Chapter II: Introduction (1)

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.