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LEBANON HOSPITAL r

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MENTAL AND NERVOUS DISORDERSI-

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ASFURIYEHI

BEIRUT

LEBANON

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62nd ANNUAL REPORT

1960 I

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DECEMBER, 1960. REPORT OF THE GENERAL COMMITTF.F.I

Lebanon Hospital for Mental and Nervous Disorders

PRESIDENT:

THE RT. HaN. THE EARL OF FEVERSHAM. D.S.O., D.L., J.P

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VICE-PRESIDENTS:

GENERAL COMMITTEE (LONDON)

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STEPHEN HARRIS, M.A., A.M.I.C.E.

ALBERT HOURANI, M.A.

Miss LETTICE JOWITT

GEORGE SOMERVILLE, M.D., D.P.M.

J. C. SAWLE THOMAS, M.R.C.P., D.P.M.

F. R. P. VINTER

Dame KATHERINE C. WATT, D.B.E. R.R.C.

THE RT. HaN. THE EARL OF SELKIRKO~~,~~~ '

DR. G. W. B. JAMES, C.B.E., M.C.

SIR HAROLD SATOW, K.C.M.G., O.D.!.

EXECUTIVE COMMITTEE (BEIRUT)

Chairman: H. LYN HARRIS, M.A., LL.B. Hon. Treasurer: O. M. DARTON, B.A., f.C.A.

Vice-Chairman: R. J. D. BELGRAVE

Honorary President: H.E. THE BRITISH AMBASSADOR IN LEBANON

Chairman: JOSEPH HITTI, M.D.

Vice-Chairman & Hon. Treasurer: W. F. GOSLING, O.B.E.

Honorary Secretary: Mrs. WM. EDDY

Mrs. Lucy B. BACKHOUSE

RAYMOND de C. BALDWIN, O.D.E.

Dame DORIS BEALE, D.D.E., R.R.C. & BAR

THE Rev. J. ANDERSON BURI.EY, M.A., f.R.G.S.,HON. C.f'.

H. BARRS DAVIiS

H. JoCELYN EUSTACE, B.A., M.B., B.CH., D.P.M.

Miss HILDA A. Fox

HIS EXCELLENCY THE LEBANESEAMBASSADOR in London

lin! RT. HaN. THE VISCOUNT DE L'ISLE, V.C.

SIR GEOFFREY FURLONGE, C.M.G., O.D.E.

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Physician Superintendent: A. S. MANUGIAN, M.D., D.P.M.

Matron: Miss E. McKERCHAR. S.R.N., R.M.P.A., R.M.N.

Consultant.r:

Specialists of the American University of Beirut.

Prof. ALBERT BOUEZ (Stomatology) DR. ALEXANDER HITTI (Cardiology)

DR. T. EL-AwAR (Tuberculosis) DR. Y. JIDEJIAN (Surgery)

Mrs. NAJIB ALAMEDDINE, M.D.

Mr$. EMILE CORTAS

H. W. GLOCKER, M.B.E.

Prof. S. B. HIMADEH

IBRAHIM A. KHAIRALLAH, M.A., LL.B.

Prof. PAUL KHLAT

JOSEPH J. McDONALD, M.D.

GEORGES N. RAYES

SA'EB S. SALAM

J. SCOTT SMITH

FRANK J. ZUKOSKI, M.D.

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Beirut Auditors: MESSRS. RUSSELL & CO., P.O.B. 540, Beirut.

London Auditors: Messrs. WOODMAN, Cox, & WILKINS, 31, Bedford Row, London, W.C.l.

Bankers: LLOYDS BANK LTD., 263, Tottcnham Court Road, W.l.

Secretary: STEPHEN E. DUNSTAN

London Office: DRAYTON HOUSE, GORDON STREET, W.C.l (Tel. EUSton 2108)

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DECEMBER, 1960.

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REPORT OF THE GENERAL COMMITTEEFOR THE YEAR 1960

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The report of the General Committee of the Lebanon Hospital for1960 must perforce commence with some words about the losses we havesuffered in the deaths of three Vice-Presidents and a Committee memberduring the year. It was not long after the Annual Meeting, at which hehad presented the Medical Report, that news came of the passing ofProfessor Alexander Kennedy. A Vice-President who was far from afigurehead, Professor Kennedy was an indefatigable worker for the goodof the Hospital, attending Committees and speaking at Meetings, and inregular correspondence with the London Office and with Dr Manugianin Beirut.

Shortly afterwards we lost Sir William Houstoun·Boswall, of ourVice-Presidents the one most frequently able and glad to attend meetingsof the Committee. His interest in the Hospital sprang from his associa­tion with it when he was British Ambassador in Beirut and was Presidentof the Beirut Executive Committee. Since his retirement from the foreignservice he h.ad been a very active Vice-President in London, and tookthe Chair at the Annual Meeting in 1956. He too was in regular ~ouch

with the London Office, helping in every way he could.Mr Fadlo Hourani's services to the Hospital had been many and

valuable. His unfailing appearance at the Annual Meeting, always withthe gifts he had collected from his Lebanese friends in Manchester, waslooked forward to by all. A fuller appreciation of his life was printedin the Annual Report for 1959.

Dr Percy Brigstocke, a member of the General Committee for twentyyears, and whose father was one of the original members of the BeirutCommittee, died in December. He had not been able to attend Committeemeetings for several years, but his interest in the Hospital remainedundimmed; his valuable work will not soon be forgotten.

We wish to record our thanks for the lives of these friends of theHospital. The personal loss of their presence and friendship is felt verykeenly.

In the early part of the year the Honorary President of the BeirutCommittee, Mr Ponsonby Crosthwaite, was honoured by the award ofthe K.C.M.G.

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Visitors to London from Beirut inc!uded Mr ~. Khairallah, of theBeirut Committee, who had a long talk ~Ith the ChaIrman of the LondonCommittee when he was in London dU~Illg the autumn. Mr MohammedKozma arrived to take a course to tram as a !utor in Nursing, and isworking very hard at the Royal College ~f N~smg. Mr Ramsey Samahaand Miss Mary Katoul returned to BeIrut III J an.uary and Septemberrespectively. Dr Joseph Haikal returned to Asfunyeh with the degreeof D.P.M., as reported last year; he had followed hIS examination withpost-oraduate work in Edinburgh and London.

The London Committee has lost Pasteur Reverdin who returned toSwitzerland in February. Miss Jowitt, the late Dr Brigstocke and MrAlbert Hourani were designated Corresponding Members of the LondonCommittee, so that we should retain the be~efit of their advice and helpwithout expecting their presen.ce at CommIt,tee meetings. The LondonOffice welcomes back Mrs Lmgard as ASSl tant; she worked for theHospital two years ago before her marriage, and ha now returned to livein London again.

In June Mr Lyn Harris met Dr Manugian in Geneva where exhau ­tive consulations took place. Mr Harris also met and talked with DrTigani EI-Mahi, head of the Mental Health Section, WHO, EasternMediterranean. whose interest in and contacts with Asfuriyeh haveresulted in work for WHO reported elsewhere.

The departure of Miss E. C. Cory from Asfuriyeh was inevitableat some time, but the loss is great. She returned to England in November,and has since been a frequent visitor to the London Office. Her firstcontract with the Hospital was as a Junior Sister in 1950; she left asDeputy Matron more than ten years later, a record excelled by few ofour past nursing staff. She is taking up a post in Tanganyika.

The gifts and donations for the work of the Hospital have continued;the missionary outlook may change but it does not fail. While we donot now expect to make converts to Christianity, we can and do helpto heal God's people, in whatever fashion they may worship him.

The future of the Hospital remains bright. The financial positionhas eased very considerably, thanks to the efforts of those in Beirutand London who have been concerned in the matter. Our thanks aredue to the Lebanese Government for its continuing concern for the workof the Hospital; and to the Swiss Government for a substantial giftduring the year.

The link with the World Health Organisation promises us muchhard but satisfying work in the future. The need for a mental hospitalsuch as ours continues, and as treatments change, and more patientscan attend clinics instead of being parted from their families, our outlookand work must change in parallel. It is better to step forward in faiththan to stand still in hope.

The Physician Superintendent and all the Hospital staff, and theOfficers and members of the Beirut Committee, must smcerely be thankedfor their hard work during the year, in face of many difficulties.

H. LYN HARRIS, Chairman,S. E. DUNSTAN, General Secretary.

2

PHYSICIAN SUPERINTENDENT'S REPORT, 1960

Mr Chairman, My Lords, Your Excellency, Ladies and Gentlemen.

I have the honour to present to you the 62nd Annual Report of theLebanon Hospital for Mental & Nervous Disorders, that for 1960-1961.

Thi~ .Report would not have been possible without the completeteam spint o~ every member of the Asfuriyeh family. Therefore, it iscorrect and nght that I begin this Report by a sincere and public ack­nowledgmen.t of my. thank~ to everyone of the staff of all ranks. Duringthe year whIch has ]us~ fim~hed .every one of them has stood by my side,at tlI~es under very trylllg sIt~atlOns; thereby making a reality my dreamof seelllg a TEAM developed III Asfuriyeh.

We in Asfuriyeh felt very deeply indeed the loss of three of ourVice-Presidents in the persons of Mr Fadlo Hourani, Sir WilliamHoustoun-Boswall, and Professor Alexander Kennedy. Many of us hadknown them personally and had developed warm friendships with them.All of us have looked upon them as the inspiring forces behind Asfuriyeh.Our best expression of gratitude towards them and condolences towardsmembers of their families is to continue to build the Asfuriyeh whichwas so dear to them.

We were fortunate in having a visit by our President, The Rt HanThe ~arl of ~eversham, D.S.O., D.L., J.P., and from Mr R. J. D. Belgraveth.e Vlc~-Chairman of the I.:ondon ~ommittee. These visits have a trulystImulatmg effect on us. It IS our Slllcere wish that such visits should bemore frequent.

The year which has just ended has been a turning point in thehi~tory of Asfu~iyeh.inmore than one way. After several years of hard­shIp and finanCIal dIfficulty, we have come out of the red. In addition,we can see our way more clearly and can plan more objectively. TheLebanese Government has increased the rate of pay from 425 to 525Lebanese Piastres per patient per day. I have the honour and the pleasureof expressing my thanks in the name of Asfuriyeh to His ExcellencyPresident Fuad Chehab and his Ministers for their kind interest in ourHospital. In addition, we received a grant of LL. 20,000 from theLebanese Government. Because of this improvement in the generalfinancial situation, it was possible to proceed with the necessary adjust­ment of the salary scales of the lesser-paid staff. The free insurance formedical and hospital care of the staff which the Hospital continues toprovide has been a boost to their general welfare.

In this same context of substantial financial contributions it is mypleasure to record my gratitude to :

1. UNRWA, which has, as always, been willing to help in pro­viding more and more facilities for the welfare of the PalestinianRefugees under treatment in Asfuriyeh.

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2. The Swiss GOl"emmellt for Fr. Sw. 45,000. A quantity of urgent­ly needed equipment was bought, which has helped ~on~iderably improvethe scientific standard of the Hospital, thereby contnbutmg to the welfareof the patients.

3. Messrs Smith & Nephew. As on a previous.occasion, .t~is yearwe were blessed with a generous gift of various nursmg necessities.

4. Asfuriyeh Ladies' Guild. In previous years we have been for­tunate enough to receive generous contributions from them .for the wel­fare of the needy patients. This year they surpassed all previOUS records.Thanks to them we have an abundant supply of linen, blankets, clothing,and two Television sets for the patients. Besides this material help,members of the Guild have regularly come every Thursday and entertain­ed the patients. The present 'homely' atmosphere of the H.ospital owesa great deal to the devoted service of I?embers o~ the GUild. The co­operation between the Guild and the Be1f~t ~om~Il1 ttee has further beenstrengthened by the Chairman of the Ladies GUild, ~rs Faud Sarrouf,attending the Beirut Committee meetings as an ex-officiO member.

STAFF

In recognition and appreciation of their services, Dr Jean Hayekand Dr Ala'Uddin Drooby were promoted to Lecturers in Psychiatry atthe American University of Beirut.

1. Departures. We are sorry to lose Miss E. C. Cory, who left uson 9th November, 1960, after ten years of devoted and loyal service. Sheis hoping to continue her service to the sick in Africa. Miss Loui.saSawyer left us on termination of her contract on 1st January, 1960. MissNajla Mattar left for Great Britain to continue her studies. Similarly,Mr Mohammed Kozma left for England on 20th September, 1960, on aWorld Health Organisation scholarship, to study for a Tutor's Diplomaat the Royal College of Nursing. Miss Therese Abu-Jawdeh left us on9th April, 1960, to join the World Health Organisation. Finally, Dr A.Nicola left us on 2nd August, 1960, to rejoin the Arabian American OilCompany.

2. Arrivals. Mr R. Samaha returned from his training at theAdministrative Staff College in London on 15th February, 1960. Dr J.Haikal returned on 8th August, 1960, having obtained his Diploma inPsychological Medicine. Miss Mary Katoul returned on 5th October,1960, after a year's experience at the Maudsley Institute in London. MissM. M. Murray joined us as Sister Tutor on 1st July, 1960. Dr R. Wazirijoined us on 4th July, 1960, and Dr R. Moharrerri on 29th September,1960. as Residents.

4

TEACIHNG ACTIVITIES

1. Medical. Students at the American University of Beirut havebeen given regular courses in Psychiatry and related subjects. Our ex­perience in giving one month's residency to the fourth year medicalstudents has been encouraging. It is interesting to note that the WH 0Expert Committee on Undergraduate Training in Psychiatry, held inGeneva on 13th-18th June, 1960, recommended that all undergraduatemedical students should have one month's residence in a psychiatrichospital.

We have also had occasional medical students from the FrenchFaculty. We are trying to strengthen this relationship for the mutualbenefit of both parties.

2. Nursing. Students at our own Nursing School have been veryappreciative of our new Sister Tutor who has inspired new life into theirwork. Our graduates are still being actively absorbed into neighbouringcountries.

Affiliation with the Nursing School of the American University ofBeirut, the Makassed School, the Christian Medical Centre, and theNational School, have continued as in previous years.

3. MisceUaneous. Under the general topic of scientific and ed­ucational activities I would like to stress the increasing participation ofAsfuriyeh staff in this kind of activity. Amongst such activities were:the Arab League Medical Conference, 4th-8th January, 1960; Post­Graduate Training in Psychiatry, 9th-11th May, 1960; Middle EastMedical Assembly, 6th-8th May, 1960; Arab Countries Dental Congress,16th April. 1960; Lebanese Neurology and Psychiatry Society; and theAsfuriyeh Journal Club.

4. Extra-Mural Activities. We have continued out-patient servicein the following Clinics:

(a) Beirut Neuro-Psychiatric Clinic;(b) Tripoli Neuro-Psychiatric Clinic;(c) Sidon Neuro-Psychiatric Clinic;(d) Beirut Prisons;(e) American University Psychiatric Out-Patient Service (Adults);(f) American University Psychiatric Out-Patient Service (Children);(g) American University Mental Health Service.There has been a regular increase in demand for psychiatric services

and help. Because of this, although the Clinics in Tripoli and Sidon arefinancial liabilities, we have continued our service. Similarly, the prisonsmental health service is given by us completely free of charge. We feelsatisfied that Asfuriyeh is true to its Mission of Service and the Author­ities are appreciative of such high quality service given freely.

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WORLD HEALTH ORGANISATION ACTIVITIES

In connection with WHO activities I have the pleasure and honourto report the following :

(a) I attended the Expert Committee for Undergraduate Teachingof Psychiatry and Mental Health Promotion, 13th-18th June, 1960, inGeneva.

(b) Dr Tigani EI-Mahi, the Regional Advisor in Mental Health forWHO (Eastern Mediterranean) visited Lebanon 17th-24th October, 1960.He studied the possibilities of training of psychiatrists, psychiatric nurses,and other ancillary personnel in Asfuriyeh. In a long discussion which hehad with the Minister of Health, Dr Elias EI-Khoury, and the DirectorGeneral of Health, Dr Jamil Anouti, the Lebanese Authorities fullybacked the Advisor's recommendation of Asfuriyeh being the RegionalTraining Centre.

(c) The above recommendation was fully supported by the RegionalSpecialists in Psychiatry who met in Alexandria 19th-23rd December,1960. I attended this session as a delegate of the Lebanese Government.In this session I had the honour of submitting a detailed programme forthe training of mental health personnel in the Region and outside theRegion.

(d) I attended the Inter-Regional Committee on Techniques ofEpidemiological Studies in Mental Health, as a delegate of the LebaneseGovernment, 6th-15th December, 1960, in Naples.

EVALUATION OF RESULTS OF TREATMENT. (Contributed byDrs Jean Hayek, A. Drooby, V. Puzantian and J. Haikal.)

This year's evaluation of results is limited to the outcome of treat­ment of two main psychiatric disorders, namely schizophrenia and manic­depression psychoses.

The other diagnostic categories have been omitted owing to thesmall number of psychoneurotic patients admitted to the Hospital andthe known prognostic outcome of the organic states. As for the drugaddicts, the symptomatic nature of their management and lack ofadequate post-discharge follow-up made it preferable not to pass anyjudgment on the efficiency of the therapy.

Schizophrenic Psychoses

.As in ea!lier years. our po~icy ~as not to limit treatment to anyparticular vanety of SChizophremc patients. Whereas it is not yet possibleto select one group of ~a~ients suitable for on~ type of drug therapy wehave grossomodo admInIstered chlorpromazme to those manifestingpsychomotor over-activity (agitation, hallucination, etc.) and prochlor­perazine to retarded apathetic patients. Electroplexy was resorted to

6

first with patients having a predominance of catatonic features.The duration of the morbid process was another criterion which

was considered in the application of different forms of treatment.Thus, Insulin Coma Therapy was preferably chosen for the patients

presenting a relatively short duration of illness. When more than oneyear had elapsed since the onset, neuroleptics were used. In the lattergroup, reserpine and prochlorperazine were the two drugs chosen.

We should mention that the efforts to select patients and treatmentwas not influenced by a preconceived idea of drug trial: thus there wereno random selections of patients and no 'double-blind' controls. Asmentioned earlier, a particular patient was given a drug thought bestfor his condition.

The three levels of response to treatment; socially recovered, re­lieved, and no change, were judged by more than one observer.

The 'Socially Recovered' condition epitomised the state of thepatient who was freed of all the psychotic manifestations and revertedto his pre-illness level of social activity. The 'Relieved' group includedcases which had attained a state of improvement enabling them to leada satisfactory level of adjustment while retaining minor (non-disabling)symptoms. Here also were counted the patients whose amelioration wasonly symptomatic (i.e., not altering the fundamental nature of the illness).

Table A shows that the Electro-convulsive Therapy/Chlorpromazinecombination is of equal value to Insulin Coma Therapy, despite the factthat latter was given to patients representing a prognostically morefavourable group. Electro-convulsive Therapy proved to be less effectivethan prochlorperazine.

Insulin Coma Therapy seemed to be in no way superior to chemo­therapy, except reserpine. This, together with similar findings fromwell-controlled studies, encouraged us to discontinue Insulin ComaTherapy.

Manic Depressive Psychosis1. In the manic group (Table B) chlorpromazine alone seemed of

equal value to Electro-convulsive Therapy and chlorpromazine (nostatistically significant difference). As only three patients were givenElectro-convulsive Therapy alone no valid conclusion can be drawn.

2. The Depressive group was treated with different methods(Table C).

The Electro-convulsive Therapy, imipramine, and Electro-convul­sive/Imipramine groups are compared with each other. The Electro­convulsive TherapyjMAO Inhibitors and MAO Inhibitor alone groupsbeing small, are not considered in the evaluation of the relative result.

The results show that there is an equality of effect between imipra­mine and Electro-convulsive Therapy although the improvement wasobviously slower to appear with the former. The suicidal patients were

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TABLE I-Showing General Results for the Year 1960

InHospital Admitted1st Jan. During

1960 the year

preferably given Electro-convulsive Therapy. Imipra~n~ was ~or~ usedfor the elderly and weaker patients. There was no stattsttca~ly slgOlficantdifference between imipramine alone and Electro-convulsive Therapy!Imipramine.

I have the honour to be, Mr Chairman, My Lord, Your Excellency,Ladies and Gentlemen. Private ...

Public Assistance

82

210

344

182

Dis­chargedSocially

Recovered

33

26

Dis­chargedRelieved

177

142

Dis­charged

NotImproved

69

68

TotalDis­

Died charges

Re­maining

31st Dec.1960

146

150

Your obedient servant, Palestinian Refugees II I II

\ A. S. MANUGIAN, M.D., D.P.M.,

Physician Superintendent.U.N.R.W.A.... 33

15

83

131

10 57

81

18

39

3 88 28

120 26

Lebanese Army... 5 45 6 40 46 4

A.G.B.U. 4 2 3 2

Beirut Muni..:ipatity 41 83 6 77 18 101 23

Free

Total

13

I 411

2

874 77 I 542 252 10 881

14

404

TABLE B MANIC GROUPECT 1 2ECT/CWorpromazine 12 25Chlorpromazine 6 6TOTAL 19 33

SCHIZOPHRENIASocially Relieved

Recovered

TABLE V

TABLE A

Insulin Coma TherapyElectro-convulsive TherapyChloropromazineECT/CWorpromazineProcWorperazineECTfProcWorperazineReserpineTOTAL

5

26222

19

419

1962151333

192

NoChange

1366

1845

1567

o213

Total % ofSocially

Recovered& Relieved

59 78%15 60%27 78%86 79%21 81 %20 75%50 70%

278 76 %

3 100%39 95%13 92%55 93%

% ofNo

Change

22%40%22%21 %19%25%30%24%

o5%8%7%

TABLE 11Showing the Religious Persuasion~ of those

Admitted Durin/: tile Year 1960Religion Male Female Total

Druze 25 9 34Latin 2 5 7Greek Catholic 21 5 26Armenian Catholic 5 1 6Assyrian Orthodox 3 - 3Syrian Orthodox 1 - 1Armenian Protestant... 2 3 5Roman Catholic - 1 1Catholic 11 6 17Protestant 10 4 14Jew... 3 2 5Indo ... 1 - 1Kurdi... 1 - 1Alawite - 1 1Episcopalian - 1 1Greek Orthodox 66 36 102Armenian Orthodox... 45 38 83Moslem 385 93 478Maronite 64 24 88

645 229 874

TABLE 111Showing t~ Nationalities of those

Admitted During the Year 1960Nationality Male Female Total

Lebanese '" 487 143 630English 5 2 7Jordanian 16 6 22Greek 3 1 4Syrian 50 27 77Turkish . . . - 1 1Indian ... 1 - 1Palestinian . . . .. . 65 31 96Russian ... .. . 2 - 2Egyptian .. . .. . 1 1 2Iraqi 4 2 6German 2 - 2French 1 I 2Cypriot .. . - 3 3Saudi Arabian 3 2 5American 1 3 4Sudanese . .. 3 1 4Iranian . .. 3 - 3Qatari 1 - IEthiopian .. . . . . I - IAssyrian .. . .. . 1 - 1

, 1\" 1\ 1.1.1.11.1.1\~:\\ ,'1'1'1'1"'1'1'1

650 224 874

95%95%92%

100%75%93%

212012

34

60

111o14

13123o3

31

DEPRESSION7783o

25

TABLE CECfImipramineECT/ImipramineECT/MAO InhibitorsMAO InhibitorsTOTAL

89

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TABLE IV

STATE OF HOSPITAL IN YEAR 1960

Remaining inHospital 31stDecember,

1960M F T

16 17 33

Total Deathsand

DischargesM F T

20 10 301 -

DiedM F T

7 2114

DischargedNot Improved

M F T

835

DischargedRelieved

M F T

DischargedSocially

RecoveredM F T

27II16

TotalAdmissionM F T

4 II7

Re­AdmissionM F T

16

Total CasesTreatedIn Year

M F T--I I 1----

36 27 6379

FirstAdmissionM F T

In Hospital1st January,

1960M F T

7 23 30 28 30 58 21 42 62 49 71 120 56 94 150 15 29 44 25 39 64 4 3 7 44 71 115 12 23 35

InvolutionalMelancholia 3 - 3 3 4 1 - 4 5 7 8 3 4 4 5 3 - 3

2 - 2 ',208 72 280 1203 23 226 I

- - - 17 1 18 10 12 22

SchizophreniasI 199 24 223 1 89 30 1191123 41 1641212 71 383 11411 95 5061 13 6 191144 48 192 I 49 18 67

Paranoid Psychosis . .. I 10 12 22 9 1 10 8 - 8 17 1 18 27 I 3 40 I 1 - 1 I 9 1 10 I 7 - 7

Senile and Arterio- I I ~sclerotic Psychoses... - 11 11 5 5 10 1 1 2 6 6 121 6 17 23 - - - I 1 2 5 3 8 'I - I 1 I 6 5 11 I - 12 12

Acute Organic § II Psychoses... 4 11 15 8 2 10 1 1 2 __9 3 12 13 14 27 5 4 9 2 - 2 I - 1, - - - I 8 4 12 1 5 10 15 I

Other Organic I I IPsychoses .. . 3 - 3 8 4 12 3 - 3 11 4 15 14 4 18 1 - 1 I 1 - 1 4 3 7 2 - 21 8 3 Il 6 1 7

I Epilepsies ... ... 15 1 16 i 10 5 15 6 4 10 I 16 9 25 31 10 41 - - - I 20 4 24 4 2 6 - 3 3 24 9 33 I 7 1 8

340 113 453 I 310 111 421 I 650 224 874 : 948 337 1285

13411- 1

51611- 1

9 116 I 200 11 211

3 12

1 9

III 404

195 10 205 I 9 4 13

I! 9 1 10 - 1 11 -

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- - - I 4; ~ s~ I 8

== == == I 2S 5 30 I I 2 3

3 - 3 I

18 4 22

235

49 1 SO

14 1 15

516

729

181 8 189

422 126 548 I 190 56 24637 40 77

9 2 11

26 8 34

40 30 70 I 1 - 1 I 19 18 37 I 16 11 27 I - - - \ 36 29 65 I 4 1 5

11 6 17

57 2 59

204 14 218

1 52

617

235

51

7 13~1 32 27 59

3 11 119 4 23

6

8

16 - 16

107

26 20 46

93 2 95

35 1 36

11 1 12

8 3 11

7 4 11

437

3 1 4

9 3 12

6 1 7

298 113 411Total

Psychoneuroses

PsychopathicPersonalities

Drug Addiction

Alcoholism

Not Diagnosed

Not Insane

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MATRON'S REPORT, 1960

Visiting. Throughout the year we have had many visitors, localand from overseas, and we are very happy to see them and to hear theircomplimentary comments at the conclusion of their tours of the Hospital.We wish they would come again or stay longer.

In 1960 these have included many representatives of the World HealthOrganisation, which organisation, we understand, will w<?rk cl<?sely withAsfuriyeh Hospital in the future. This is a wonderful IllcentIve to allstaff to go ahead and make this Hospital one of the best in the world.

Stafi Changes. Miss L. J. Sawyer, Sister Tutor, te~inated he: con­tract on 31st December last and did not return. In Apnl her ASSistant,Miss Abu Jawdeh was offered a World Health post and she also left us., .This was a sad blow to the keen young students who had started off wIthsuch enthusiasm and we offer them an apology that their training wasinterrupted for a time.

Miss E. C. Cory, Deputy Matron, carried out her long-standing in­tention to seek pastures new and she left in Nov~mb~r for leave .at hom~ :we understand she will probably now be workmg III TanganyIka. MISSCory was naturally loath to leave after ten years' service; one be­comes very attached to places and people, but she felt she owed it toherself to make a change. We wish her well.

Many of our recently graduated staff have left Beirut to join thestaff of hospitals in neighbouring countries where the remuneration andother amenities are far in excess of those offered here. We hear fromthem from time to time and all seem happy, and report that they are en­deavouring to cany throughout their profession the aims and idealswhich were installed into them by expatriate staff in Asfuriyeh in the past.

One or two of our female nurses have married during the past yearand we have lost their services, either whole or part time. It is regrettablethat those members of staff cannot be replaced in spite of all efforts madeby radio, talks at schools, and personal contacts. The opening up ofprofessional posts and other more attractive vocations make us wonderwhat will happen in the near future.

Graduations. The percentage of passes in the Final Hospital ex­aminations continues fair. In an effort to raise the standard of educationand efficiency, this has to be faced, and we do not anticipate 100%success during this transition period.

Appointment. On 1st June Miss M. M. Murray took up her ap­pointment as sale Tutor. Miss Murray is an Australian who has wideexperience in many countries and has assessed thoroughly the grade ofnursing desired in all types of nursing, and under all types of conditions.We look to her to do much to inspire her young students and alreadywe see signs of improvement.

12

·

Social Activities. The enthusiasm of the members of the StudentNurses' Group waxes and wanes at intervals. They have had severalsuccessful film shows and also 'Tambala' parties and Whist parties. TheSwimming Pool was put in order again and this form of sport and recre­ation was also most enjoyed.

Christmas festivities showed much talent among the students whichhad either lain latent or had just not been explored. Several of the malestudents produced, entirely on their own initiative, a very well thought­out play, which was greatly enjoyed by the staff and patients. A few ofthe young female students also produced a short one-act play at theChristmas party.

Parties, on a larger scale, were held in the Social Recreation Club forthe return from the United Kingdom of Dr Haikal and also for the de­parture of Miss Cory. Both parties were well-attended and a happy at­mosphere ensued. As usual, photographers were much in evidence andmany mementoes exist to remind us of those evenings.

Ladies' Guild. We continue to feel extremely grateful to the mem­bers of the Ladies' Guild for their very keen personal interest in theHospital in general and its many poor patients. We are even more grate­ful for their financial aid which always comes so generously as soon asrequested. We now have two television sets presented by this group ofladies. Clothing of poor patients is entirely the work of our good friends-indeed, we tremble to think what our patients would look like wereit not for the wonderful donations which come from this quarter. Beddingalso would be in a poor state were it not for the continued hard workof those ladies who raise funds for our needs.

Not the least of their good works are the bi-weekly visits of smallgroups of the members. Meetings with patients are usually held in theOccupational Therapy centre or in the Social Club, and the ladies bringwith them sweets and cigarettes which are much appreciated.

Affiliation. Nurses from the Christian Medical Centre, from theMakassed Hospital, and from the American University Hospital cometo us at intervals for a two-month period which is part of their ownHospital curriculum. They fit in very.well on the whole. ~nd appreciatethe work in the classroom of the medIcal officers, and VISIt some of thepoor patients in whom they have become particularly interested.

Our own final year students spend one month as residents at theAmerican University Hospital prior to their final examinations. We findthat this is most valuable to them in their knowledge of general nursing.

General Remarks. The work of the nursing staff of the Hospitalgoes on fairly well in spite of the many difficulties which arise. Wewould like more encouragement in our efforts to improve the state ofthe buildings and the entertainment facilities of staff and patients. Repairs

13

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whi~h are so necessary are continually being set aside and this is frus­tratmg to those young and keen charge nurses who are so anxious to dowell. In spite of explanations that money is in short supply they continueto feel that their own progress is delayed. We hope soon to have moreand regular maintenance.

E. McKERCHAR, Matron.

ACTING ADMINISTRATOR'S REPORT 1960

V~ry few major works have been carried out during 1960. Thefollowmg are some of the more important jobs done on the variousVillas and Wards.

Khairallah House. In the early part of November 1960, ProfessorK. Ye.remian of ~he Engineering Department of the American Universityof BeIrut was kind enough to come up to Asfuriyeh and check on thefoundations of Khairallah House. After a thorough and careful check­up of the whole building, Professor Yeremian stated that there was noimmediate danger to the building at all. But he has suggested that weshould make four additional reinforcements: two major ones to thenorthern side of the building where the beam is cracked due to thesinking of the earth, .and two minor ones to the western side to preventth~. earth from p~shing out the balcony. All cracks in the walls andceIlings of the vanous rooms should be refilled. Also the cracks in theroof should be cover~d with a specially prepared paint to prevent waterleakage. The whole Job was done before the end of November as in­structed by th~ ~gineer.. Since the completion of the job no t;aces ofwater leakage m. the ~I1I?g and walls have been noticed, although wehave had torrential ram smce on many occasions.

Dis~nsary and Laboratory. At the request of the Doctor in chargeof the DIspensary, a door was opened in the wall separating the Dispens­ary fr~IJ?- the Lab~ratory i!l order to facilitate the work of the LaboratoryTechnicIan, who .IS also m charge. of the Dispensary. The whole De­partment was whitewashed and pamted, and slight re-arrangement wasmade in the furniture.

Holland House. A kitchenette was found essential to the Matron'sfiat. The small verandah to the northern side of the flat was most con­v~nient for this ~onvers~on. I~ was a minor jO? of building a long glasswmdow and fixmg a smk WIth complete fittmgs and drainage whichmade a considerable improvement. '

Main Kitchen. During the latter part of September it was noticedthat the chimney of the main kitchen was tilted. To avoid any accidentsit was knocked down to roof level and then rebuilt to a height of threemetres. It was a successful task done by the same contractor who hadrepaired Khairallah House.

14

'1'

A new Gas Oil motor burner was purchased for the Main Kitchenstove. The Kitch~n Superintendent and staff were very happy to get it.It saved a lot of time and energy, for it was then no longer necessary tomove the motor from the Third Class Kitchen every time it was needed.

.Laundry. Th~ unused section of the Laundry House that was anex-kItchen staff reSIdence and store was remodelled and converted intoa new Sewing Room with a Central Linen Store. A partition was builtto separate the olive store completely from this new department. Thewhole place was whitewashed and painted. A new set of racks andshelves was installed. The introduction of a Central Linen Store hasbeen proved most economical and is a great success. Having the SewingRoom adjacent to it, as well as the Laundry, has tremendously facilitatedthe work of both Departments. The basement of Philadelphia Housewhere the Sewing Room was formerly located has been converted into abulk foodstuffs store.

Cafeteria. An area of approximately 70 square metres of thenorthern part of the Hospital main dining room was converted into aCoffee Shop for the use of the Staff, Patients and Visitors. A partitionwas built separating the Coffee Shop from the Dining Room; also a smallkitchenette was erected for the preparation of coffee, tea, light refresh­ments and sandwiches. The whole shop was colour washed and painted.It was furnished with new Formica top metal tables and bamboo chairs.All the expenses and costs of modelling the Coffee Shop amounted toLL. 1,500, which was covered by the income from the Social Club Shopin a period of five months.

Wate'r Well. The water pump motor which was purchased inNovember 1959 burnt out again early this May, having worked smoothlyand satisfactorily for some months. To avoid the sudden shortage ofwater, which would cause a lot of inconvenience to patients and staff,the necessary German-made spare parts were purchased from Beirutand installed, at a total cost of LL. 1,500.

Transport. An increase in the consumption of oil and petrol usedfor the Hospital's 1957 station wagon was discovered; this necessitatedthe overhauling of the engine at a reading of 145,000 kilometres.

Though the policy in the past has been to change the car everyfour years, it is hoped that with this overhaul of the engine, and with someminor repairs, the buying of a new car can now be delayed for about twoyears.

It has finally been possible to register the Chevrolet Panel (pick-up)purchased last year to replace the Bedford truck ~hat was bought ~romthe British Army in 1942. However, we are permItted only to use It asan ambulance and not, as had been hoped, as a multi-purpose vehiclefor load carrying and passenger use, as well as an emergency ambulance.We are hoping that in the New Year we will be allowed to use it as a

15

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means of transporting provisions, foodstuffs, and other materials fromBeirut to the Hospital.

Electricity and Water Supply. The electricity supply has beenquite normal and satisfactory owing to the good condition of our gen­erator, which we have often used during the year.

The water supply has been adequate this year, though we have hada little trouble with our water pump, as previously mentioned in thisreport.

Food and Kitchen. Having reorganised all the systems of our pro­vision and foodstuffs stores, stock control and purchasing, and havingthoroughly checked up market prices by finding the right agents throughwhom to do most of our purchasing, I am happy to report that this yearwe have saved on food alone, in a period of nine months, an amount ofroughly LL. 16,000, even though the menus have been improved con­siderably as compared to previous years. I wish to take this oppor­tunity to thank Mrs S. Azar, the Kitchen Superintendent, for her co­operation in this matter.

Donations. The Swiss Government has donated to the Hospital,through the United Nations Relief and Work Agency in Lebanon, anamount of LL. 33,645, which made it possible for us this year to pur­chase the following equipment:

1 Suction machine for use on the wards;8 Modem pen motors for the Electroencephalography machine;1 Stroboscope (Photic Stimulation set for the E.E.G. machine);1 Tape Recorder for the Medical Officers' use in Conference;2 Dictaphones;5 Weighing scales for different wards;1 Rotating machine for the Laboratory.

We are hoping that in the early part of 1961 we will be able topurchase the rest of the equipment which will be composed of :

4 Pieces of Laundry equipment;1 Spectrophotometer;2 Air conditioners.

Ladies' Guild. During the months of June and July the Ladies'Guild was very kind in presenting to the Hospital two television sets,which were installed in English House and Philadelphia. The two setshave proved to provide very good entertainment for both male and fe­male patients.

The Ladies' Guild has also generously granted us an amount ofLL. 11,000, which has enabled us to purchase enough blankets, towels,and sheeting material to start our Central Linen Store.

Loterie Nationale. The Loterie Nationale Department of theMinistry of Finance has also given us a handsome donation of LL. 5,000which we have received through the Chairman of the Beirut ExecutiveCommittee.

16

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Offices an~ Staff. Since my return from England in February, Ihave ~een workmg on reorganising the Administrative Offices, the Stores,the. KItchen, a~d the Works and Repairs Department. This has proveda tIme-consummg task. In the Administrative Offices an Accounts Officehas been created where all the Hospital accounts and books are kept.Miss Odet.te Haddad is in sole charge of this new Office and has provedmost effiCIent. She deserves a special word of praise. An AdmissionOffice has been introduced to Gockler House where all admissions anddischarges of patients take place. The following-up of Private patients'accounts and debts are made by Miss Nadia Haddad in this same office;Miss Nadia Haddad has done very well in dealing with these accounts.Mr Saa Hawi, a yong man from Schuweir High School, was appointedto the post of Junior Clerk in the General Office in early March 1960.

The office of Mr George Kamel, our Personnel Officer, has beenmoved to the Basement of Philadelphia House, in order to have a closercheck on the Works and Repairs under his control. Mr Albert Parteyanis still in charge of the Hospital stores. Both Mr Kamel and Mr Parteyanhave continued to give their usual high standard of service throughoutthe year.

Indemnities. Four members of our ancillary staff have been dis­charged with indemnities as they are all above 60, the age of retirement.So far we have not replaced them as a reorganisation of the Works De­partment is still under thorough study. The positions held were those ofa Mason (bricklayer), a Carpenter's mate, a Wood-shed man, and aLabourer. During the last five months we have felt that we were notin urgent need of filling these vacancies, as the work has not suffered.

Finance. The general situation this year has been good as comparedwith 1958 and 1959, income particularly showing a gratifying increase, duemainly to the increased rates payable by Government an~ Public Author­ities for their patients. An increase of LL. 1.00 per patient per day hasbeen made by the Ministry of Health, bringing the Government patients'daily rate up to LL.5.25. This same incre~se affected th~ ~eirut Muni­cipality fees and those of the Central Comilllttee for ~alestIman Refugees.The private Third Class patients' rate of pay was mcreased from LL.175.00 to LL.200.00 per month in the early part of April, as approvedby the Beirut Executive Committee. These increases in the fees have beenof considerable help.

In conclusion I wish to thank the Physician Superintendent, Dr A.S. Manugian, the Matron, Miss E. McKerchar, for their many kindnessesand ready help on every occasion, my colleagues and all st~ff m~mbersin the service of Asfuriyeh to whom I a~ grateful for theIr asslstan~eduring the year. I wish to express my gratitude and thanks to the ChaIr­man and members of the London General Committee and the BeirutExecutive Committee.

RAMSEY E. SAMAHA, Acting Administrator.

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ANNUAL GENERAL MEETING, 1961

The Sixty-second Meeting of the Lebanon Hospital f?r Mental andNervous Disorders was held on Thursday, 1st June, 1961, m the West Hall()f the Royal Society of Medicine 1 Wimpole Street, London, W.l, theRt Hon. The EARL OF FEVERSHAM, D.S.O., D.L., J.P., in the Chair.

The Chairman: Lord FEVERSHAM, opening the meeting, said:Ladies and Gentlemen, you will know that during the course of la~t yearwe sustained severe and very sad losses of friends of the HospItal. Iwish particularly to refer to the death of Professor Kennedy, one of ourVice-Presidents since the early 1950's. Those of. you who. h.ave beenclosely associated with the Hospital w~l~ know of ~IS great actiVIty on. thehospital's behalf since that date. He VISIted Asfunyeh on many occaSIOnsand his advice and recommendations were of the greatest value to ~hemedical and lay staff in Beirut and here. Last year at our annual meetmghe presented the medical report.

We have lost another Vice-President, Sir William Houstoun-Boswall,who was Honorary President of the Beirut ComJI.littee ~hen he w~sH.M. Ambassador in Beirut. He was elected a Vl~e-Presldent. on hiSretirement as Ambassador, and he too gave much time to the mterestsof the Hospital. He took the Chair in my absence at the 1956 AnnualGeneral Meeting.

Mr Fadlo Hourani has died since the last Annual General Meeting.His efforts on behalf of the Hospital have been unparallelled. Everybodyhere was a friend of his. It would be improper for me to try and ~numer­ate all the things he did for the hospital and we greatly deplore hIS death.

Dr Percy Brigstocke, a member of the Beirut Committee, was theson of one of the original members, and had for many years been a mem­ber of the London Committee although in recent years he was unableto attend the meetings due to bad health.

I would ask you to stand for a moment in silence in memory ofthese gentlemen.

The meeting stood in silence for a few moments.

Apologies for absence were received from: H.E. The ~baneseAmbassador, H.E. The Belgian Ambassador, The Earl of SelkIrk, DrWalter S. Maclay, Dame Doris Beale, Mr R. de C. Baldwin, Dr H. J.Eustace, Mr S. Harris, Mr Albert Hourani.

The Chainnan: I am very glad to have this opportunity of welcom­ing you to this Annual General Meeting. Since our last meeting therehave been some outstanding events in this country which have markedthe very great progress whic~ ha~ taken place to reduce the ~courge ofmental disorder. Firstly, I thmk It would be ~rue to say that It has n~wbeen realized, perhaps more than at any prevIOUS date, that men!al dIS­order is a tremendous scourge and that it observes no boundanes nor

18

frontiers .. Secondly, it has been realised more fully that the incidence ofmental dIs~ase can be red~ced; and, thirdly, that the suffering of patientscan be relIeved to the pomt where they may live either at home or inhostels-.or at least a great number of them-and I think you wouldagree WIth m~ that these three achievements have been made becauseto-day more IS known and understood about mental disorder not onlyby d~ctors and ~taffs but also by statesmen, pOliticians, and what I woulddescnbe as ordmary people.

World Mental Health Year which has not yet concluded in thiscountry has made an outstanding contribution because it has maintainedthe. :vider understanding of mental disorder and has provided oppor­tum~Ie~ for a v~st ~xchange of knowledge between both voluntary andspe~Ia.lIst orgamsatIOns an~. members. of the public, and my own As­socIatl~m has beep very pnvIleged dunng the course of this year to playa leadmg role .wIth the World Mental Health Organisation in the pro­gramme~ of. thIS year. <?ne of the many impressions that I get is of theextraordmanly high calIbre of the discussions and lectures which havetaken place during the year, and which have been contributed by a largerange of eIIljnent people throughout the world.

In this country during World Mental Health Year we have seenthe implementation of the Mental Health Act, the whole force of whichdepends so much on the acceptance by lay people of an entirely newconcept of treatment for the care of the mentally disordered; I supposethat you would agree with me that the concept that lay people must bep~epared to look after and provide for the maintenance of the mildlydIsordered people at home or in hospital or at work is one of the mostimportant with which we must concern ourselves to-day. Advances intreatment can therefore be said to have been made possible. Now it ispossible to get advances in attitude to make the new concept a success.It I?eans that if the Minister of Health in this country is going to do whathe mtends to do, there is a long way to go respecting this advance in at­titude. Without it he cannot pursue the plans which he mentioned at theConference of the National Federation of Mental Health, where he saidthat the reduction in the number of patients meant that old buildingscould be knocked down and acute mental illness could be treated ingeneral hospitals.

This statement, which was given wide publicity, caused a greatdeal of surprise in some circles. Many problems of detail need of courseto be thrashed out and controlled before the plan can take effect andthese problems ventilated. In a debate in the House of Lords on theHospital Service I said then, and I think it is worth repeating, that theMinister based his contention on what I regarded as an indisputable factand not on conjecture, but the fact also remained that we are to-day onlyon the frontier of mental health research. There are, as we know, tremen­dous discoveries yet to be made, and you will be interested to observethat quite recently Regional Hospital Boards have followed closely onthe Minister's heels and have announced that they have plans for thedemolition of old buildings and the construction of new psychiatric wards

19

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in general hospitals. We feel in the National Association of Mental

Health that a very close watch must be kept on the status and use of the

remaining mental hospitals if they are not to become no more than de­

positories for the chronically ill and even worse than they were before,

and that is an observation shared by a great number of people.

I think you would agree that in this country at least the atmosphere

is one of hope and of progress, but I had thought in reviewing contem­

porary thought in general terms of the whole problem of mental disorder

that we must guard against the danger that all the publicity which has

been given in World Mental Health Year and the expression of plans

and good intentions does not obscure the darker side. The darker side

can be summed up by saying that research needs the constant stimulation

of money and manpower, that staff have to be recruited and trained,

and that plans must not be allowed to founder for want of a sense of

urgency and enthusiasm.

I think you would agree with me that in this field we are on the

frontier of knowledge and in the next decade or two there could be very

startling results. They could appear anywhere in the world where mental

disorder is being investigated. They can be fostered by the exchange of

ideas and the adoption of new techniques, and especially by the provision

of money.

Wherever we have a centre of inspiration and progress as we have

at Asfuriyeh we must try to take every opportunity for the advancement

and adoption of new ideas which may bring that break-through nearer.

In the case of Asfuriyeh we are well placed in that part of the world to

contribute more than may be reflected by a Balance Sheet or by the

number of staff and personnel and patients on whose behalf we are

advancing by the medical skill, enthusiasm and keenness which is so

constantly demonstrated at that establishment.

I hope you will forgive me for speaking outside the terms of context

of an annual general meeting dealing with the internal and domestic

affairs of Asfuriyeh but I know that this audience does comprise many

who are experts and authorities on this subject of mental disorder and

I think it therefore appropriate to use the occasion to give you my views

of where we stand in looking at the general picture at the present time. I

do also feel that perhaps I am more competent to do that than to speak

with any great authority or detailed knowledge on the affairs o~ the

hospital although since the date of the last annual general meetmg I

have had opportunity-and it was a pleasure-to visit the hospital, to

meet many members of the staff and hear from the Committee some of

the measures which have been considered and contemplated.

We are to-day very fortunate in having with us Dr Joseph Hitti,

the Chairman of the Beirut Committee, an old friend of many of you here

to-day, to speak to us, and I am muc~ looking f?rward to beil!g brought

up to date and hearing what the BeIrut COmmIttee tells us III London

we should do, where we should go, and how we should do it. It is

for that reason and indeed also for the other reports that we are now

20

going to hear that I have not attempted to say too much about thehospital.

Financial Report

Mr 0 .. M. Darton (Hon. Treasurer): My Lord, Ladies and Gentle­

men,-It .gIves me pleasure once again to present to you the accounts of

the HospItal for the year ended 31st December, 1960. A few copies of

the .accounts are avaIlable; I am sorry that it is not possible to provide

copIes for all of you present here this afternoon. The accounts as usual

are subject ~o audit, and you will i~ due. course find a det~iled copy

bound up WIth the annual report whIch wIll be sent to you later on inthe year.

Turning to the d~tailed figures you will see that the patient's fees

at £95,808 .shows an mcrease of. some £10,100 compared with the fees

of the prevIOUS year. For these mcreases our thanks are mainly due to

the Lebanese Government who have recognised that the costs of treat­

ment of our patients have been continuously rising. They have therefore

agreed to a material increase in the daily rate for those of their patients

whom we have under our care.

On the expenditure side, you will see that there has been some

saving, the total expenditure, including the London expenses, has amount­

ed to £102,678, a decrease of some £5,700 compared with the previous

year. There have been a number of small saving in various directions;

one of the most notable ones is the saving resulting in the more efficient

purchasing of foodstuffs with no adverse effect on the quality of the

food supplied to the patients, in fact, rather the reverse appears to bethe case.

Those of you who were here last year may possibly recollect that

I then told you that over a period of three years to December, 1959, the

Hospital had sustained losses totalling no less than £28,000. This year

I am glad that I have a better state of affairs to report; for 1960 the

accounts show a surplus of £2,849, which compares with a deficiency of

some £10,501 for 1959.

In presenting the Financial Report I would like particularly to

mention our indebtedness to the Swiss Government for the material

help they have given the Hospital during 1960, also to the Ladies' Guild

in Beirut who have contributed 11,000 Lebanese pounds which has been

used for the purchase of blankets and linen. This represents a very con­

siderable effort on their part. In past years we have had with us our

loyal and staunch friend, Mr Hourani who, as you will recollect, brought

with him a cheque year by year and it is sad that he will no longer be

with us at our meeting. Following Mr Hourani's death a small memorial

fund was started by the Committee and it is I think a fitting tribute to

his memory that the 1960 accounts will contain the amount so far col­

lected of some £120 which your Committee in due course will spend on

some fitting object.

21

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Whilst it is clear that there was some easing in the financial situationduring 1960, the immediate benefit is likely to be absorbed by increasesin salaries to certain members of the staff which are now somewhat over­due and on these grounds alone we must not relax our efforts. Thisyear has perhaps been a somewhat uneventful one, but we must notforget that by ever improved methods of treatment our doctors areseeking to alleviate and cure those entrusted to. our c~re and the sumtotal of all this work year by year must be formIdable mdeed. Many ofyou, I know, have been subscribers for many years .and I do hope thatby this very practical means you will continue to aid the work we areendeavouring to carry out on your behalf.

The President: Thank you very much. Befor~ asking for. a se~onderI will refer to the gift of medical materials WhICh we receIved m theautumn of 1960 from Messrs Smith and Nephew, a British pharma­ceutical firm who on a previous occasion gave ~s a simila~ gift and weacknowledge it with very great pleasure and gratitude. I thmk the figurewould be reflected in the accounts.

Mr Darton: Yes.Mrs Lucy Backhouse: I would like to second the adoption of the

Accounts. I have had a most interesting acco~nt of t?e tremend~msamount of time and energy and goodwill the ladl~s put mto the Gmld;they give the coffee, tea and the ~o?d, and t~e preffilses of the coffee shopare given free of charge; they VISIt the patients and have t~em out forlittle outings, with cups of tea and sweets and. cakes. ~t IS wonderfulhow this develops. It is a represeJ?-t~tive comffilttee. It IS no~ only themoney, it is not only the blankets, It IS the thought and gOOdWIll and weare very grateful to them.

The Accounts were adopted.

Election of General Committee

Miss Laidlaw moved :That the following be elected to serve as the General Committee

for the year 1961 :Mrs Lucy Backhouse Miss Hilda FoxMr R. de C. Baldwin M. Leopold GautierDame Doris Beale Mr H. Lyn HarrisMr R. J. D. Belgrave Mr Stephen HarrisThe Rev. J. A. Burley Dr George SomervilleMr O. M. Darton Dr J. C. Sawle ThomasMr H. Barrs Davies Mr F. R. P. ':'interDr H. J. Eustace Dame Kathenne Watt

and as Corresponding Members:

Mr Albert Hourani Miss Lettice Jowitt

She said: I have been asked to say a very few wo.rds from the nursingpoint of view and I am very honoured to do this. I should perhaps

22

mention that I had the great pleasure of visiting the Asfuriyeh Hospitala few years ago and seeing for myself the work which has been donethere, in particular the nursing. To-day we are pleased to have with usat the Royal College of Nursing one of the nurses from Asfuriyeh whois studying for the Sister Tutor Diploma of London University.

You have heard of the many advances which have been made, part­icularly in the field of mental health, and it is quite true to say thatto-day more than ever before people are travelling more, they are gettingto know more of each other in different countries, and it is of greatimportance that nursing education should be forwarded in every waybecause the nurse has to do with so many people and he or she is verymuch concerned with the care of the whole person. Because of that im­portant task nursing education is of vital importance, particularly inthe domain of the matron and all those undertaking senior administrationwork. However far medical science advances, and it is advancing veryrapidly, the actual treatment which is carried out must of necessity lagbehind what is known, and the more that we can teach nurses to under­stand and carry out the work of research which is being done, the betterthe patient will be cared for.

I think when I visited the Hospital I got very much the impressionthat very great care and attention was being given to nursing education,and it seemed to me that it followed very much the lines of nursingtraining in this country. I was asked to say why particularly we wouldlike nurses from the Lebanon to come to this country for further training.One of the answers is that we do feel that we here can give them certainaspects of nursing work and development which cannot be given any­where else. We do try very much to give them practical and theoreticalaspects and that is one of the strengths of British nurses, that they havea combination of practical actual nursing care and the study of it theo­retically. The two must go together.

It gives me very great pleasure to move the resolution for the elec­tion of the General Committee.

Miss M. Alexander: I second the resolution with great pleasure.

The President, putting the motion, thanked Miss Laidlaw for hervaluable remarks.

The resolution was carried.

Election of the Auditors

Mr J. D. Knight: It gives me great pleasure to move the reappoint­ment of the Auditors. I was involved with the Hospital's finances forsome years and I have heard no complaint against them. I move:

That Messrs Woodman, Cox & Wilkins be reappointed Auditors forthe year 1961.

Miss Hilda Fox seconded, and this also was carried.

23

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General Report

Mr H. Lyn Harris, M.A., LL.B., Chairman of the General Commit­

tee, moving the adoption of the General Report, said: We met here last on

Thursday, 1st June, 1922, for our Annual Meeting, and here we are again:

there are not many more here to-day than were here then, but I do not

think it matters. Looking round and meeting people one realises that

yve have here a small group of people who are in some way or other

mtensely interested in the work which Asfuriyeh is attempting to

do and I think that is what really matters. We are part of a community,

part of a very interesting community. Perhaps I can best illustrate what

I want to say by referring to an incident which happened to Dr Hitti

and myself when I was last in the Lebanon in the autumn of 1959. It

was so characteristic of the Lebanon and Dr Hitti himself, whom we are

extremely glad to have with us to-day. It illustrates the closeness of

community life there and the good fortune we have in having as our

Chairman of the Beirut Committee a man with his broad outlook. It

was necessary during the course of the negotiations which were then

going on with the Government that we should call and discuss one or

two things with the President of the Republic. Dr Hitti took me to the

President's House about five miles to the north of the City. When we

got there I began to realise the atmosphere in which we were; we drove

into the courtyard where the sergeant of the guard was on duty and a

number of taxis were taking people to see various officials of the Govern­

ment, or were waiting about, and I noticed that Dr Hitti knew everyone

and everyone appeared to know Dr Ritti.

I had imagined a rather formal occasion and, indeed, there was due

formality about it, but we were ushered in, handed on by various officials

into the house and very soon into the presence of the President. When

the business was concluded I prepared to depart. As we did so, Dr Hitti

spotted in the room outside a considerable number of men all of whom

he knew, and seeing that he was going to be in conversation with them

I returned and in a moment I found myself being introduced by Dr

Hitti to the entire Cabinet which was just about to meet. Everything

was very friendly, I was made very welcome, with a most deliberate formal

informality. When we had done what we were supposed to do we went

away. Both of us I think were rather elated, we had had a delightful

session with the President and with the Cabinet and we went down­

stairs in a state of great happiness. Out in the courtyard there was the

sergeant of the guard, there were all the taxi people, and a number of

very fine cars, and again they all saluted Dr Ritti who knew everybody.

The point which struck me so tremendously was that he was exactly the

same with the humblest taxi driver in Beirut as he was with the Minis­

ters and the Cabinet. I said something to him about this on the way

and he said, "Oh, well you see, we are a democracy!" It was one of

those occasions which impresses itself upon one tremendously and that

is the sort of atmosphere in which we are attempting to do our com­

munity work.

24

. There was an illustration. on the level of a community, and it was

m. that place ~hat we are trymg to do our community work. Dr Hitti

WIll be. speakmg to you about the medical side and we have heard

som~thlI~g of t?e nursing side and I want to speak' about a part of com­

mu~ty life whlc? h~s very seldom been referred to at this annual general

meetmg, but.whic.h mterests me intensely, I suppose partly because most

of m~ workmg hfe has been spent in communities about the size of

Asfunyeh a?d I do know something about what it takes to make a

communal hfe run smoothly. I have in the last few weeks received the

~eport of th~ A~ting A~ministrat?r, ~r Samaha, and I am enormously

Impressed with .It. Behmd all this skilled work which we have heard

about, .all that IS do~e for the patients, there is an enormous amount

of detaIled hard sloggmg work by those who keep that work going, not

only. by the.doctors a~d nurs~s but by the laymen associated with hospital

adilllmstratlOn, .the httle thmgs WhICh really matter and which oil the

wheels and whIch enable a community of some 450 patients and 350

attendants, nurses and doctors, to run smoothly, and to run in such

har:nony that t~e best ~rofessional work can be done for the patientswhIch, after all, IS the pomt of the whole affair.

R~nning a commu~ity and helping to make it run is not at all an

easy thmg; endless detaIl day after day, endless little things which have

to be solve~, and it is with great. pleasure that I am able to report to

you that things appear to be runmng very smoothly and very happily.

All sorts of interesting innovations have been worked out and

~hanges made, little. things wh~c~ iron out the difficulties of having to

lIve as a group; agam we are hvmg there a community life in the midst

of th~ larger community life of the Lebanon and the more effectively

that It can run, the more smoothly it can run, the better it is for the

work we are doing, and the better it is for the larger community in which

we are trying to play our part.

Before I go into some of the details, I would like to refer to one or

two .specially interesting things in the General Report. There has been a

conSIderable working with and activity with Dr Tigani EI-Mahi, of the

Mental Health Section of WHO Eastern Mediterranean Region. The

work ~f. the Hospital has been so well recognized by them as to give

us addItIonal status and additional work. In connection with that work

th~ Matron and Dr Manugian spent some weeks in Abyssinia helping

wI.th the establishment of a mental hospital there, and I have just re­

ceIved a letter from Dr Manugian in which he tells me he has been asked

to spend six months in South Viet Nam on mental health work. Of

course we cannot spare him, but it is very encouraging that the status of

the hospital is being recognized in this way.

Miss Cory left us this year. She came to an end of the work which

she felt she could usefully do in Asfuriyeh and has now gone to work in

Tanganyika. Miss Fox and I had very close contact with Miss Cory

during the time she was preparing to go out and it was some years after

her first application to us that she felt she could do the work effectively

25

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and went out to Asfuriyeh. Her service has covered a period of con­siderable transition from time to time which she has sUf?lounted a~ddespite which she was able to give fine work to the hospItal. She WIllbe missed by many people, and I am sure we wish. her very good fortunein the further work she is undertaking. She was wIth us altogether aboutten years.

At the end of the Report we thank the Physicia~ Superinten?ent andthe Hospital staff. I would like to take this opportumty of thankm.g thempersonally. We are very grateful to all who live in the commumty andwork in it.

Now for a few moments I want to detail a few things whi~h MrSamaha mentioned. When I was at the Hospital 18 months ago.It.wasreported to me that there were cracks in the walls of one of the bmldmgs,and in the floor and one or two people thought the place would fall do.wn.It sounded as if it would be disastrous if it did!. That. has been gon~ mtoand Mr Samaha reports that it has been gone mto wIth e.xtreme ~kIl1 ?ya Professor in the Engineering Department of the Amencan UmversI.tyin Beirut who reported that the building would stay up for a good .whileif it was properly seen to. A kitchenette w~s fou~d to b~ essential tothe Matron~s fiat; that has been built: the chimney m the kItche~ look.edas if it would fall down; that has been dealt with. We a~e dealmg withbuildings some of which have been up for 60 years and qUite a number ofthem have been through a very severe earthquake.

A new gas-oil motor burner has been put in to the kitchen, which hasa great charm for all those who have to use it. The sewing ro~m .andthe central linen store have been re-erected as part of the reorgamsatlOn;the central linen room, the laundry and the work room a~e all closetogether now. A proper cafeteria h~s. been esta~lished and III the cafe­teria the staff, the patients, and the VIsItors are mmgled to~ether and thatmakes for community life. All the expense of modellmg the co~eeshop part of the cafeteria was supplied by. the income from ~he SocIalClub shop over a period of five months. It IS self-help for patients.

There has been the usual business over the water, the difficulties ofthe pump, getting further supplies, repair. work and so on. An increasein the water supply has been effected thIS year due to the care of thepeople responsible.

The Swiss Government has given us a very generous contributioJ.l tothe hospital and made possible the purchase of some interesting thmgswhich are helpful in the community life. We are very grateful.

Reference has been made to the Ladies' Guild who have given usso much help and encouragement, not only on the financial side but intheir individual work for the patients which is one of the most importantthings of all. It gives the patients the feeling that there are people inter­ested in them who will give time and sympathy to their affairs.

Altogether, I am tremendously encouraged by last year's work at theHospital and in the course of time we shall be having a report on this

26

year's work. We hope to get out to you from the office as soon as possiblethe 1959 and 1960 Reports.

I have pleasure in moving the report.

The President: When I had the privilege of attending the BeirutCommittee Dr Hitti, its Chairman, welcomed me. We all know the in­valuable service he gives to the Hospital and we are all very glad towelcome him to this meeting to-day.

Medical Report

Dr Joseph Hitti, M.D., Chairman of the Beirut Executive Committee,said: If the Chairman of the General Committee comes to Beirut it isp~r~ of .our obligation towards him as the representative of a body ofdI.stmgu~shed persons, who comes thousands of miles in order to promotefnendship and the cause of humanity, to advance mental improvement,to come from Europe, from England, from London, to the Lebanon, topay tribute to him, but if I come from the Lebanon where this goodwork is being run, supported and executed to London I feel humiliated ifI hear a word about myself or about my people from the Lebanon whoare serving our country. You here in England have sacrificed very muchover the last 60 years in this noble task. I feel it a duty to thank every­body who has served on your Committee and everybody who is interestedin this noble cause and sacrificed his responsibilities, duties and pro­fessional work for a noble cause thousands of miles away. Therefore,will you kindly accept my thanks to you and to the Committee for ask­ing me to be here. I count it a great privilege and honour to be with you.

The Medical Report was despatched, I believe, and I was supposedto put a few comments on it and will be delighted to answer any questionsto the best of my knowledge and belief. As you know, Asfuriyeh openedits doors in August 1900 to relieve the suffering caused by mental illhealth, and Asfuriyeh with its treatment of mental illness has played animportant role in all modern ways of treatment. Asfuriyeh has beenthe leader in the Middle East and often has been in advance of manyEuropean and American centres: in 1936 convulsant therapy, in 1952tranquillisers, and open doors in 1956 with modern methods. The maintherapeutic work is now the therapeutic community to which the Chair­man has referred. The whole Hospital is a village with each small wardas a unit of the family, with over 25 nationalities and 19 religions re­presented, and it is surprising how well this community works.

What impresses the visitor is the calm and peaceful expression ofeverybody, patients, doctors and staff. In keeping with its pioneeringrole in therapy Asfuriyeh was the first Hospital in the Middle East tohave a Psychiatric Nursing School, in 1948. Our graduates are absorbedinto most of the neighbouring countries, where they are badly needed.In addition, several of the countries of this region are now sending theirstudents for training at Asfuriyeh. We have already some 18 students,12 men and 6 girls. Saudi Arabia is now negotiating to send 18 students

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to be trained as nurses. It follows that the establishment of the medicaland nursing schools has helped us to keep a high academic standard, andbecause of this we enjoy the full confidence of the Lebanese Goyernm~ntwhich entrusts to our care the majority of their mental patients mcludmgthose from the Prisons. In spite of these heavy responsibilities As~uriyehhas never neglected the poor. We have many patients whose care IS free.we have many patients who have been in the hospital for a number ofyears and many who pay only small amounts; food, clothing, outings, andso on, being given by the Hospital. We encourage visitors to cOI?e andspend the afternoon with the patients, talking to them and havmg teawith them. Because of this our course of training for doctors has beenrecognised by the Conjoint Board; the last three medical officers whocame to Britain for the course passed their examinations successfully.This training programme for scientists and nurses has been made use ofby the World Health Organisation for the Eastern Mediterranean Region.These activities open new horizons and Asfuriyeh has to meet these newrequirements.

In addition to training personnel our services are invoked by neigh­bouring countries for organising their mental health services. This type ofactivity will be extended, and we look forward to carrying forward theideal of our Founder, Theophilus Waldmeier. We pledge ourselves tothis mission. In the success of this mission the people of Great Britainhave played an important role, carrying the greatest burden and respon­sibility, and we come now to share with you our own responsibilities incontinuing with this noble work for the service of humanity.

The President: I know how greatly you appreciate the words whichhave fallen from Dr Hitti and I hope they will be kept for a future record.We do appreciate what you have said to us to-day. Has anybody anyquestions they wish to ask ....

Vote of Thanks to the President

Miss Hilda Fox: This year the privilege falls to me to offer ourthanks to the President. We thank him very much for coming to thismeeting and presiding over us. Since he took office in 1950, the yearthat the Hospital celebrated 50 years of work, I think he has only missedthe annual meeting twice or three times, which is very unusual in aPresident. We also find it very remarkable and unusual that our Presi­dent should not only be interested in this subject at home, but he hasspent some years living in the Mediterranean countries and has visitedAsfuriyeh, and is an acknowledged expert on mental hospitals. AsChairman of the National Association for Mental Health and morelately as the pilot of the Mental Health Bill through the House of Lords,Lord Feversham has been able to lead our Hospital to a wider experienceand has been able to bring it within the range of modern preventivetreatment and the treatment of mental health in the community.

On your behalf, I do offer our very warm thanks to him for comingtoday and speaking to us-we always enjoy what he says to us and

28

profit by it-and for the delightful way he has conducted this annualmeeting. (Applause.)

The President: It is extremely kind of Miss Fox to say such nicethings and for you to receive them in the way you have done. I am onlysorry that I cannot do m?re detailed work on behalf of the Hospitalbut the pressure under which I am put at the present time makes it im­possible to do any more, I am quite open and frank about that.

Little has been said of the appreciation owed by the Hospital to MrLyn Harris, Mr Belgrave, Mr Darton and Mr Dunstan, and I would askyou to give them a particular word of praise for what they do duringthe twelve months. (Applause.)

I now declare the meeting closed.

29

LEBANON HOSPITAL FOR MENTAL AND NERVOUS DISORDERSBalance Sheet, 31st December, 1960

Less: Depreciation to date ...

WOODMAN, COX & WILKINS,t!uditors.

We have audited the above Balance Sheet an~ attached. Income and Expenditure Account wI'th theLondon books and vouchers produced to us and th th B AMessrs Russell & Co., Chartered Accountants WI. e elrut ccounts and .Balance Sheet certified by

d h. h W ' Beirut, Lebanon, and we certify that the same are in

accor ance t erewlt. e have relied upon the Hon. Treasurer's division of expenditure between Beirutand London, and have verified the investments31 Bedford Row, London, W.c.!. .

231'd July, 1961.

Income and Expenditure Account for the Year ending 3,1st December, 1960

EXPENDITURE INCOME

Beirut Expenditure (including£ £ £ £

Beirut Income:depreciation) 95,952 Patients' Fees 101,858

London Expenditure 1,574 Garden and EstateBeirut Reserves: Occupational Therapy'"

392

Amount transferred to Special Clinic ... .', ...22

Contingencies Fund 4,353 Bank Interest and Sundries1,623

Transfer to Provision for627

Doubtful Debts 825 Subscriptions, etc. :104,522

Difference in Exchange5,178 United Kingdom 516

261 U.S.A. ... 390Transfer to Accumulated Fund Lebanon and Americar't"Ap~~i

being Surplus of Income over161

Expenditure for year 2,965 Interest on Investments (Gross)1,067

341

£105,930 £105,930

£

7,898

607

9,868

37,089

73,970

£129,432

2,111

2,031276627

3,33894

1,532

£

18,229

16,158591

42,53032,662

41,678852

103,41229,442

17,562667

... 19,9283,770

LondonCash­

BeirutLondon

Investments at cost­Accumulated FUl1d

Curre11t Assets-Stock on Hand at Beirut

Debtors­BeirutLess: Reserve

Investments at cost-Endowment Funds (excluding

an investment administeredby Provident TradesmensBank & Trust Company ofPhiladelphia U.S.A.)

For Peter Coats EndowmentFor Jessup EndowmentFor R. F. Fox MemorialFor Retiring AllowancesFor Scott Moncrieff TravelFor Extension Fund

(Market Value £7,116)

Fixed Assets-Land and Building at Beirut:

Cost to 1st January, 1960Less: Depreciation to date

Equipment and Furniture atBeirut:Cost to 1st January, 1960

Additions during year, at cost

315

7,898

118

39,451

105

74,877

2,695

77,842

£74,457

4,123

£129,432

3669

£

3,915208

2,20379

2,270

1,532

2,031276627

3,33894

34,797

Endowment Funds-Peter Coats Endowment FundJessup Endowment Fund ..R. F. Fox Memorial Fund .Retiring Allowances FundScott Moncrieff Travel FundExtension Fund:

Balance at 1st Jan-uary, 1960 1,472

Add Income for year 60

36,889

Excess of Income over Ex­penditure for year

Staff Furlough ReserveSpecial Contingencies Fund:

Balance at 1st Jan-uary, 1960 32,536

Amount provided perIncome & Expend-iture Account 4,353

Less: payments dur-ing year ... 2,092

Current Liabilities-Sundry Creditors: Beirut ...

London

Fadlo Houral1i Memorial FUl1d­Contributions received in year

.hfuriyeh Reserve Funds­Obsolescence Reserve .,.Special Reserve for Purchase

of Equipment-Donations received in

year 2,621Less: expended and

transferred to Ac-cumulated Fund 316

Accumulated Fund-Balance as at 1st January, 1960Add: Transfer from Special

Fund for Purchase of Equip-ment ... . ..

Exchange adjustments:­Asfuriyeh Special ReserveFundBeirut Clinic ...

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