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ith in music. In some instances music was then abandoned altogether, whereupon there was such an outcry from the workers that the program was reinstated with hot swing entirely eliminated. Both extremes are bad. Giving the workers what they want is a more difficult problem than it appears at first. It requires not one but a number of questionnaires over a period of time to keep up with changing tastes."

"Music must be played at the right time to obtain the best results. Marches create a cheerful atmosphere and should be played at the beginning of sessions, as well as at the end. The best time of the day for Strauss waltzes is at the so-called 'fatigue periods.' There is something about three-quarter time that is very refreshing at moments of fatigue. Besides the music is gay and light-hearted, and leads all other forms in popular appeal according to questionnaires filled in at three large plants."

In the hospital occupational therapy shop, music may originate from the public address system, a record player, or the radio. It would seem that the most suitable in the average hospital would be the use of the radio, which the therapist can change at intervals of fifteen minutes or longer in an attempt to get unexciting music at a low volume level.

FOOTNOTES:

MEALTIME MUSIC

Patients who are confined to bed, or for that matter, to a hospital, find meals progressively monotonous in spite of the fact that there is a greater variety offered them than was theirs at home. This monotony results in part from the color and nature of the environment, the personnel, the general atmosphere of the hospital, and the constraining nature of institutional restriction. While dining at home some of these factors are subconsciously dissipated by trivial intimate conversation, friendly faces, individual attention and the security of the things for which "home" stands.

Since ancient times music has been used as an accompaniment to meals. The instruments used by the ancients for this purpose were usually those which emitted soft sounds. Voltaire said that our purpose in going to the opera was to promote digestion. During the preceding century, dinner music became stylized and consisted largely of semi-classical pieces or waltzes played softly in slow tempo by string ensembles. During the past twenty-five years there has evolved a form of dinner music which is not only a marked departure from the old, but has come to be used as a source for dancing between and during courses. Whether the physiologic and psychologic effects of dancing during a meal are harmful, beneficial, or of no moment remains undecided. Certainly there seems to have been little interest in analyzing its effects. During the period when dinner-dance music was available only in a few places, the number of those who could be affected by it was very small. But, with the more recent installations of "juke" boxes, and other forms of mechanically reproduced music, into all varieties of dining places, the problem is worthy of investigation.

Most people derive pleasure from the consumption of appetizing food. Most people derive pleasure from music played to their taste. Although the logic of the following thought is subject to criticism, it does sound reasonable to state that two pleasurable experiences enjoyed simultaneously, should add up to a greater happiness than that afforded by either individually. Food has received thorough study with respect to preservation, preparation, serving, and the time of day when each item is most satisfying. Some of the conclusions have been arbitrary, but for the most part, people eat the food that agrees with them physiologically and psychologically. There is no especially good reason why cereals should be eaten by adults only in the morning. It has become a matter of custom or advertising, and the minds of the masses have become conditioned to feel that cereal is especially good at breakfast time. A generation ago the breakfast menu in some homes differed little from the present day dinner fare. Eating habits have become set in the minds of most people and there is little that can be done to change them rapidly. Daily routines have given rise to certain music conventions as well. Until recently, music at breakfast was uncommon. Bernard Shaw wrote, "Music after dinner is pleasant: Music before breakfast is so unpleasant as to be clearly unnatural." With the advent of radio this has changed even if Shaw has not. Lunch rooms, barbershops and other public places where people spend time inactively, are equipped with mechanisms for reproducing music. The practice of reading or even studying school work at home with the radio on has become increasingly prevalent. The tempo of living has stepped up to the point where most people, especially the younger, like to do two things at once, especially if one of these is to listen to music.

The effect of different foods upon digestion and health is known, and most persons eat with a regularity which is related to capacity and needs. They are usually able to select the items they desire, the time at which they will eat, and the period for consumption.

The ideal attitude while eating is one of mental serenity and physical repose. If certain criteria are observed music can be relaxing. The elements which increase relaxation are melody, rhythm, and softness. If the music which accompanies meals is carefully selected it can make eating more pleasurable, and this is desirable for patients in the hospital.

Mealtime music must be unobtrusive. It must lack stimulating qualities which attract attention. If the diner can promptly name the selection played five minutes earlier, that piece was too impressive in score or performance. Perhaps the most suitable form of dinner music is that played by a small string ensemble. The piano and harp are also very satisfactory, alone or in combination with the ensemble. When the piano is played in the hesitant legato style of Eddie Duchin it is particularly desirable. The shrill sounds of the flute or the brassy sound of the trumpet must be omitted. The music must be soft and slow. Avoid vocals and strange instruments.

The volume of the music should be maintained at as nearly the same level as is consistent with the source of the music. It should begin without fanfare or any attempt to attract attention. The level of intensity should not interfere with conversation, for, if the loudness of the music demands an increased volume of voice to carry on normal conversation, it defeats the purpose of relaxation by evoking increased energy on the part of the speaker. When possible the end of the selection should fade out. There should be nothing abrupt about the selection, and unusual sequences or novelties should be avoided. The music should be fluent and entirely unexciting. The interval between pieces should be brief in order to sustain auditory reception at a fairly continuous level. Five to ten seconds between numbers is recommended, and this coincides approximately with the time required to change discs on an automatic or manually controlled record player. Musical selections should be played in groups. The groups should last a total of about fifteen minutes with rest intervals of about three minutes. This simulates the requirements and performance of the live ensemble and has become a part of stylized dinner music. The music should last as long as the meal.

Ideally, the source of the music should not be obvious, and to this end a concealed loud speaker has an advantage over the live ensemble, which through its motions or the physical appearance or mannerisms of its members may distract diners. There should be no vocal announcements between selections. Occasionally a listener will want to know the name of the song being played because it is familiar, reminiscent, or sweet. When the budget will permit, printed or mimeographed programs are most welcome to those whose interest is aroused.

The music recommended, is the music which has been played by dinner ensembles for years. Their repertoires usually include waltzes by Strauss and his contemporaries; selections from operettas by Herbert, Friml, and Romberg, and the popular favorites of the past decade, such as selections from the musical comedies of Kern, Cole Porter and Gershwin, or the songs of Carmichael and Berlin.

It cannot be emphasized too strongly that mealtime music must be physiologically non-stimulating, and noisy music is to be avoided. "Douglas Jerrold declared that he hated to dine amidst the strains of a military band; he said he could taste the brass in his soup." . A foreman of a shop in which music was played during mealtime begged that raucous music be omitted "to give the digestion a break".

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.

Southern Roses 26322 B Sweetheart Waltz 26322 A Black Eyes 20037 B Our Waltz 27853 B Holiday for Strings 27853 B Fr?hlingstimmen 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

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

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 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 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.

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.

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.

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.

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.

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.

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