Chapter V: Introduction (4)

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