Noise: Sound Out of Place?

In 1958 health charity The King’s Fund published the first of a series of enquiries into ‘Noise Control in Hospitals’. This report acknowledged the long history of concerns about the implications of noisy hospitals for patient wellbeing, citing Florence Nightingale’s Notes on Hospitals: ‘unnecessary noise is the most cruel absence of care which can be inflicted on sick or well’. This report, and its follow-on studies, resulted from interviews with patients and practical advice about how to minimise noise in hospitals – including simple maintenance, such as oiling doors. Its findings were not necessarily surprising or new, but they did reflect a renewed interest in patient-centred care and in creating the best possible environment for healing. This document was symbolic of a (perceived) trend in modern culture towards public noise abatement, and the conception of noise as a public health issue.

From a sensory history perspective, these reports are interesting on a number of levels. They provide rare insights into patients’ experiences of hospital soundscapes and of the noises that preoccupied them, including differences in noise perception between individuals (particularly with age) and over the course of an illness: as one patient noted, ‘the noises only disturb me when I do not feel well’. They remind us again of the difference between objective sound levels and the perception thereof, including how noise can be exacerbated by other sensory experiences (such as pain). The follow-up reports also allow us to think about change over time and whether recommendations have really translated into action. They encourage us to think about the ways in which sound intersects with hospital design, its materiality, its layout, and its dynamic nature.

At a more implicit level, these reports also provoke us to think about the meaning of ‘noise’: it is significant that they draw upon the language of ‘noise’ rather than ‘sound’. Like the famous anthropologist Mary Douglas’ conception of ‘dirt’ as ‘matter out of place’, is any sound inherently ‘noisy’ or does it become so as a result of context? Is ‘noise’ simply a matter of volume, or is it about the ways in which sounds are placed – or misplaced? Does a sound become noise when it is perceived as ‘unnecessary’ (to go back to Nightingale)? A simple example: patients might expect the beeping sound of a machine when undergoing a test, but not the noise of medical equipment intruding from other rooms when trying to sleep. Personal preference also plays a role in these definitions – ‘music to my ears’ might be ‘noise’ to another’s ears.

The question of control implicitly also underlies this distinction between sound and noise. The active/passive nature of different senses is a common topic in sensory histories of hearing, and remains a hotly debated issue. While we must be careful not to overstate the passive nature of hearing, or to claim any total inability to direct this sense, it is significant that hospital soundscapes have so often been described in terms of sensory intrusion (particularly for people seeking rest). Headphones and earplugs provide some potential for control of soundscapes, but in general hospital sounds seem more dynamic, persistent and more likely to be unwillingly ‘received’ than some other sensory experiences.

This noise/sound question also pushes us towards questions about the changing cultural and individual perception of hospital soundscapes, rather than only their changing nature or volume. We know for example from Alain Corbin’s famous work, on the shifting meaning of bells in rural France, that a single sound can carry a range of meanings that shift across time and place. So what are the implications of this kind of approach for histories of sound, noise and the hospital? It directs us to think more about the meaning, as well as the levels, of different sounds. The King’s Fund identified a growing concern about traffic and building works in the 1970s, for example: did this trend only reflect a greater level of these forms of noise pollution, or also a growing intolerance of the same noise? Their study also indicated consistently that many patients were less sympathetic to sounds of laughter than to sounds of pain. This seems counter-intuitive, as laughter has long been culturally established as a more positive sound, but in the hospital laughter took on a specific meaning: a lack of consideration for those seriously ill, by those less ill or in recovery. We must try to understand how sound has been culturally, historically and individually constructed. Only then can we write rich histories of hospital sound (and noise) that go beyond counting decibels.