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LEBANON HOSPITAL-

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ASFURIYEH

BEIRUT

LEBANON I

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59th ANNUAL REPORT

1957--

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NOVEMBER, 1958

PRESIDENT:THE RT. HON. THE EARL OF FEVERSHAM, D.S.O., D.L., I.P.

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The FutureThe result of all this closer co-operation has meant the crystallisation of

plans. It has been realised that our service is still essentially that of the pioneerand that our role is to go forward, showing the way to those who would followin similar work for the mentally sick of the Middle East. This being so, thetime has come for a big advance beyond the confines of a simple hospital forthe mentally sick at Asfuriyeh on the Damascus Road. Plans are underdiscussion for incorporation of the latest forms of rehabilitation of recoveringpatients ; for the opening of work among children; service in connection withthe elderly; and for a really scientific and humane approach to the medico­legal cases, etc. All of these carefully thought-out schemes need planning inrelation to the right location, the training of adequate staff; and also call forcontinued goodwill from and co-operation with the Ministry of Health inLebanon. Some of these plans are already being initiated in a small way,while others are as yet' on the drawing board " but care is being taken by theCommittee to ensure that in all this envisaged advance there shall be a con­tinuance of the best that the Lebanon Hospital for Mental and NervousDisorders has to offer in service to the Middle East.

Dr. Ala Addin S. Drooby and the ChildrenPerhaps one of the most urgent of these new ventures is that for children

who are maladjusted or who have organic deficits. Already a beginning has

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Contacts between the General Committee and the Beirut Executive CommitteeAnother healthy sign of our growing community has been increased liaison

between the Committee in London and the local Executive Committee inBeirut, and there has been quite a brisk traffic from either side to the other.

A short while ago we lamented the withdrawal of Mr. R. J. D. Belgravefrom the Beirut Executive Committee on his transfer to the Iraq PetroleumCompany at Qatar. Now he has returned to England, and we have been veryglad to have the benefit of his wisdom and experience as a member of theLondon Committee.

Others who have fostered the closer contacts have been Professor Kennedyand Dr. and Mrs. Sawle Thomas, who visited the Hospital in May/June; andDame Katherine Watt, on her return from the Opening of the new Hospital atIbadan, also spent some days at Asfuriyeh in November/December. FromLebanon we have welcomed Dr. Hitti, Mr. Gosling, and others, all sharing theirimpressions and getting down to serious discussion of the future of Asfuriyeh.Mr. Albert Hourani, who spent an academic year at the American University,Beirut, was a very welcome guest at the Beirut Executive Committee meetings,and his dear father, our oldest Vice-President, has also been visiting Lebanon.

REPORT OF THE GENERAL COMMITTEEFOR THE YEAR 1957

AdvanceThe year 1957 has been marked, perhaps more than any other year recently,

with a spirit of adventure and advance. There has been special emphasis onfuture planning, and, in spite of many difficulties-shortages of staff, politicalunrest in surrounding countries, ageing buildings, and other set-backs-thespirit of the Founder which brought Asfuriyeh into being 57 years ago is stillthe driving force for service to-day. It is a healthy state and Asfuriyeh is stilla live young community, ever growing, and spending itself to the limit ofcapacity to serve those for whom it was founded.

Consultants:PROF. H. A. YBNlKOMISHIAN (Internal Medicino)

DR. SAHYOUN (pathology)PROF. ALBERT BOUBZ (Stomatology)

VICE-PRESIDENTS:SIR WILLIAM HOUSTOUN-BOSWALL.

K.C.M.G., M.C.DR. G. W. B. JAMES, C.B.E., M.C.PROF. ALEXANDER KENNEDY, M.D.,

F.R.C.P., D.P.M.SIR HAROLD SATOW, K.C.M.G., O.B.B.

DR. T. EL-AwAR (Tuberculosis)DR. A1.BXANDER HrrrI (Cardiology)

DR. Y. JIDB1IAN (Surgery)

EXECUTIVE COMMITTEE (BEIRUT)

Honorary President:Chairman: JOSBPH HITTI, M.D.

Vice-Chairman and Hon. Treasurer: W. F. GOSLING, O.B.E.Honorary Secretary: E. P. SOUTHBY

JOSEPH J. McDONALD, M.D. GEORGES N. RAYESPROF. S. B. HIMADBH H. C. LEES, F.C.A.

H. W. GLOCKLER, M.B.E. MRS. WM. EDDYMRs. EMILE CoRTAS MRS. NAnB ALAMEDDINE, M.D.

SA'EB S. SALAAM FRANK J. ZUKOSKI, M.D.

IBRAHIM A. KHA!RALLAH, M.A., LL.B.Physician Superintendent: A. S. MANuGIAN, M.D., D.P.M.

Deputy Matron: E. e. CoRY, S.R.N., R.M.N., R.M.PeA.

Administrator: F. L. MARsH

Beirut Ariditors: MESsRS. RUSSELL & Co., P.O.B. 540, Beirut.

London Auditors: MESsRS. WOODMAN, Cox & WILKINS, 31 Bedford Row, London, W.C.t.

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

GENERAL COMMITTEE (LONDON)Chairman: H. LYN HARRIS, M.A., LL.B. Hon. Treasurer: O. M. DARTON, B.A., P.C.A.

MRs. Lucy B. BACKHOUSE MIss HILDA A. FoxRAYMOND DE C. BALDWIN, O.B.E. ALBERT HOURANI, M.A.

DAME DoRIS BEALE, D.B.E., R.R.C. & BAR MISS LETTICE JowrrrR. J. D. BELGRAVE Pasteur CLAUDE REVERDIN (Switzerland)

P. W. BRiGSTOCKE, O.B.E., M.B. GEORGE SOMERVlLLB, M.D., D.P.M.TIm REv. J. ANDERSON BURLEY, M.A., F.R.G.S., HON. C.F. J. C. SAWLB THOMAS, M.R.C.P., D.P.M.

(Chairman of the Medical Committee)H. BARRS DAVIES DAME KATHERINE C. WATT, D.B.B., R.R.CH. JOCELYN EUSTACE, B.A., M.B., B.CH., B.A.O., D.P.M.

Secretary: STEPHEN E. DUNSTAN

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

Lebanon Hospital for Mental and Nervous Disorders

HIs EXCELLENCY THE LEBANESEAMBASSADOR in London

TIm RT. HON. THE VISCOUNT DE L'ISLE, V.CeG. W. FURLONGE, Esq, C.M.G.. O.B.E.

FADLO HOURANI, Esq.TIm RT. HON. THE EARL OF SELKIRK, O.B.E., A.F.C.

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been made with a ten-bedded unit in Irish House under the supervision ofDr. Drooby. Dr. Drooby with his wife and smal.l son cam~ to England in1955. After gaining the first part of his D.P.M. III record tIme, he spent ayear with his family at Memphis, Tennessee, U.S.A., for the necessary. year'sexperience before attempting Part II. He returned as soon as possible toAsfuriyeh to relieve staffing shortage and was in London on. his way throughjust long enough to complete his examination on the eve of hIS d.eparture. Hetherefore did not know of his success in gaining the D.P.M. until he was backat work at Asfuriyeh. He is to be congratulated on having obtained theDiploma in Psychological Medicine. Besides this service with the children atAsfuriyeh, Dr. Drooby has a full programme with the Out-Patients' clinic forchildren run in conjunction with the American University of Beirut, and it ishoped that this section will grow and more adequately meet the increasingdemand for psychiatric work of this kind in the Middle East. Dr. Droobyalso shares in the teaching programmes and other work at the Hospital.

Completed Contracts

Miss Ann Powell: After a very strenuous two years, Miss Powell left us,having put a great deal of herself into improvements for the patients and forthe hospital generally. Since her departure, Miss Cory, as Deputy Matron,has done magnificently and, as always, she fosters a team spirit among theNursing Staff which is so much to be commended. Mr. J. D. Knight: Familyresponsibilities called Mr. Knight home after nearly six years of devoted workand we are very grateful for the fine work he did. Of Miss Phyllis Cooper,who leaves after six years, it has been said by one who knew her work well :, Just what Miss Cooper has put into her work as Sister Tutor can be seen inthe quality of the senior graduate nurses who are now in charge of departments-those who were under her care as Junior Nurses. To all ranks of nursesshe gave herself and always somehow kept in touch with the patients also.'She also organised the Wednesday Evening Services for the staff. Miss Walkerwill be missed for her quiet efficiency which was much appreciated at Asfuriyehduring the three years she was there.

Renewed Contracts

Miss Emily Harrington: After leave in Canada, she returned to Asfuriyehas Assistant Matron and she is a great help in that post as also with the lecturingshe contributes to the Training School for nurses. Mr. Douglas Brett renewedhis contract after Long Leave in Britain, returning as Chief Male Nurse asfrom 9th May, 1957. As with others, his willingness to delay taking his leave,to fit in with staffing plans at the Hospital, was much appreciated. His presencethere is a source of strength and encouragement to all at Asfuriyeh. Miss M.Boger: She returned on December 1st and, pending the arrival of the newSister Tutor, Miss L. J. Sawyer, has added her quota of teaching service in theTraining School with cheerful efficiency.

Junior Assistant Physicians

Dr. Vahe Puzantian is in Edinburgh studying for his D.P.M. Dr. FuadAshkar left us for a post at Memphis, Tennessee, U.S.A. Dr. HaratourSabounjian joined the staff as from 19th November and Dr. Abdo Abu-Zeidas from 6th January, 1958. Dr. Joseph Haikal, who took up an internship atAsfuriyeh for one year as from 19th June, has been giving extremely helpfulserVIce.

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Post-Graduate Courses for Students

In addition to those who are already adding General Training to theirMental Nursing qualifications, Asfuriyeh students are taking courses at theAmerican University of Beirut, and others are taking General Nursing at theChristian Medical Centre, all of which contacts are broadening their minds andcontributing towards future leadership in Mental Nursing in the Middle East.

Other Staff News

Mr. Habeeb Husseiny left us to take up a post with the Arabic section ofthe RRe. in London. The following have managed to continue their activitiesat Asfuriyeh in spite of having entered the state of matrimony: Miss LeilaMattar who has become Mrs. Bitchakji, and Miss Selwa Firr is now Mrs.Anwar Radwan. We wish them both well. In addition to her service asPsychiatric Social Worker. Mrs. Radwan has also became the Editor of TheEcho, the new Staff Newspaper.

Ex-Matrons

The London Office has had many visitors, as usual, and among them mostwelcome calls from both Miss Jane Gibb and Miss Annie F. Mitchell, valiantex-Matrons, who continue to take a lively and helpful interest in the Hospital.

Resignation of the General Secretary

The General Secretary decided on 1st September, 1957 to accept a Callto South Africa which she had received some months previously. She will ofcourse, continue to be deeply interested in the welfare of the Hospital. MissMelita Alexander and Miss Marion Wilkinson who had helped Miss Harveyin the Office, both felt that with the change, their service should terminate.They have both given loyal unstinted service and the Hospital owes them adebt of gratitude for unassuming faithful work.

Mr. Stephen E. Dun"tan

The appointment of Mr. Dunstan to the post of General Secretary is avery fortunate one for the Hospital. He is well known to friends as the sonof Edgar G. Dunstan and also as the Manager of the firm of Edgar G. Dunstan& Co., which he will continue to run in the adjoining office. With efficientsecretarial assistance, he should be able to supervise both concerns very ably.Apart from a natural interest in the work of the Hospital, he has for years beenready to play the part of a good neighbour in times of emergency and thushas learnt much of the foundation, history and future plans of Asfuriyeh.

Linked to the EternalHaving regard to all the new ideas and plans for the future, it is good to

reflect on the keen interest of all concerned with the Hospital's affairs and toremind ourselves again of the purpose for which this work was brought intobeing: to serve the mentally sick of the Lebanon and surrounding countries,and most especially the poor among such sufferers. In a world which is hurry­ing along fast on the material level we do well to pause and remember ourwork of healing is linked with the Eternal. It was this timeless power, whichwas in Christ, which drew those needing His ministry to their sick and wearybodies, their tormented minds and their lonely spirits. As they pressed towardsHim He gave them wholeness of body, mind and spirit. And in our serviceto-day, that same eternal power needs to be evoked, whatever our progress onthe material levels, whatever our latest equipment, our streamlining of buildings,

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to the next stage. This is a much wider field, and one which affects differentstrata of the community ; such as, social welfare, resocialization, child guidance,industrial medicine, training of psychiatrists and psychiatric nurses, etc. Inbrief, this is an opportunity to make Asfuriyeh an Institute from which psychia­tric service in its fullest sense can be given, thereby putting at the disposal ofthe communities it serves the experience Asfuriyeh has gained during its 57years of existence. It is a new sphere of activity outside and within theboundaries of a mental hospital. with particular stress upon the extramuralactivity. This is the next stage we are planning to move on to. The need forsuch an Institute in the Middle East to-day is as acute as the need was for aMental Hospital in 1896 when the great Missionary, Theophilus Waldmeierand his co-workers planned Asfuriyeh. I am sure we are their worthy followers.

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Out-Patient Clinics(a) The Beirut Neuro-Psychiatric Clinic has .continued its usefl:ll service

as in previous years. This year we were able to give more exp~rt.gUl~ance .tochildren and their parents, thanks to Dr. A. S. I?rooby who spe~lahzed m Chll~Psychiatry in the United Kingdom and the Umted States. It IS ~oped ~hat Itwill be possible in the not too distant future to have a proper Child GUIdanceCentre.

Hospital Day

In keeping with our plans for resocialization and a closer integration intothe communities' activities, the 23rd May was chosen as Hospital Day. It isproposed to keep this day as a regular Annual Event for the general public tovisit all the Departments of the Hospital, following the graduation ceremonyof our Nursing School. The first ceremony which took place was given a goodstart by two of the distinguished members of our London Committee, ProfessorAlexander Kennedy and Dr. J. C. Sawle-Thomas. On that occasion interviewswere arranged with the various members of the Hospital by the British EmbassyRecording Service. These recordings were later broadcast by the LebaneseBroadcasting Service on 27th May at 17 : 05 hrs. A similar broadcast wasmade by the British Broadcasting Corporation on 4th July, 1957, through thekind offices of Mr. J. Rae.

Training in Psychiatry: American University of Beirut

Drs. Hayek, Drooby and myself have continued the Psychiatry Coursesof the Medical and Nursing Students at the American University of Beirut.In keeping with the general improvement of teaching procedure, this year theFourth Year Medical Students spent one month as residents at Asfuriyeh.Similarly the Nursing Undergraduates from the American University of Beirutspent two months in full residence at Asfuriyeh. This is clearly a move in theright direction. This year there was a greater interest on part of the FifthYear Students in selecting psychiatric internship for the elective. I am indebtedto Dean J. J. MacDonald, Professor C. Plimpton, Chairman of the Departmentof Medicine, and Dr. R. Tabbara, Chairman of the Curriculum Committee,for their full co-operation. ....

The outpatient psychiatric clinics at the AmerIcan UnIversity of Beirutwere continued as before. In addition, this year Dr. Drooby starL~d the out­patient psychiatric clinic for children at the American University of Beirut.

Similar affiliation facilities were extended to the Makassed School, theChristian Medical Centre School, the National School and the Lebanese RedCross School of Nursing.

957

H. Lv HAHHfS, Chairman oj the LondonGeneral (ommittee.

ROSf A D. HAHVEY, , ecretary.

TE DE T'S REPORT,;PER, . 1 LORDS, LADlES A 0 GE TLEME ,

he honour of presenting the 59th Annual Report, that for the

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The TTlain poli hich was dominant in planning the activities of furi~ ehd jng the urrent ear was that of reorganization of the Lebanon Hospital for

ental and. ervous Disorders.To understand better the need, and indeed the urgency for uch a

rear.:ar.,zation. it ould be helpful to review salient points in the pioneeringor of sfuriyeh.

In 1896, Theophilus Waldmeier, a Quaker Missionary, with a group ofmen and \-\omen belonging to different races and religions, felt the need offreeing the' Mentally Afflicted' unfortunates who were confined to cells andattached to hains. On the 6th of August, 1900 the first patient was taken intothis ha en of Asfuriyeh.

'er since that date, the modern history of psychiatry in this region beganto be written along the lines of progress achieved in Asfuriyeh. Having ucces ­fully attained humane care, the 'Asylum' changed into a 'Hospital'. Anyonewho has closely followed this development cannot but admire and respect themission and devotion of those responsible for Asfuriyeh's pioneering work.At this juncture I would like to put particular stress upon the e.'pre sion'pioneering work'. For those who take for granted all the blessing of modemsocial and medical progress, it is difficult to appreciate fully the true \ alues ofAsfuriyeh's achievements in keeping in the front line of psychiatric progre s.Whatever new progress has made its appearance in more advanced p ychiatriccentres, Asfuriyeh was the first Institution to adopt these 'pilot project . andintroduce them into this region. This was true for the physical methods oftreatment, started in 1936; the School of Nursing started in 1948; the opendoor policy and resocialization project, started in 1956. In keeping with thisprogress, 1957 has been a year of planning further reorganizalion of Asfuriyehfrom a Psychiatric Hospital to a Psychiatric Institute. The pioneering missionof Asfuriyeh as a psychiatric hospital has been full. This mission having beensuccessfully performed, and the mental hospital care of patients hm ing beengradually transferred to National Authorities, the time has come for ,1(h ancing

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TABLE I-Showing General Results for the Year 1957

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Dis­chargedSocially

Recovered

AdmittedDuringthe year

InHospital1st Jan.

1957

Total

Beirut Municipalityl

Free "

Palestine Refugees

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V.N.R.W.A. , ,IA.P. Prisoners , 'ILebanese Army . ,

Dis- Ch~:~~d b~otal m~~ingcharged Not Dis- 31st Dec.Relieved Improved Died charges 1957

Private " I 114 392 I 40 217 I 112 9 378 128

P_u_b_h_'c_A_s_si_st_an_c_e'_','~~-~1_8-6~~~:-~~_2-1~4~~~~:I-~~~1~6~-=--:I· --11-9--1;--79--- _14_1 228 172

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20 59 I 5 I 42 I 16 1 164_64_1-__15---1

13 26 I - I 6 I 19 - 1:__2_5_1-_14-----i

2 16 I 1 I 4 I 8 - I _13_:__5--;

8 I - 1 4 1- -1 4

29 97 I 4 1 70 I 16 2 I 9_2_1-_3_4------1

23 2 I I 1 - I I 2 I 4"I '---I----i

.. 1 400 814 I 67 I 463 1 251 28 1 809 405----'--'1----1----:1-----1 I I ---

As for the group of people manifesting mania and depression, the use ofthe Tranquilizers was almost a matter of routine, except in those cases wherethe immediate use of E.C.T. was highly indicated. It is the opinion of someof us that the association of chemotherapy before and with electroplexy offerstherapeutic advantages. .

In conclusion it may be said, that we have been more concerned With a4total-push' sort of management rather than concentrating o~ one particularvariety of treatment thought to be profitable .to a group of disorders..

I would like to conclude with the followmg: The Lebanon HospItal forMental and Nervous Disorders is the product of two realities. In the firstplace, the need by the inhabitants of thi~ region for disinterested servi~e t? .thoserequiring Psychiatric guidance. ~~ m the s~con.d pl~~e, the avaIlabIlIty ofmen and women with pioneering mISSIon and SCientific VISiOn to see these needs

9

complete recovery at home. However, at time of their discharge they couldonly be considered as relieved. The insulin coma and the convulsion therapiescontinue to be 'stock medicine' for the specific types of disorders.

It will be noticed that this year our insulin patients have all systematicallyreceived electroplexy. The patients that were included in this table have hadnot less than 15 comas and not more than 35 comas. A certain percentage ofthese insulin patients, and almost all of those who were treated by Electroplexy,were also given ataractics some time during their hospitalization. In otherwords, we have combined what is known to be of advantage to the patient inorder to have as large and as satisfactory a result as possible. Thus, the patientswho were diagnosed as schizophrenic and were considered to be too difficultto manage in the treatment wards were given ataractics before the onset ofInsulin Coma Therapy. Some who had not shown sufficient progress afterthe termination of Insulin Therapy, and with whom Epileptic ConvulsiveTherapy failed, were given the advantage of some of the ataractics during thelatter part of hospitalization, and were advised to continue such a regimen afterdischarge. The same rationale was applied in case of the patients also diagnosedas schizophrenics, who were not suitable for Insulin Coma Therapy, but whosetreatment involved electroplexy.

(b) Out-Patient Clinics in Tripoli and Sidon. In an endeavour to makepsychiatric facilities available to the remote parts of the country these twoclinics were started. I would like to express my sincere thanks to Dr. R. Boyesin Tripoli and Dr. Saadallah Khalil in Sidon for having put at our disposal theirhospitals for our psychiatric out-patient service.

Staff

Miscellaneous

Asfuriyeh's activities extend beyond the Hospital walls and boundaries ofLebanon. It is in this setting that the following activities should be interpreted:

(a) Mental Health Lectures under the auspices of Asfuriyeh Ladies' Guildwere cor:tinued as before. (b) Middl~ East Medical Assembly. We partici­pated th~s year by a documentary showmg 'Progress of Psychiatry in the MiddleEast dunng the Past 56 Years'. (c) Visits to Qatar and Dhahran, which I madefor con~ultations. with Loca~ .Autho~ities to discuss Psychiatric problems.(d) Medical Meetrngs: I participated m the Second International Congress of9'roup .Psychotherapy an~ Second International Congress in Psychiatry-bothIn ZUrIch. Also, the Bntish Medical Association (Middle East Branch) inBasra.

(a) Arrivals.-Dr. Ala-ud-Din S. Drooby, B.A., M.D., D.P.M., returnedfrom two years post-graduate training, having successfully obtained his Diplomain Psychological Medicine. Dr. Drooby spent one year at the MaudslayInstitute in London and one year at the University of Tennessee in Memphis.He had been particularly interested in Child Psychiatry. The lack of such aservice in Asfuriyeh had been felt for a considerable period.

(b) Departures.-Dr. F. Ashkar went to the University of Tennessee,Memphis, for post-graduate training. Dr. V. Puzantian went to the Universityof Edinburgh for post-graduate training. They had both rendered valuableservice to our Hospital. I wish them both success.

Miss A. Powell left the Hospital in July upon termirIation of her contract.Mr. J. D. Knight left the Hospital in August upon termination of his contract.I wish them both good luck in their new posts.

We were fortunate to have a visit by Dame Katherine C. Watt, D.B.E.,

R.R.C., who spent a fortnight in the Hospital and discussed important plans ofconsiderable value to the welfare of the staff and patients. Her visit coincidedwith that of Miss Elma Waldmeier, a grand-daughter of the Founder ofAsfuriyeh. Following her visit and discussion with the Staff of the Hospital,Miss Waldmeier promised to reorganise the Hospital Committee in the UnitedStates. She also showed a very keen interest in the plan of reorganisation andpromised to play an important part in raising funds to realise the new plan.I wish her all success.

Evaluation of Results of Treatment (Contributed by Dr. Drooby)

Con~ern~ng the evaluati?~of the resu~tswith the various ,methods ofphysicalth~rapy, SOCially recovered mcludes patients who are conSidered to be sociallyadJuste~, al~hou~h .no~ necessarily up to the level of their normal pre-psychoticstate. .RelIeved mdicates only symptomatic improvement with the basicpsychOSiS unaltered; but the majority of these cases have been able to return~o ~heir home environmen.t. for variable periods. 'Not improved' includespatients whose mental COn~ItIO? and symptoms remain unaltered by treatment.It must const,~ntlybe kept m mmd that many of the relieved are actually sociallyrecov.ered patients who are taken out of Hospital as soon as they have improvedsuffiCiently to be manageable at home. They continue their improvement to

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~-g.a~ ~_ t<l U

t<l '"o a::g ~Eo-<

~l'

I6I11511122I25

1323

I50276

71

21135

41

814

2

II228

17928

II5

593

I4II

I:2

4II

1676

1I

I3

II15

I323

486

518 296

Showing the Nationalities of those AdmittedDuring the Year 1957.

Male Fell/al" Toral

TABLE ill

Nationality

Adeni ..American ..Assyrian ..Bahraini ..Belgian ..British ..Bulgarian ..Canadian ..Dutch ..Egyptian ..Ethiopian ..German ..Greek.. ..Iranian ..Iraqui . . . .Jordanian ..Kuwaiti ..Lebanese ..Palestinian ..Quatari ..Russian ..Saudi ArabianSyrian ..Turkish ..Yugoslav ..

814

1387

12321

242

378495

90400

2914

1194

6

749

1

Female Total

535

53

26135

1361

232I

182

3249

42

64265

168

15

518 296

Male

638

TABLE II

Showing the Religious Persuasions of thoseAdmitted during the year 1957.

in the light of the requirements of the changing times, and their willingness togive this guidance irrespective of race, religion or social status. Therein, isthe strength of Asfuriyeh. For as long as these two dynamic forces, peopleneeding guidance and people willing to give it, exist, Asfuriyeh will continue itsprogress and service.

To the Chairman and Members of the London and Beirut Committeesas well as to all my co-workers who are continuing Asfuriyeh's scientific andhumanitarian mission, go my thanks and gratitude.

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

Your obedient Servant,A. S. MA UGIAN, M.D., D.P.M.,

Physician Superintendent.

Religion

Armenian Catholic ..Armenian OrthodoxArmenian GregonanArmenian ProtestantAssyrian ..Anglican ..Caldenian ..Druze "Evangelical ..Greek CatholicGreek OrthodoxJewish ..Latin ..Maronite ..Moslem ..Protestant ..Roman CatholicRussian Orthodox ..Syrian CatholicSyrian OrthodoxI

I

I

\0..... ..... 0\0\.....

V) ..... ..... ..........

10

- '---'---'---'-~-'---"---I---I---I---I---I---'~~-'---'-_.- --,

I I I -I

TABLE VIYearly Comparison of Admissions and Discharges and Average

Number in Daily Residence

I

,

'\'\'\'1 '1'1'1,\ ,\ ,\ ,I ,1,1 ,i

\

, 1\"

IACTING MATRON'S REPORTThe Nursing School has continued to make satisfactory progress. A

summer school of five students was commenced. The standard of intelligenceof this group was fairly good. Selection boards are now established, and anattempt made to recruit students with a higher educational level, but unfor­tunately we are still finding it difficult to obtain candidates with qualificationsabove elementary standards.

In March Mr. Ahmed Younis, having completed his General Training atthe Kennedy Memorial Hospital in Tripoli, returned to duty. This we hopedwould be the answer to our language problem in the School. He was assistingwith the Preliminary Training School, and carrying out practical nursingdemonstrations on the wards.

In view of the increasing number of graduate nurses remaining with us, itbecame apparent that we could no longer have attendants in charge of wards.Many had given years of faithful service, and at this time some preferred toleave, taking their indemnity. Those remaining were re-orientated into otherpositions.

May 23rd as Open Hospital Day, from the result of careful planning, wasall we had hoped it would be. Part of the procedure was the GraduationCeremony when five Final Nurses were presented with their certificates andbadges. Afterwards many of the students acted as guides for those visitorswho wished to go round the Hospital.

Mr. Michel Dahdouh, graduate nurse of 1951, was granted a W.H.O.Scholarship for one year's post graduate study in England, as an observer invarious hospitals throughout the U.K. He commenced his tour on June 16th.

Having completed a two year contract, Miss A. Powell left on July 9th.During her period as Matron, a great deal of her drive and initiative was directedto the upgrading of the chronic patients.

Miss Reid-Graham, who had taken a local contract for one year, decidedto renew this for a further year's service as Night Sister.

Miss Ramona Halaby and Miss Mary Katoul, two graduates of 1955,having completed their course of study in general nursing at the ChristianMedical Centre in Beirut, returned to duty on September 16th. Miss Halabyas Sister in Charge of Scottish House (Female Admission Ward), and MissKatoul in Lebanon House (Treatment Centre, Admission Unit and De LuxeWing).

The Nursing Affiliation Programme is now well established. MissHarrington during the year had dealt very ably with groups from the AmericanUniversity Hospital, the Lebanese Red Cross, The Christian Medical Centre,and from the Makassed School of Nursing. All these nurses had two months'practical experience and theoretical teaching. An affiliation programme forour own nurses was also established, and groups of four-two boys and twogirls-were sent to the University Hospital for two months' practical experiencein general nursing.

Mr. Brett went for home leave on July 1st, and returned on October 1st asChief Male Nurse with full jurisdiction of the male side of the Hospital. Someweeks after his return his left knee began to give trouble (the result of an oldwar wound) and for some weeks it was necessary for him to have complete rest.It had been feared that surgery would be needed, but fortunately it respondedto conservative treatment. For some time, however, care had to be taken,but during this period of incapacity he was preparing and carrying out extralecture programmes for the student nurses.

13

Average NumberYear Admitted Discharged in daily

Residence1951 179 168 851952 225 206 991953 275 280 1201954 359 345 1161955 412 384 1281956 470 499 1271957 392 378 1131951 144 106 1691952 222 224 1851953 182 158 1921954 256 264 195 ,1955 228 225 2001956 218 232 1941957 214 228 1931951 53 62 841952 69 65 781953 72 69 731954 24 65 491955 62 61 371956 89 97 311957 97 92 341951 420 376 3671952 598 575 4201953 618 597 4341954 748 765 4271955 805 773 4391956 770 806 4211957 814 809 416

12

TABLE V (b)Electro-Convulsive Therapy, 1957

Socially I Not IRecovered Relieved Improved Total

- W. 'T. '0 M. -;¥'T:"""--;;:-F w. T:"""I-----;;:;;-,I--~ 1 1·44 28 19 47~ 14 -721 30·43 69

--I----if---I-- - -- - - - ---'-12 22 31·88 12 25..!!.- 53'621_4 _6~ 14'~~

3 5 35·71 3 6 9 64'27, - - - - I 14

~ 1 2 ~ 23 3(;--::;;-'-51-813 26 -ilso~29----=-II- ~ 129 ----=-1~~«-=-I202

TABLE V (a)Insulin Coma Therapy and Electroplexy Combined

Patients

Diagnosis

PRIVATE

AsSISTA CE PUBLIQUE ..

M.

Schizophrenia · . 1

Depression · . · . 10

Mania · . · . 2

Others .. · . · . 1

TOTAL · . -

BEIRUT MUNICIPALITY ..

TOTAL OF ALL PATIENTS

II

I

Il

I

II ,- ,-----,- -,- -,-

I I I I

I

I

! I

In October a new group of seven boys and. thr~e girls was t3;ken into thePreliminary Training School. The final Exammatlons gave us nme graduatenurses, seven of whom were retained as staff nurses.

Miss Leila Mattar had hoped to return to England to take her certificate inGeneral Nursing, but instead decided to get m~rried. We were glad to knowshe would remain as Sister in Charge of Amenca House, where she had doneso much to establish a rehabilitation programme.

In November Asian 'flu hit us with full force, and at one time we hadaround sixteen personnel down with it, and foun~ we ha~ to op~n ~rigstockeHouse as a sick bay. Our water situation was qUIte drastic at thIS time. Theweekly bathing of patients was carried out by means of a trickle of water goinginto a bucket on a primus stove, and economically showered over each patient.It was also extremely difficult keeping up teaching standards in hygiene to newstudents.

Our plans for organising the teaching of the Preliminary Training Schoolwere badly shaken when Mr. Ahmed Younis without any notification absentedhimself from duty on November 2nd, and some days later we received a letterstating he was working in Saudi Arabia.... This in spite of the fact that he hadsigned a two-year contract which he had no scruples in breaking after a fewmonths' work. Considerable financial support had been given him whenstudying at the Kennedy Memorial Hospital, and on returning to duty he wasreceiving maximum salary above that of other local personnel. This couldnot have hit us at a worse time, since Miss Cooper was then due to terminateher contract.

Because she had the problems of the School so much at heart, Miss Cooperdelayed going on leave for a further two months, and finally left on December19th. Her five years' work in the Nursing School will be long rememberedand appreciated. Miss Cooper was not only concerned with the progressof the student nurses, but took an active interest in the welfare of the patients.

Miss Walker also felt she could not commit herself to returning and althoughher contract ended in October, she decided to stay an extra month in order tobe with Miss Katoul for a while in Lebanon House. She finally left for U.K.on December 5th. During her three years with us Miss Walker always exerciseda quiet efficiency in her work which did much to establish organisation.

At the end of November we were pleased to welcome Dame KatherineWatt, D.B.E., R.R.C., who visited the Hospital for ten days. During this timean informal Graduation Ceremony was arranged, when the Finalists from theOctober Examination could receive from Dame Katherine their Diploma ofNursing. The full Graduation Ceremony was planned to take place on OpenHospital Day, May, 1958.

On December 1st, Miss Boger returned from Home Leave, and agreed totake over Irish House. This department for chronic female patients was sadlyin need of restoration. With her usual enthusiasm and drive, Miss Boger hadboth patients and ward transformed in a very short time.

The Occupational Therapy Department has had a few ups and downs butunder the. supe~visi.on of Miss Wadad Sabbagh, a graduate nurse of 1952, steadyprogress IS mamtamed. Four hundred Lebanese pounds was raised from thesale of work in December. Unfortunately a very wet day prevented manyoutside visitors attending.

During the year we have been delighted to welcome members of the Ladies'Guild who have brought gifts of cake, sweets, and fruit for the patients. What

14

is even more appreciated, groups of ladies have come to take tea with thepatients in the various wards and in this way have shown a personal interest inthe individuals as well as in the work itself. We have also to thank the Ladies'Guild through Mrs. Manugian for their very generous gift of 143 blankets anda stock of new underwear provided for the chronic wards.

The religious Services have continued as usual. Our own student nursesconducted the non-denominational service in Arabic for the patients eachSunday morning, and Mrs. Manugian with unerring faithfulness has continuedto be pianist at these services. Miss Cooper continued to arrange the Wednesdayevening service for staff until the time of her departure, then Miss Cory tookover, assisted by Mrs. Wakim.

With the gradual reduction of the European staff the upgrading of thelocal personnel must be steadily established. The year has brought its dis­appointments and setbacks, but our eyes are now focused on the not too distantfuture, when the dream of those who laid the foundations of the School will berealised : for this Hospital to become a training centre for psychiatric nurses,run by well-trained Lebanese staff.

E. C. CORY,

Acting Matron.

DEPUTY A.DMINISTRATOR'S REPORT, 1957J wish to summarise the outstanding features of events which occurred in

the various establishments of this Department during the year 1957.

BUILDING WORKSA policy of remodelling and reconstruction of some of the houses was

adopted, as in previous years, in order to improve the social state of conveniencefor the patients. Following are some of the more important items :-

Irish House Children's Department. In late September 1957, the south­west dormitory and half of the dining room of the female wing in Irish Housewere chosen to be the centre for the Mentally Retarded Children with BrainLesions, and was remodelled to hold a Playroom, Dining Room, Bedroom andBathroom for 12 occupants. This department turned out to be beautifullydecorated and equipped and rather attractive for children. I wish to take thisopportunity to thank Dr. A. S. Drooby, who lent his invaluable services to bringthis new creation into effect.

Watson Smith, Waldmeier and Irish Houses. The water and drainagepipes of these houses were found to be rusty mainly in the bathrooms andlavatories. This had caused a considerable consumption in water at thehospital because a large proportion of the water was being wasted throughleakages in the metal pipes. These pipes are at least 25 years old. To remedythis we have changed all of the most necessary pipes and installed a new pipenet in the needed areas.

Robert House. At the appropriate request of Dr. A. S. Manugian, thePhysician Superintendent, and the Medical Staff, Robert House was partitionedinto two sections the reason being the necessity of separating the prisoners andthe drug addicts,' who were increasing ~r~du.ally in numb~r.' from the chronicpatients. The work included the partitIomng of the dmmg room and thecorridor at the entrance. The preparation of a separate dining room and thereconstruction of lavatories and bathrooms on the drug addict side made itcompletely independent from the chronic section of Robert House. Both

15

I

1\ ., \1.1.1.1 ,1.1

\

r- -I

divisions were painted and whitewashed, resulting in a much more pleasant andattractive appearance.

English House. Here also a partition was built to separate one wing forthe acute male admissions from the other for the chronic patients. Thispartition was built at the entrance of the corridor; with this partition sixprivate rooms and one dormitory was formed. An old dormitory wasremodelled into a dining room which was, with all other rooms in the wing,completely painted and whitewashed in cheerful colours and attractively fur­nished, including curtains, to comply with the comfort and convenience of bothpatient' and staff. vVe found Dr. Joseph Haikal's ideas and suggestions veryhelpful and guiding and we sincerely appreci1te his kind efforts and interestsin helping us remodel and redecorate both English and Robert Houses.

GI ckler House. In early November 1957 a complete interior white­washing and painting vvas done in Glockler House. A slight change wasmtroduced to the furniture of the Doctors' Consulting Room, 'vhich i.1cludedthe installation of venetian blinds. A room in the ground floor which was notmuch in use was turned into an office for the Psychiatric Social Worker. Thisnew office proved to be a very convenient, comfortable, and well-arranged onefor both the social worker and the patients with their relatives. The furnitureof this office was supplied from the Hospital general furniture stores.

In order to prevent visitors from interfering with the work of our telephoneoperator, a wooden trellis partition was placed on either side of the frontverandah, and a telephone booth was installed in the operator's room for useby staff and visitors.

Incinerator. A new incinerator was constructed in Moumnieh about50 metres from the tennis court. This has replaced our old method of destroy­mg garbage and has pro ed to be much cleaner and more sanitary in operation.

Stores. In the basement of the Physician Superintendent's Residence.where the main stores of the ho pital are located, a room was constructed belo~

the balcony for the purpose of storing old files. In that room stationery cup­boards were placed to be used for office and ward stationery supplies, as thecontrol and distribution of stationery is now the responsibility of the storekeeperof the hospital main stores.

General Repairs. A general badly needed repair of bathrooms, paintingand v"hitewashing was carried out in Strawbridge, Brigstocke, Lowrie. andLebanon Houses, and the Mortuary.

ESTATE, 'ater Supply. The water supply this year was inadequate, which made

it rather difficult for e~ryone, especially the staff on the wards. The hospitalwater well had a capaCIty of 120 cm. per 24 hours early in the summer. Thisquanti~y. \\as red~ced to ?5 em. per 24 hours towards the end of September.In additIon to thIS reductIon there was an additional shortage in the supply ofwater caused by a burnt out pump, damaged because of the low level of atel'.Because of this e had to mak~ use of a small waterspring \\ ith the capacity of20 em ... per :4 hOuys. located In Moumnieh and drawn up to the swimmingpool, trom. \\here It \\as pumped to the small reservoir up the hill. A newpump \ a mstal1ed ~or the purpos~ on the S\\ imming pool; it \\ as especiall).creat d for the u. e ot the laundry, smce his water supply was not adequate foruse el e here; It brought tremendous relief when org,:l!1i ed.

Garden. The olive ~rop .was not too good because the year 1957 \\arath.e~· a bad )ear f?r ?ll\es m Lebanon; we were obliged to purcha e anaddItIOnal amount 01 oln es for the \\ mter stores as the crop amounted to about

16

·

,!

only 5 metric tons. But the crop was not as bad as in the previous years of1951, 1953 and 1955.

The produce from the Moumnieh gardens this year did not measure up toexpectations as the garden suffered tremendously from the shortage of waterand for this reason the orange, banana and vegetable crop was rather poor.

The wood supply was this year secured from the hospital grounds, manyold dead trees were cut down, chopped into small logs and stored in the wood­shed for the winter. A quantity of 40 tons was cut, which was enough to meetthe hospital demands in 1957.

Estate Boundaries. In accordance with a presidential decree No.4 datedNovember 30th, 1954, a new road was constructed south-east of the hospitalfrom the Damascus Road down to Moumnieh. This has taken from theproperty of the hospital about 2,750 square metres, the width of the road being12 metres, leaving a piece of land outside the hospital grounds measuring 300square metres. An agreement was reached to have a new fence on the hospitalproperty built by the same company (C.I.L.) which initiated this road. In aneffort to straighten the boundaries, it was necessary to have a share of theother company's property to be given to us without any compensation becauseit has fallen on to our side of the fence.

KITCHENMrs. Magda Sonnwald, our Dietitian and Kitchen Superintendent, left us

in May 1957 after seven years' continuous service: the kitchen was left for sixmonths under the entire control of the Head Cook, who had taken a shortcourse of cooking at the Bristol Hotel; but since it was found necessary toacquire the services of a Kitchen Superintendent in order to keep a high standardof food preparation and qualified order. we appointed Mrs. Salwa Azar inearly December 1957.

Special stores were rearranged for the kitchen in order to enable the hospitalto have a better control over the daily stocks. The room that was formerlyused for the preparation of labeneh was converted into a dishwashing room.This has proven to be a much more convenient arrangement for dishwashingand at the same time provided more cooking space and more cleanliness in themain kitchen.

BAKERYIn order to increase efficiency and reduce costs in the bakery we have

purchased an electric dough mixing machine. Formerly the dough was mixedentirely by hand, which resulted in both high production costs and low qualityof dough. This new electric dough-mixer has given us better quality dough atlower labour costs. The annual saving because of the mixer is estimated atL.L.1,800. New shelving was installed in the bakery to provide more spaceand give more facilities and cleaner appearance.

SPORTS AND ENTERTAINMENT CLUBThe small shop inside the social club was rearranged with shelving and

generally fitted out to meet the in~reasin~ demands .of. the patients and thehospital staff. It had a general whltewasnmg and pamtmg. The sm~Jl waterpond on the plaza in front of the club was completely removed to gIve morespace for the club members and .guests d.uring the .summer season. The club'sincome has been steadily increasmg and ItS operatIOns are successful. I wouldlike to thank, at this point, all those who have devoted their time and effort to

17

, \""'1.1.1.1 IIi~~'\" ,'1'111 '1'1'1

\

I

I

,

-,- - - -~~'_'_I._'-

00lr)0-.......

~'"'

~....-....--<;:;

~

-t:::.....!:::'-!:::~

~\:;......

----"::;:::S5

006~.(5-.'-"-..\:;......'-~~~

-t:::......,\:)'

......-\:;I::l.,

'0'\:)......\:)

..:::I::l.,

.!::;\:;

!:::~

A~furiyeh 1957

OFFICE STAFFOur Administrator, Mr. John D. Knight, left for England in the early

part of August on furlough. We had quite a busy summer season. Althoughunderstaffed, the office staff were able to carry out the work very smoothly andmost efficiently. I would like in this connection to express my thanks to allthose who helped us, especially and in particular Misses Odette and NadiaHaddad, who proved their capacity and loyalty.

revive the club and make it a success, especially the members of the ClubCommittee.

FURNISHING AND EQUIPMENTThrough the financial aid of the Lebanese Ministry of Social Affairs, it

was made possible for us to procure five Norge electric refrigerators, whichwhere distributed where necessary in the wards. These have greatly facilitatedthe work of the wards, each ward being independent in its possession.

The locally-made fuel heaters were replaced by Coleman exported heaters,to add to the comfort of the wards.

ELECTRIC SUPPLYI am glad to report that the electric supply was normal owing to the good

working order of the Electricity Generator.

TRANSPORTA new 1957, 8-seater Chevrolet Station Wagon was purchased in early

February to replace the 1953 station wagon. Unfortunately, it was involvedin an accident on June 6th of this year, causing minor injuries to some of ourhospital administrative staff. Our Social Worker fractured her arm, butfortunately had a successful recovery.

FINANCE AND DONATIONSThe general financial situation has been fairly good. An application has

been put before the Ministry of Health, and negotiations by the PhysicianSuperintendent are in hand for an increase in the daily patients' fees, as theoperating cost per patient daily is continuing to rise; the average cost perpatient day being pI 660 (l5/-d.) as against pI 652 (l4/6d.) for the year 1956.Due to this increase, the Beirut Executive Committee decided to augment thePrivate Patients' fees as from October 7th, 1957 to the following rates :-

Old Rates New RatesI Class L.L. 450 per month (£51) to L.L. 500 per month (£57)II Class L.L. 275 per month (£31) to L.L. 300 per month (£34)III Class L.L. 150 per month (£17) to L.L. 175 per month (£20)

The Trans-Arabian Pipe Line Company has contributed as usual a generousdonation of LL 10,000 (£1,130). It is contemplated assigning this amount forpurchasing an X-Ray Machine during the coming year.

The usual sum of LL 4,000 (£450) was a handsome donation from theMinistry of Social Affairs. Other kind donations have also been receivedduring the year.

In concluding this short report I would like to express my deep appreciationand gratitude for the confidence and trust that both Committees, Dr. A. S.Manugian, the Physician Superintendent, and Mr. J. D. Knight, Administrator,

18

Female Graduate Nurses, Spring 1957, with some previous graduates andBritish staff

Male Graduate Nurses, Spring 1957

Miss Amal Abu Khair

Mr. Mohammed Sahli

Mr. Khalil Karam Miss Maida Keojian

Mr. William Mahfoud Mr. Sabah Saad

Student Nurses graduated October 1957

Miss Antionette Abdul Ahad Miss Hadia KaddouraMr. Houran Hourani

Patients returning fromArabic Service in CoryHall, 1957.

placed in me. It was a l:eal pleasure to assume the responsibilities given to meand to get the co-operation of the various hospital staff members.

RAMSAY E. SAMAHA,

Deputy Administrator.

\

ANNUAL GENERAL MEETING, 1958The 1958 Annual General Meeting was held in the Winter Garden of the CoraHotel, Upper Woburn Place, London, W.e1, on Wednesday, 22nd October,1958, at 5 p.m., the Rt. Hon. The Ea.rl ofFeversham, D.S.O., D.L., J.P., in the chair.

The Chairman: We meet this year in difficult times for the Lebanon~o~pital and! am very. glad to see that by your presence here to-day you aregIvmg your time and Interest to support the devoted work of the staff atAsfuriyeh. During the last few months, I have read many messages from theHospital and at all times, despite the distractions of pol itical strife, these messageshave contained a very vigorous spirit of enterprise and initiative.

As many of you know, we have been seeking to extend and improve theservices which the Hospital provides for the cause of mental health in theLebanon and, as you know, the negotiations have been fraught with greatdifficulty of one kind and another, but I have been very impressed with thepatience and the energy both of the staff and of the many friends of the Hospitalwho have drawn up the plans and investigated the sites.

I see from the papers that have been submitted to me that only last week theGeneral Committee were faced with an impasse over the question of test drillingfor water on the sites prospected by Dr. Higginbotham, a geologist, whose helpto do this work was given by Messrs. Wimpeys. The feeling, as I understand it,of the Committee at present is that we shall have to carry out a good many ofour plans on the present site and that now is not quite the time to think ofmoving elsewhere.

In furthering the traditions which the Hospital has founded and maintainedin the Middle East, a great deal of thought has been given to the planning of anInstitute of Psychiatry. When the time comes, which we hope will not be sofar distant, the Hospital will be prepared for a very extensive step forward inthat direction.

You will, I think, agree that the drive forward in the field of mental healthin the Lebanon is on a parallel with the developments which are taking placein this country at the present time. Tn my capacity as Chairman of the NationalAssociation of Mental Health I am, of course, in very close touch with thenational and local representatives of government, and also I am in touch withthe voluntary organisations who are pressing forward with imaginative schemesfor improving the mental health services in this country.

We know that Parliament intends to take action on the recommendationsput forward by the Royal Commission on Mental Health. Local authoritieswill be called upon to implement the decisions of the Government and they arenow looking to my Association for guidance. The a.spects of ~ental heal~hare growing in momentum. You will agree that there IS a.change In the publIcattitude towards the prevention and the cure of mental dIsturbance.

All this means that there are so many calls upon my time that, very regret­fully, I can devote only the minimum time to the interests of As~uriyeh. Manyactivities which I would otherwise like to undertake have to give way to thedemands of the mental health organisations in this country and also the demands

19

Oxen ploughing inHospital grounds

.. _-

.

I I.-

I

!-+---+---t----+--

now imposed upon me by a Government Inquiry of which I am Chairman.But I would like to take this opportunity of saying at the Annual GeneralMeeting that it is a privilege to be associated with the enlightened and pro­gressive medical research and approach to the care of the mentally ill which issuccessfully followed at Asfuriyeh. The constant and intimate liaison betweenthe staff of the Lebanon and the people in this country cannot be anything butbeneficial.

I am very glad to see with us this afternoon Mr. Hourani, who is a tirelessworker for the Hospital. I am sure you would like to know that Mr. Houraniis also representing His Excellency the Ambassador, who has apologised thathe is unable to come to-day owing to pressure of work. T would like to sayhow sorry I am that His Excellency is not here, but I hope Mr. Hourani willconvey our acceptance of his apology.

Now we come to the financial report which I will ask our HonoraryTreasurer Mr. Darton, to give.

Mr. O. M. Darton: I have pleasure in presenting the accounts of theHospital for 1957.

As you will know, the income of the Hospital is mainly derived frompatients' fees in Lebanon. It is also derived in this country and elsewhere fromour many subscribers and from dividends received on our investments. InLebanon we have received £104,335 in all, while there has been received inLondon amounts totalling £1,700.

The cost of running a hospital such as this is made up of many items, theprincipal of which are wages and food, and we have in fact incurred expenditurein Lebanon amounting to £105,998 during the year on these and other items,apart from the expenditure in London of £2,735.

Now, our total expenditure compared with the previous year has fallenby £7,159 mainly through a saving in salaries and wages. Unfortunately ourincome has also fallen by an even larger amount of £12,791, chiefly on accountof the reduction in the number of private patients. Thus we are substantiallydown on the figures of the previous year and, after making a transfer to SpecialContingencies Fund of £5,651 (from which payments of £4,860 were made),compared with a transfer of £2,619 in the previous year, there is a deficit forthe year of £8,349, compared with a surplus in 1956 of £315.

During the past year we have spent and charged to capital account some£3,625 on improvements to the buildings and on new furniture and equipment.This compares with expenditure of £7,516 in the previous year.

Some of you will already have heard of the death of Miss Gibb, who servedthe Hospital so faithfully as its Matron during the major part of her workinglife. Miss Gibb has bequeathed one-sixth of the residue of her estate to theHospital and we are touched that she has remembered our needs in this way.

Since the end of the year we- have also heard that the late Mr. W. L.Chadwick of Glasgow has left the Hospital a legacy of £250; he was at onetime a regular subscriber to our local Glasgow collection.

No annual meeting would be complete without the presence of our friendand Vice-President Mr. Hourani. As is his custom he does not come emptyhanded. He has in fact brought with him donations which he has collectedfrom his friends in Manchester and elsewhere amounting to £87. 'We areindeed grateful to him for his continuing and untiring service to the Hospitalthroughout the years.

I sometimes think that the more long-standing members of the Committeelook back almost with nostalgia to the time before the war when the Hospital

20

pursubled its .way ~orwar.d in co~paratively uneventful days. These are indeedtrou ous times m WhICh we lIve-times moreover full of change. We arehere, ~oweve!,. to meet the challenge of these days and I think we should allcouhn! It a pnvilege th~t we can do so either by our gifts of time or of moneyto t IS most worth whIle cause.

The Chairman: Are .there any questions that anybody would wish to askMr. Darton on the ~nanclal statement? If not, will somebody from the floormove that the finanCial statement be received?

Miss Lettice Jowitt : I have pleasure in moving that it be received.Miss Hilda Fox: I have pleasure in seconding.The motioll was put to the meeting and was carried.

ReSOlutions

The Chairman: , The ~ext item i~ the election of the General Committee,and I have pleasure III askmg Mr. HIghwood, of the British Council, whom Iam glad to see here to-day, to propose a resolution.

. Mr. R. Highwood (Brit~sh Council) : I am proposing that the same Com­rruttee who have served you In ,the past should serve again next year. I thereforeformally move that the followmg be re-elected to the General Committee for theyear 1958/59 :

Mr. H. Lyn Harris, Mrs. Luc) Backhouse, Mr. Raymond de C.Ba.ldwin, Dame Doris Beale, Mr. R. J. D. Belgrave, Dr. Percy W.Bng~tocke, Rev. J. Anderson Burley, Mr. O. M. Darton, Mr. H. BarrsDaVIes, Dr. H. Jocelyn Eustace, Miss Hilda A. Fox, Mr. AlbertHouran~, Miss Lettice JOVlitt, Pasteur Claude Reverdin, Dr. GeorgeSomervIlle, Dr. J. C. Sa ,Ie Thomas, and Dame Katherine Watt.The motion was seconded from the floor.The Chairman: Thank you very much. It bas been moved and seconded

that the names read out to you be elected as the General Committee. Thosein favour? Those to the contrary? That is carried.

The Chairman: I will ask Miss Phyllis Cooper to move a resolution.Miss Phyllis Cooper: Having worked on the nursing staff of Asfuriyeh for

five years until fairly recently, I am very pleased to be here to-day and I amproud to feel that I have been able to playa part in the wonderful work ofAsfuriyeh.

I have been asked to propose this motion. I move that Messrs. WoodmanCox and Wilkins be reappointed the Auditors for the Lebanon Hospital forMental and ervous Disorders for the year 1958.

Mrs. Lucy Backhouse : I second that.The motion was carried unanimous!)'.

o The Chairman: We ha e the great benefit of the presence of the formerBishop in Jerusalem, Bishop Stewart, to speak to us this evening. The dateof the Annual General Meeting \0\ as, in fact, particularly arranged many monthsago to meet his convenience. He has come up specially from Kettering tospeak to us and he is going bac: there to-night. We are particularly gratefulto you, Sir, for making this journey and coming to assist the Lebanon Hospitalin this way. I am only so ry that there are not more members of the Associationor of the Hospital to hear you this evening, but I know that those who arepresent will give you the 'very \\armest welcome.

21

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In ~t, I ~?tice that am~ng the patients dealt with in that year, there were 24natIOnalIties and 18 dIfferent religious communities. That in itself is anindication of ho~ far t~e effects of Asfuriyeh are spreading and of how gener­ously they are gIven WIthout that blessed or cursed word in the Middle East,discrimination.

So~e of you may know that about half a mile south-west of Bethlehem,on the SIde of the road that leads to Hebron, there is a comparatively modernstone archway, rather characteristic of some of those rather imposing entrancegateways that one sees about in the Middle East which have no connectedfence round them. One can just as well walk round them as go through them,but they at least suggest that this is the approach to something, even if you donot approach it through the gate but go round, which is just as short and as easy.

Over that archway there is a varving of St. George and the Dragon. Itindicates the way to a village, which is only half a mile further on, along a sideroad. It is the village of El Khidr, 'The Evergreen', who, as those of you whohave been in the Middle East know, is more often than not St. George. ElKhidr, 'The Evergreen', is sometimes Elijah or other characters, but mainly itis St. George.

There, in that ancient village of El Khidr, is a very ancient Christianchurch. It goes back, I believe, to the 5th century, and in that church thepeople will show you the chains where they used to fasten up the insane of thecountry in the belief that it would cure them. The fact was, I imagine, that ifit did not cure them, it killed them, and so if they lived at all they were cured.

The old church is still there, the chains are still there and the comparativelymodern archway is there. I had a very good friend in the old Arab priest wholooked after that church and whose animals used to corne up the stairs to joinus when I went to have a cup of coffee with him.

Just across the road from the imposing gateway is what was one of themost distressing of all the refugee camps of Jordan. It is on a bitterly exposedhill, largely rocky. Where it was not rocky, in winter-time it was pools ofmud. For the first year or two after 1948, there were sC?me hundre~s of peopleliving in any sort of shelter they could get together-a bIt of tarpaulm, perhaps,fastened on two rocks with stones heavy enough, they hoped, not to get blownaway. That is how it was for the first year or two. .It has grown more an~more habitable as stone huts, and so on, have been bUllt for the people, but Itis still an appalling place. If the inhabitants of that place are not would-bepatients, I do not know why they are not.

All that is just about 200 miles as the crow ~ies from Asfuriyeh. Ashuman knowledge, science and charity go on, Asfunyeh IS 1,50~ y,ears aheadof El Khidr, and yet they coexist to this day. ~o me, that. p,athetIc lIttle c~lUrchof El Khidr, with its tradition of curing lunatics by chammg t?em uP. m theholy place, is the origin of the nam~ of t~e Bethl.ehem HospItal WhICh weknow as Bedlam. And there is Asfunyeh, SIde by sI~e n?t so far away. T,hatis a picture of the advance that has been made and IS bemg made, and whIch,please God, we shall help them to go on making, getting further and furtheraway from the horrors of what used to be.

Perhaps Dr. Eustace could ~ell us just how f~.r we ca? equate the I?entaland nervous diseases of to-day WIth what appears m th~ BIble as posseSSIOn byevil spirits. I imagine they are fairly closely connected m some way o,r an?ther.But it occurred to me to think of ~ome of the cases that c~me to one. s m~d o~possession in one form or another m the New Testament- My name IS Leg~on .for we are many'. I suppose the man who would know would call hIm a

23

The Rt. Rev. Bishop W. H. Stewart (former Bishop in Jerusalem) : I havean uncomfortable feeling that many of you know at least as much about theLebanon as I do, and possibly more, and that there are some who know some­thing more recent about the Lebanon than I do. It is seven years since I lastspoke at a parallel meeting to this one. It is also eighteen months since I tookprobably my last sight of the Middle East, leaving from the Lebanon. I havebeen, and have been glad to be, as far as possible in fairly constant touch eversince, but there are those here who have been there and back possibly morethan once since I last saw it. And of course, as Mr. Darton has suggested, agreat deal has happened in the Lebanon within the last eighteen months, muchthat was disturbing.

It is not my place-nor, indeed, am I competent-to speak of those thingsthat have been happening in the Lebanon, but I am glad to know that whateverthey may have been, we here in this room can all wholeheartedly unite indesiring the integrity and the stability, the happiness and prosperity, of thatmost beautiful country in the Near East. I am glad to think that Mr. Houraniwill accept that assurance from all of us.

More than that, however, I feel also that the very facts of history withinthe last year or two are in themselves a very strong and powerful plea for thework of the Lebanon Hospital. That Hospital represents a contribution verylargely, although not entirely, British-one is glad to think that other countries,and other countries of the West, have a hand in it-to the integrity and stabilityof the Lebanon, which is entirely non-political. It makes no distinction ofrace or of creed and it asks no return. It is, in fact, to quote a phrase which wehave seen quite a lot in recent years from that part of the world, , Aid withoutstrings'. Aid without strings is what is being asked for from so many partsof the world, and I feel that the Committee of the Lebanon Hospital can honestlysay that aid without strings is what they seek to give, and do give. That, Ihold, is truly Christian. I would go further and say that it is truly Christ-like.It goes to meet the needs of to-day.

I have no statistics and no facts on which to estimate whether the incidenceof mental and nervous sickness is greater in the Middle East than it is elsewhere,or even whether it is greater now than it used to be; but thirty-one years'experience in the Middle East certainly leads me to be quite confident in sayingthat the provision for dealing with mental and nervous diseases is a good dealless in the Lebanon than it is in some more fortunate, although less beautiful,parts of the world. And you and I all know that it would be infinitely less stillif it were not for Asfuriyeh.

I may be wrong, but so far as I know there is no other institution in theMiddle East that is anywhere in the same street as the Asfuriyeh in its ownparticular line. That is of vast importance, not only for what it does, but forwhat it is showing the rest of the Middle East can be done, and how it can bedone.

When your former Secretary asked me if I would speak at this meeting­it was quite a long time ago-she sent me, possibly by way of inducement, atranscript of what I said at the same meeting seven years ago. I tried then tomake the point-and I do not hesitate to make it again-that not the least ofthe services of the Asfuriyeh is that it has shown, is showing and will continueto show, from the Lebanon what will increasingly come to be done in Iraq, inSyria, in Turkey and, possibly, in Jordan. It has been a model to the surround­ing countries of how to get about this extremely difficult job.

I was looking just now at the 1956 Report. I am only sorry that I did notsee it until I came into this room and I have not had time to study more of it.

22

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schiz?phrenic. Where was he? He was in the tombs by the Sea of GaWee,.75 miles away from Asfuriyeh, perhaps, in a direct line.

One of the most fascinating expeditions I ever made in the Holy Land wasto what re~ains of the town of Umm Qeis, that rocky town south-east of theSea of G:alilee, where in an Arab village to-day you can read the inscriptions inGreek-If you are able to read Greek upside down-that are still built into thewalls of the houses. That is where he came from; that is where he was, inamong the stones.

There was another case, the boy at the foot of Mount Tabor the Mountof Transfiguration. I do not know what he was-perhaps an 'epileptic-Ihave no medical science whatever. But he would have been a good patient,and he was perhaps 20 miles nearer to Asfuriyeh than Umm Qeis. The daughterof the Syro-Phoenician woman up the Lebanon coast was another. All ofthose, I believe, would to-day have found their way to Asfuriyeh if somebodycould have helped them to get there and if somebody could have provided somefunds-although I believe I am right in saying that even if there are not anyfunds, Asfuriyeh would take them in if it possibly could. I do not think Iam exaggerating when I say that Asfuriyeh is doing to-day what the Masterwas doing in the days of the Gospel.

There was another example further away. There was one in Macedonia,a girl of Philippi. If you look at the list in the last printed Report, you willfind that the patients included Greeks, Albanians and all sorts of people. Thatgirl would not have been out of reach of Asfuriyeh either. The previousReport said that there were Albanians, Cypriots, Poles and Turks among thepatients. I remember seeing two Afghans there, let alone the people who camefrom the Persian Gulf.

I claim for the Lebanon Hospital that it and its work are in the direct lineof descent from the work of Our Lord himself, and as such I claim that theyhave a right to ask our support and our interest. I know that I need not sayit to you, because you would not be here if you were not interested and werenot helping, but it is something that we can perhaps put across to other peopleand get more people to help.

At the same time, I honestly believe, as, I think, we all can, that theLebanon Hospita~ is playing its part in helping to solve the world's bafflingproblem of the MIddle East. A few months ago, there were 310 Bishops meet­ing here in London t~gether (I was not one of them). Afterwards, they saidthat the one word whIch ran through all their discussions was reconciliation.I fancy that the work of the Lebanon Hospital is doing just that, reconcilingmen and women to life, reconciling them in many cases to themselves and bythe very mixture of race and creed, by the very generosity that spreads ~verthem all and asks no questions, helping to reconcile the nations and peoplesthemselves to one another.

I do not mean that it is consciously missionary work. I know it is notand I know it ought not to be, and I know that it would probably completelywreck its work if it were. I imagine that a great many of the patients of theLebanon Hospital hardly realise where the help is coming from or why it iscoming; but there, as on another occasion, 'the servants which drew thewater knew'.

The Chairman: We have also to pay tribute to the wonderful address wehave heard from Bishop Stewart. In the meanwhile, I will ask Mr. Baldwinto give the General Report.

24

Mr. R. de .C. Baldwin, O.B.E. : In presenting the Annual Report for the~ebanon Ho.spI~al for last year, I do not propose to go into much detail regard­mg the multIfanous aspe~ts of the. work which we have been performing there.They are mostly set out faIrly fully m the reports of the Physician Superintendentthe Matron and the Almoner. '

I woul~, of course, like to pay tribute to the devotion of all the servantsof the H OSPIt~l. The~ have been very sorely tried of late, but even in ordinaryyears-we mIght possIbl~ say that last year was not an ordinary year-theyhave been face to face WIth constant strain and difficulties.

I should like to enlarge a little on what our Chairman has said about thefuture deve~opmentat the Hospital. For some time, we have been coming tothe conclusIOn that one of the stages of the pioneering work of the Hospitalhas just about. been .re~ch~ng its fulness. For more than fifty years, we havebeen engaged III assImI1atmg and practising, and passing on to the people ofthe Middle East, all the latest theories of the art of healing the mentally sick,and we must, I think, take some credit for it.

The point has now been reached where there are a certain number, althoughnot nearly enough, of national hospitals who are fairly fully qualified to lookafter the mentally afflicted, and who do it very well and competently. In otherwords, although they may not yet be in the same street with us, they are justaround the corner.

The question was, what were we to do next? Should we continue on thesame lines as we are, still fulfilling the need in the country, or should we go onbeing pioneers? There was not much doubt about that. There is plenty tobe done. All our specialists on the Committee, the doctors on the BeirutCommittee and the Physician Superintendent himself, were very keen that weshould branch out into new aspects of our work. For example, the borderlinetreatment of patients and rehabilitation and child welfare clinics go outside thebounds of the Hospital.

It then became a question of whether Asfuriyeh was altogether now asuitable centre for that sort of thing. It must, however, be remembered thatBeirut has grown up, and grown up fast, and we are faced with the prospectof being enveloped by Beirut.

We therefore began to look about and wonder whether it would not bepossible to find some place, a little further away from Beirut, to which we couldtransfer some, ifnot all, of our energies. It would have to be a gradual process,but there it was. We began to look round and, as you have heard, we wentinto the possibilities of various sites.

Then, fate intervened. The trouble in the Lebanon broke out and therewas nothing we could do for the moment: The people of t?e Lebanon had, .asyou know, caught the same contagion ,:"hICh. ~as c~ught vanous other countnesof the world and instead of settling theIr politIcal differences by peaceful means,started erecting barricades and shooting at each other. There was nothing wecould do about that.

Obviously there was no room in Asfuriyeh and in the other hospitals ofthe country to'house all the shooters and treat them until they got ri~ of theirfirst attack of acute dementia. And so we had to fall back on the Idea thatAsfuriyeh must continue to be our c~~tre. For one thing, there is plenty tobe done in the way of extra-mural actIvIty. ~or example,.we w0l!ld very muchlike to increase the area of our clinics for outSIde consultatIOn, whIch we alreadyhad going in Beirut, Sidon and Tripoli. We would like to establish others inother parts of the country.

25

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Then there is the question of a psychiatric institute, which must comelater, and, more immediately, the following up of the cases of patients who havebeen discharged from the Hospital and returned to ordinary life, which inmodern jargon, I believe, is called 're-socialised'. It is a terrible word, but itgIves the meaning. All of this requires financing, and so I hope very muchthat all of you who have so generously contributed to our necessities in thepast will go on ministering to our needs.

It is early days yet to say how these troubles in the Lebanon will affectour revenues, but I do not think one needs to be a pessimist to foretell that weare ~oing to have a good many financial headaches in the next year or two.I think revenues are bound to go down. There is not the money in the country.

Before I sit down, I would like to allude to the sad news of the death ofMiss Gibb. She served the Hospital for about 33 years, before the beginningof the First World War and up to the end of the Second World War. She wasMatron and I knew her well. She was a grand woman and a tower of strengthto the Hospital, and a friend of all the world. May she rest in peace.

I commend the Report to your attention. I am sure it is well worthstudying.

The Chairman: I now ask Dr. Jocelyn Eustace to give the Medical Report.

Dr. H. Jocelyn Eustace: It is a very great privilege for a comparativenewcomer to the Committee to be asked to present the Medical Report. Unfor­tunately, I have not the intimate acquaintance that Professor Kennedy couldgIVe you last year of the Hospital and its personnel, but at least I have anancestral interest in the Hospital as Dr. and Mrs. Waldmeier stayed with mygrandparents when they made their tour before starting the Hospital in about1890

Dr. Manugian's report, which you have before you, tells only part of thestory, but it does tell of the immense amount of work which is going on in theHospital and how much the work is changing. He says that the major trendin the last year has been towards reorganisation of the Hospital, changing itfrom a hospital to an institute. The whole position in psychiatry is changingso rapidly at present that it is changing out of all recognition. I am sure theFounder of the Hospital would not recognise the position nowadays in whathe would find in a mental hospital.

If you look at the number of people admitted, for example, you would seethat during the last six years the number of patients admitted has been almostdoubled. The number of patients leaving the Hospital has been more thandoubled. The average number in the Hospital went up slightly but is nowtending to come down. That is the position to be found in mental hospitalseverywhere; far more patients have been admitted, but far more are leaving.

Why is that happening? We must give great credit to the variousorganisations in which the Earl of Feversham takes such an active interest andsuch an active part for the change in attitude towards mental hospitals and thechange in attitude towards the understanding and sympathy which is now givento the mental patient. The background of sympathy and understanding fromoutside the hospital is equally as important as the medical and nursing helpgained through the Hospital itself.

But also, in these changing conditions, we must give credit to the drugfirms, because they are producing most amazing new medicines and new formsof treatment which have revolutionised the running of the hospitals and theirinternal working. In the old days, we used to have horrible wards ; the poor,unfortunate people who were kept there could not be controlled. Now, we

26

do not have those wards. Patients are n bl .interests of the Hospital and its difli t ?w.a ~ to take a full part 111 all thesee patients who perhaps for t teren 111stItutIOns. It has been fantastic tonow able to tak~ part in'ordinwen y years have ~e~~ looked upon as incurablemodern drugs and mode . ary, every-~ay actiVIties, thanks very largely to

rn Improvements 111 treatment.

The ~{~:;:sn~~~a~~i~~~~ti~~~~l~h~hc~a~~e~:h:c~have co~e:o th~ hospital.not only must we be prepared for them' we ~a e frep~re orht em; butforesee that in th t [; d· . ve 0 pIOneer t em. I can

b e ~o ar I.stant future mental hospitals as such will be asempty as tu erculoSIS sanatona are now. I honestly believe that we will cometo the stage where we can treat patients altogether as out-patients.

. Las~ year, Dr. Kennedy made the interesting suggestion that in connection~Ith.a vIlla~e, we should start a centre for treatment, where the patients couldlIve 111 the vIll~ge but come to the centre for treatment. It would be a kind ofvast day hospItal such as. has been so well organised in Bristol and in Londonwhere they have been domg such excellent work. '

Nowaday~, what happens is that the patient who comes to the Hospital~a~ the.extra ~Ifficulty of having to face suddenly a Western way of living whichIS mevltable m the Hospital life. P~ofessor Kennedy's idea is that if onlype?ple co~ld be treate~ more from theIr home as day patients, which should beqUIte pOSSIble now, thIS would be a step in the right direction.

.l?r. .Manugian remarks ~ha~ the. Lebanon Hospital is the product of tworealIties. the need fo~ psychIatn~ gUIdance and the availability of disinterestedmen and wo~en to gIve that gUIda~ce irrespective of race, religion or socialsta~us. That IS the strength of Asfunyeh, and that will assure the continuationof ItS .work. I feel th.at you can ~ave the greatest confidence in our MedicalSupenntendent and hIS staff and m all the workers in the Hospital to carryforward these schemes and make them successful.

I have the greatest pleasure in presenting the Report.The Chairman: At this Annual General Meeting, I think you will agree

that .we have had s?me very interesting statements. We have had a compre­henSIve survey rapIdly but thoroughly enunciated by various people. Mr.Darton has touched on finance and Mr. Baldwin has given a most interestingr~port about the future prospects of Asfuriyeh and the intentions and thedIfficulty of carrying them out a~ the present time.

You have had a very interesting report from Dr. Eustace who has shownus very cle~rly that Dr. .Manugian, the Superintendent of the Hospital, and thewhole of hIS staff are domg valuable work at Asfuriyeh ; and, last but not leastyou have had a very inspiring address from the Lord Bishop on the ethical andmoral-religious impact of Asfuriyeh in the Middle East. To all those gentlemenwe are very greatly indebted.

I feel that it would be quite wrong to allow this meeting to close withoutsome reference from me to the valuable work that Miss Harvey did as Secretaryfor so many years. We are sorry that she is not with us, but I would like herto. know that she is remembered and that her long association with the HospitalWIll always remain close in our appreciation and memory. Mr. Dunstan hassucceeded her and as far as I can tell, from the correspondence that he sends tome, he is doing his job most effectively and thoroughly.

~ should als? like to say how greatly ever.yone must be indebted to Mr. LynHarns, the ChaIrman of the London CommIttee, for what he does at this endon behalf of the Hospital. He is, of course, as Chairman, responsible forconveying the results of recommendations of various CommIttees to the

27

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done anything in this connection will alway t k't b' 1honour. s a e I as emg a p easure and an

Mr. Darton has always bee .friend Mr H . h n gr~clOUS enough to say a good word for his

. ouram w 0 annually brmgs a contribution to the Hospital That

money comes from a small band of Syrian and Leb f' d . M . hh ~ '1 h anese nen s m anc ester

w 0 never lal to tank me for calling on them ~ thO b' t b h. t th A f' . lor IS 0 ~ec ecause t ey

apprecIa e at s unyeh IS for all and for the glory of God in Lebanon.

dI hahve very gr~at pleasure in moving a vote of thanks both to our Chairman

an to t e Lord BIshop. '

The vote of thanks was accorded unanimously by acclamation.

The Chairman: I shall ask the Lord Bishop to reply on behalf of both of us.

The Rt. Rev. Bishop W. H. Stewart: I shall endeavour to carry out your

commands promptly and shortly. We do not want to go on thanking each

other more than we nee~.. I wou~d only say that hearing what Mr. Hourani

has to ~ay abolft Dr. Hittl and hIS friends in Manchester and elsewhere we

!hank hIm for hIS example and hope that Dr. Hitti and all Mr. Hourani's fri~nds

m Manc~ester may hav~ t~e health and the strength and the willingness to

serve WhICh Mr. Houram hImself has shown as an example.

. The.Chairma~: It falls to me to announce to you that on the way out

thIS even.mg there IS a plate for anyone who wishes to contribute to the cost of

the meetmg. That concludes o~ Ann.ual General Meeting. I thank you very

much for your presence here thIS evenmg. I hope that during the next twelve

months we do well and that Asfuriyeh goes from strength to strength.

MISS JANE GIBB

Miss Gibb passed away on 7th October 1958 at her home in Kilbirnie

Ayrshire, .Scotland. She was for 33 years Matron ~t Asfuriyeh, from 1913 t;

1946, durrng the two world wars. Her service to the Hospital was inestimable.

The following obituary note has been written by Miss Hilda Fox, for many

years General Secretary and now a member of the London General Committee

who knew Miss Gibb very well. '

Miss Gi~b was trained at Glasgow Royal Asylum, Gartnavel (1904-8),

'Yhere she gamed the Certificate of the Royal Medico-Psychological Associa­

~lOn; then for four years at the Birmingham Infirmary, taking her certificates

ill General Nursing and Midwifery. After a year as Assistant Matron at

Perth Royal Asylum she was chosen for the pioneer international work at

Asfuriyeh.Miss Gibb arrived in Beirut in 1913, and at once set herself to master the

colloquial Arabic necessary for her duties and to gain understanding of the

people and problems of Lebanon and neighbouring countries, and of their

Turkish rulers. Lebanon was then an extremely poor country, and all the

funds for establishment and upkeep of the Hospital had to be raised in Europe

and North America. Mental nursing was unknown in the area and Asfuriyeh

had to win its way against superstition and opposition. The patients often

arrived in chains, after much suffering due to ignorance or fanaticism. In those

early days Miss Gibb had to search for girls from the hill villages to train as

attendants and nurses; many had never seen a bed and none knew anything

about nursing. By the time she left, with the help of her excellent staff of trebly

qualified British Sisters, she had established not only a modern mental nursing

centre, but a small but promising training school for student nurses, and had

29

President, but I realise that his whole heart is wrapped up in the mterests of the

Hospital. I am sure that it would be your wish to take this opportunity of

showing your appreciation to him as Chairman of the London Committee.

(Applause).Vote of Thanks to the Chairman

Mr. Fadlo Hourani: Last year, I had the honour of moving a vote of

thanks to the Chairman by proxy. I was not able to come myself because of a

small ailment, but I believe that my letter was read. Now, all I would say, in

your name, in the name of the Ambassador, who has asked me to represent him,

and in my own name, is to convey our hearty and sincere thanks to our Chairman

for his interest and his inspiration. May I add one word also to say how

grateful we are to His Lordship the Bishop for coming all this way and giving

us such a wonderful address?

Before I sit down, perhaps our Chairman will allow me to say a word

about my visit to the Hospital early this year. I arrived there on 18th December,

1957, a'ld had four months there with my daughter. It was probably the happiest

h ')liday I ever had in my life. Everything was most beautiful. I will not say

more.Before I come to the Hospital, there was one thing which impressed me

very much. At the gate of my daughter's house there was a flower shop.

Outside, there were any amount of tall Christmas trees. Every day they

seemed to be cleared and others put in their place. On enquiry, I found that

our fellow citizens the Moslems were buying those Christmas trees for their

homes. Anybody who has been in the Middle East and knows anything about

the feelings which used to exist between Moslem and Christian will appreciate

this more than I can describe it. It was a wonderful thing. A lot of Moslem

children studied in our schools, so that eventually, in Beirut, Christmas was a

national feast for both Moslems and Christians. I mention this because to my

mind it is something outstanding. I have never heard of such a thing before.

On my arrival, I found His Excellency the Lebanese Ambassador was in

Beirut. As he had never been in the Hospital, we both went and saw Dr.

Manugian, who for a full hour was our guide, philosopher and friend. He had

a kind word for all the patients, of whom he seems to know everyone. The

Ambassador was delighted. To me, it was always an inspiration to go to the

Hospital.On another occasion, there was a public m.eeting in a cinema on behalf of

Asfuriyeh. There were more than 1,000 people there, with the elite of Beirut

all coming to do homage to Asfuriyeh. Then there was a meeting of the

Executive Committee, to which I was invited. I sat next to the Chairman.

Believe me, it was most touching. The spirit of the members who were there

was exactly the spirit of the members who meet here. When they had to

appoint a Chairman, somebody asked Dr. Hitti if he would allow his name to

go forward. This is what he said: 'So long as God gives me health and

strength, I am willing to serve'. That if the spirit of Asfuriyeh.

Shortly before I left, Dr. and Mrs. Manugian said: 'Will you come and

have a meal with us? Then, you can see our staff'. So I went and saw the

staff. It was not a meal, but a banquet. The whole staff were there-doctors

nurses and others; there were nearly 40 people, and we had a meal together:

After that, we went into that fine parlour, and I went round the room and made

a special point of speaking to the British nurses and assistants there. I found

them, on the whole, absolutely happy and glad to do their job at Asfuriyeh.

I could go on for a long time speaking about Asfuriyeh. It is an inspiration

and an enjoyment to be connected with it. I feel sure that all of us who have

28

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LEBANON HOSPITAL FOR MENTAL AND

Balance Sheet, 31st December,

Current Liabilities-Sundry Creditors-Beirut

London ..

30,848Less payments during

year .. ., .. 4,860

Deduct: Exchange adjustment­Asfuriyeh Special ReserveFund.. ..

Excess of Expenditure overIncome for year .. . .

,: \

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£

8,446

1,938

31,084

80,775

13,279

94,054

£135,522

2,124276547

4,052

871,360

4,869

10,7922,366

12,593464

35,8791,624

37,50324,224

£

101,4122,000

103,41222,637

ERVOUS DISORDERS

1957

Equipment and Furniture atBeirut:

Cost to 1st January, 1957 ..Additions during year at cost

Less Depreciation to date

Investments (at cost):Endowment Funds (excluding

certain investments admin­istered by Provident Trades­men's Bank and Trust Com­pany of Philadelphia,U.S.A.):

For Peter Coats' EndowmentFund.. .. .. ..

For Jessup Endowment Fund ..For R. F. Fox Memorial FundFor Retiring Allowances FundFor Scott Moncrief! Travel

Fund.. .. .. ..For Extension Fund .. . .

(Market value £7,560)Investments (at cost):

Accumulated Fund ..(Market value £1,977)

Current Assets:Stock in hand at BeirutSundry Debtors: Beirut (less

Reserve) . . . .London .. ..

Cash at Bank and in hand:Beirut.. .. ..London .. ..

Less Depreciation to date

Fixed Assets-Land and Buildings at Beirut:

Cost to 1st January, 1957 ..Additions during year at cost

29,977

8,363

8,446

91,628

6,866

99,991

£93,125

5,471

£135,522

2,124276547

4,05287

£

3,9621,509

2,270

1,569150

14

8,349

1,360

1,962

40I

4,863

25,988

4,863

4,863

1,569

6,432

1,309

51

Less Transfer to Accu­mulated Fund (Fundsutilised in accordancewith donors wishes) ..

Endowment Funds-Peter Coats' Endowment FundJessup Endowment Fund ..R. F. Fox Memoral Fund ..Retiring Allowances Fund ..Scott Moncrieff Travel Fund ..Extension Fund:

Balance at 1st Jan­uary, 1957

Add Income for yearto date ..

Asfuriyeh Reserve Funds­Obsolescence Reserve .. . .Special Reserve for Purchase of

Equipment:Balance 1st January,

1957 . . . .Donations received

during year

Staff Furlough ReserveSpecial Contingencies Fund:

Balance 1st January,1957 . . .. 25,196

Amount providedduring year per In­come and Expen-diture Account .. 5,652

Accumulated FundsBalance as at I st January, 1957Add: Balance transferred from

Special Reserve for Equip­ment as at I t January, 1957

Proceeds of Trust Funds nowreleased and to be remittedfrom U.S.A. .. ..

Exchange adjustment, etc.,Beirut Clinic . . . .

Surplus on sale of investment ..

•

taken a large share in making Asfuriyeh one of the most finest and mostsuccessful institutions of the Middle East. For over 21 years she served underthe late Dr. Watson Smith and for nearly 12 under Dr. Stewart Miller.

During these 33 years she was responsible for all nursing care in theHospital, and for the nursing staff and attendants. Her outstanding work wasdone often in extremely difficult conditions, including two world wars, yet shewas always cheerful. For these pioneer and magnificent services to the countryMiss Gibb was decorated by the Lebanese Government in December, 1936,receiving the silver Lebanese Medal of Honour from H.E. Dr. Ayoub BeyTabet, Secretary of State, an unprecedented honour for a British Nurse. TheLebanese staff of the Hospital themselves gave a firework display and fete in herhonour.

Perhaps Miss Gibb's service can best be summed up in the words of theilluminated Address presented to her on her retirement in May, 1948, by theLondon General Committee, which was signed personally by all the Vice-Presidents and Members:-

On your retirement after 33 years as Matron of this Hospital, we, themembers of the General Committee, wish to express to you our gratitude forthe splendid service you have given to the Hospital from 9th April, 1913, to9th April, 1946.

By your hard work and careful management, you have had a large sharein transforming Asfuriyeh from a small place of 103 beds to the important500-bed Hospital of today. By your teaching and example you have set astandard of order, cleanliness and skilled nursing, combined with justice,kindliness and individual care, which will endure. Over and above theseremarkable achievements we shall always remember the uncalculating giftof self which has inspired all your work and has been the secret of itsinfluence and success.

We congratulate you, we thank you, and we wish you well.

I

I

30 31

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Income and Expenditure Account for the year ending 31st December, 1957

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£114.697

Interest on Investments (Gross) ..Transfer from Accumulated Fund to cover

Excess of Expenditure over Income ..

ExpBNDITURE £Beirut Expenditure (including

Depreciation) . . . . · . 106.311London Expenditure . . · . 2,735Beirut Reserves:

Amount tran~ferred to SpecialContingencies Fund .. · . 5,651

INCOMEBeirut Income:

Patients' Fees .. . .Garden and Estate ..Occupational Therapy ..Donations .. ..Clinic .. .. .,Bank Interest and Sundries

Difference on Exchange ..Subscriptions. etc.:

United KingdomU.S.A... ..Armenian Appeal

£

· . 100.458· . 737· . 119· . 49· . 2,346· . 625

---· .· . 888· . 465· . 50

---

104,334­314

1.403297

8.349

£114.697

We have audited the above Balance Sheet and attached Income and Expenditure Account with the Londonbooks and vouchers produced to us and with the Beirut Accounts and Balance Sheets certified by Messrs. Russell& Co.• Chartered Accountants. Beirut. Lebanon, and we certify that the same are in accordance therewith. Wehave relied upon the Hon. Treasurer's division of expenditure between Beirut and London, and have verified thoinvestments

I r-+---+----+---+--

31 Bedford Row. W.C.l18th Jurv. 1958

WOODMAN, COX & WILKINS.Auditors.

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