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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.

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.

PROGRAM

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 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.

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.

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.

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.

EQUIPMENT AND LIBRARY

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

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.

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 , 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.

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.

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.

The following are some books suggested for inclusion in the hospital patient library:

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.

DIRECTION

The introduction of music into the hospital will depend not so much upon its proven value as an aid to medical practice as upon the interest of someone on the staff who loves music or recognizes its importance in the mental hygiene of the patients. There are many reasons for the absence of music in some hospitals which may seem difficult for the musician to comprehend. The acceptance of a music program in a hospital calls for increased budget and space. These are two items which constantly beset the hospital director and they are sometimes matters of improbable solution. For the chronic type of hospital the problem must be solved. Other drawbacks are found in the contemplated interference of medical and nursing procedures. Hospitals are traditionally havens of quiet and the uninformed hospital director or his staff may envisage a conversion to a three-ringed circus of sound. The progress of music in hospitals will depend largely upon the ingenuity and intelligence of existing organizations and the examples they can set for prospective hospitals.

The musical program of a hospital need not necessarily be conducted by a musician, but a trained person is most desirable. There are people with an intense love for music and so comprehensive a grasp of its many fields that they might be capable of conducting a hospital program although unable to play an instrument. At some institutions music has been guided by volunteers with great satisfaction to staff and patients, but this is an age of specialization and a paid, trained musician will usually be worth the salary in efficiency, dependability, and control.

DIRECTOR

Music for patients differs from music for the well. The average musician is not qualified to decide which patients should or should not have music. There are too many well meaning musicians who have had one or two personal experiences or heard of others in which the efforts of the musician were rewarded by apparent miracles of mental reaction. Musicians are not capable of evaluating such changes nor do they bother to recount what the condition of the patient was an hour or a day after this personal exposure. Musicians must have medical direction. The medical director of music does not have to be a trained musician but he should be acquainted in a general way with most musical forms which appeal to a majority of patients. His most important qualification will be the ability to rise above personal prejudices of musical taste. He must recognize that musical tastes can be as diverse as individual appetites for different foods, and feel free to order music as he would food for patients. It will be his duty to prescribe quantity, quality, duration, and intervals of music; to contraindicate music for the irritable, certain post-operative patients, the acutely ill, and any others for whom he thinks music is wrong. It will be necessary for him to protect the patients from the possible musical whims, hobbies, convictions or over-enthusiasm of the musical aide.

The director should be selected from volunteers on the staff. For the physician director of music to be chosen in any other way is to hamper the musical program. He must be a physician who has the time or can make the time to carry out his part adequately. At the outset the director should have daily conferences with the senior musical aide in which he should not only outline the procedures desired but should observe the musician at work with patients.

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