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This chapter explores the literary representation of urban silence, which was both sought and feared in the late Victorian era. As the suburbs spread, comparisons were made between the ‘real’ silence of the country and its artificial counterpart in the city; this is discussed in the context of Richard Jefferies’s work, including After London. Elsewhere, in The Napoleon of Notting Hill, Chesterton responds to the ‘horrible’ silence of modernity, which is synonymous with London’s grey streets, while Doyle’s Beyond the City celebrates the potential of suburbia. As this chapter reveals, such works respond to a city now seemingly without an ‘end’, and writers increasingly represent the contrasting auralities of town and country.

There have been many readings of late Victorian and early Edwardian fiction that argue for the influence of early cinema on writers’ visual imaginations. However, as this chapter explores, writers’ auditory imaginations were also engaged by a newly popular ‘tone’, exemplified by music hall entertainment, and more generally by the noise of musical mechanization, as heard in different forms of ‘street’ instruments, such as the pianola. Through an analysis of tunes and tones represented in different novels, including Wells’s Kipps, Gissing’s Thyrza, and Conrad’s Chance, this chapter reveals writers’ broader responses to London’s popular culture.

Studies of this period have tended to focus on the influence of written ‘journalese’ in a rapidly expanding popular press. However, there was also much contemporary comment about spoken language, as the newly educated and enfranchised working classes took to the ‘platform’ in the democratic cause. The 1880s and 1890s were a period of noisy oratory, riots, and strikes in London; this chapter focuses on literary representations of crowd sounds, including the speeches of the populist ‘workman orators’. The sound impressions of novels such as Gissing’s Demos and Harkness’s Out of Work reveal how writers responded to social progress and democratization at a revolutionary time in the city’s history.

In this chapter, experience of the ‘news’ is analysed from an auditory perspective, and the wider relationship between sound, time, and information is explored. How might Victorian and Edwardian Londoners first hear about a news event and what does this reveal about the progress of modernity? This question is addressed through readings of Conrad’s The Secret Agent and Ford’s A Man Could Stand Up (Parade’s End), both of which focus on real-life events. Conrad’s novel is discussed in the under-explored context of urban oral traditions—such as the shouting newsboys, whose practices exemplify a transitional era for popular news consumption. In Ford’s novel, the aurality of the news of the First World War Armistice also takes on a wider symbolism, signalling both the noise of celebration and social change.

In the United States (US), heart failure (HF) is the leading medical condition resulting in hospital admission. Despite advances in treatment, the number of HF deaths has continued to increase. At Carolinas Medical Center (CMC), more than 950 annual HF admissions provided an opportunity to examine morbidity, mortality, and readmission rates. Within the facility there exist two HF disease management programs treating more than 1,500 patients annually. Through a systematic approach to identify the root causes of morbid and less severe complications, the facility addressed process improvement steps to positively impact HF treatment. Included in these strategies was a link to the outpatient continuum of care created for the HF patient.An examination of the HF program revealed the care to be fragmented, both organizationally and physically. A majority of readmissions could be prevented through closer patient follow-up and more aggressive therapy. Intensive education for staff about the disease management process, medication interventions, smoking cessation, and nutrition counseling was lacking. An interdisciplinary committee, with strong administrative support, was established to evaluate the current program and recommend changes. Delivery of patient care was changed to an integrated care management system model identifying the root causes of the most prevalent operational and clinical deficits. Process improvement steps were immediately implemented. The 30-day readmission rate (all causes) decreased from 18% to 6.1%, the readmission rate for HF decreased from 7.3% to 1.7%, mortality declined by 25%, and morbid complications decreased by 35%. Evaluation of processes and clinical outcomes are ongoing in order to develop strategies for even greater improvement within the HF program.