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LEBANONHOSPITAL-

FOR MENTAL and NERVOUS DISORDERS.

ASFURIYEH . BEIRUT · LEBANON

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II 53rd ANNUAL REPORTII 006

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A Changeof Name

Interchangeof Views

The StewardAccountant andhis Assistants

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.! Le anOD Hospital for M D aI and Nervous DisordersPRESIDENT:

TIm RoT. HoN. 11IB EARL OF FEVERSHAM. D.S.O.• D.L•• J.P.

VICE-PRESIDENTS:.E. THJl LEBANESE MINISTER. in London Sa WILLIAM HOUSTOUN·BOSWALL,

(Da Vleroa KHOURI) Je.C.M.G., M.C.RT Ho • THE LORD Da L'ISLE AND Da. G. W. B. JAMES, C.B.I., M.C.DUDLEY. V.C. PROF. ALEXANDER KENNEDY. M.D., P.R.C.P••

SIR WYNDHAM DEEDES. D.P.M.G. W. FURLONGE. Bsq.• C.M.G.. SIR HAROLD SATOW. Je.C.M.G., O.B.I.

0.B.8. THE RT. HON. 1'HB EARL OF SELKIRK, 0.B.8.•PAJ)LO HOURANI. BIq. A.P.C.

SIR RONALD STORRS. IC.C.M.G•• C.B.B•• LL.D.GENERAL COMMI'ITEE

(LONDON)CIuJIrmQII: H. LYN HARRIS, M.A.. LLL

Hon. TreQ.furer: O. M. DARTON, B.A., F.C.A.The Rev. R. H. van APELDOORN (Netherlands). Miss LETnca JOWITT.Mrs. L B BACKHOUSB. The Hon. M.uGARET KINNAIRD.RAYMOND de C. BALDWIN. 0 LB. ANGUS M...cNIVEN, M.B., M.R.C.•.Dame DoRIS BEALB, D.B.B.• R.R.C. Pasteur CLAUDE REVERDIN (Switzerland).P. W BIUGSTOCKJl, 0. B., M.B. GEORGI SOMERVILLE, M.D., D.P.M.The Rev J. ANDERSON BUJU..EY. M...... P.R.G.S.. J. C. S"'WLB THOMAS. M.R.C.P.• D.P.M.H B....u D ...VIES. Hon. C.P. (Chairman of the Medical Committee).AulaaT HoURANl, ....... DAM1l KATHERINB WATT. D.B.E•• R.R.C.

EXECUTIVE COMMl1TEE IN BEIRUTBon. Presltknt ~ E. A. CHAPMAN-ANDREWS. C.M.O.. 0.B.8.

Cludrman: H8NRV W. GLOCKLBR, 0.B.8.Hon. Secretary: R. J. D. BBLOR"'VE.

Hon. TrftU",,,: W. F. GOSLINO.Professor HAMl'LTON ANDERSON KENNETH JOLV. O.B.Il.MR. Et.nLB CoRTAS .AM1N KHAIRALLAH, M.D.Mrs. FaaEn' CIt...WPOY. SABB BEY SLAMProf'eaor HlMADEH E. P. SOUTHBV.JosaPH HIm, M.D. G. E. F. WlNDLBo

MEDICAL DIRECTOR• W. M. FORD ROBERTSON. M.D. (PSYCH.). ".B.. CH.B.(EDIN.).

Sellior AuistQlll PhyslclllM: A. S. MANVGIAN. ".D•• D.P.M.• G. M. Arv...Z1AN. M.D.Assl.rtQllt PlJyslcltuu: ROBUT CHECRJ. ".D•• A. R. LABBAN. ".D.

Matrotr: MIls ANNul F. MITCHELL, SoR.N•• a.M.p C.M.B.Hospital Secretary: J. D. KNIGHT. U.H ....

NIr"t Superintendent: Miss E. Hm.EN CARNOCHAN. Head ofOccupational Therapy: MIss K ...THERINBa.M.p..... M. BL"'IR, M.....O.T.

Sister Tutor Miss PHYLLIS CooPla. s.a.N•• a.M.N. Kitchen Superintendent and Dietitian: Mrs. LBOHelld Sister: Miss B. CoNSTANCIl Coav. SONNWALD (Austria).

S LN•• LM.N. Superintendent ofLaundry: Miss C"'NAAN.DepGrtmental S~ter (in charge of Treatment Assis!ant Housekeeper:. Miss A. HADDAD.

Rooms). MISS A. S. WORDBN. s.a.N.• a ....N. MedIcal Secretary: MISS DORIS M. TRAPPlTT.Ward Slsurs: MIS AL.... VIOTTO (ItaJy). Clerk and Staff Supervisor. Hon Secretary 0/

Miss O. GaYPM'" (Holland). Social clUb: ERNEST RrMMrNGTON.Dq"ty Clrarge Nurse: D VID B. DBw..... Head Attendant: YOUSBF IBRAHIM.

I.LN.......N•• a .....Consultant8:

DR. T. ALw.... (Radio)osy) PRoFESSOa YENI KOMSHIAN (Internal Medicine).DR. AuXANDBR Hrrn (CardiololY). DR. .AM1N KHAIRALLAH.])a. Y. JlDUIAN (Surpry). DL SAHYOUGH (PathololY).

Delllal S",.eo1l (Yl.sltlng): Da. ALBIaT BovIlz.

",,,dltO'6: Mean. WOODMAN. Cox &: WlLICINS. Effingham House.Arundel Street, LondoD. W.C.2.

Btulkn.: LLOYDS BANK: LTD., 263 Tottenham Court Road, W.t.General Secretary: Misl HILD Fox.Assistant Secr.tary: Miss ROSIN HARVEV.

Part-tllM AS8istant: HtlBBRT FORSTBR.LONDON OFFICE:

DRAYTON BOUSE. GORDON STREET. LONDON. w.e.t (Tel. EUSton 1108)

REPORT OF THE GENERAL COMMITTEEFOR THE YEAR 1951

For the second time in its history the name of the Hospital has beenchanged, to keep pace with changing concepts and functions. Thus" The

Lebanon Hospital for the Insane" of 1898 became in 1914" The Lebanon Hospital for Mental Diseases ", and in 1951,at a meeting of subscribers on February 17th, the furthertransition was made to the more hopeful and inclusive title

of "Lebanon Hospital for Mental and Nervous Disorders".

It has been a year of great movement, as shown in the report of theMedical Director; heralded by a visit to the Hospital by the London Chair­man during the last few days of 1950 and first of 1951-his first visit, owing

to the war, since he became Chairman in September, 1938.There were many matters requiring discussion between

London-Beirut-Asfuriyeh; the most important being theConstitution (including policy, finance, powers and executive

functions, not revised since 1939), the question of an extension for neuroticand neurological cases, many necessary improvements, and a better salaryscale for the nursing staff. It was valuable, too, that the Chairman should visitDr. and Mrs. Ford Robertson at the end of their first year at Asfuriyeh, and,altogether, the visit proved a very useful one. The major questions of com­mittee relationship were settled, a draft contract for nurses was adopted, anda scale of salaries, based on the Whitley Scale, was approved; also super­annuation arrangements under the Federated Superannuation Scheme~ sothat there should be no loss of benefit if members of the staff returned toBritain. Later, the National Insurance arrangements were also revised inLondon, at some cost to the Hospital, and all British staff can now qualify forthe Old Age Pension.

Close touch with the Beirut Executive Committee continued as a resultof further visits. In April, Mr. Gosling (Hon. Treasurer in Beirut) came toLondon on furlough, and discussed financial matters with Mr. Darton. Inthe same month Sir William Houstoun-Boswall (Honorary President of theBeirut Executive Committee) returned to England, was elected a Vice-President,and has attended the meetings of the General Committee ever since. In July,Mr. Hourani (Senior), visited Lebanon; in October, Mr. Kenneth Joly waspresent at the meeting of this Committee; III November, Mr. Belgrave(Honorary Secretary in Beirut) had several long talks here during his furlough,especially connected with staff matters.

We also had the advantage of seeing Mr. Willis, while he was under treat­ment in a London hospital, and just before he returned to Lebanon in Marchhe attended a meeting of the General Committee and laid before Members

a two-year plan, costing £18,000, which was approved.We are glad to report that Mr. Rimmington, who has

done such good work in the Asfuriyeh office for two years,has now been given a formal contract, including furloughin England for himself and his wife and children. (Mr.

Rimmington was previously in the Palestine Police, and his wife is Lebaneseby birth.)

Mr. Lowrie also remains in the office, but is due to retire next spring,when he will complete 25 years of faithful service. We are happy to reportthat Mrs. Lowrie's health has been greatly benefited this year by an operationon her throat.

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Long-ServiceWorkers

The Matronand herNursing Staff

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In October, Mr. Willis decided not to renew his contract when the first threeyears ended on 31st March, 1952. Being a qualified Surveyor, he has doneparticularly valuable work in maintenance and renovation of buildings (seethe Medical Report). Indeed, a large proportion of the Hospital buildingshave now been overhauled, decorated and wholly or partly re-equipped, inaccordance with the two-year plan, and a new house containing flats for ourtwo Senior Assistant Physicians was completed at Christmas and is a greatsuccess.

Mr. Willis became Steward-Accountant at an anxious time in the Hospital'sfinances, and we are grateful to him for a solid contribution towards re­establishing these as well as for his work in estate-management.

In the latter he had the constant and expert assistance of Isber Wehbeh,our foreman of works, who has been at Asfuriyeh now for well over 32 years,and has undertaken the building of many of the houses. Th.e value of the

continued presence and work at the Hospital of loyal, skilledand devoted people like Isber, like Adil Adeeb (chauffeurand buyer of provisions, 31 years), Azziz Hitte (carpenter,31 years), Nairn and Yousef Ibrahim (senior attendants,

28 and 24 years respectively), "Tasso" (electrician and handyman, 22 years),Hanna Abdou (plumber, 18 years), Shaydan Assad (now in charge of the boot­repairing department, 17 years), as well as of many others with shorter termsof service to their credit, can never be measured. They represent some ofthe foundation stones on which this Hospital is built, and we think of them withgratitude and affection.

Dr. Ford Robertson has had an exceptionally heavy year. His professionalduties took him far afield, and brought responsibilities and burdens whichneeded additional support from his wife, his friends and colleagues. We are

thankful that he has endured the strain and stress so well.The Medical Mrs. Ford Robertson continues to give immeasurableDirector and help in quiet ways, apart from her more visible work as thehis Assistants active Honorary Secretary of the Ladies' Guild.

In July, Dr. Ford Robertson went to Switzerland, where, among otherthings, he continued the search, begun by our kind friend, Dr. Revilliod, fortwo Swiss post-graduates to help at Asfuriyeh for a year, their experience thereto be recognised by their professor of Psychiatry as part of their training.(We had unfortunately failed to find British post-graduates for this work.)Dr. Ford Robertson had the pleasure of meeting the Geneva Committee forthe first time, under their President/Honorary Secretary, Miss Le Fort, and ofdiscussing this and other matters with them. A particularly useful week inLondon followed, July 13-20, when many matters were considered and settled.There were also visits to Jordan and Iraq during the year.

For services to the Hashemite Kingdom of Jordan, Dr. Ford Robertsonwas awarded the Star of Jordan (2nd Class) by King Talal on September 14th.

During this summer he was formally appointed Clinical Professor ofPsychiatry at the American University of Beirut, with an extension of teachingduties which put a heavy strain upon him as head of a hospital, but which arerewarding as pioneer work. In this task-as always-he has had the immediateand complete co-operation and help of Dr. Manugian and Dr. Aivazian, whohave been on the medical staff now for 17 and 12 years respectively (includingDr. Manugian's war service in the M.E.F.), and who continue to bear a largeshare of responsibility for treatment and teaching at the Hospital, at the Clinicand at the American University, Beirut; also of Dr. Chucri, who, after a year'smost acceptable service, was appointed to the permanent medical staff on

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January 1st, 1951. Further details of teaching activities in connection withpost-gra~u.ate doctors and nurses, as well as with medical students (now 1()()under tUItion) ~nd student-nurses, will be found in the Medical Report.

1f1e .HospIta~ seems now well on the way to becoming an effectivePsychiatnc Teaching Centre for Lebanon and countries around.

We are glad to be able to report that in the late summer the Committeeaccepted an offer ?f service from Dr. A. R. Labban, who had been in Londonfor two years takrng the Course for the Diploma in Psychological Medicineat the Maudsley Hospital, under the auspices of the Lebanese Government.Dr. Labban had n.ot i~tended to .sit for the D.P.M. examination, but in defer­ence to the Co~nrmtte~ s strong WIsh agreed to do so, and just before Christmaswas successfl.!l rn passrng Part 1. It is hoped that he will return during the nextyear or two rn order to take Part II. He took up residence at the Hospital inFebru<:try, 1952. We loo~ forward !O l?r. Labban's contribution to Asfuriyeh,as he IS the first fully trarned psychIatns.t of Lebanese nationality, and had anexcellen~ record at the Maudsley. He IS eager to serve his country, and wehope will be able to do so happily through Asfuriyeh.

. In October we had the great pleasure of welcoming Dr. Chucri and hisWIfe to England, where Dr. Chucri came to pursue his studies in Psychiatry andNeurology at Manchester University. He is the first French-trained Lebanesedoct,?r on the ~sfuriyeh staff, joining after experience on the staff of a generalhosp!tal at HaIfa. . He, also, should bring a unique contribution to emich!he life .of the Hos:l.)lta~. We hope that Dr. and Mrs. Chucri's stay here will bernterestrng and satIsfyrng, especially as they have had to leave their two smallsons in Beirut for the sake of this specialised study abroad.

Two important additions have been made during the year :-Dr. Alexander. Hitt~, . as Consulting Cardiologist, providing means for

Consultmg Staff receIvrng reports on heart and circulation of patientsand Dr. T. Alwar, as Radiologist, able to furnish X-ray

reports, especially useful in connection with T.R

The Committee were glad to hear of the invitation to the Medical Directorfrom the Mother Superior and Franciscan Sisters, to the opening of th~" Hospital of the Cross ", by the President of the Republic on November 11th

in celebration of the 50th anniversary of the foundation ofDeir-es-Salib Pere Jacques' mission. It is their earnest wish that there

shall be full co-operation between Asfuriyeh and all bodiesin the Lebanon who are working for the prevention and cure of mental andnervous disorders and the care of the abnormal, and Dr. Ford Robertson'spresence on this important occasion will, we hope, have testified to this wish.

In the spr~g, Miss Morrissey came home on her first furlough, and onJune 20th deCIded not to renew her contract. Miss Morrissey had actednot only as Matron but Sister Tutor, and did magnificent work in launching

the Student-Nurse scheme and seeing it through its firstthree formative years.. They were: years of much difficulty,finanCial and otherwIse, and MISS Morrissey had manyobstacles to overcome. We thank her for all the good workthat she did, and wish her well in her new appointment at

Bahrein.

The Committee were fortunate in having Miss Mitchell, Deputy Matron,on the spot, for, after 12 years on the staff, she is familiar with all branchesof the work, can. spea~ Arabic, and h.as a wide knowledge of the country.On June 28th, MISS MItchell was appornted Matron, and is carrying out herduties with tireless energy and devotion.

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The other four arrived in England on February 9th, 1952, to train in ame!1tal hospital here for the British qualification as Registered Mental Nurse,whic~ would make them eligible later on for the higher posts at Asfuriyeh.All dId well at the terminal examination of the Preliminary Training School,and are now working in the wards. Time will, of course, be needed to allowthem to adapt themselves fully to the very different conditions and surroundings~ere, just as it takes time for our British staff to become adapted to the bewilder­mg and sometimes almost overwhelming change of environment and languagewhen first they arrive in Lebanon. The Students have the great advantageof knowing English. We look forward with confidence to fine service fromthem, both here and on the Asfuriyeh staff when they return.

There were important changes in the office this year, for on July 2nd,Miss Rosina D. Harvey took up work as full-time Assistant Secretary. Thework had been increasing steadily for years, and for the previous two Miss

Fox had had the pleasure of half-time help from Miss AlysLondon Office Earle. Mter June 30th, however, Miss Earle was unable

to remain in London.In Miss Harvey the Committee have the co-operation of one who is not

only a very experienced secretary-accountant, but has lived for some 25 yearsin Lebanon and Pal~stine, and is deeply interested in the Near East, its prob­lems and development; one, also, who is equipped for succession as GeneralSecretary in due course.

The Hospital film was shown at the Retreat, York, by Miss Fox in April,and also at High Wycombe Friends Meeting. In the second half of the yearshe and Miss Harvey had hoped to do more to arouse interest and collect

funds, but actually little in this direction proved possible, beyondMeetings a preliminary visit by Miss Harvey (October 25th-November 6th)

to the local committees in Edinburgh and Glasgow. Withthe Hospital so short of fully-trained nurses, it became necessary to concentratethe secretarial energy on finding nursing staff of the right kind-a difficult taskat any time, but specially so now, with a world-dearth of qualified nurses.

Thus the sending of news to Auxiliary Committees and local treasurers,the finding of new subscribers to replace old and faithful friends who, alas,drop out every year, the "reminding" of those who so kindly subscribeannually-these and other things have, of necessity, taken a secondary place.

ARMENIANS. A few unexpected gifts have come in, chief among thesebeing a donation of £250 from the Committee of the Friends of ArmeniaMissionary Society, towards the treatment and support of Armenian patients

at the Hospital. It is not always realised that, besides refugeesSpecial Gifts from several countries, the Hospital always has a number of

Armenian patients, most of them very poor, if not destitute,and some obliged to stay for years. Many have to be provided with clothingas well as treatment and care. To have funds earmarked to help these wasa joy indeed, and we were very grateful to The Friends of Armenia for theirtrust and co-operation, of which this is by no means the first instance.

This year there have been no fewer than 67 Armenian patients at theHospital and a great many treated as out-patients at the Beirut Clinic (seeTable on p. 16). At the Asfuriyeh end, there has been welcome help from theArmenian General Benevolent Union towards their support.

A LEGACY of £50 was received with deep appreciation on March 6th;the kind thought of an old subscriber, the late Miss Grace Easterbrook.

The Committee also acknowledge, with much gratitude, a GRANT of £250again this year from the Brummana Medical Fund of the Friends ServiceCouncil, towards the salary of Thomas Willis, the first member of the Society

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Anothe~ most welcome newcomer was Miss Doris Trappitt,who arrIved on December 3rd to take up the new position ofMedical Secretary, and of whose work no doubt more will

be heard next year.

In April, an old member of staff, Mrs. Magda Sonnwald, returned as House­keeper-Dietitian, on an experimental basis, Miss Haddad most kindly fittingin with the new arrangements and taking duty in the early morning and evening

so that Mrs. Sonnwald can manage her home duties inBeirut. Planning for and feeding a community of some540 persons each day is no light matter, and we are verythankful to have Mrs. Sonnwald's skilled help once more.

In a hospital she is on familiar ground, for she was formerly Dietitian andhead of the kitchens at the State Hospital of Vienna (2,000 beds), with manyspecial diets to provide. She is devoted to Asfuriyeh, speaks Arabic and isan economical manager. Under her care the dietary is steadily improving.

KitchenSuperintendent

The staff was reinforced on October 22nd by the welcome arrival of Mrs.Arnold Brown, who had previously served in the Grenfell Mission, Labrador.She came for six months as Assistant to the Occupational Therapist and teacher

of English to the Student-Nurses. To Mrs. Arnold Brownwe owe particular thanks, as her service was voluntary andher knowledge of languages invaluable. When Miss JoanBaird gave up her work as Occupational Therapist early in1952, Mrs. Arnold Brown kindly kept the Department going

until the new Head (Miss Blair) was due to arrive in the spring.

New MedicalSecretary

A VolunteerMember ofStaff

Training ofNurses: theAsfuriyehCertificate

Miss Constance Cory, a doubly qualified nurse whom we had knowl?- forfour years, sailed for Beirut on January 13th, 1951, to become a Ward SISler,and was put in charge of America House. At the end of January, when MissLow (the Senior Sister) left, Miss Cory took charge of the treatment room,and in due course was promoted to be Head Sister. For particulars of herinvaluable service this year, see the Medical Report.

Miss Alba Viotto, a young Italian with a teacher's diploma and also theSwiss qualification in Psychiatric Nursing, sailed from Genoa on February 8thand has done outstanding work. Hitherto, there had been no Ward Sister atWebster House, of which she has charge. Two of her friends, Miss Cesaroneand Miss Folchini-also ex-teachers, trained in mental nursing in Switzerland­were appointed during the summer, but most unfortunately neither has yetarrived, owing to political troubles in the Near East and visa difficulties. Thislargely accounted for our shortage of expert nurses during the latter part ofthe year.

We were proud and glad that, as mentioned in Dr. Ford Robertson'sreport, five of the first gro.up of Student-Nurses (Mohammed Kazma, NajlaMattar, John Ashkar, MIchel Dahduh, and Leila Mattar) obtained the

Asfuriyeh Certificate in Psychiatric Nursing in August afterthree years' training. The examination papers were dra~ upin co-operation with the Matron and Sister Tutor of theAmerican University, and Dr. Itani, Psychiatrist to the Munici­pality of Beirut, attended the sittings. Certificates werepresented to the successful candidates at a Graduation Ceremony

on August 17th, when Dr. Manugian administered the Florence NightingaleOath and Mr. Glockler made the presentations (see photograph).

Since then Alice Verbedian has also graduated, to our great pleasureand she and Michel Dahduh have become Staff Nurses. 'I

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The Ladies'Guild

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REPORT OF THE MEDICAL DIRECTORFOR THE YEAR 1951

MR. CHAIRMAN, My LORDS, LADIES AND GENTLEMEN,I have the honour of presenting the 52nd Annual Report, that for the

year 1951.In concluding my report last year, I was bold enough to say that we had

laid good foundations for recovery after the post-war crisis and awaited 1951with eagerness and confidence, ready to accept any challenge. To quote

a famous phrase, last year was "the end of the beginning" andGeneral this year was the entry into a phase of more ordered and rapid

development and of a demand for expansion that has taxed mystaff and myself to the utmost.

During one of the hottest summers for 25 years, our admission rate reacheda climax of 415 patients in residence, 29 more than last year's peak, with paralleldemands upon our out-patient clinic service. The total admissions were 438,as against 411 last year. The clue to this is the growing recognition of ourhospital as a modern diagnostic and therapeutic unit with progressive ideasand a desire to give honest service to the community. More than this, we areno longer hidden from the public gaze since extending the" open door policy",especially to the educated youth of the Lebanon. Thus, gradually, fear is beingreplaced by enlightenment, trust and a willingness to accept the fact that wecan and do fully restore the mentally sick. To cope with these pressuresin the face of shortage of skilled nursing staff and at the same time maintainordered progress has been a situation not unattended by anxiety and greatstrain. Both for my medical colleagues and senior executives it has beena year of most strenuous but satisfactory endeavour.

The kaleidoscopic and eventful scene of the Middle East as it reflectedupon ourselves in the past twelve months can only be selectively high-lighted,when so much of interest has come our way. The Christian Medical Associa­tion annual meeting in the autumn, the student nurses' first graduation, thevisit of the Syrian Minister of Health and his administration and of our newBritish Minister in Lebanon and Executive Committee President, Mr. Chapman­Andrews, the registration of the hospital under the Law of the new Republic,the fulfilment of several building and renovation schemes, especially thedoctors' quarters, the arrival of a contingent of student nurses from Jordan,and, lastly, the completion of the drilling of our well and finding ample goodwater, all of these events were new milestones in the history of tbe hospital.The task of welding together our mixed junior team of attendants has continued,altbough not without growing pains. The Ministry of Social Affairs has beenhelpful in this task, and with it we have spent much time in straightening outa tangle of difficulties that surround the Labour Code on claims for familyallowances and overtime. Internal regulations for use by the hospital havebeen worked out, which include a code of personal conduct, especially applicableto those working with mental patients. This code is new in the history ofLebanon and has been accepted by the Ministry. Next year, when certainoutstanding financial settlements to our attendants have been made, we hopeto see our relations with our subordinate staff established on a sounder andmore satisfactory basis.

I would like to make mention of the splendid work of our Matron, MissMitchell, and Miss Cory, who together have successfully undertaken the fullload of administrative and nursing duties and a great deal else besides. Nopraise is too high for their devotion to duty, self-sacrifice and stout-heartedness

The General Committee wish to congratulate the Ladies' Guild in Beirutfor their splendid achievements. The clothing and other comforts which

they have been able to provide for the patients have beenquite invaluable. There is a wide field at Asfuriyeh for suchindividual service, and we hope it will be more and morecultivated. For no hospital can fully succeed without the

personal touch in all departments.

of Friends to serve on tbe Asfuriyeh staff since the Founder, TheophilusWaldmeier, died. In addition, a capital grant of £1,000 from the residue ofthis Trust bas been most generously allotted for an approved building, to helpforward the medical work at Asfuriyeh.

We also received with particular pleasure and gratitude a gift of £100,besides his subscription, from Mr. Barrow Cadbury, to be used towards the pro­vision of the EXTE SIO for nervous sufferers. This matter is very much inmind.

Among" SERVICES RENDERED" to the Hospital at the London end whichshould be acknowledged, are the legal advice which Mr. Barrs Davies sogenerously continues to give, year after year, whenever necessary.

We have also greatly appreciated the kindness of Dr. KatWeen Priestmanin seeing women candidates at short notice, and supplying full medical reports.

There is also the continued aid to acknowledge of all those who COLLECTFUNDS for the Hospital, in several lands, and who help to make it known. Weare grateful to them all.

We were grateful to the Prayer Union for the Prevention and Healing ofMental Sufferers for again concentrating in prayer for Asfuriyeh for a fort­night this year, and trust that they will continue sometimes to remember our

patients and staff in this way, wbich opens the door to healing.The Things It was also a great pleasure to hear that the Christianof the Spirit Medical Association (of Lebanon and countries around) held

. . its annua~ n:eeting at Asfuriyeh in October. The three days offellowship WIth these mISSIOnary doctors was evidently an inspiration to ourstaff.

It is fit~ing that As~uriy~b should be a centre for the things of the spirit,for Tbeop1?i1us W~ldmeler? ItS ,~enerable Founder, and his colleagues plannedand established thIS HospItal for the love of Christ" and for love of theirafflicted and ~appyneighbours.. There have always been people of that spiritther~. And It .IS th~se who contmue to work in the same spirit who are able~o ~Ithstand tnals, ~Iscouragementsand disappointments; for life at AsfuriyehIS difficult and requrres grace and power. Such love in the old words "feelsno burden, thinks not?ing or .t~ouble,. attempts what is above its strengtb,pleads no excuse ?f ImpossIbility ... IS able to undertake all things, andcompletes many things ... where he who does not love would faint and liedown ... Though. ~eary, it is not tired; though pressed, it is not straitened;~hough al.armed, It IS not confounded ; but as a lively flame and burning torch,It forces ItS .way. upwards and s.ecur~ly passes through all ".

May this Dlvme Love, which gIves " quietness of heart and great peaceand festive joy" fill all hearts at Asfuriyeh.

On behalf of the General Committee :H. LYN HARRIS, Chairman.HILDA Fox, General Secretary.

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( iew from theMedical Director's house)

ASfURIYIH

HOLLA"'DHOUSE

VISITING DAY

AMERICANHOUSE

CENTREOF THE

HOSPITAL

"o ER BEIRUT

A D THE

MEDITERRANEAN

GE ERAL VIEW

in the face of all difficulties. To Miss Viotto, our Junior Sister, likewise fellthe opportunity of fine service and I wish to express my gratitude to each onefor their work at a time when no reinforcements from Britain could be found.

On the medical side, my senior physicians, Drs. Man'!gian, Aivazian andChecri, bore the brunt of the clinical work, and for theIr loyalty to myselfand the hospital and their tireless energy I am most grateful. To our rankswe welcomed Dr. J. Hayek as a junior assistant. Again I wish to stress thespirit of team work that has been amongst us, as witnessed in our weekly caseconferences, at which all important decisions are made, with outside colleaguesoften attending. The only disturbing note was Dr. Aivazian's seriousoperation for gastrectomy in April, compensated by his remarkable recoveryand rapid resumption of duty, for which we were deeply thankful.

In exploring fields of work and collaboration outside the Lebanon fromwhich we receive many private patients, it has been my pleasure to have beenable to make personal contact with the Minister of Health of Jordan duringthe summer and to arrange for student nurse candidates to join us for trainingin the autumn. In December, I was invited to Baghdad by the Minister ofSocial Affairs of the Iraq Government to review with them their present andfuture mental health services and to advise on their new hospital. At theirrequest, a report was submitted dealing with the many problems which theirmedical administration confronts. At that time I had the active help of MissW. Bowling, Nursing Adviser to the Iraq Government, and it is hoped thatsome of their general-trained nurses will come to us for our course in psychiatricnursing next year.

In June we much enjoyed an official visit from the Minister of Healthof Syria, with many of his departmental chiefs and our opposite numbers atIbn Sina Asylum, Damascus. We hoped to obtain some kind of mutualcollaboration, but the rapid political changes in that country unfortunatelyprevent progress of that kind.

Our relations with the Ministry of Health and Assistance Publique havebeen cordial, and a better appreciation of the services we are able to give isbeing established. With the Municipality of Beirut, this understanding isnow complete, and we owe much to Dr. A. Itani, Inspecting Psychiatrist tothe Municipality, for his confidence in and appreciation of our work. By hisefforts we hope to see laid the foundation for a Municipal mental healthdepartment, working closely with us.

Our contract quotas with the above authorities, of 180 and 80 patientsrespectively, have always been maintained and, in the summer, often muchexceeded. In respect of this we have achieved stability financially, basedlargely on the fact that our work is now both recognised and respected, andwe are glad to reciprocate in every possible way.

Our medical equipment has been further augmented by a third electro­shock apparatus, installed in a new small treatment room in the administrationhouse. There we also have our new electro-cardiographic apparatus, withwhich, with Dr. A. Hitti's help as our cardiologist, we now carry out routineexaminations on nearly all patients. In the laboratory, too, useful appara­tus has been added to improve the scope of our diagnostic service. We nowmake up our own glucose ampoules for use in the insulin cases, thus effecting aconsiderable saving. Mr. Sader continues to be a reliable technical assistant,whose services are much appreciated.

The now sound financial position of the hospital is a measure of ourcombined efforts and, happily for all of us, we are rewarded by seeing oursurplus revenue ploughed back into this and that much-needed new projector renovation, new cleanliness and brightness, better food and general standardsfor our patients. This year has seen much fulfilment in respect of these things.

8

Staff

Estate andBuilding Report(by Mr. Willis)

In a very heavy year of building and alterations the face of the hospitalhas noticeably changed: Firstly, a substantial new building was erected tohouse Drs. Manugian and Aivazian and their families, thus releasing ScottishHouse for patients. The new building is of rough-dressed stone with redtiled roof, very much in the traditional style and harmonises well with theexisting buildings.

The ground floor of Strawbridge House has been entirely re-modelledto provide single bedrooms and a sitting room for staff nurses and seniornurses. The arrival of Miss Trappitt as Medical Secretary posed a problemin accommodation which was very successfully solved by converting the upperfloor of the Director's house into a self-contained suite. The America Housecorridor of 11 rooms and toilets was completely renovated, and later in theyear extensive redecorations were also undertaken in Philadelphia andKhairallah Houses. The olive store was divided, to make a workshop forpatients. All these alterations and renovations were carried out on a contractbasis by Isper Wehbe, the hospital's Foreman of Works, whose energy andresourcefulness have been a great help.

The installation of a nine-line telephone system has proved an asset insaving both time and energy. The gardens and estate have as usual madea useful contribution to the feeding of the hospital, though the olive crop waslight. New plantations of bananas have done exceptionally well, and stillmore ground is being made over to them. With the improvement in watersupply bananas may well be our most important crop in years to come,particularly as the erection of new buildings nearly always means sacrificingsome olive trees.

After nearly six months' absence on sick leave, Mr. Willis was able toresume his duties in April, his surgeon having happily achieved a successfuloutcome. Mr. Willis is to be commended for his control and supervision

of our building and reconstruction programme which, asreport shows, was extensive.

The appointment of Miss Mitchell, our Deputy Matron,to the position of Matron was welcomed by all. She replaced Miss Morrisseywho while on furlough, decided not to renew her contract. After eightmon'ths' service, Miss Cory was promoted to be Head Sister in recognition ofher valuable work.

Owing to Miss Haddad's state of health in May, she obligingly st~pped

into a more junior position to allow Mrs. Magda Sonnwald, a form~r KItchenSuperintendent and Dietitian (1940-1942), to assume control. This arrange­ment has worked out very happily, and her skill as a manager and dietitianhas been reflected in the all-round improvements.

Dr. R. Cbecri was appointed as an assistant psychiatrist as from January1st, 1951, and left for England in October to begin studies for the Diploma ofPsychological Medicine. Dr. John Hayek, a post-graduate of four years'standing, was appointed a junior physician in August.

9

recur.

Perhaps the most important development during the year has been thesinking of the new well, a large-scale undertaking which was very efficientlycarried out by the Iraq Petroleum Company. This company also lent the

hospital a temporary pump and motor, pending the arrivalof a pump on order in England. The temporary pump isnot of sufficient capacity fully to test its output, but there isevery indication that the water shortages that have sohampered the working of the hospital in the past will not

•

..

DAMASCUS

tt

BEIRUT

IRrSH HOUSE (1936)

JOHN CORY HALL

VIEW FROM THE AIR, 1938KHAIRALLAH HOUSE

ROBERT RYERSS HOUSEW ALDMEIER HOUSE

WATSON SMITH HOUSEENGLISH HOUSE

IRISH HOUSEPHILADELPHIA HOUSE

SWISS HOUSEHOLLAND HOUSE

RECEPTION PAVILION STRAWBRIDGE HOUSEDIRECTOR'S HOUSE STEWARD'S HOUSE

KHAIRALLAH HOUSE (1936)

PHILADELPHrA HOUSE (1904)

LAUNDRYAMERICAN HOUSE

SCOIT-MONCRIEFF HALLSCOITISH HOUSE

I1....--

ReligiousObservances

TheSocial Club

,

, \ ",'1.\,'1 II~ '\'1'\ ,~'I'I'I '1'1'1

The Department ofPsychiatry, AmericanUniversity of Beirut

We are now fai~ly adequately equipped for most standard routine andtechmc~l procedures, and the amount of investigations carried

The Laboratory out. this year has been considerable. In certain patients,Justice cases for example, the scientific method has proved

to be ?f the greatest valu~ when.we are asked to assess responsibility for crimirJalbehavIOUr. The only dlsappomtment has been our inability to begin linesof research that one so much desired. Time has not permitted.

This valual:?le asset to the hospital's life, for both staff and patients, hashad a progressIve year.. The exp~riment of insisting upon self-managementunder an elected Executive CommIttee of which I continue to be Chairman

is working out well, an'd Mr. E. Rimmington, our active ClubSecretary and Treasurer, has also done much to smooth outdifficulties and encourage cohesion. It has remained self­suppo~ting financiapy and has been able to purchase a refriger­

ator and new furn~shmgs and fittmgs. The generous contribution made bythe ~ondon CommIttee of gaJ?es of all kinds for patients and staff has beena st~ulus all;d much app!eclated. Before the winter set in a large space­heatmg fuel-oIl stove .was mstalled, w~ich did much to make the Club really?ornfortable and a ?nght r~ndezvous m the cold evenings. Our membershipIS abo'!t 90, and IS growmg.. Many successful parties, with dancing andentertamments, were held dunng the year, some of which augmented theClub's revenue.

This association of Beirut ladies continues to do a fine charitable workfor the destitute patients admitted to our care. Mrs. K. Alamuddin (President)

and Mrs. Ford Robertson (Secretary and Treasurer) with theLadies' Guild aid of an Executive Committee of about 40 members have

. ~ubscribed or collected the useful sum of LL2,656 (nearly£300). WIth thIS, over 700 garments were provided in addition to second­hand clothing from friends, also games, cigarettes, books and magazines. ToMatron and our Nursing Sisters especially, these ample contributions have beenmost heartening, and our patients' pleasure and pride on receiving a newpossession makes all this effort well worth while.

For my colleagues and myself the past academic year has been very full,interesting and worth while. The courses which I undertook in Normal andAbnormal Psycho-Biology to the first and second year students have now,

I believe, passed the experimental stage, requiringonly minor changes for the coming year. The usualfourth-year two-semester course in'Clinical Psychiatry,largely shared with Drs. Manugian and Aivazian,has continued, while the new venture of the elective

fifth-year internships of six students over a period of 12 months has, up to thepresent, worked out satisfactorily. In respect of this, we need to enlarge andimprove upon our resident medical staff quarters. Internships are of mutualvalue and we shall endeavour to make their period of service and of instructionas productive and stimulating as possible, since from their ranks we hope tobe able to pick out the possible future psychiatrists.

Beginning in January, a three-months' intensive course in psychiatricnursing was again undertaken for the final year of the A.U.B. Hospital TrainingSchool. Drs. Manugian and Aivazian and Miss Morrissey again undertookthese lectures. Three of this class spent two months as nurse interns at theirown wish, which was a happy and successful experiment that will be repeatednext year.

Another venture that fell to my lot was that of instructing in NormalPsychology the new group of Public Health nurses training under Point Four.

11I

Our policy of the open door has resulted in a spate of organised visitsby students from many faculties, the American University, Beirut, the FrenchUniversity and the Beirut College for Women. Other schools and colleges

have also contributed their quota. For all these, there is a 90-Visitors minute tour, tea in my house and a talk and answering of questions.

Among other welcome visitors have been His Excellency, Dr.Victor Khouri, Lebanese Minister in London; Dr. Leslie Banks, Professorof Human Ecology, Cambridge ; Mr. Fadlo Hourani, one of our Vice-Presidentsand his son, Mr. Albert Hourani; Mr. and Miss Philibosian of the ArmenianBenevolent Union, New York; Lady Mayer and her daughter; three delegatesfrom the new State of Libya, studying the educational establishments of theLebanon; and Dr. Estella Warner of the United States Public Health PointFour programme. However busy we are, visitors are always welcome, for wefeel that much can be gained or given thereby.

In April, Miss Joan Baird replaced Miss Abu Nassar and was quick toget her department going according to her own ideas. Later,

Occupational however, she found herself unable to continue and tenderedTherapy her resignation. Two sales of work were held, m October

and December.

Last year our plans for the future were uncertain and reorganisation wasneeded, but we were hopeful, nevertheless, that 1951 would be a milestonein our history. Indeed, this was so, for on August 17th five out of seven final­

year nurses graduated in an examination standard that fellStudent Nurses' not far short of that required in Britain. With the helpTraining Scheme of our London Office and of the British Council here, by.,. the e!1~ of the year the long-desired plan to complete their

trammg m one of our BntIsh mental hospitals was achieved. The four selectedstudents were Najla and Leila Mattar, John Ashkar and Mohammed Kazmawho are in a sense pioneers in that they are helping to shape the future andto ~reate ade,Quate standards of knowledge and service to their country, towh.Ich they w~ all,. we hope, return. We at Asfuriyeh wish them God-speed.It IS ~he .first !lffie m Lebanon that young men and women have qualified aspsychiatr~c-tramed nurses free of expense, and have then been given theopportumty of fur~her study abroad, again without cost to themselves. Wehope that others will follow. Our new first year of eleven students of whomthree are girls, are a lively and promising group of youngsters keen a~d showinga loyalty that is encouraging. '

10

In October, we welcomed Mrs. Arnold Brown who offered her whole­time services for six months in whatever capacity she might be found useful.Her work in teaching English and in looking after and mothering our first­year student nurses, including the Jordanians, has been a delightful success,for she has the capacity to inspire devotion and loyalty.

Mr. Charles Little, after spending a useful year in the ceramics andprinting section of the Occupational Therapy Department and in the newworkshop, left in December to join his family in Nairobi.

These Services have continued each Sunday almost without intermission,the three months' vacation period for the theological students being filled byour own student nurses. Hymnal and, after the service, classical music is

provided by Mrs. Manugian, and her devotion to this dutyhas been deeply appreciated. From 100-120 patients attend.In July, two theology students took fourteen days' internship,and the report they gave of their experiences has been both

instructive and encouraging.

I·

I

I

I ~

I

I~

I

II

1.~I~

---+------+---+-------+~

---+----+----+------+II~

«.

The BeirutNeuro-PsychiatricClinic

1

I'

i

I

They are a hand-picked class of nine experienced nurses, recruited from manyMiddle East countries. This aspect of their training forms part of a tentativefuture scheme worked out by Dr. Warner and myself on Mental Health asone aspect of Public Health.

I have every reason to be gratified and proud of my colleagues' work inthis sphere. It is a responsible and heavy task, and one which they do mostwillingly and conscientiously. In fulfilling this somewhat ambitious programmeI am indebted to Dr. Hamilton Anderson, the Dean of the Faculty, andespecially wish to thank Dr. R. Ghantus, who has been an ever-ready counsellorin matters of administration.

Post-graduate training has become a further aspect of the Department'swork, for now and in the future adequately qualified psychiatrists holdingsome kind of diploma in Psychological Medicine are an urgent requirement,if the mental health services of the Middle East are to develop. In this matterwe are making a beginning ourselves by having sent Dr. Ch6cri to Britain atour own expense, and we hope that Dr. Hayek may later likewise go. Dr.A. R. Labban, already a post-graduate student at London University, has beenasked if he would sit for the Diploma and later join our staff. Academicqualifications are one of the basic requirements for a teaching hospital suchas ours, and our contribution for the future has to grow in the milieu of theMiddle East region, but we have to call upon our established teaching centresin Britain for help. This is a matter of importance which is already undermost careful consideration by Professor E. W. Anderson, Professor ofPsychiatry at Manchester University, and myself, and I trust there will be asuccessful outcome.

During the year two papers were read and published, the first by Dr.G. H. Aivazian, entitled "Modern Concepts of Sexual Behaviour" (TheLebanese Medical Journal, May, 1951), and the second by myself, read beforethe second Middle East Medical Symposium, November, 1951, held under

the auspices of the Department of Medicine, AmericanPublications University, Beirut, and U.N.R.W.A., entitled "Some

Problems Concerning the Approach to a Middle EastPsychiatric Service". (In press for The Lebanese Medical Journal, January,1952.)

At the Christian Medical Association's Annual Meeting, Drs. Manugianand Aivazian presented clinical papers-the former dealing with the treatmentof acute delirious mania and the latter upon the use of controlled electro­shock in cases presenting cardiac and allied disturbances as complications.

Medical Report(Contributed by Drs. Manugian and Aivazian).

Analysis of Results of Treatment. Results have been evaluated at thecompletion of treatment as Recovered, Relieved and No Change.

Recovered includes patients who are considered as socially adjusted notnecessarily up to the level of their " normal pre-psychotic state". '

Relieved. Improvement here is only symptomatic and the basic psychosisis unaltered. Only a few of these cases have been able to return to their homeenvironment.

No Change includes patients whose mental condition and symptomsremained unaltered by treatment.

Comments on Table Va; Insulin Treatment.1. As the b~lk of the schizophrenics of long standing and consequently

o~ poor pro!P;l0SIS have been gradually ~eeded out in previous years withdifferent phySIcal methods of therapy, thIS year's group undergoing insulin

12

treatment .are better s~lect~d fo~ their suitability. However, a fair percentageof the patients were wven InsulIn for humanitarian reasons to give the benefitof the doubt ~o ~ed!cally unfavourable cases. This probably explains thealmost equal dIstnbutIOn of the total.percentages of the schizophrenic group.These figures ~re found to conform qUIte closely, however, with those recorded,for example, In the Annual Report of Runwell Hospital for 1950.

2.. The best ~esults (64' 5. per cent.) of recovery were obtained with thecatatomc .type, thIS. figure beIng, we believe, a fair approximation of thatexpected In catatoma.

3.. Although w~ ha~e as yet a meagre follow-up social psychiatric service,;~ndenng th~~e studIes Incomplete, we believe about 30-40 per cent. of the~ecovered group relapse and. should have further treatment, concerning

which we have no clear expectatIOn of remission.4. The sing~e "Recovery" quoted of "mixed" schizophrenia could

equally well be dIagnosed as affective reaction (mania). In this connectionwe have been using insulin coma therapy either modified or full for casesof affective reaction who have a prolong~d clinical course and who do notrespond well to elec~ro-.shock. Our .r~sults in the past have been encouragingand have, we feel, Justified the addItional work entailed.

Comments on Table Vb: Electro-Shock Therapy. The relatively lowfigures of " Recoveries" in our depressive patients is due to the fact that assoon. as improvement sets in, a significant percentage are taken out by 'therelatIves for convalescence at home. We do know, however, in spite of oursomewhat limited follow-up facilities at the Beirut Clinic, that the majority ofsuch cases clear up, giving results that compare favourably with those elsewhere.

Comments on Table Vc : Electro-Narcosis. The figures for this treatmentare too small for comment on account of our limited success in the courseof nearly three years' trial.

Pre-Frontal Leucotomy. Operations have continued as in previous years.Further information will be submitted in a subsequent Report when numbersare sufficient for statistical purposes.

* * * *Last year we felt that the limit of our consultation capacity had been

reached, but the figures show nearly 300 more were undertaken. Dr. Checrihas now taken on a session and was successfully doing this when he left for

Britain in October. The figures and the kind ofservice our Clinic is able to give show still moreclearly the need for this kind of work in Lebanon.It is often strenuous but is satisfying, especially whenwe can feel that no patient need be refused because

of inability to meet the moderate charges made. Perhaps next year we may. be able to enlarge and improve our premises.

1951 1950Number of Consultations . . . . 2,731 2,436Full Fees .. ., .. .. 217 156Reduced Fees . . . . . . 1,953 1,854Free . . . . . . . . . . 561 426

As a preliminary to the development of a sister hospital, the failure torealise even a beginning has been a source of deep disappointment to mycolleagues and myself. We have tried every method of enlightenment to make

known the great need; that the scheme would be financiallyThe Nursing successful, and that there is danger in undue delay. O~Home compensation is, however, the realisation of a new TreatmentProject Centre at Asfuriyeh, with accommodation and environment

suitable for the earliest cases of mental or nervous disturbancewho must be separated from those with major behaviour disorders. One day:

13

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"•

2

4

4

10

11

95

18

70

398

183

Re­maining31st Dec.

1951

6

6

6

4

7

10

62

376

106

168

Total

2

2

6

9

19

3

2

6

5

4

2

44

58

42

166

3

2

2

52

89

19

10

Dis-Dis- charged

charged NotRelieved Improved Died

3

4

27

71

34

14

5

7

31

18

Dis-Dis- charged

charged Soc. Re­Recovered covered

2

4

2

2

13

10

53

10

144

179

420

4

2

8

9

23

84

79

145

354

InHospital Admitted1st Jan. During

1951 Year

PalestinianRefugees

Private .,

I.R.O.

Minister ofJustice

Public Assistan~

I.R.O. (Medical)

I believe the way will open, but before then our major problem of an adequatesupply of trained nursing personnel will have to be solved.

I have to repeat what I said in my last report that words alone cannotpossibly convey the surge of life and activity that is now the being and purposeof our hospital. Not all of it is visible or spectacular; much quiet, devoted

work goes on in the villas-our Junior Sisters' work and thatConclusion of our own Junior Staff Nurses, for example. Our standards

have risen a little higher in nearly every department, organisa­tion and specialisation continue, we have gained cohesion and the real teamspirit happily crops up now and then. None of these essentials are maintainedeasily; only unremitting vigilance and devotion on the part of the admin­istration, medical and otherwise, holds on to our gains.

Our weakest department is in the insufficiency of the trained Junior Nursinggrades, e.g., Ward and Junior Sisters and Staff Nurses. Our need is great,but we have to remember, too, our duty to our own student nurses, of whomeach year a few more will be available as graduates, plus those now in Britaingaining additional qualifications, who will join us later.

We continue to have sober confidence in the future and to avoid com­placency ; we have the spirit of enterprise, but medical, scientific and ethicalstandards still come before material gain or prestige. As Medical Director,I still feel keenly conscious of my shortcomings and yet proud to commandthis somewhat unique organisation with all its varied pattern and colour, soindicative of the life of the Middle East which it serves.

In closing, I wish to thank both Committees for their unfailing support,with the special mention of Hilda Fox for her endless goodwill and perseverancein coming to our aid. To my Medical Colleagues, Matron and Sisters for theirdevotion to duty and loyalty, and to many others of whom no mention is made,I am sincerely grateful.

I have the honour to be, Mr. Chairman, My Lords, Ladies and Gentlemen,Your obedient Servant,

W. M. FORD ROBERTSON, Medical Director.TABLE I-SHOWING GENERAL RESULTS FOR THE YEAR 1951

Lebanese Army

Armenian Ben­evolent Union

BeirutMunicipality

Free

TripoliMunicipality

I- -,- --,- _'~I_I__'_'__I_'-----_I~'_-~

~,---,---.I_---I---_I J.__-.J_

TABLE Vb

ELECTRO-CONVULSIVE TREATMENT, 1951

Diagnosis Recovered Relieved No Change Total

M W Total % M W Total % M W Total %

Schizophrenia-Catatonic · . · . · . 6 1 20.6 8 6 41.2 7 6 38.2 34

Paranoiac · . · . · . 1 - 5.0 4 4 40.0 4 7 55.0 20

Hebephrenic · . · . · . - - - - - - 2 4 - 6

Simple · . · . · . - - - 2 - 28.6 4 1 71.4 7

Manic Depression-Depression · . · . · . 3 4 63.6 2 2 36.4 - - - 11

Mania · . · . · . 3 5 61.5 1 3 30.7 - 1 7.8 13

Acute Delirious Mania · . 1 - - - - - - - - 1

Involutional Melancholia · . 2 - 25.0 - 2 25.0 - 4 50.0 8

Chronic Mania · . · . ·. - - - - 1 - - - - 1

Psychoneurosis-Anxiety · . · . · . 2 - 33.3 4 - 66.7 - - - 6

Hysteria · . · . · . 1 3 57.1 1 1 28.5 - 1 14.4 7

Mental Deficiency with Psychosis - - - - - - - 3 - 3

GRAND TOTAL · . 19 13 22 19 17 27 117

TABLE Vc

Electro-Narcosis Treatment

Diagnosis Recovered Relieved No Change Total

M W M W Total % M W Total % %

Schizophrenia-Paranoiac · . · . · . - - 2 - 40.0 3 - 60.0 5

Hebephrenic · . · . · . - - - - - 1 - - 1

GRAND TOTAL · . - - 2 - 4 - 6

ARMENIAN PATIENTS

1. TREATED AT LEBANON HOSPITAL FOR MENTAL AND NERVOUS DISORDERS1st March, 1951 to 1st May, 1952.

No. of No Duration

Patients ConditionRecovered Relieved change Died of Hospitalisation

M W M W M W M W M Wf----.

PRIVATE · . · . 7 2 Acute 5 - 1 - 7 2 - 1 50.5 roths.

6 1 Chronic 1.0 "

BEIRUT MUNICIP. · . 1 4 Acute 1 1 1 6 8 - 26.5"

6 6 Chronic- - 82.0 " (3 still in

hospital)

AsSISTANCE 1 5 Acute 1 3 4 4 7 1 21.0 "4 10 Chronic - - 58.0 " (3 still in

PUBLIQUE · . hospital)

A.G.B.U. · . · . 2 4 Acute 2 4 3 5 131.0

"5 4 Chronic

- - - 27.5"

FREE · . · . 1 Chronic - - - - - 1 - - 3.0 "

32 35 = 67 patients.

2. TREATED AT *BEIRUT NEURO-PSYCHIATRIC CLINIC AT FREE AND REDUCED RATES

Year Reduced Rates No Charge1949 412 114

1950 599 257

1951 795 3891952 (to 1st May) 290 161

• Out-Patient Clinic of the Lebanon Hospital for Mental and Nervous Disorders.

16

•

ENGLISH

HOUSE

WEBSTER

HOUSE

(1939)

HOLLA 0

HOUSE

(as enlarged1936)

THE GREENE MEMORIAL HOUSE (1914)

"

T6

54211152

676

2157

1417

22

420

those

497

112

154

2

266

TABLE IIIShowing the Religious Persuasions of

Admitted during the Year 1951M W3 3

23 3114 77 4

40 124 2

50 262

10876

Armenian CatholicArmenian OrthodoxDruze ..Greek CatholicGreek OrthodoxJewish ..Maronite ..Methodist ..Moslem ..Protestant ..Roman CatholicSyrian CatholicSyrian Orthodox

T24355

1410

1287

8271

71

420

Admitted

2

1233

27

1132

154266

TABLE IINationalities of thoseduring the Year 1951.

M W22343

1171

1746261

44

Showing

Albanian ..American ..BritishCypriotEgyptianIrakianJordanianKuwaitiLebanesePalestinianPolish ..Saudi ArabianSenegaleseSyrian

PART OF THE ESTATE

THE

SOCIAL CL B

, .

GRADUATIO

CEREMONY,

AUGUST 17, 1951

Administration of the

Florence Nightingale Oath by

Dr. Manugian.

ANNUAL MEETING, 1952THE FIFTY-THIRD ANNUAL MEETING was held at the

Ambassadors Hot~l,.~ondon, W.C.!, on Thursday, June 19th, 1952, precededby te<;t and ~n. exhIbItIon of photographs and plans, including a model of theHospItal buildmgs and estate. The meeting was presided over by Sir WilliamHoustoun-Boswall, K.e.M.G., M.e., formerly British Minister in Beirut andHonorary President of the Beirut Executive Committee of the Hospital.

The Chairman gave a message from the President, Lord Fevershamspecially regretting his inability to be present, and also read a letter of regretand sympathy from Lord Selkirk. The Conference of Her Majesty's repre­sentatives in the Middle East, meeting at the Foreign Office that same afternoon,had taken away two of the Hospital's Vice-Presidents, but they were delightedto have with them Dr. Victor Khouri, the Minister for Lebanon-anotherVice-President-as well as Mr. Hourani. The Foreign Office was representedby Mr. Wardrop. They were also privileged to have with them the LordBishop in Jerusalem, who had recently visited the Hospital, and representativesfrom the Embassies or Legations of the United States of America, the Hashe­mite Kingdom of Jordan, Holland, Switzerland and Italy.

It might be asked "Why are all these people here and interested in thisHospital ?" The reason was that it was founded 53 years ago by a Swissmissionary, Theophilus Waldmeier, who set up committees in Switzerland,Holland, Germany, Britain, America and Canada. All the Auxiliary Com­mittees worked with the central committee in London, and supported the workthrough them. "Italy is represented because we have an Italian nurse who hasproved a great success. The Arab States have representatives here because theyare our supporters and patrons, and, we hope, beneficiaries. And for ourselves,we are here because we all like to do something for others who are less fortunatethan ourselves."

The Hospital, said Sir William, is a purely international effort. For fourand a half years he had had the privilege of taking part. in th~ Beirut activitiesas Honorary President. At first he had thought of thIS as Just one of thosesmall jobs which came to a Minister as Minister. But after a single 1?eetinghe found himself extremely keen. It was a most remarkable work, and If thosepresent this afternoon could have seen the improvement which he had seen duringhis years in Beirut, he was sure they would.h~ve bee~ a.stonished. Progresstakes place at almost an alarming rate, and It IS astomshmg how the finance,by the grace of God, has kept pace with the improvements needed and thehigh standards continually striven for.

17

The Medical Director had sent the following characteristic cable for thismeeting:-

"Warmest greetings from all to Asfuriyeh friends on 19th. In finefettle and greatly heartened by splendid recruits: many thanks. TreatmentCentre foundations beginning today. Ready December. Another finelandmark of progress."Sir William said that if the Committee in Beirut had voted the very large

sum needed for this Treatment Centre, the meeting could be certain that thatmoney would produce every centime that it was worth, for most of them were"tough business men ".

In this country opportunities for charity were said to be somewhat lacking,because, owing to the general lack of charity in mankind, the Welfare Statehad been conceived. Had natural charity done all that it ought to have done,no Welfare State would have been necessary. A heavy burden of taxationtherefore falls on individuals here. Nevertheless it is good for us morally togive in charity, otherwise we are not doing our duty to our fellow man. Letus set an example by subscribing to this Hospital, which caters for the mentallydiseased throughout the Middle East, and let us also influence our friends togive to it. In these countries there is, so far, no State Medical Service. TheArab countries are coming on at a great pace, but it is impossible to do every­thing at once; and, after all, this Hospital does exist, and is patronised bythem.

In the list of nationalities of patients admitted last year, he saw Lebanese,Syrian, Albanian, American, British, Cypriot, Egyptian, Iraqi, Kuwaiti,Palestinian, Polish, Saudi Arabian, Senegalese. Thus it was obvious that manyraces were catered for, as well as religions. There was no prejudice. It was,indeed, one of the finest pieces of work he knew-absolutely altruistic, with no­one on the staff" making a good thing out of it "; in fact the Committees werequite exercised about some of the salaries. The staff gave so much to the workthat they could never be recompensed in a material way.

The Chairman then called upon The Anglican Bishop m Jerusalemto address the meeting.

Bishop Weston Henry Stewart, D.D., said that on his way to the meetinghe had met Her Majesty's Minister in Beirut going to that other Conference,and Mr. Chapman-Andrews (who is now the Honorary President of the BeirutExecutive Committee of the Hospital) had asked him to convey his greetingsboth to the Chairman and to the meeting.

Some years ago, said Bishop Stewart, when Palestine was still a State,two men came to his door to ask for his assistance. They lived in a block ofmodel dwellings, and said that on their staircase there were 47 people, 12 ofthem children. Two were keeping guard in a third-floor room over a man whowas dangerous, not to say homicidal. His visitors had spent two days goinground Jerusalem, searching for someone to take in this poor fellow. The nearestavailable hospital was Bethlehem, and it was full. The police would put theman in a cell if someone could make him commit a crime, but otherwise theywere powerless. So, failing the Department of Health and the Police, theycame to the Anglican Bishop! It took him another 36 hours to find a place,and then it was only secured by turning out a patient, one degree less violent,from the Government mental hospital in Bethlehem. He gave this reminiscenceas an indication of the gravity of the need for the kind of work that Asfuriyehis doing. He would go so far as to say that the absence of adequate servicefor mental cases was one of the blots upon the late administration in Palestine.

It was, as the Chairman had pointed out, not only the Lebanese thatAsfuriyeh served. The Lebanese Government had been very good to Asfuriyeh,and he was sure that in doing so they were aware that they had greatly helpedneighbouring countries.

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Bishop Stewart said that he had visited the place a month ago. He couldad~ one more country. to the C~airman's list, for there were then at least twop~tIents from Afghamstan. HIS o~n .diocese was pretty extensive, but the~IO~se .of Asfunyeh was larger still, mc1uding people from Turkey. This,m hIS VIew, was one of the strongest pleas for this work. Another was thatit is leading the way among the surrounding States, showing how such workcan be done, may be done, and, please God, will be done. He believed thatIraq had been consulting with Asfuriyeh as to the possibility of starting a similarplace, and that there seemed to be a reasonable prospect of something beingdone.. Return~g to his own visit, he could not say anything on the professional

SIde, but he dI~ know a good atm.osphere when he met it: he did know gentlenesswhen .he sa~ It; ~nd, so fa! as IS humanly possible in the peculiar sorrow andsuffermg wIth which Asfunyeh deals, he knew happiness when he saw it. Agood atmosphere, gentleness and happiness were the things that struck him ashe went round. It was, unfortunately, a Saturday afternoon, when most ofthe work and all the technical treatments were in suspense, but he saw patientsin almost every sta e, and came away feeling much as the Chairman did whenfirst he went there.

Asfuriyeh is, in that sense, a pioneer institution-founded to show whatcan be done, and how it can be done. It is, however, more than that, for it isa place that is training people for such work. He was sure that as the surround­ing countries developed some kind of service on these lines, it was to Asfuriyehthat they would send their trainees.

Lastly, he would put forward another plea for supporting this place, basedupon what he would call the indirect or reflex action of Asfuriyeh. Sir Williamhad said that the Beirut Committee were a set of tough business men. Speakingas a Bishop, he was profoundly grateful to find the oil men, bankers, the shippers,all these business "toughs ", getting together in a cause not only of humancharity but the charity of God.

Mr. H. Lyn Harris, Chairman of the General Committee, presented theReport of the General Committee. The activities there mentioned were thebackground, the general arrangements and organisation.behind the real ~orkof the Hospital of which Dr. Grey Turner would be speaking. The CommItteesexisted to help the mentally and nervously afflicted, but much had to go onbehind the scenes to enable this work to be carried out and to provide the means.A great deal had happened during the year, and he was happy to say that co­operation between the Committee in the Lebanon-which had ~een extremelyactive-and the Committee in London had been even more cordial than before.They had worked together in great harmony.

It was a real pleasure to have Sir William Houstoun-Boswall in the Chairthat day. He was one of the la~est r~cruits from the Lebanon to bec0rr:te aVice-President, and was able durmg hIS regular attendance at th~ com~It.teemeetings to give advice born from expert .knowledge. To ha~e hIm preSIdingtoday at a meeting representing so many mterests and countnes and facets ofthe Hospital's work was most valuable.

They were also happy to have with them three of the first four Lebanesenurses who had won the Asfuriyeh Certificate, and had come t.o E~gland tocomplete their mental training. They wer~ at Runwell HospItal m Essex,and doing very well, theoretically and practIcally. He welcomed them to themeeting as forerunners of the many men and. women w~o would, he hoped,come here and help to establish a local nursmg profeSSIOn for t~e mentallyafflicted in the Middle East. There were also already at the Ho~plta~ studentnurses from the Hashemite Kingdom of Jordan, some of whom nught m courseof time complete their training in England.

19

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The Report showed an increased number of patients, many close andhelp~ul c.ontacts between Lebanon and London, great activity in building andrepa~s, m renewals and in fresh schemes. A great deal of work had beenrequIred at this end in connection with finding personnel.

. Referring to the new members of staff, Mr. Lyn Harris hoped that two moreItalian nurses, trained in Switzerland, would join Miss Viotto. The latter haddone magnifice.nt work in connection with one of the houses, where her personal~are and devotIOn had made her patients not only happier but more fit, and hadunproved the whole atmosphere. The Committee were also grateful forthe invaluable work done by Mrs. Arnold Brown, a volunteer, for the studentnurses and occupational therapy department. In Miss Trappitt they hadfound an extremely good medical secretary from a well-known British hospital,who felt the call to this work. In April Mr. J. D. Knight, a skilled andable man, connected with the same group of hospitals, took up the work ofsteward-accountant. Today they had with them Mr. David Dewar the firstBritish male nurse since early days, who was due to start for Asfu;iyeh veryshortly.

The Committee were very happy to have with them that day, too, one ofthe medical staff, Dr. Chucri, who was taking special courses of study in thiscountry and on the Continent. Altogether, it had been a most strenuous andactive year, but one of great interest, bringing a sense of accomplishment. TheCommittee felt happy in the personnel whom they had been able to recruit,and looked forward with confidence to the welding together of these men andwomen in a harmonious team under Dr. Ford Robertson.

Mr. O. M. Darton, F.e.A., Honorary Treasurer of the Hospital, inpresenting the accounts for the past year, which are subject to audit, said:" We have received in Beirut, largely in the form of patients' fees, the sum of£70,965. This shows some increase over the figure of the previous year. Theincome received in London from subscriptions and donations, legacies andincome from investments, etc., has amounted to £1,508, making a total incomefor the year from all sources of £72,473. This income has been expendedin the following way. We have spent a total of £61,558 on the cost of actuallyrunning the Hospital, and it may be of interest to you to know that of this sumapproximately one-half is absorbed by salaries and wages, one quarter by food­stuffs, and the remaining quarter by the cost of fuel, repairs to the buildings,renewal of equipment and many other sundry items of expenditure. Theexpenses paid in London have amounted to £1,542. The sum of £8,791 hasbeen transferred to the Special Reserve Fund in respect of staff indemnities andother claims, and there thus remains a surplus for the year of £582, which hasbeen credited to the Contingencies Fund.

We have spent during the past year and charged against the ContingenciesFund the sum of £6,284 for much-needed additional buildings and equipment.Included here is some £4,000, which represents the major part of the cost oferecting the new doctors' quarters.

During the past year we have received for the Extension Fund a mostwelcome g~t of £100 f!om the Barrow Cadbury .Fund, and in the current yeara further gift amountmg to £200 from The Fnends of Armenia earmarkedfor Arn:enian patients. . We are indeed grateful for these gifts, 'and in thisconnectIOn you may be mterested to know that during 1951 we treated some60 Armenian patients at the Hospital, whilst over 1,000 consultations were givento Armenians at our Beirut Clinic during the past year.

During the current year we plan completely to renovate Swiss House atthe cost of some £3,000, but by far the largest item of expenditure will be thenew treatment centre which we plan to put up at a cost of some £25,000. Our

20

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embarking on expenditure of t~s magnitude at the present time representsperhaps s.omewhat of an act of faIth on the part of the Committee, as anyhowten:P?ranly ~e shall have to borrow from the bank in order to finance theb':!ildmg. ~t IS hop~d event~ally, however, that the use of the treatment centreWIll result m some mcrease In the fee .

With all this .expenditure on our hands we do most earnestly appeal toyou for yo~r contmued support. I know that in these days it is difficult foranyone to mcreas~ the amount of his or her contribution, but possibly, if youare not already domg so, you would agree to contribute under a deed of coven­ant, whic~ has the effect of nearly doubling the benefit of your subscription tothe HospItal.

If Asfuriyeh is to continue to play its part as a modern treatment centrefor mental diseases, it seems to me that we must move forward with the timesan~ it is in this spirit th~t we now embark on this new undertaking, and in th~belief that we are carrymg out a thoroughly worth-while piece of work in thealleviation of mental suffering in the Near East."

The Chairman then welcomed Dr. Grey Turner to the meeting, not onlyfor himself but as Assistant Secretary of the British Medical Association, ableto interest other doctors in this work and to help to keep the Hospital up todate. Dr. Grey Turner had lately been to Baghdad to a meeting of the MiddleEast Medical Association and had afterwards visited the Hospital.

Dr. Grey Turner, M.e., said that he had great pleasure in presentingthe Medical Report of the Hospital, on behalf of his friend Dr. Ford Robertson.He had no right to do so, as his two brief visits had been purely social. Onboth occasions, indeed, he had been unlucky. On the first, in the course ofhis journey a tin of treacle had discharged its contents over his evening clothesand everything else, so he arrived in a very psychiatric state. The secondoccasion was almost worse: he had made a feverish journey by car fromJerusalem to Damascus in an attempt to catch the night plane, and had missedit by two or three minutes. So on both occasions he was sadly in need of theserenity, repose and therapeutics to which the Lord Bishop had referred.

He had read this report with great interest. It chiefly took the form ofa series of tables the first giving the total number of patients admitted duringthe year (420) and their disposal. Of these, 31 were discharged" recovered. ",71 " socially recovered "-this meant that they were perhap~ not equal. to gomgback to their previous occupations, but could go to slffipler Jobs-89 dIscharged" relieved ". It was a little difficult to distinguish between the two last groups:patients who were" relieved" could not perhaps take up any work, b~t theycould go back to their families, would behave normally and not reqUITe re­straint. Finally, 166 were discharged "not ~p~ove~ " and 19 h~d died.

As they all knew, mental disease, psychlatnc dIsease, was s~ill rat~er anuncharted sea. It was one of the youngest bran~hes of the medIcal SCIences,and was rapidly developing. Having regard. to ItS present state, he thoughtthese figures were very creditable and very satIsfactory. About 190 out of the420 went out distinctly improved. That was not at all bad, and comparedfavourably with figures in this country. .

The Chairman had already referred to the second table, whIch showed thedistribution of these patients by nationalities. Natura;llY'. by. far the ~e~testproportion were Lebanese. The third table showed dlstnbutIOn. ~y religIOns.Again, the biggest proportion was Moslem, but many other religIOns figuredprominently. .

In Table IV (printed on p. 15) by far the largest group. diagnosed was !heschizophrenic (368 in this category out of the tot3;1 of 774 pat~ents treated ~ur1ll;gthe year). That proportion was a good. deal hIgher than .It ~o~d be III thISco t h· h as interesting. One did find that the distnbutIOn not only

un ry, w IC w . d' difii t t f th Idof physical but of mental disease vane m eren par s 0 e wor .21

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Coming to results of treatment, he mentioned Insulin Coma treatment.As they knew, some mental diseases were treated by injection of big dosesof insulin, which induced a convulsion in the patient. This seemed to have avery salutary effect in certain forms of mental disease. He believed this factwas noticed accidentally, when treatment was being given to a diabetic patientwho was also mentally diseased; an overdose was given by mistake, and thedoctors noticed a great improvement in the mental condition. This illustratedthe way in which discoveries in Medicine were sometimes made. In any casethe Insulin Coma treatment was now established, and carried out on a largescale at Asfuriyeh. The results of this method were: 26 cases recovered,28 relieved, 27 no change-in other words, results roughly in thirds. That,again, he considered, compared satisfactorily with similar results in this country.

Electric shock treatment was also used. Seeing the good results from theinsulin treatment medical science had set about finding other ways of inducingthe same kind of ~onvulsion,one way being by passing an electric current throughthe brain. That was also done on an extensive scale with suitable patients nowa­days. The results at Asfuriyeh were: 28 patients recovered, 41 relieved, .44no change. That was rather a low figure for recovery, but Drs. Manuwanand Aivazian who contribute this part of Dr. Ford Robertson's report, pomtout as the p~obable reason that many of the patients show such. dramaticimprovement that their relatives remove them before they ought to ~e dIsc~arged.We are up against the same thing in this country too. The relatIves th~ thepatient is all right and take him home, not realising that this treatment, like anyother has to be extended long beyond the point of apparent cure and has to befollo~ed up by careful convalescence and observation. In ~he Middle East,no doubt it is even more difficult than here to put that pomt across to therelatives. ' However, as the report points out, the doctors do see some of thesepatients at the out-patient clinic in Beirut City, and in many cases find that therecovery has progressed and the patient really has .recovered.. Probably ~:mecould again say that the proportion is roughly one-thrrd: one-third: one-thrrd;which is satisfactory. .

The Beirut Neuro-Psychiatric Clinic Dr. Grey Turner consIdered to be amost important part of the Hospital. As ~entioned above, it. was v.ital tofollow up the patients when they left, to contmue treatment durmg therr con­valescence outside, and to spot any tendency to relapse.

There was no doubt that, as the Bishop had said, Asfuriyeh was a pioneerpsychiatric centre in the Middle East. Psychiatry being so new a branch ofmedicine, we were not so very far in this country from the days when mentalpatients were locked up, put in chains, immersed ~ water or treate.d by met~ods

of restraint-treatment which we should now consIder barbarous: m the MIddleEast they are even closer. There, in many countries, tteatment of mentaldisease is still entirely a matter of restraint, that is, locking up the patients andkeeping them away from society. In the rest of the world, in Western Europe,it is now realised that psychiatric disease is in fact disease, which should betreated, and that restraint is a very minor part of the treatment. Asfuriyehis pioneering these ideas in the Middle East. He was immensely impressedwhen he saw round the place. He entirely agreed with the Bishop that theatmosphere is amazingly encouraging. Somehow, you almost felt you couldnot but get better there, for it is such a beautiful place, so efficiently run,everyone so friendly and cheerful, the medical staff and nurses so gentle. Thewhole atmosphere was wonderful.

His visit to that part of the world was in connection with a tour of branchesof the British Medical Association, and he was glad to hear from the Secretaryof the Middle East Branch that they hoped to hold a meeting at Asfuriyeh.That would be a grand thing, for it would show all the doctors in that area that

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Asfuriye? exists. They w<;mld be shown round, Dr. Ford Robertson would beable to Impart some of hI~ o.wn enthusiasm, and it would do a great deal toincrease ~owledge and (mcIdentally) enhance the prestige of the Hospital.He hoped It could be arranged.

~o!her important and useful .fun~tion that Asfuriyeh is undertaking isthe t!am~g of l<;>cal nurses. Nursmg m man.y countries of the world, andcertamly m the MIddle East, l~gs a good way behind the standards of this countrywhere yve were perhaps first m the field under Florence Nightingale and havemain~amed .that lead. The standard of nursing in this country he consideredthe hIghest m the world. Dr. Ford Robertson told him that his nurses tendedto concentrate too much on theory and not enough on practice and he had hadthe pleasure o~ findin.g f~r him a First ~dition of Floren~e Nightingale'sNotes on Nurszng, WhICh IS a wonderful little book, packed with excellentsound commonsense and fundamental nursing precepts. He recommendedit to any of them who could get hold of it.

Dr. Ford Robertson had asked. hi~ to ~ake ?~e point. He said we badlyneeded one or more of the provmcIal UruversItIes to arrange an intensiveTwo-Year Post-Graduate Course for the D.P.M. (Diploma in PsychologicalMedicine). If there were anyone present who was connected with one of theBritish universities, perhaps he would take that need back to his MedicalFaculty, and urge them to introduce a two-year intensive course for medicalstudents from overseas, and particularly from the Middle East. The presentthree-year course was impracticable.

He would like to congratulate the Committees and Hospital on havingas Medical Director Dr. Ford Robertson. As many there would know, he wasa famous son of a famous father; a talented and able psychiatrist, full ofenthusiasm for the work, and Dr. Grey Turner had no hesitation in sayingthat the Committee was extremely lucky to have him there in Beirut. It waswith much pleasure that he presented Dr. Ford Robertson's report.

The three Annual Reports, having been put to the meeting, were formallyadopted. Some questions followed-on after-care (unfortunately not yetorganised), the sending of doctors and nurses from Holland and other countries(a Dutch Sister, Miss Grypma, had just -been appointed, and other applicationswould be most welcome), and social life for the staff.

A list of the Members of the General Committee, as shown on the insidefront cover, was read by Mrs. Arnold Brown (who had recently returned fr?mAsfuriyeh) with a motion that all of these be re-elected, and a further motIonthat Mr. Darton be re-elected Honorary Treasurer of the Hospital and Messrs.Woodman Cox and Wilkins be re-elected Auditors. These resolutions were,seconded and cordially accepted. .

In conclusion The Chairman thanked all the speakers for therr welcomehelp that afternoo~, as well as the audience for coming to the meeting, and h?pedthat out of this meeting there might be many offers of help and useful suggestIons.

Mrs. Robin D. Collmann (Australian delegate to the United. NationsInternational Conference at Stockholm and a member of t~e Exec~tIve of theMelbourne Branch of the National Council of Women) saId that It gave hervery great pleasure to move a vote of thanks to t.he C~airman that af~ernoonfor the very capable, interesting and tactful ~ay m WhICh he had charre~ themeeting. They could assure him that he was m no way fe!t to be a substItute,but that he had been the right Chairman for these proceedings. .

. If there was one thing more than anot~er that appeal~~ to her m what hesaId, it was his use of those two words, the Welfare ~t~te . She hoped thosewords appealed to every one there, irrespective of politIcs and that they ~ouldnever depart from the English language. None of us could be truly CItIZensunless we were doing something for others.

23

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The two things that we need in this world today, she said, are a greaterunderstanding of human nature and a better international understanding. Inthis Hospital in Lebanon we have an international centre which is not onlytrying to heal and mend the minds of actual people, but is also trying to under­stand human nature. We spend a great deal of money on scientific research,but, as our medical speaker had said today, medical science has lagged behind inthe understanding of mental health, and she was very pleased to hear that weare making such strides in endeavouring to understand the mentally handicapped.She took a special interest in this subject because her husband was a researchpsychologist, working here in England for this end.

As an Australian, she also wanted to say that many Australians havehappy memories of this particular Hospital. During the last war half of itwas used as a general hospital and convalescent hospital, and many Australiansoldiers remember very happily their experiences there.

For herself, she had been so enthused by the Secretary and AssistantSecretary about this Hospital and its work, that she had promised, when shereturned to Australia, to try to revive the Lebanon Hospital Committee thereso that there might be at Asfuriyeh some permanent memorial from theAustralian people, that they might be able to show their practical appreciationof what had been done in the past and to forward its work in the future, for theadvancement of this branch of medical science.

She had indeed esteemed it a great privilege to be there that day, and wassure that all of those present would wish her to express to the Chairman of theday their great appreciation of his services.

The motion was carried by acclamation.

Special appreciation was felt of the presence throughout the meeting (under his ownflag) of His Excellency The Minister for Lebanon, Dr. Victor Khouri, who had recentlyvisited the Hospital and was in full sympathy with its work. Dr. Khouri had notified hiswish not to be called upon for a speech if he managed to be present.

The General Committee also much regretted not having a few words from anotherVice-President, Mr. F. Hourani, who had to return to Manchester before the end of themeeting. Mr. Hourani has now served on the General Committee for almost 33 years.He brought to London that week a gift of £100 from the Lebano-Syrian group at Manchester.

Lebanon Hospital for Mental and Nervous Disorders.Balance Sheet December 31st, 1951.

Capital Funds- £ £ Land and Buildings at Beirut- £

i .lliIlI..Lan"lId.ailDLjd~B~W~·I~d~iniP~~F!.UD..:.d.:.'_~~L -l:-...;C~O~s~t!!tO~ISlJt i!!Jan~uiar~y~, 119~5=-1_~.,;.. --, 53,lm5. lao." 1st January, 1951 .. 53,805 Additions durina 1951 • L 4,409

7,0421,875

8,9173,616

£

S8,214

5,301

[1.

AUXILIARY COMMITTEESUnited States of America-

Treasurer: PAUL W. BROWN, JNR., 1632 Chestnut Street, Philadelphia, 3, Pa.Switzerland-

President/Han. Sec.: Mlle. RENEE LE FORT, 14 Rue Senebier.Treasurer: M. LEOPOLD GAUTIER

SCOTTISH COMMITTEES

Edinburgh-Han. President: THE RT. HON. THE EARL OF SELKIRK, O.B.E., A.F.C.

Chairman: SIR HUGH ROSE, BART.Acting Han. Secretary: J. A. W. STONE, ESQ., O.B.E.

Glasgow and West of Scotland­Chairman: I. MACKENZIE, M.A., M.D., F.R.F.P.A.

Han. Treasurer: J. CAMPBELL DAVIES, EsQ.LADIES' GUILD OF HELP

Central-Chairman : Mrs. L. B. BACKHOUSE.

Han. Secretary: Mrs. C. H. MERZ, 61 Holland Park Road, W.14.Lebanon-

President: Mrs. ALAMUDDIN.Han. Secretary: Mrs. FORD ROBERTSON.

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--£115,744- 006.

£ £ 1\ ",9,645 \ \.\ ,\ ,I ,1,1

1,246

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722

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I-- 74050

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he investments.KINS,

AlUlitor8.

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5,301

58,214

7.0421,875

8,9173.616

£53,11054.409

Land alld Building, at Beirut­Cost to lst January.! 1951AdditioDs duriog 1~51

££

Lebanon Hospital for Mental and Nervous Disorders.Balance Sheet December 31st, 1951.

The two things that we need in this world today, she said, are a greaterunderstanding of human nature and a better international understanding. In

We have audited the above Balance Sheet and Income and Expenditure Account with the London booband vouchers produced to us and with the Beirut Accounts and Balance Sheet certified by Messrs. Russell & Co••Chartered Accountants, Beirut, Lebanon, and we certify that the same are in accordance therewith. We have retiedupon the Hon. Treasurer's division of expenditure between Beirut and London, and have verified the investments.Bffingham House. Arundel Street, LondoD, W.C.2. WOODMAN. COX & WILKINS,28th July, 1952. . dud/torI•

£

74050

305250171

'.301

£

58.214

42,024

70.965

10,204

73.720

£72,481

£115,744

580309931 .

7.0421.875

8,9173.616

2.000280

4515.000

752.399

£53,1105

4,409

£

69,6451.246

722

1.163

17,268460

21,5031,603

Beirut Income­Patients' FeesCultivationsBank InterestDonation

Subscriptions:Great Britain ••Jubilee AppealArmenian AppealSwitzerland

Legacy, G. D. Easterbrook. deceasedInterest on Investments ••Grant towards Salaries .•Refund: Staff Insurance

INCOME

Current Assets-Stock in Hand at BeirutSundry Debtors: BelJ11t (less rc­

reserve)London .. ••

Cash at Banks and in Hand:Beirut ..London

Less Depreciation to date

Investments, at cost, includiDamoney on deposit-

For Peter Coats EndowmentFund.. .. .. •.

For Jessup Endowment FundFor Robert Fortescue Fox

Memorial Fund . . . .For Retiring Allowances FundFor Scott Moncrieff Travel

Fund.. .. ..For Contingencies Fund(Market value £10.467)

Land and Buildings at Beirut-Cost to 1st January. 1951 .•Additions during 1951

Equipment and Furnitllr. at Beirut­Cost to 1st January. 1951Additions during 1951

£

15.443

93.668

18,681

2.008

58,214

£61,521

371,543

8,791

71.892

589

5.3012,000

280

4515,000

75991

3,905

76,217

£72.481

8.791

3,219176

1.286722

£

53,8054,409

4,9311.875

6,8061.505

19,776589

1,505

21.870

6,427

3,395

£115.744

Income and Expenditure Account for Year ended December 31st, 1951.

Asfuriyeh Special Contingencies Fund-Balance, 1st January, 1951 9,890Transfer from Income and

Expenditure Account

Less Additions to Capital andDifference on Exchange

Transfer to Contingencies Fund

Peter Coats Endowment FundJessup Endowment FundRobert Fortescue Fox Mem-

orial FundRetiring Allowances Fund .•Scott Moncriefi' Travel Fund ..Extension FundAsfuriyeh SpeCial Reserve Fund

Accumulated Surpluses­Beirut Clinic:

Balance, I st January. 1951 ..Surplus for 1951

Contingencies Fund:Balance, 1st January. 1951 ••Surplus for 1951 . . •.Transfer from Equipment and

Furniture Fund

Sundry Cndltors -BeirutLondon

Capital Funds-Land and Buildinas Fund,

Balance 1st January. 1951 ••Additions during 1951 ••

Equipment and Furniture FundAdditions during 1951. • . .

EXPBNDITURB

Beirut Expenditure (including depreciation)Difference in Exchange .. . . . .London Expenditure . . . .Transfer to Asfuriyeh Special Contingencies

Fund .• ••

Lebanon Hospital for Mental and Nervous Disorders.Balance Sheet December 31st, 1951.

Surplus for year. transferred to ContingenciesFund .. .. .. .. •. •.

•

USE OF THE VILLASO~n,d

Male KHAlRALLAH HOUD Early and convalescent ·. ·. .. 1936

Patiea ROBERT RYEItSS· Acute .. ·. ·. ·. ·. ·. 1903

ENOLISH· Quiet and sub-acute ·. ·. ·. ·. 1914WATSON SMITH (ground 800r) Chronic, quiet and infirm ·. ·. ·. 1934

WALDMIlIER Chronic sub-acute ·. ·. ·. ·. 1931

- WALDMBlER ANNBXB Chronic quiet and infirm ·. ·. ·.Female WEBSTER Housa Early and convalescent ·. ·. ·. ·. 1939 .

Patieal8 IRISH Chronic quiet ·. ·. ·. ·. ·. 1936

PHILADELPHIA Chronic sub-acute ·. ·. ·. ·. 1904

AMEJuCA Acute ., ·. ·. ·. ·. ·. 1900

Mixed GLOCJU.I!R Housa Early cases, also for diagnosis ... .. 19S0I

Staff HOLLAND Housa Matron and Sisters ·. ·. ·. .. 1905Kitchen and Store, Central Dinin, Hall ,nlarg,d 1936

S'IllA.WBRIDOB· Hospital Secretary and family, Occupational or.

Therapist, Sister Tutor, Housekeeper, ~,

Staff Nurses •• ·. ·. ·. ·. 1906

SWISS Deputy Charge Nurse, Male Student Nurses,Laboratory Assistant and others .• • . 1900

WATSON 8MITH (1IT FLooR) Medical staff, Post-graduates, Interns ·. 1934

SC01TlSH Female night staff, senior and junior, Graduate I~

nurse interns, Sister. (Temporary use) •. 1933I

• Given In Memoriam.Other BulldlngJ-JOHN CoRY HALL (1906) for relisious services, lectures, cinema: LADY SCOTr-MONCIlD!PF HALL for Occ:upational Therapy (1938), PHARMACY and LABORATORY,LAUNDRY and PATIENTS' WORKSHOP, WORKMEN'S Housp, WORKSHOPS, FUEL and STORE HOUSES,THREE ARMY HUTS, 1941 (Female Staff Dormitory, Male Staff Dormitory, Beddina Store).Recreation Ground-Basket Ball, Badminton, Deck Tennis, Open-Air Swimming Pool.

The LEBANON HOSPITAL for MENTAL and NERVOUS DISORDERS (originally called., The First Home for the Insane in Bible Lands ") was founded on the initiative of a Swiss missionary,Theophilus Waldmeier, to rescue from untold suffering those who were chained and neglected inunseen places 01 taken to mountain caves to undergo" exorcism," a!: the orly methods of dealingwith mental illness. During a two-years journey Mr. and Mrs. Waldmeier formed committees invarious countries, under a Central Committee in London with Executive Committee in Beirut.

The land was bought in 1898 and the Hospital opened in 1900. Different coutries provided thebuildings, which stand in about 38 acres of grounds, 4S0 feet up, on the slopes of Mount Lebanon,about 6 1DI1es from Beirut on the Damascus Road.

A Neuro-Psyc:biatric Oiaic was opened in Beirut in October, 1947.Number of Patieal8 in Resideace, July 16, 19S2: 430 006

The Asfuriyeh Estate was made WAKF, FORM OP BEQUEST TO TIIJl LEBANON \that is dedicated as a religious foundation, in HOSPITAL\ 1\ \\11

1912, and is held- in trust by the General Com- I \ \ \ .1./.1

mittee in London. It is to be used:- I bequeath to the Treasurer or Treasurers

~~:if\ 1\'\'\'1 '1'/'1

.. For works ofmercy to thos, who are afflicted 009 \with mental and nervous diseases of all kinds for the time being of the Lebanon Hospital for\ \~

\

from among th, people ofubanon andSyria as far Mental and Nervous Disorders, whoseIU the accommodation wl/l allow, according to the

~~\ \

\

judgm,nt of the overseer of the Wak/. And the office is at Drayton House, Gordon Street,1physician shall tr,at without any distinction by 1\relUon of s,ct or religion, until God }reals. And London, W.C.l, the sum of.•........••.•.• '" "-the overseer further extenrh th, benefit of this

",dowmentto all sufferers with m,ntal and nervous fre, of duty, to be applicable to the general

~"" \

\

dlselU's without distinction ofcou",ry or creed... And this Walif is sellled, dt'dlcated, and legal, purposes of the said Hospital; and I declare ~and shall not be sold nor granted, nor mortgaged,

nor appropriated • •• stJ that this Wakl (endow- that the receipt of the Treasurer or Treasurers ""~'".

menl) may remain Intact until God Inherits theelll'th and ,verything In II." for the time being of the said Hospital shall

(Extract from the translation of the Arabic "- ITItle Deed.) be a sufficient discharge for the same.

,,}.",-

008 ~ "-....

Prinl,d for Edgar G. Dunstan &: Co., Drayton House, Gordon Street, London, W.C.I, by Th, HerefordTimes LId. (T.V.), London and Hereford.

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