p> - -<p class="footnote" id="fn63"><a href="#fna63">[63]</a> <i>The Old Testament</i>, I Samuel, <abbr title="chapter">Chap.</abbr> 16, verse 23.</p> - -<p class="footnote" id="fn64"><a href="#fna64">[64]</a> Ortmann, Otto, <i>The Physiologic Mechanics of Piano -Technique</i>, London, 1929.</p> - -<p class="footnote" id="fn65"><a href="#fna65">[65]</a> Pearson, Hesketh, <i>G. B. S.</i>, New York, 1942.</p> - -<p class="footnote" id="fn66"><a href="#fna66">[66]</a> Pierce, A., <i><abbr title="medical">Med.</abbr> Bull. <abbr title="veteran's administration">Vet. Adm.</abbr></i>, 1934, 21:142.</p> - -<p class="footnote" id="fn67"><a href="#fna67">[67]</a> Porta, J. B., <span xml:lang="la" lang="la">Magia natural.</span>, <i>in Roger, J. L.</i></p> - -<p class="footnote" id="fn68"><a href="#fna68">[68]</a> Rameau, J. P., <i xml:lang="fr" lang="fr">Traité de l’harmonie</i>, Paris, 1722.</p> - -<p class="footnote" id="fn69"><a href="#fna69">[69]</a> Reade, W., African Sketch Book, <i>in Diserens.</i></p> - -<p class="footnote" id="fn70"><a href="#fna70">[70]</a> Roger, J. L., <i xml:lang="fr" lang="fr">Effects de le Musique</i>, Paris, 1803.</p> - -<p class="footnote" id="fn71"><a href="#fna71">[71]</a> Schoen, M., <i>The Effects of Music</i>, London, 1927.</p> - -<p class="footnote" id="fn72"><a href="#fna72">[72]</a> Schoen, M., <i>The Psychology of Music</i>, New York, 1940.</p> - -<p class="footnote" id="fn73"><a href="#fna73">[73]</a> Seashore, K., <i>Psychology of Music</i>, New York, 1938.</p> - -<p class="footnote" id="fn74"><a href="#fna74">[74]</a> Tarchanoff, I, <i xml:lang="it" lang="it">Arch. Italien de Biol.</i>, 26:313.</p> - -<p class="footnote" id="fn75"><a href="#fna75">[75]</a> Thorndike, L., <i>A History of Magic</i>, <abbr title="volume">vol.</abbr> 2, New York, 1923.</p> - -<p class="footnote" id="fn76"><a href="#fna76">[76]</a> Valentine, C., The Aesthetic Appreciation of Musical Intervals -Among Children and Adults, <i><abbr title="British">Brit.</abbr> <abbr title="journal">J.</abbr> <abbr title="Psychology">Psychol.</abbr></i>, 1944, 6:190.</p> - -<p class="footnote" id="fn77"><a href="#fna77">[77]</a> Vernon, P. E., Auditory Perception, <i><abbr title="British">Brit.</abbr> <abbr title="journal">J.</abbr> <abbr title="Psychology">Psychol.</abbr></i>, -1934, 25:123.</p> - -<p class="footnote" id="fn78"><a href="#fna78">[78]</a> Vescelius, E., <i>Music and Health</i>, New York, 1927.</p> - -<p class="footnote" id="fn79"><a href="#fna79">[79]</a> Wallaschek, R., <i>Primitive Music</i>, London, 1893.</p> - -<p class="footnote" id="fn80"><a href="#fna80">[80]</a> Wedge, G., <i>Keyboard Harmony</i>, New York, 1924.</p> - -<p><span class="pagenum" id="Page_129">[Pg 129]</span></p> - -<p class="footnote" id="fn81"><a href="#fna81">[81]</a> Willis, T., <i xml:lang="la" lang="la">Cerebri Anatome Nervorumque</i>, cap. XVII, -Amstelodami, 1664.</p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h2 class="nobreak" id="INDEX">INDEX</h2> -</div> - - -<ul class="index p2"> -<li class="ifrst">Aesclepiades, <a href="#Page_6">6</a></li> - -<li class="ifrst">Aide, duties of, <a href="#Page_xvii">xvii</a>, <a href="#Page_121">121</a></li> - -<li class="ifrst">Aide, qualifications of, <a href="#Page_xvi">xvi</a>, <a href="#Page_120">120</a></li> - -<li class="ifrst">Albrecht, Wilhelm, <a href="#Page_11">11</a></li> - -<li class="ifrst">Alcoholic psychosis, <a href="#Page_63">63</a></li> - -<li class="ifrst">Altschuler, I., <a href="#Page_60">60</a>, <a href="#Page_66">66</a>, <a href="#Page_68">68</a>, <a href="#Page_69">69</a></li> - -<li class="ifrst">Amateur shows, <a href="#Page_101">101</a></li> - -<li class="ifrst">Amphion, <a href="#Page_2">2</a></li> - -<li class="ifrst">Analysis, instrumental, <a href="#Page_57">57</a></li> - -<li class="ifrst">Anesthesia, use with, <a href="#Page_75">75</a></li> - -<li class="ifrst">Ankle exercise, <a href="#Page_54">54</a></li> - -<li class="ifrst">Appetite, musical, <a href="#Page_42">42</a></li> - -<li class="ifrst">Apollo, <a href="#Page_xi">xi</a></li> - -<li class="ifrst">Aquinas, <abbr title="saint">St.</abbr> Thomas, <a href="#Page_42">42</a></li> - -<li class="ifrst">Areteus, <a href="#Page_8">8</a></li> - -<li class="ifrst">Aristotle, <a href="#Page_xi">xi</a></li> - -<li class="ifrst">Armstrong, John, <a href="#Page_1">1</a></li> - -<li class="ifrst">Arteriosclerotic psychosis, <a href="#Page_64">64</a></li> - -<li class="ifrst">Atheneus, <a href="#Page_6">6</a></li> - -<li class="ifrst">Aurelianus, <a href="#Page_6">6</a></li> - -<li class="ifrst">Avicenna, <a href="#Page_74">74</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Background music, <a href="#Page_73">73</a></li> - -<li class="ifrst">Bacon, <a href="#Page_8">8</a></li> - -<li class="ifrst">Band, patient, <a href="#Page_70">70</a></li> - -<li class="ifrst">Beacham, H., <a href="#Page_9">9</a></li> - -<li class="ifrst">Beaunis, B., <a href="#Page_17">17</a></li> - -<li class="ifrst">Beckett, W., <a href="#Page_79">79</a></li> - -<li class="ifrst">Bedside instruction, <a href="#Page_95">95</a></li> - -<li class="ifrst">Beethoven, L., <a href="#Page_29">29</a></li> - -<li class="ifrst">Bites, treatment of animal, <a href="#Page_7">7</a></li> - -<li class="ifrst">Boerhaave, H., <a href="#Page_8">8</a></li> - -<li class="ifrst">Books about music, <a href="#Page_117">117</a></li> - -<li class="ifrst">Brocklesby, R., <a href="#Page_12">12</a></li> - -<li class="ifrst">Bücher, K., <a href="#Page_19">19</a></li> - -<li class="ifrst">Butler, Nicholas M., <a href="#Page_xii">xii</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Calisthenics, music for, <a href="#Page_76">76</a></li> - -<li class="ifrst">Capella, M., <a href="#Page_6">6</a></li> - -<li class="ifrst">Carle, F., <a href="#Page_86">86</a></li> - -<li class="ifrst">Cart, music, <a href="#Page_94">94</a>, <a href="#Page_112">112</a></li> - -<li class="ifrst">Catatonic schizophrenia, <a href="#Page_66">66</a></li> - -<li class="ifrst">Cato, <a href="#Page_5">5</a></li> - -<li class="ifrst">Cavallero, C., <a href="#Page_86">86</a></li> - -<li class="ifrst">Celsus, A. C., <a href="#Page_xii">xii</a>, <a href="#Page_8">8</a></li> - -<li class="ifrst">Champlain, S., <a href="#Page_11">11</a></li> - -<li class="ifrst">Chateaubriand, <a href="#Page_2">2</a></li> - -<li class="ifrst">Children, music for, <a href="#Page_90">90</a></li> - -<li class="ifrst">Chiron, <a href="#Page_5">5</a></li> - -<li class="ifrst">Chomet, Hector, <a href="#Page_xix">xix</a>, <a href="#Page_12">12</a></li> - -<li class="ifrst">Chopin, F. F., <a href="#Page_30">30</a></li> - -<li class="ifrst">Chronically ill, music for, <a href="#Page_98">98</a></li> - -<li class="ifrst">Color in sound, <a href="#Page_28">28</a></li> - -<li class="ifrst">Community sing, <a href="#Page_69">69</a>, <a href="#Page_101">101</a></li> - -<li class="ifrst">Confucius, <a href="#Page_5">5</a></li> - -<li class="ifrst">Counter-irritation, <a href="#Page_74">74</a></li> - -<li class="ifrst">Criteria of therapy, <a href="#Page_xiii">xiii</a>, <a href="#Page_61">61</a></li> - -<li class="ifrst">Crosby, Bing, <a href="#Page_18">18</a>, <a href="#Page_91">91</a></li> - -<li class="ifrst">Curriculum for aides, <a href="#Page_123">123</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Dalcroze, J., <a href="#Page_76">76</a></li> - -<li class="ifrst">Damon, K. F., <a href="#Page_28">28</a></li> - -<li class="ifrst">Dancing as exercise, <a href="#Page_78">78</a></li> - -<li class="ifrst">David’s Harp, <a href="#Page_xi">xi</a>, <a href="#Page_5">5</a></li> - -<li class="ifrst">De Marian, <a href="#Page_28">28</a></li> - -<li class="ifrst">Democritus, <a href="#Page_11">11</a></li> - -<li class="ifrst">Densmore, F., <a href="#Page_3">3</a></li> - -<li class="ifrst">Dentistry, music in, <a href="#Page_75">75</a></li> - -<li class="ifrst">Desault, P., <a href="#Page_7">7</a></li> - -<li class="ifrst">Direction of hospital music, <a href="#Page_118">118</a></li> - -<li class="ifrst">Diserens, C. M., <a href="#Page_42">42</a></li> - -<li class="ifrst">Dorian mode, <a href="#Page_xi">xi</a></li> - -<li class="ifrst">Duchin, E., <a href="#Page_84">84</a>, <a href="#Page_86">86</a></li> - -<li class="ifrst">Duration, effect of, <a href="#Page_18">18</a></li> - -<li class="ifrst">Dunlap, K., <a href="#Page_19">19</a></li> - -</ul> -<ul class="index p2"> -<li class="ifrst">Easter music recordings, <a href="#Page_114">114</a></li> - -<li class="ifrst">Eby, Julia, <a href="#Page_67">67</a></li> - -<li class="ifrst">Egyptian use of music, <a href="#Page_4">4</a></li> - -<li class="ifrst">Emotional response to music, <a href="#Page_32">32</a><span class="pagenum" id="Page_130">[Pg 130]</span></li> - -<li class="ifrst">Enjoyment of music, <a href="#Page_32">32</a>, <a href="#Page_39">39</a></li> - -<li class="ifrst">Epilepsy, music in, <a href="#Page_8">8</a>, <a href="#Page_11">11</a></li> - -<li class="ifrst">Eurhythmics, <a href="#Page_77">77</a></li> - -<li class="ifrst">Exercise, effect of music on, <a href="#Page_75">75</a></li> - -<li class="ifrst">Exercise through music, <a href="#Page_50">50</a></li> - -<li class="ifrst">Expectation, role of, <a href="#Page_27">27</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Factory, use of music in, <a href="#Page_79">79</a></li> - -<li class="ifrst">Faith, Percy, <a href="#Page_86">86</a></li> - -<li class="ifrst">Farinelli and Philip V, <a href="#Page_10">10</a></li> - -<li class="ifrst">Fatigue, effect on, <a href="#Page_76">76</a></li> - -<li class="ifrst">Flute, the magic, <a href="#Page_11">11</a></li> - -<li class="ifrst">Functional Occupational Therapy, <a href="#Page_45">45</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Galen, <a href="#Page_7">7</a></li> - -<li class="ifrst">Gaston, E., <a href="#Page_59">59</a></li> - -<li class="ifrst">Gatewood, E., <a href="#Page_79">79</a></li> - -<li class="ifrst">Gehring, A., <a href="#Page_28">28</a></li> - -<li class="ifrst">Gellius, A., <a href="#Page_6">6</a></li> - -<li class="ifrst">General paresis, <a href="#Page_63">63</a></li> - -<li class="ifrst">Gilman, B., <a href="#Page_30">30</a></li> - -<li class="ifrst">Goldman, Edwin Franko, <a href="#Page_31">31</a></li> - -<li class="ifrst">Good music, <a href="#Page_38">38</a></li> - -<li class="ifrst">Grosseteste, R., <a href="#Page_8">8</a></li> - -<li class="ifrst">Group singing, <a href="#Page_69">69</a>, <a href="#Page_101">101</a></li> - -<li class="ifrst">Gundlach, R., <a href="#Page_18">18</a>, <a href="#Page_26">26</a>, <a href="#Page_34">34</a></li> - -<li class="ifrst">Gurney, E., <a href="#Page_21">21</a>, <a href="#Page_25">25</a>, <a href="#Page_31">31</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Hanson, Howard, <a href="#Page_26">26</a>, <a href="#Page_27">27</a></li> - -<li class="ifrst">Harrington, A., <a href="#Page_69">69</a></li> - -<li class="ifrst">Hauptmann, M., <a href="#Page_20">20</a></li> - -<li class="ifrst">Head-phones vs. loud-speakers, <a href="#Page_93">93</a></li> - -<li class="ifrst">Hebrew use of music, <a href="#Page_xi">xi</a>, <a href="#Page_5">5</a></li> - -<li class="ifrst">Heinlein, C. P., <a href="#Page_17">17</a>, <a href="#Page_22">22</a></li> - -<li class="ifrst">Helmholtz, H. L. F., <a href="#Page_20">20</a></li> - -<li class="ifrst">Hevner, K., <a href="#Page_22">22</a></li> - -<li class="ifrst">Homer, <a href="#Page_5">5</a></li> - -<li class="ifrst">Hulbert, H., <a href="#Page_77">77</a></li> - -<li class="ifrst">Hydrotherapy, music and, <a href="#Page_66">66</a></li> - -<li class="ifrst">Hysteria, <a href="#Page_68">68</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Imaginal response to music, <a href="#Page_37">37</a></li> - -<li class="ifrst">Indian, American, <a href="#Page_2">2</a>, <a href="#Page_34">34</a></li> - -<li class="ifrst">Industrial music, <a href="#Page_79">79</a></li> - -<li class="ifrst">Instantaneous recordings, <a href="#Page_106">106</a></li> - -<li class="ifrst">Instrumental analysis, <a href="#Page_57">57</a></li> - -<li class="ifrst">Instrumental instruction, <a href="#Page_103">103</a></li> - -<li class="ifrst">Iriquois practice, <a href="#Page_3">3</a></li> - -<li class="ifrst">Intensity, effect of, <a href="#Page_17">17</a>, <a href="#Page_22">22</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Jacobson, E., <a href="#Page_19">19</a></li> - -<li class="ifrst">Jaw fracture, music in, <a href="#Page_58">58</a></li> - -<li class="ifrst">Jerrold, D., <a href="#Page_86">86</a></li> - -<li class="ifrst">Johnson, M., <a href="#Page_77">77</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Karwarski, T., <a href="#Page_28">28</a></li> - -<li class="ifrst">Key, effect of, <a href="#Page_23">23</a></li> - -<li class="ifrst">Kostelanetz, A., <a href="#Page_86">86</a></li> - -<li class="ifrst">Kraines, S., <a href="#Page_69">69</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Lacedemonian music, <a href="#Page_5">5</a></li> - -<li class="ifrst">Lantern slide preparation, <a href="#Page_102">102</a></li> - -<li class="ifrst">Levine, M., <a href="#Page_69">69</a></li> - -<li class="ifrst">Library of music, <a href="#Page_116">116</a></li> - -<li class="ifrst">Listening to music, <a href="#Page_36">36</a></li> - -<li class="ifrst">Live music, <a href="#Page_34">34</a>, <a href="#Page_96">96</a>, <a href="#Page_99">99</a></li> - -<li class="ifrst"><i xml:lang="la" lang="la">Loca dolentia decantare</i>, <a href="#Page_6">6</a></li> - -<li class="ifrst">Lombardo, Guy, <a href="#Page_86">86</a></li> - -<li class="ifrst">Lower extremity exercises, <a href="#Page_53">53</a></li> - -<li class="ifrst">Luther, Martin, <a href="#Page_3">3</a></li> - -<li class="ifrst">Lydian mode, <a href="#Page_xi">xi</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Manic-depressive psychosis, <a href="#Page_64">64</a></li> - -<li class="ifrst">Mealtime music, <a href="#Page_82">82</a></li> - -<li class="ifrst">Medical direction, <a href="#Page_119">119</a></li> - -<li class="ifrst">Medicine man, <a href="#Page_3">3</a>, <a href="#Page_4">4</a></li> - -<li class="ifrst">Melancholy, involutional, <a href="#Page_64">64</a></li> - -<li class="ifrst">Melody, effect of, <a href="#Page_19">19</a></li> - -<li class="ifrst">Mendelssohn, F., <a href="#Page_30">30</a></li> - -<li class="ifrst">Mental deficiency, <a href="#Page_71">71</a></li> - -<li class="ifrst">Mental disease, <a href="#Page_9">9</a></li> - -<li class="ifrst">Mental disease classification, <a href="#Page_62">62</a></li> - -<li class="ifrst">Mode, effect of, <a href="#Page_20">20</a></li> - -<li class="ifrst">Mood effects, <a href="#Page_17">17</a>, <a href="#Page_22">22</a>, <a href="#Page_32">32</a>, <a href="#Page_40">40</a></li> - -<li class="ifrst">Morale, effect on, <a href="#Page_7">7</a></li> - -<li class="ifrst">Mozart, W., <a href="#Page_11">11</a></li> - -<li class="ifrst">Mursell, James, <a href="#Page_18">18</a></li> - -<li class="ifrst">Music aide, training for, <a href="#Page_123">123</a><span class="pagenum" id="Page_131">[Pg 131]</span></li> - -<li class="ifrst">Musical therapy, <a href="#Page_xi">ix</a>, <a href="#Page_xviii">xviii</a>, <a href="#Page_57">57</a>, <a href="#Page_61">61</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">National Music Council, <a href="#Page_xiv">xiv</a></li> - -<li class="ifrst">Nearchus, <a href="#Page_6">6</a></li> - -<li class="ifrst">Newton, Isaac, <a href="#Page_28">28</a></li> - -<li class="ifrst">Noyes, A. P., <a href="#Page_61">61</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Occupational Therapy, <a href="#Page_44">44</a></li> - -<li class="ifrst"><i>Orenda</i>, <a href="#Page_3">3</a></li> - -<li class="ifrst">Orpheus, <a href="#Page_2">2</a></li> - -<li class="ifrst">Ortmann, Otto, <a href="#Page_17">17</a></li> - -<li class="ifrst">Operating room, music in, <a href="#Page_75">75</a></li> - -<li class="ifrst">Opponens action, <a href="#Page_52">52</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Paget, V., <a href="#Page_36">36</a></li> - -<li class="ifrst">Painful level of sound, <a href="#Page_41">41</a></li> - -<li class="ifrst">Palmer House Ensemble, <a href="#Page_86">86</a></li> - -<li class="ifrst">Paresis, general, <a href="#Page_63">63</a></li> - -<li class="ifrst">Parlor organ as foot exercise, <a href="#Page_54">54</a></li> - -<li class="ifrst">Patient band, <a href="#Page_70">70</a></li> - -<li class="ifrst">Pediatric ward, music in, <a href="#Page_90">90</a></li> - -<li class="ifrst">Percussion instruments, <a href="#Page_55">55</a></li> - -<li class="ifrst">Persian use of music, <a href="#Page_5">5</a></li> - -<li class="ifrst">Philip V of Spain, <a href="#Page_10">10</a></li> - -<li class="ifrst">Photoism in music, <a href="#Page_28">28</a></li> - -<li class="ifrst">Phrygian mode, <a href="#Page_xi">xi</a>, <a href="#Page_6">6</a></li> - -<li class="ifrst">Physical therapy, <a href="#Page_45">45</a></li> - -<li class="ifrst">Physiologic effects of music, <a href="#Page_34">34</a></li> - -<li class="ifrst">Piano; analysis of motions, <a href="#Page_52">52</a></li> - -<li class="ifrst">Piano playing for exercise, <a href="#Page_50">50</a></li> - -<li class="ifrst">Pianola, value of, <a href="#Page_52">52</a></li> - -<li class="ifrst">Pierce, A., <a href="#Page_70">70</a></li> - -<li class="ifrst">Pinel, P., <a href="#Page_11">11</a>, <a href="#Page_44">44</a></li> - -<li class="ifrst">Pitch, effect of, <a href="#Page_17">17</a></li> - -<li class="ifrst">Plato, <a href="#Page_5">5</a>, <a href="#Page_76">76</a></li> - -<li class="ifrst">Plectrum instruments, <a href="#Page_53">53</a></li> - -<li class="ifrst">Plutarch, <a href="#Page_6">6</a></li> - -<li class="ifrst">Pocket instruments, <a href="#Page_54">54</a></li> - -<li class="ifrst">Porta, J. B., <a href="#Page_11">11</a></li> - -<li class="ifrst">Primitive people, music among, <a href="#Page_xi">xi</a>, <a href="#Page_2">2</a></li> - -<li class="ifrst">Production, effects of music on, <a href="#Page_80">80</a></li> - -<li class="ifrst">Program distribution system, <a href="#Page_93">93</a></li> - -<li class="ifrst">Program notes, effect of, <a href="#Page_33">33</a></li> - -<li class="ifrst">Psychiatry, value in, <a href="#Page_72">72</a></li> - -<li class="ifrst">Psychologic effects of music, <a href="#Page_36">36</a></li> - -<li class="ifrst">Psychosis, alcoholic, <a href="#Page_63">63</a></li> - -<li class="ifrst">Psychosis, arteriosclerotic, <a href="#Page_64">64</a></li> - -<li class="ifrst">Psychosis, manic-depressive, <a href="#Page_64">64</a></li> - -<li class="ifrst">Public address system, <a href="#Page_93">93</a></li> - -<li class="ifrst">Pythagoras, <a href="#Page_xi">xi</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Quarin, <a href="#Page_8">8</a></li> - -<li class="ifrst">Quintillian, <a href="#Page_76">76</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Radio, bedside, <a href="#Page_91">91</a></li> - -<li class="ifrst">Rameau, J. P., <a href="#Page_18">18</a>, <a href="#Page_20">20</a></li> - -<li class="ifrst">Reade, W., <a href="#Page_19">19</a></li> - -<li class="ifrst">Record library, <a href="#Page_115">115</a></li> - -<li class="ifrst">Remedial exercise, <a href="#Page_78">78</a></li> - -<li class="ifrst">Renaissance of art forms, <a href="#Page_xii">xii</a></li> - -<li class="ifrst">Response to music, <a href="#Page_36">36</a></li> - -<li class="ifrst">Rhythm, effect of, <a href="#Page_18">18</a></li> - -<li class="ifrst">Room, listening, <a href="#Page_111">111</a></li> - -<li class="ifrst">Rose, D., <a href="#Page_86">86</a></li> - -<li class="ifrst">Rubinstein, A., <a href="#Page_30">30</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Sauvages, G., <a href="#Page_12">12</a></li> - -<li class="ifrst"><abbr title="saint">St.</abbr> Chrysostome, <a href="#Page_9">9</a></li> - -<li class="ifrst"><abbr title="saint">St.</abbr> Patrick’s Day music, <a href="#Page_114">114</a></li> - -<li class="ifrst"><abbr title="saint">St.</abbr> Thomas Aquinas, <a href="#Page_42">42</a></li> - -<li class="ifrst">Schizophrenia, <a href="#Page_65">65</a></li> - -<li class="ifrst">Schoen, M., <a href="#Page_32">32</a>, <a href="#Page_37">37</a></li> - -<li class="ifrst">Schönberg, A., <a href="#Page_41">41</a></li> - -<li class="ifrst">Schumann, R., <a href="#Page_30">30</a></li> - -<li class="ifrst">Scorpion bites, music for, <a href="#Page_7">7</a></li> - -<li class="ifrst">Seashore, C., <a href="#Page_107">107</a></li> - -<li class="ifrst">Secret remedies, <a href="#Page_xiii">xiii</a></li> - -<li class="ifrst">Selinsky String Ensemble, <a href="#Page_86">86</a></li> - -<li class="ifrst">Shakespeare, W., <a href="#Page_9">9</a>, <a href="#Page_13">13</a>, <a href="#Page_59">59</a></li> - -<li class="ifrst">Shaw, G. B., <a href="#Page_84">84</a></li> - -<li class="ifrst">Shopwork, music in, <a href="#Page_79">79</a></li> - -<li class="ifrst">Sickert, W., <a href="#Page_42">42</a></li> - -<li class="ifrst">Sioux Indian practice, <a href="#Page_3">3</a></li> - -<li class="ifrst">Slumber music, <a href="#Page_90">90</a></li> - -<li class="ifrst">Sonorous fluid, <a href="#Page_12">12</a></li> - -<li class="ifrst">Stravinsky, Igor, <a href="#Page_42">42</a></li> - -<li class="ifrst">Surgery, music in, <a href="#Page_75">75</a><span class="pagenum" id="Page_132">[Pg 132]</span></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Tarantula bites, music in, <a href="#Page_7">7</a></li> - -<li class="ifrst">Tarchanoff, I., <a href="#Page_76">76</a></li> - -<li class="ifrst">Taste, musical, <a href="#Page_38">38</a></li> - -<li class="ifrst">Templeton, Alec, <a href="#Page_91">91</a></li> - -<li class="ifrst">Tempo, effect of, <a href="#Page_25">25</a></li> - -<li class="ifrst">Thalamus, role of, <a href="#Page_68">68</a></li> - -<li class="ifrst">Thaletas, <a href="#Page_6">6</a></li> - -<li class="ifrst">Timbre, effect of, <a href="#Page_18">18</a></li> - -<li class="ifrst">Toneless instruments, <a href="#Page_95">95</a></li> - -<li class="ifrst">Tuberculosis ward, music in, <a href="#Page_92">92</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Ulysses’ wound, <a href="#Page_5">5</a></li> - -<li class="ifrst">Upper extremity exercise, <a href="#Page_51">51</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Valentine, C., <a href="#Page_21">21</a></li> - -<li class="ifrst">Vernon, P. E., <a href="#Page_36">36</a></li> - -<li class="ifrst">Vescelius, Eva, <a href="#Page_xix">xix</a>, <a href="#Page_12">12</a></li> - -<li class="ifrst">Vibration, effect of, <a href="#Page_7">7</a></li> - -<li class="ifrst">Victor Salon Orchestra, <a href="#Page_86">86</a></li> - -<li class="ifrst">Violin as exercise, <a href="#Page_52">52</a></li> - -<li class="ifrst">Viper bite, music in, <a href="#Page_7">7</a></li> - -<li class="ifrst">Vocal music, <a href="#Page_32">32</a>, <a href="#Page_35">35</a></li> - -<li class="ifrst">Voice, human, <a href="#Page_35">35</a></li> - -<li class="ifrst">Voltaire, <a href="#Page_82">82</a></li> - -<li class="ifrst">Volume, effect of, <a href="#Page_80">80</a></li> - -<li class="ifrst">Volunteers, hospital, <a href="#Page_97">97</a>, <a href="#Page_99">99</a></li> -</ul> -<ul class="index p2"> -<li class="ifrst">Wallaschek, R., <a href="#Page_4">4</a></li> - -<li class="ifrst">Wallawalla practice, <a href="#Page_4">4</a></li> - -<li class="ifrst">Waltzes, effects of, <a href="#Page_81">81</a></li> - -<li class="ifrst">War, music in, <a href="#Page_7">7</a></li> - -<li class="ifrst">War songs, <a href="#Page_7">7</a></li> - -<li class="ifrst">Ward sings, <a href="#Page_96">96</a></li> - -<li class="ifrst">Wasambara practice, <a href="#Page_4">4</a></li> - -<li class="ifrst">Weber, Marek, <a href="#Page_86">86</a></li> - -<li class="ifrst">Willis, T., <a href="#Page_10">10</a></li> - -<li class="ifrst">Words, effect of, <a href="#Page_35">35</a></li> - -<li class="ifrst">Working songs, <a href="#Page_79">79</a></li> -</ul> -<hr class="chap x-ebookmaker-drop" /> -<div class="chapter transnote"> -<h2>Transcriber’s Notes</h2> - -<p>In a few cases, obvious errors or omissions in punctuation have been -fixed.</p> - -<p><a href="#Page_ii">Page ii</a>: “nervous insistance,” changed to “nervous insistence,”</p> - -<p><a href="#CONTENTS">Table of Contents</a> and <a href="#INDEX">Index</a>: “Eurthymics” changed to “Eurhythmics”</p> - -<p><a href="#Page_xvi">Page xvi</a>: “of human ature” changed to “of human nature”</p> - -<p><a href="#Page_xix">Page xix</a>: “forget his preconcieved” changed to “forget his preconceived”</p> - -<p><a href="#Page_8">Page 8</a>: “delerium, melancholy and mania” changed to “delirium, -melancholy and mania”</p> - -<p><a href="#Page_12">Page 12</a>: “she admitted after after having” changed to “she admitted -after having”</p> - -<p><a href="#Page_25">Page 25</a>: “in every singly key” changed to “in every single key”</p> - -<p><a href="#Page_31">Page 31</a>: “Largo al Factotem” changed to “Largo al Factotum”</p> - -<p><a href="#Page_41">Page 41</a>: “Most people have been conditioned” changed to “Most people who have been conditioned”</p> -<p><a href="#Page_44">Page 44</a>: “sooner those who remained” changed to “sooner than those who remained”</p> - -<p><a href="#Page_53">Page 53</a>: “are readily adpatable” changed to “are readily adaptable”</p> - -<p><a href="#Page_60">Page 60</a>: “which has lead some musicians” changed to “which has led some -musicians”</p> - -<p><a href="#Page_65">Page 65</a>: “may appear quiet normal” changed to “may appear quite normal”</p> - -<p><a href="#Page_68">Page 68</a>: “more powerful subconcious” changed to “more powerful -subconscious”</p> - -<p><a href="#Page_69">Page 69</a>: “for heterogenious groups” changed to “for heterogeneous -groups”</p> - -<p><a href="#Page_77">Page 77</a>: “preferable the piano” changed to “preferably the piano”</p> - -<p><a href="#Page_78">Page 78</a>: “places of assemble” changed to “places of assembly”</p> - -<p><a href="#Page_84">Page 84</a>: “barbershop and other public” changed to “barbershops and other public”</p> - -<p><a href="#Page_92">Page 92</a>: “alloting certain periods” changed to “allotting certain -periods”</p> - -<p><a href="#Page_94">Page 94</a>: “musical programs and hospital announcement,” changed to -“musical programs and hospital announcements,”</p> - -<p><a href="#Page_110">Page 110</a>: “age range of the patient” changed to “age range of the patients”</p> - -<p><a href="#Page_115">Page 115</a>: “with continuous acession” changed to “with continuous -accession”</p> - -<p><a href="#Page_120">Page 120</a>: “the appelation “music aide”” changed to “the appellation -“music aide””</p> - -<p><a href="#Page_122">Page 122</a>: “programing for concerts” changed to “programming for -concerts”</p> - -<p>In the <a href="#BIBLIOGRAPHY">bibliography</a>, “Electrophsiology of Mental Activities” was changed -to “Electrophysiology of Mental Activities”; there is no anchor for reference <a id="Barker"></a><a href="#fn6">[6]</a> Barker. L., -in the text.</p> - -<p>In the <a href="#INDEX">index</a>, “Mental disease classication” changed to “Mental disease -classification” and “Cavotte from Mignon” changed to “Gavotte from Mignon”</p> - -<p>The original <a href="#INDEX">index</a> had T located after W. This has been fixed.</p> - -<p>There are numerous probable mistakes in the French and German -references in the footnotes; these have been intentionally left as per -the original.</p> - -<p>The spellings of “Philippe Pinel” and “Richard Wallaschek” have been -corrected.</p> - -</div> -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK MUSIC IN MEDICINE ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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