Chapter VI: Introduction (5)

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.

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[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.

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[75] Thorndike, L., _A History of Magic_, vol. 2, New York, 1923.

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[81] Willis, T., _Cerebri Anatome Nervorumque_, cap. 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.