Socio-Economic Development in

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Disparities and Power Struggle in
China’s North-West Alessandra
Cappelletti
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Socio-Economic Development
in Xinjiang Uyghur
Autonomous Region
Disparities and
Power Struggle in
China’s North-West
Alessandra Cappelletti
 Socio-Economic Development
in Xinjiang Uyghur Autonomous Region
 Alessandra Cappelletti

Socio-Economic
Development
in Xinjiang Uyghur
Autonomous Region
Disparities and Power Struggle
in China’s North-West
Alessandra Cappelletti
Xi’an Jiaotong-Liverpool University
Suzhou, China

ISBN 978-981-15-1535-4 ISBN 978-981-15-1536-1 (eBook)

https://doi.org/10.1007/978-981-15-1536-1

© The Editor(s) (if applicable) and The Author(s) 2020

This work is subject to copyright. All rights are solely and exclusively licensed by the
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189721, Singapore
 Introduction

This book is the outcome of a project aimed at understanding trans-

formations and assessing disparities in the quickly changing Xinjiang
Uyghur Autonomous Region (XUAR). The oasis mentioned in the title
refers to Xinjiang oasis towns, which are the focus of my research, and
to a metaphorical oasis characterized by diversity and energy. An oasis
which is disappearing and is becoming something else. The intraregional
disparities and land acquisition dynamics are part of what is making this
change happen.
I am writing this introduction after a long process of taking distance
from the research object and findings, which I needed to interpret and
analyze on the basis of the new developments in the Xinjiang’s context.
A mixture of painful and liberating feelings is currently absorbing me.
The deep sense of pain is generated by the awareness that it is becoming
more and more difficult to reach out the many Uyghur friends, sources
and scholars who have been reference persons for this work, as they are
in the middle of a controversial process of ideological re-education in
Xinjiang’s facilities, called by the Chinese government “vocational and
education centers”.1 The sense of liberation comes from the fact that this

1For an understanding of the official line, see “China Focus: Unveil the truth of Xinjiang

vocational, education centers”, in Xinhua News Agency, 3rd May 2019. The exact nature
and the different kinds of these facilities still need to be assessed. As also academics and
intellectuals have been taken there, there must be a whole range of centers classified
according to the goal the government wants to reach: “vocational and education centers”
are meant for non-educated Uyghurs, while ideological re-education centers could have

v
vi INTRODUCTION

work is the outcome of fieldworks, reflection and elaboration over the

past ten years, and of an overall reconsideration based on recent devel-
opments in Xinjiang. In 2007, I was in the region with a confused and
probably naïve idea that Uyghurs and Hans could not coexist because
their respective cultures and ethnicities are too different, that Beijing was
the oppressor and that Uyghurs were passive victims. Slowly and gradu-
ally, I had the chance to realize that Uyghurs have agency, and that this
agency could be a key factor in contexts where power relations are unbal-
anced. Media reports and secondary sources looking at the situation
merely from the surface can be biased and are normally unable to see this
agency.
The first time I got off the plane in Urumqi, Xinjiang became a kalei-
doscopic and complex place I could not manage to stop thinking of.
I left my job in a bank and proposed a Ph.D. project on the Xinjiang
Production and Construction Corps because I felt the urgency to enter
the region with the possibility to stay for long periods of time, eventually
get access to its secrets and understand its deep dynamics. The diversity
of the social context, in terms of ethnicity, appearances, customs and cul-
tures was striking, and the creeping conflictual ethnic relations I could
sense were in a way disturbing; therefore, I decided to turn that super-
ficial and biased initial understanding into something deeper, a knowl-
edge that could help me entering in a kind of empathetic dimension with
the situation, in order to interpret it and, eventually, to be able to give
a minor but grounded contribution for trying to improve the state of
things. The whole process turned into something more important which
determined which kind of person I want to be.
Having the chance to get empirical knowledge, experiencing what
people in Xinjiang are living in their daily activities and routine, coping
with the same problems they have, turned my initial perspective into
both an awareness and a responsibility. It never happened to me before
to feel so strongly that what we see and feel at a first sight, merely backed
by a superficial knowledge collected from readings and news reports,
can be as deceiving and biased such as looking only at a few elements

been established for intellectuals, academics, writers, journalists, artists and so on. As the
situation is still evolving while I am writing (end August 2019), this is only a hypothesis.
 INTRODUCTION vii

in an unlimited picture. When I have got the feeling that I was like the
Zhuangzi’s frog in the well, never able to discuss the ocean, and that I
needed to open my mind on what I was experiencing, I got a sudden
awareness of mechanisms and dynamics that I could not see before.
Aprioristic concepts led me to automatically categorizing whatever I was
seeing, and this way of keeping the eyes wide shut led me to looking
at things by adopting a dualistic perspective. It was only when borders
and categories fell down, eyes turned wide open and what surrounded
us started to permeate me, that awareness started to grow within myself,
and I started to feel the responsibility. Too many people were involved
in my project, too many took the risk to help me, and they did not ask
anything in return. I had therefore a responsibility, and I now realize that
this book reflects merely a partial and limited image of their thinking, it
is the outcome of my humble analysis and of my subjective interpretation
of facts.
What concerned me in particular is how we think of and understand
“development”, a teleological incremental process leading toward a goal
which is never really reached, a concept which has been conceived and
adopted for political purposes in different societies and cultures, at dif-
ferent times in history. Concepts as “urbanization” and “development”,
closely interrelated and understood as being the pathway to one another,
as well as propagandized and instrumentalized to reflect and adjust to
new power relations, are analyzed critically, in order to provide an inter-
pretation of how power and its whole range of declinations in human
interactions inform our way to understand people’s personal trajectory,
and how it empirically impacts it.
My hope is that this work provides some useful knowledge on the
recent socio-political and economic dynamics in Xinjiang, valuable at
least to get an understanding of what is going on at the moment in the
region.

Acknowledgements
As I am the only responsible for the positions I took in this work and
for its shortcomings, I want to thank many more friends, contacts, inter-
viewees and scholars than those I am allowed to mention here without
going beyond the space limitations. The many ordinary people I had
chats with and farmers encountered during the fieldwork were of much
more help than they can realize.
viii INTRODUCTION

I was attracted by the region since my bachelor’s years, when a col-

league of mine, Eloisa Concetti, was working on the Hui district in
Beijing and told me once: “You know that in China there is a popula-
tion claiming a territory for itself, an independent country, that they live in
Xinjiang and are called Uyghurs?”. She was already familiar with the topic;
she already went to Xinjiang for fieldwork. It was the end of the 1990s. It
must have been a very different time back then in Xinjiang. When she was
there, there was still a harsh struggle, Sufi authorities were at the time—
even if underground and persecuted—powerful. They had a strong influ-
ence on local communities; their impact on local affairs was deep. And
the power struggle had probably still an open ending. Jiang Zemin, the
­careful and low-profile President, was in charge of guiding China.
While all the shortcomings and problems this manuscript still has
are only my responsibility, what is good here, the “hidden gem”—as
an anonymous reviewer called it, and I am very grateful to him for the
encouragement he gave me—within this work needs to be credited to
many people: Two anonymous reviewers, colleagues, but mainly those
we were actively involved in this research and who do not have the possi-
bility to speak out anymore.
Prof. Abduresit Jelil Qarluq has been of a constant and generous sup-
port, without him I would have never been able to enter into Uyghur
society to such a deep extent. He gave me the opportunity to participate
in the Sino-German Poverty Alleviation Project in Xinjiang as researcher
working on land allocation issues. Without this fundamental experience,
my understanding of the dynamics underlying the relations between local
authorities and farmers in the Kashgar prefecture would have remained
at a rather superficial level, while I would never have grasped core mech-
anisms internal to Uyghur society. Thanks to this work and research
experience I had the possibility to get access areas which in 2012 were
still closed to foreigners and Chinese non-residents as Peizawat County,
Akto County, and Barin village, to collect material and make interviews
to farmers. Without Prof. Qarluq constant and brave help, all the qual-
itative and sociological analysis related to the development-related issues
would have been much poorer. Prof. Marco Buttino deserves a very
special mention for his invaluable encouragements and insights on eth-
nic categories during the early and most difficult stages of the project
elaboration.
Sincere thanks are reserved to Prof. Rahile Dawut and Prof. Ekber
Niyaz, professor of Uyghur folklore and Archaeology respectively, at
 INTRODUCTION ix

Xinjiang University, for giving support to me throughout the whole

process. Professor Niyaz was at the time archaeologist at the Centre
for Archaeological Research in Turpan and guided me across the
Taklamakan ruins, and the hidden aspect of Xinjiang society and history.
Prof. Ilham Tohti made me better understand the current conditions of
Uyghurs in the Chinese society, helping me to reflect over the situation
of interethnic relations and over the impact of investments and moderni-
zation over traditional societies. All my colleagues and friends in Xinjiang
and China have been a constant source of inspiration, support and com-
ments during the research process. My Uyghur friends, inside and out-
side Xinjiang, need a particular mention, since they always did their best
to help me in logistic and everyday difficulties, as well as in providing
additional meanings to my research and in enriching my thesis, mainly
with material and information about their conditions and perceptions,
sometimes even at their own risk. I take the opportunity to warmly thank
all the many people in China from academia, government, business, art,
and other several fields who helped me in many ways, providing infor-
mation, helping to contact people, and arranging meetings with target
groups. Simon James, author of the Xinjiang Video Project, deserves
a special mention for his help encouraging me during all the stages of
my work. I am grateful for the financial support provided by Università
di Napoli “L’Orientale”, which granted me with a three-year scholar-
ship which allowed me to pursue my research aims and to carry on my
studies in London, Beijing and Xinjiang. My current university, Xi’an
Jiaotong-Liverpool University, provided me with the right state of mind
and quietness of the Suzhou campus to finalize this project, while my
friends helped me to bear the hard times during the research and writ-
ing process. I do not have words to really acknowledge the support by
Michelangelo Cocco, my husband, a brilliant journalist, who helped me
in adopting key categories in political sciences analysis to analyze dynam-
ics and historical events and provided me unique insights on Muslim
societies and power dynamics.

The Study
“What is Xinjiang?” is a key question in my research. The geopolitical
environment, the historical and cultural humus and the religious milieu
are all influenced by the cultures of Central Asia, including the Ferghana
valley and its Westernmost edge of Samarkand, the Eastern end of the
x INTRODUCTION

Oxus River (or Amu Darya), and, more Eastward, the Jiayuguan Pass.2
Across this vast territory, the influences of the Achemenid, Mongolian
and Alexander the Great’s empires are still visible in the cultural and
social heritage, often merged together into new and original local cul-
tures. Borders are in fact a later arrangement, thus, while studying
what today we call Xinjiang, we need to make an effort to consider the
broader Central Asian area. The Uyghurs is a diverse population, the
result of the intermingling among Pakistanis, Russians, Indian, Iranian
and Mongolian peoples. Nestorianism, Manichaeism, Buddhism and var-
ious schools of Islam have been simultaneously, or in turn, the local pop-
ulation’s faith.
The focal point of this dissertation is on socio-economic dispari-
ties in contemporary XUAR, as they have been generated in the devel-
opment process of the region. A comparative case-study approach has
been adopted, with a focus on two regional contexts: Kashgar Prefecture
(Kashi diqu 喀什地区) and Shihezi sub-prefectural level Municipality
(Shihezi Xianji xingzheng danwei 石河子县级行政单位). The research
has the ambition to represent a small contribution to the broader schol-
arly literature about intraregional disparities in China, about how the
relationship between ethnicity and power has a deep impact on ine-
qualities in certain multi-ethnic societies, and how ethnicity and élite
cooptation can be political tools to guarantee the status quo. On the
background of the relationship between a central power and its periph-
eral territories, the construction of categories like “ethnic group” and
“nation” as developed by Michael Hechter is a major theoretical refer-
ence for the whole dissertation.
Xinjiang is one of the twelve provincial-level administrative entities
included in the Western territories development strategy (Xibu da kaifa
西部大开发) launched in 2000 by Beijing, and it has been target of a
massive influx of investments connected to the “19 Provinces and Cities

2In Gansu province, the Jiayuguan pass is the first pass at the Western end of the Great

Wall of China. Accordingly, to the commonly accepted definition of Central Asia, the
concept would include the five independent republics emerged from the Soviet Union:
Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. Following a broader
conceptualization, accepted by UNESCO, other included areas are Afghanistan, North-
Eastern Iran, Kashmir, Northern Pakistan, Mongolia, Xinjiang, Tibet and Southern Siberia
in Eastern Russia.
 INTRODUCTION xi

support Xinjiang” (shijiu sheng shi duikou yuanzhu Xinjiang 十九省市对

口援助新疆) central plan, together with the destination of Han Chinese
migrants from Inner China in search of a better life. The region repre-
sents a challenge in terms of access to archive material, political sensitiv-
ity and logistics. It is featured in some specialized touristic publications
as a peripheral oases’ area on the Silk Road, while the social, economic
and political information we have about the territory are often chan-
neled through the official communication apparatus controlled by central
authorities, or via statements by Uyghur émigré groups. Both sources are
usually unreliable for reasons which do not pertain to the scope of this
work, but which can happen to be quickly mentioned in the course of
the dissertation.
The research offers new knowledge and a new perspective about this
area between China and Central Asia, mainly about the economic and
social conditions of its peoples prior to the Xi Jinping administration,
and on the challenges the local population and the authorities were fac-
ing in a pivotal time in the history of the region (between 2009 when
the Urumqi’s riots occurred and the ascent to power of Xi Jinping.
Through a “research from within”, my effort is to give a contribution
to those academic researches focused on dynamics underpinning changes
and disparities in Xinjiang and China.
The main challenges of this study are basically two: is to study
Xinjiang from within China and Xinjiang, and to avoid simply adding
new knowledge and notions, but to make an effort in providing new
insights and perspectives, new hints for reflection as to how provincial
and central government shall find motivations in choosing to develop the
region in a more equal and sustainable way, instead of leaning on growth
and ethnic factors with too little consideration about the impact on envi-
ronment and peoples. The whole work is then an attempt to provide a
new perspective on the current inequalities existing among the popula-
tion in Xinjiang.
As a last consideration, we can say that this study might be a contri-
bution to China studies in the discipline of social sciences. The main par-
adigm for assessing inequality consists in providing a broader and more
people-oriented perspective on development issues, taking into consid-
eration two classification systems and questioning them: the World Bank
one, based on per capita income, and the UNDP rankings of “human
development”.
xii INTRODUCTION

While what is happening in Xinjiang and to Uyghurs is part of a

broader national strategy to build a national identity and occurred—and
is still occurring—in different ways in other parts of China, responses of
people in Xinjiang are different due to local peculiarities, historical path
dependencies as well as socio-political and economic factors.

Entrance to the courtyard of a Uyghur rural household (DSCN 2283)

 Praise for Socio-Economic Development
in Xinjiang Uyghur Autonomous Region

“Based on careful fieldwork conducted at the start of the 2010s, this

book illuminates the interplay of ethnicity, development, and inequal-
ity in Xinjiang during an important period in its recent past. Drawing
on her deep familiarity with Uyghur language and culture, Alessandra
Cappelletti does specialists in both development studies and Chinese
studies a great service by presenting her findings on life and power rela-
tions within a complex region, just before dramatically tightening con-
trols began to cause great suffering to its people and block scholarly
access to its towns and cities.”
—Jeffrey Wasserstrom, Chancellor’s Professor of History,
UC Irvine, USA, and co-author of China in the 21st Century:
What Everyone Needs to Know

“A deep dive into my occupied homeland, this highly thoughtful empir-

ical work is as harsh as ice on nude skin. Part of the collective memories
of Uyghur people in East Türkistan, it speaks to their souls and sorrows.”
—Abdürreşit Celil Karluk, Professor, Ankara Hacı Bayram Veli
Üniversitesi (AHBV), Turkey

xiii
 Contents

1 Previous Scholarship, Methodology and the Concept

of Development 1
1.1 The Kaleidoscopic Dimension of Xinjiang
and the Genesis of This Work 1
1.1.1 How Did This Work Start? 3
1.1.2 Historical and Cultural Background 6
1.2 Previous Research 8
1.2.1 Xinjiang Economic Situation 8
1.2.2 Xinjiang Social Issues 11
1.2.3 Notes on Ethnicity as Determinant of
Development Disparities: Some Reference Works 14
1.2.4 Internal Colonialism and Ethnicity 17
1.2.5 Capabilities and Human Development Index
(HDI) 19
1.3 Research Problem and Questions 20
1.3.1 Research Problem 20
1.3.2 Research Question 21
1.3.3 Ethnicity and Inequality 21
Bibliography 22

2 Xinjiang Economic Development 29

2.1 From Special Economic Zones to the Belt
and Road Initiative 29

xv
xvi CONTENTS

2.2 Regional Characteristics and Resources 30

2.2.1 Geographic Position 30
2.2.2 Demographic and Administrative Profile
of Xinjiang 33
2.2.3 The Uyghurs 35
2.3 Historical Outline Since the Collapse of the Qing Dynasty 37
2.3.1 The “Great Game” and the Warlords’ Period 37
2.3.2 Post-1949 Xinjiang 40
2.3.3 Twenty-First Century Xinjiang 46
2.4 Macroeconomic Profile 48
2.4.1 Xinjiang Development in the 1990s 49
2.4.2 Gross Domestic Product (GDP) 51
2.4.3 Per Capita GDP 54
2.4.4 GDP Composition by Sector and Increase Rate 56
2.4.5 Primary Sector 56
2.4.6 Secondary Sector 58
2.4.6.1 Resources 59
2.4.6.2 Xinjiang’s Oil and Other Resources 60
2.4.6.3 Infrastructural Projects 62
2.4.7 Tertiary Sector 64
2.4.8 Agriculture, Industry and Services 65
2.4.9 Central, Provincial/Regional, Local
and International Investments 66
2.4.10 Urban–Rural Divide and Increase
in the Agricultural Output 71
2.5 Infrastructures and Foreign Direct Investments (FDIs) 72
2.5.1 Infrastructures 72
2.5.2 Foreign Direct Investments (FDIs) 75
2.6 “Large-Scale Development of the Western Regions”
(西部大开发 Xibu da kaifa) 79
2.7 The Project “Nineteen Provinces and Municipalities
Support Xinjiang”—Year 2010 (19 个省市对口支援
新疆 Shijiu shengshi duikou zhiyuan Xinjiang) 87
2.8 Knowledge and Technology Transfer 91
2.9 Conclusive Remarks 98
2.9.1 Investment Policies at the Local Level
and Center-Periphery Relations 102
Bibliography 111
 CONTENTS xvii

3 Social Development in Xinjiang Uyghur Autonomous

Region 117
3.1 Preliminary Notes on Sociological Research in China
and Xinjiang 117
3.2 Research Methodology and Fieldwork in Xinjiang 119
3.3 Xinjiang and Its Development Processes 122
3.3.1 Urbanization 122
3.3.1.1 Urbanization Processes in Xinjiang
After 1949 126
3.3.2 Population 128
3.3.3 Statistical Figures on Urban and Rural Population 131
3.4 Notes on Disparities in Xinjiang 135
3.5 Social Problems and Ethnic Divide 138
3.5.1 HIV 138
3.5.2 Alcohol Abuse 144
3.5.3 Gender Issues 147
3.5.3.1 Beijing’s Policies 148
3.5.4 Domestic Violence and Divorce Rate 152
3.5.5 Health Disparities 154
3.5.6 Environmental Degradation 158
3.5.6.1 Desertification 162
3.5.6.2 Nuclear Tests 163
3.5.7 Education 165
3.5.7.1 Impact on Minority Schools 169
3.6 Conclusive Remarks: Uneven Regional Development 170
Bibliography 174

4 Walking in Two Worlds: Kashgar and Shihezi 183

4.1 Kashgar and Shihezi: Main Statistical Indicators
(2011 and 2016) 183
4.2 Commonalities and Differences Between Kashgar
and Shihezi 184
4.3 Historical Background 190
4.3.1 Kashgar 190
4.3.2 Shihezi 197
4.4 Endowments and Administrative Framework 199
4.4.1 Kashgar 199
4.4.2 Shihezi 205
xviii CONTENTS

4.5 Cultural Background 208

4.5.1 Kashgar 208
4.5.2 Shihezi 211
4.6 Higher Education 212
4.6.1 Kashgar Teachers’ College (喀什师范学院 Kashi
Shifan Xueyuan) and Kashgar University
(喀什大学 Kashi Daxue) 212
4.6.2 Shihezi University (石河子大学 Shihezi Daxue) 214
4.7 Water Resources 216
4.8 Xinjiang Production and Construction Corps (XJPCC):
“State Within the State” and “Region Within the Region” 217
4.9 Conclusions 224
Bibliography 227

5 Land Use and Acquisition Dynamics in Kashgar: Power

Struggles and Social Change in a Contemporary Oasis 231
5.1 Land in China 231
5.1.1 The Farmers’ Position 233
5.2 “Results Delivering” as a Defining Trait of Local
Officials’ Identity in Xinjiang 234
5.2.1 A New Situation 234
5.2.2 Under Special Conditions 237
5.2.3 Delivering Results 238
5.3 Xinjiang as “Internal Other”: Farmers, Authorities
and New Rules and Regulations in the Management
of Agricultural Land 239
5.4 Fieldwork Design 241
5.4.1 Background 241
5.4.2 The Fieldwork 242
5.5 “Regular” and “Additional” Agricultural Land
in Xinjiang 246
5.5.1 Regular Agricultural Land 246
5.5.2 Additional Agricultural Land 246
5.6 Agricultural Land Contracts and Documents 248
5.6.1 Land Use Certificate 248
5.6.2 Land Leasing Contract 248
5.6.3 Cadastral Map 249
5.6.4 Commitment Letter 249
 CONTENTS xix

5.6.5 Program Commitment Letter 250

5.6.6 Report on Land Allocation Provided by Local
Authorities 250
5.6.7 Farmers Information Table 250
5.6.8 Commitment Document 251
5.7 Within Kashgar’s Rural Villages: Participant
Observation and Engagement with Local Communities;
Formal and Informal Interviews with Farmers
and Local Officials 251
5.7.1 Participant Observation as a Fieldwork
Approach to Double-Check Collected
Information and Data 252
5.7.2 Participant Observation Implied the Following
Major Activities 253
5.8 Legal Validity of Land Documents 256
5.8.1 The Lawyers’ Tasks 256
5.9 Power Struggle and Displacement in a Transitional
Environment: Interpretation and Reflection Over
Fieldwork Outcomes 259
5.9.1 Land Acquisition as a Factor of Destabilization
and Disorientation 259
5.9.2 Power Struggle 260
5.9.3 Displacement 261
5.9.4 A Transitional Environment 262
5.10 Conclusions: Farmers Are Discouraged to Cultivate
the Land and a New Xinjiang Is Being Built 263
Bibliography 266

6 Uyghurs vs. Uyghurs: Fragmented Identities

in Contemporary Xinjiang 269
6.1 From a Multinational to a Nation-State:
The Current Debate Over Ethnicity 269
6.1.1 Ethnicity in China 271
6.2 Ethnic Affiliation and Social Practices 275
6.3 Affirmative Action and Preferential Policies
for Minorities 278
Bibliography 280
xx CONTENTS

7 Conclusions: The CCP and a “Bridge Society”

in XUAR—Ethnicity as a Tool for Social Engineering
and Stratification 283
7.1 Human Development Index and “Capability Approach” 285
7.2 Summary of Fieldwork Findings 287
7.3 Ethnic Perspectives: Who Benefits? 290
7.3.1 The Bridge Society 290
7.4 Theoretical Implications: A Social Pact Between
Beijing and the “Bridge Society” 292
7.4.1 Original Hypothesis 294
7.4.2 Current Thesis 295
Bibliography 297

Appendix 1: Questionnaires 299

Appendix 2: Acronyms and Abbreviations 307

Appendix 3: Place Names in the Kashgar Prefecture 309

Index 311
 List of Figures

Fig. 1.1 Information plaque related to a past Poverty Alleviation

and Development Program in a village close to Kashgar
(Picture taken by the author) 19
Fig. 2.1 GDP increase in Xinjiang 1999–2016 (100 million RMB) 53
Fig. 2.2 Per capita GDP increase in Xinjiang 1999–2016
(100 million RMB) 54
Fig. 2.3 Increase of the primary sector in Xinjiang—100 million RMB 57
Fig. 2.4 Share of the contributions of the primary industry
to the increase of the GDP in Xinjiang (%) 57
Fig. 2.5 Increase of the secondary sector in Xinjiang—100
million RMB 59
Fig. 2.6 Share of the contributions of the secondary industry
to the increase of the GDP in Xinjiang (%) 59
Fig. 2.7 Increase of the tertiary sector in Xinjiang—100 million RMB 64
Fig. 2.8 Share of the contributions of the tertiary industry
to the increase of the GDP in Xinjiang (%) 65
Fig. 2.9 Total investments in fixed assets in Xinjiang
(1999–2016, 10.000 RMB) 67
Fig. 2.10 State budget funds in Xinjiang (1999–2016, 10.000 RMB) 67
Fig. 2.11 Domestic loans in Xinjiang (1999–2016, 10.000 RMB) 68
Fig. 2.12 Bonds in Xinjiang (1999–2016, 10.000 RMB) 68
Fig. 2.13 Foreign investments in Xinjiang (1999–2016, 10.000 RMB) 68
Fig. 2.14 Self-raising and other funds in Xinjiang (1999–2016,
10.000 RMB) 69
Fig. 2.15 Investments in fixed assets by composition
(2016, 10.000 RMB) 69

xxi
xxii LIST OF FIGURES

Fig. 2.16 Investment in fixed assets—rural/urban (1999–2009) 71

Fig. 3.1 Newspaper board in a village (DSCN 5291. Picture
taken by the author) 123
Fig. 3.2 Xinjiang population from 2000 to 2016 129
Fig. 3.3 Increase in the urban population in Xinjiang
and related percentage (2000–2016) 132
Fig. 3.4 Urban population in Xinjiang and related percentage
(2000–2016) 132
Fig. 3.5 Employed persons in Xinjiang by industry
in percentage (1952–2016) 133
Fig. 3.6 Barbers in a village—barbieri 134
Fig. 3.7 Poster indicating the length of beards and accepted
kinds of clothes 152
Fig. 3.8 “Sending children to school is glorious, not sending
them is illegal” (DSCN 4074) 156
Fig. 3.9 Uyghur children in a bilingual school in a village
(DSCN 4134) 166
Fig. 3.10 Training room in a government facility with Lei Feng
and Confucius (DSCN 3363) 169
Fig. 3.11 Board on the political work in a village (DSCN 3861) 173
Fig. 4.1 Kirghiz nomads on the Karakorum Highway (DSCN 1767.
Picture taken by the author) 193
Fig. 4.2 XJPCC pioneers with Wang Zhen in the 1950s (Picture
taken by the author in the Bingtuan Museum in Shihezi) 219
Fig. 4.3 XJPCC pioneers in Shihezi in the 1950s (Picture taken
by the author in the Bingtuan Museum in Shihezi) 220
Fig. 4.4 Uyghurs selling jade stones to Han buyers near Khotan
(DSCN 7758. Picture: Michelangelo Cocco) 225
Fig. 5.1 Poster informing farmers on the necessity to sign
a labor contract when they go to work in urban areas.
Interestingly enough, the new represented worker
in the poster is a kebab seller (Picture taken by the author) 236
Fig. 5.2 New square, in a Han Chinese style and with trees common
in Inner China, in a Uyghur rural village (Picture taken
by the author) 263
Fig. 6.1 Rebyia Dasha in Urumqi, the shopping mall established
by Rebiya Kadeer, just before the demolition (Picture taken
by the author in 2009) 275

Map 3.1 HIV prevalence among IDUs in East Asia (Source WHO) 141
 List of Tables

Table 2.1 Ethnic groups in XUAR. Data 2016 (Xinjiang Statistical

Yearbook 2017, Table 3.8) 34
Table 2.2 Projects related to the “Nineteen provinces
and municipalities support Xinjiang”—year 2010
(19 个省市对口支援新疆 Shijiu shengshi
duikou zhiyuan Xinjiang) 88
Table 4.1 Selected statistical indicators of Shihezi and Kashgar
(2011 and 2016) 183
Table 4.2 Cross-sectional comparative table on differences
and commonalities between Kashgar and Shihezi 185

xxiii
 CHAPTER 1

Previous Scholarship, Methodology

and the Concept of Development

1.1  The Kaleidoscopic Dimension of Xinjiang

and the Genesis of This Work

Xinjiang Uyghur Autonomous Region is a multidimensional space1

encompassing a complex variety of identitarian factors, an autonomous
region in China, with a geographical and territorial dimension, but also
a metaphorical space, loaded with a multiplicity of political meanings and
senses of belonging. Writing about Xinjiang today, in summer 2019, as
a Western scholar and observer, means drawing a direct link with the
intense campaign of ideological reeducation in force in the region and
reflecting over the nature and challenges of the Chinese authoritar-
ian regime. We should not make the mistake though of thinking about
Xinjiang almost exclusively in connection with Beijing. Xinjiang is much
more than that: It is a metaphorical, emotional, interactive and intellec-
tual place where the production of knowledge is usually highly polar-
ized, due to an engrained and well-rooted-in-history political struggle.
As scholars, but above all as human beings, we should avoid the episte-
mological and heuristic fallacies which lead to reinforcing binarisms and
oppositions, such as Uyghurs–Hans, Chinese–non-Chinese, oppressors
and oppressed. Opening our minds to new perspectives of knowledge is
the only way to make progresses in better understanding the world.

1 Yang et al. (2019).

© The Author(s) 2020 1

A. Cappelletti, Socio-Economic Development
in Xinjiang Uyghur Autonomous Region,
https://doi.org/10.1007/978-981-15-1536-1_1
2 A. CAPPELLETTI

This study takes into analysis the disparities in the social and economic
development in Xinjiang Uyghur Autonomous Region (XUAR),
People’s Republic of China, in a time span ranging from 1999 to 2016.
The original study, my Ph.D. dissertation, analyzed the socio-economic
development of the region from 1999 to 2009; therefore, this work
required an important process of updating and re-interpreting the situa-
tion on the basis of the new conditions. China today is different from the
country I lived in 1999 and different also from China in 2009. Standards
of life improved, allegedly for all,2 but in an unequal way, and while all
what is “Western” attracted the curiosity and interest of Chinese people
until some time ago, today more space is left to the idea of rediscover-
ing the culture and local characteristics of a rich and diverse civilization.
Basic needs are not anymore people’s first concern. This is also par-
tially true for the area which today we call Xinjiang, “new territory”
in Chinese, a vast region lying in the Northwestern part of China, the
­biggest administrative unit in the country, covering the same land area
of Germany, France and Italy altogether. Populated by more than 23
million people mainly belonging to thirteen officially recognized ethnic
groups, the majority of them Muslim,3 Xinjiang borders on eight inde-
pendent states: Mongolia, Russia, Kazakhstan, Kyrgyzstan, Tajikistan,
Afghanistan, Pakistan and India, and internally with Gansu and Qinghai
Province on its Eastern border and the Tibetan Autonomous Region
(TAR) on the South. Its geography and demography, as well as its natu-
ral resources, make the region a geo-political and a highly strategic area
for Beijing since at least two thousand years.4
This work is focused on social and economic disparities in Xinjiang, in
the framework of the more extensive literature on development, identity
and dynamics underlying economic and social inequalities in contempo-
rary multi-ethnic contexts. Other countries and political environments

2 Sun and Guo (2015).

3 According to Xinjiang Statistical Yearbook 2017, the officially recognized minorities
­living in Xinjiang today are (from the biggest to the smallest): Uyghur, Han, Kazakh, Hui,
Kyrgyz, Mongolian, Xibo, Russian, Tajik, Uzbek, Tatar, Manchurian and Daur. 61% of the
regional population is Muslim, while the two most represented ethnicities are the Uyghurs
and the Hans (46 and 39%, respectively). In these statistical data, the population of the
Xinjiang Production and Construction Corps (XJPCC), around 3 million, is not counted.
4 See Chapter 2.
 1 PREVIOUS SCHOLARSHIP, METHODOLOGY AND THE CONCEPT OF DEVELOPMENT 3

could have been chosen as well.5 Reasons why I chose Xinjiang are
several: The interaction between “development”, “disparities” and
­
­“ethnicity” in this frontier region is highly emblematic; center-periphery
mechanism and the related socio-economic implications overlap at dif-
ferent levels; Xinjiang is currently undergoing a transformation from a
traditional society, based on a familial and state-directed economy, to a
“modern” society, where the central state continues to control funda-
mental economic activities, but at the same time, other actors are striv-
ing to obtain their socio-economic space. At the same time, the role of
religion, Islam, traditionally constitutive of Xinjiang’s society, politics and
economy, is being downsized in a deep political effort undertaken by the
CCP. While the majority of local Uyghur Muslims perceives the develop-
ment model which is being implemented in Xinjiang as top-down, Han
immigrants hold a different, more positive, perspective: They thank the
CCP for taking care of the area by investing and supporting it in a clear
path to development. In a region where these forces concentrate and
interact to generate or influence change and development, deep dynam-
ics and factors at the basis of disparities can be detected, analyzed and
interpreted. This is basically why the area is a perfect object of research.
Another reason is my background of studies on Chinese politics and
international relations: The choice of this autonomous region is there-
fore more suitable than any other areas, on both a methodological level
and an analytical level.
A third reason for this choice is that, before the formal beginning of this
research in 2009, I had already been in Xinjiang for relatively long spans
of time. During these early phases back in 2007 and 2008, she had the
opportunity to collect an amount of contacts and material which allowed
her to start approaching the issue of interconnections between ethnicity
and disparities with a certain level of awareness, in the framework of the
more extensive scientific discourse on inequalities and their determinants.

1.1.1   How Did This Work Start?

The genesis of this research work is rooted in a series of journeys to
Israel and in the occupied territories of Palestine in different occasions
from 2005 to 2008. Simultaneously, I had the chance to go to Xinjiang

5 For example, Greece and its Muslim minorities in Western Thrace, the Israel and

Palestine case, Turkey and its Roman and Kurdish populations in Istanbul.
4 A. CAPPELLETTI

in 2007 to write reportages for Italian magazines. It was not easy not
to compare the two situations. Their resemblance, on which I reflected
across the years, was the starting point for the elaboration of a research
project on Xinjiang. In the phase of the project draft, an attentive eye was
constantly put on the Palestinian situation, mainly on the colonization
process in the West Bank. Dru Gladney6 already analyzed, even if partially,
similarities and differences between the two situations. After a careful
evaluation of the possibility to elaborate a comparative research project,
I realized that too many difficulties and obstacles were on the way. The
distance between the two countries and cultures, the complexity of both
situations, together with the linguistic and analytical skills required for
such a research, were complex enough factors to discourage me from
starting such an ambitious work. Thus, I decided to start studying in
depth what, in works by Western authors and media, it has often been
called the “internal colonisation” process of Xinjiang. The main actors
involved are considered to be the Han organization Xinjiang Production
and Construction Corps (XJPCC, also called bingtuan),7 while the pri-
mary theoretical framework I relied on is the “internal colonialism”
model elaborated by Michael Hechter,8 who, taking as reference the
Welsh and Celtic questions in Great Britain, worked out a comprehensive
yet detailed theory of internal colonialism. As a critical voice, I considered
Barry Sautman (2000) as an interesting alternative perspective.9
After two years of Ph.D. research on the bingtuan system in Naples,
London, Beijing and Xinjiang, I had the opportunity to join the Ph.D.
dual degree agreement between my home university, Oriental University
of Naples, and the Department of Tibetology at Minzu University of
China. The occasion was unmissable, since provided the opportunity to
work together with a Uyghur tutor, live and study in the region with a

6 DruGladney (2002).
7 Thebingtuan, or Xinjiang Production and Construction Corps (XJPCC), are an eco-
nomic, political and social administrative unit operating only in Xinjiang. With their own
territory and activities, they act independently from the regional government administra-
tion. For a more exhaustive explanation, see the related sections in this monograph.
8 Hechter (1987).

9 Sautman argues that, for the Xinjiang case, it is impossible to refer to “internal coloni-

zation”. He mainly considers that the region is not a depopulated and peripheral area (as
the “internal colonization” model would require), but a central geostrategic and economic
hub which is growing both in terms of population and GDP.
 1 PREVIOUS SCHOLARSHIP, METHODOLOGY AND THE CONCEPT OF DEVELOPMENT 5

regular student visa and with a research authorization issued by a Chinese

institution of higher education. This new situation, together with the
new research environment at Minzu University of China, required a
reconsideration of the original research project, which is still fundamental
in the current work, since Shihezi, one of the two areas chosen as case
studies, is in fact the most important bingtuan city in Xinjiang.
The new research proposal was therefore centered on the analysis of
intraregional disparities in Xinjiang, mainly on the basis of economic and
social data collected during my period of study in China and the field-
work in the region. The nature of this research required me to enrich my
background in China Studies with interpretative and analytical categories
from the fields of sociology and anthropology.
The outcomes of this work, which is interdisciplinary and methodo-
logically grounded on information, data and material collected among
different social groups in the field, partially contradict the initial hypoth-
esis: Disparities were firstly ascribed to a metaphorical wall between the
two cultures and ethnicities, Uyghur and Han, and therefore to the
impossibility of an actual communication. Ethnicity emerged, indeed,
as the main factor of inequality in Xinjiang. While ethnicity is not a key
concept in itself, it becomes such because of the lack of capable Uyghur
political representatives and intellectuals proposing a critical perspec-
tive. In this context, Uyghurs are easily ethnicized, and “being Uyghur”
or “being Han”, if not relevant as such, becomes therefore of primary
importance. In this way, the social pact between Han and Uyghur elites
and establishments10 becomes more and more solid, and the status quo
and connected interests are guaranteed. As a consequence of this eth-
nicization of the public and political sphere, inequalities in the produc-
tive structure of the economy and due to different forms of governance
remain well rooted, while dynamics related to economic systems, group
cohesion and power struggles are the basis of the unequal distribution
of resources and related socio-economic disparities. The concept of eth-
nicity becomes therefore instrumental and circumstantialist. The implica-
tions of the circumstantialist/primordialist debate in the anthropological
literature are discussed in Gil-White (1999).
The functional role of the ethnic question in the mechanisms
of power relations emerges clearly. Drawing from historical and

10 Mainly Uyghurs coopted in the Party, government and XJPCC system, a “bridge soci-

ety” between Beijing and local people in Xinjiang.

6 A. CAPPELLETTI

anthropological works,11 ethnicity once again comes out as a political

construction, a device which, leveraging on existing differences, tends to
strengthen borders and not commonalities and can be easily adopted as
a way to gain power, maintain the status quo and consolidate existing
social and political roles. According to the situation in the field, a steady
social pact and the maintenance of the status quo are then based on a
clever use of the “ethnic question”.

1.1.2   Historical and Cultural Background12

The Chinese Western regions have a history of over 2000 years, associ-
ated with trade and exchange, cultural and ethnic diversity, frontier set-
tlements and different kinds of local governments. The classic novel of
Chinese literature Journey to the West (西游记 Xiyou ji) is a fictionalized
account of a zoomorphic monk13 going on pilgrimage to India (then
known as the Western regions), a story which left a long-lasting impact
on the Chinese collective mind and contributed to the elaboration of a
mythology of an allegedly mysterious region. The marriage of Princess
Wencheng to the ruler of Tubo (present-day Tibet) during the Tang
Dynasty, was a tangible symbol of political and cultural alliance, while
Chang’an (present-day Xian) was the national capital and the Eastern
starting point of the Silk Road. Another historical link between China’s
West and its neighbors is the less well-known “Southern Silk Road”, that
linked present-day Chengdu to India, Pakistan and Burma, via Kunming
and Dali, from as early as the third century B.C.
During the Qing Dynasty, large-scale military expeditions to the
Northwest, present-day Xinjiang, and the excessive development on the
löess Plateau area of Shaanxi, are historical antecedents to the “Go West”
campaigns, prior to the twentieth century, used to support the official
line that the Western regions are a crucial component of the territorial
integrity of the country since antiquity.14

11 Fabietti (2007), Pasquinelli (2005), Remotti and Buttino.

12 for a more extensive Historical Background, see the first part of Chapter 2 in this
book.
13 Corresponding to the historical character of Xuanzang.

14 This official narrative is also supported by recent measures taken by the central gov-

ernment, for example, the displacement of the “Jowo Shakyamuni” life-size statue given
by Princess Wencheng as dowry to king Songtsen Gambo from a less important position in
 1 PREVIOUS SCHOLARSHIP, METHODOLOGY AND THE CONCEPT OF DEVELOPMENT 7

The lack of complete historical records and data, together with unre-
liable official accounts and reports, as well as other political factors, all
makes the debate on the Chinese influence in Xinjiang an issue on which
general consensus has not been reached yet; therefore, elaborating on
the topic is still a sensitive job, among Western as well as among Chinese
historians and scholars. It will be interesting to know whether contra-
dictions of views and perspectives, political claims and historical records,
will be eventually being absorbed into a consensual and unambiguous
historical version in the medium term. According to the available relia-
ble data, the final annexation of Xinjiang into the Chinese Empire took
place in 1759, after the war against the Zungar tribes and under the
auspices of Emperor Qianlong. Only then, after the suppression of the
powerful Zungar nomadic peoples, a systematic policy of integration of
the region into Inner China could start, mainly through fiscal and insti-
tutional channels. This point in history is of fundamental importance
for the integration of Xinjiang into the structure of imperial China.
According to the thesis by James Millward (1998), the main channels of
inclusion were fiscal and institutional, which means that Xinjiang became
an increasingly important source of revenues for the central government
and that the whole regional management was mainly entrusted to Han
and Manchurian officials, who started to replace the local amban.15
From 1949 until the fall of Mao Zedong, Beijing’s attention and
investments were mainly directed toward the Han settlers belonging to
the leftist current inside the Communist Party and obedient to the most
dogmatic Maoist line, especially during the Cultural Revolution.16
During the 1980s and 1990s, central investments and subsidies were
primarily addressed to the powerful and influential XJPCC, reestablished
by Deng Xiaoping for geostrategic and domestic reasons, after their
dismantling in 1979. This situation generated severe unbalances in the

Johkang temple to a more prominent location inside the temple, where the Buddha statue
given by the Nepalese Princess Bhrikuti once stood up. This is meant to demonstrate that
Tibet had a privileged relationship with the Chinese emperor, a political link prevailing over
that with the once powerful Nepalese kingdom.
15 Manchu word for “high official”: Qing imperial residents of non-Han or Manchu ori-

gins in charge of working as mediators between the government ranks and the local popu-
lations of the same ethnicity.
16 The works by Donald McMillen are the most detailed and complete on Xinjiang dur-

ing Mao.
Another random document with
no related content on Scribd:
SYNONYMS.—Parkinson's disease; Shaking palsy; Trembling palsy;
Senile chorea; Chorea festinans. The first name is due to the fact
that the disease was first fully described by Parkinson in a book
published in England in 1817.

Paralysis agitans is a neurosis, chronic in its forms and

characterized by a tremor which gradually increases in extent and
severity. The tremor is not increased by voluntary muscular
movements. A peculiar manner of walking, known as festination,
comes on later in the disease, and there are also alterations in the
attitude of the head and trunk.

It is a disease which belongs to middle age, being rarely seen before

forty years, although cases are quoted by Charcot as early as twelve
and sixteen years. Constant and prolonged exposure to dampness
and cold seems to bring on the disease, and it is sometimes caused
by sudden emotion, like fear or distress. The following case is an
instance of the latter:

Case I.—Mr. A. M——, æt. fifty-two years, consulted me Oct. 1,

1883. He is a bookbinder by occupation. His habits have been good.
He had a chancre in 1861, but had no secondary troubles. He was in
the army from 1861 until 1866. In 1866 he went into business for
himself, and, although his business was large, he had no great
anxiety or worry. His general health has been good, and he has had
no illness except an attack of malarial fever about six years ago. In
May, 1883, he was standing by an elevator door on the fourth floor of
his place of business, and, seeing that the elevator was caught by
something, released it. It immediately fell with a crash to the second
floor, and as there were two or three persons on it, Mr. M——
thought they must have been killed or severely injured. He was
greatly excited and alarmed, and soon after he had assured himself
that none of the occupants of the elevator had been hurt, discovered
a trembling of the right hand. The tremor has continued ever since,
and has extended to the arm and leg.
On examination there is seen a coarse tremor of the right arm and
leg while the limbs are at rest. A voluntary muscular movement stops
the tremor, and it also ceases during sleep. When he makes an effort
with the right hand, as, for instance, in squeezing the dynamometer,
the tremor ceases in the arm, but becomes greatly exaggerated in
the right leg. While occupied in doing anything he does not notice the
tremor, and it stops when he is lying down.

The dynamometer shows, right hand 150°, left hand 120°. After two
years have elapsed the disease has gradually progressed in
severity.

SYMPTOMS.—The course of the disease has been divided into three

stages—the period of invasion, the stationary period, and the
terminal period.1
1 Lectures on Diseases of the Nervous System, by J. M. Charcot.

Period of Invasion.—There are several modes of invasion, but the

most frequent by far is slow in its onset. The disease comes on
gradually, first showing itself as a slight tremor in the hand or fingers
while the part is at rest. It is not constant, and ceases as soon as the
patient's attention is called to it. There is sometimes preceding the
tremor rheumatic or muscular pain in the affected arm. The tremor
may first occur in the foot. Should the disease begin in the hand—
and this is most common—the movements are peculiar. They may
consist of a fine rhythmical tremor, or the fingers move in a
methodical way over each other. Charcot speaks of the thumb and
forefinger being rubbed together as if the patient were spinning wool.
While this movement of the thumb and finger is going on the wrist is
being flexed by jerks. During the early stages of the disease the
tremor is observed only at intervals. It comes on intermittently when
the patient is not thinking of it and while the limb is at rest, and
ceases as soon as any voluntary muscular effort is attempted. The
act of grasping the hand or taking up an object is enough to check it
for the time. In a patient now under my care I have often noticed
during the early stages a well-marked tremor of the right hand while
it was lying in her lap, but it would at once cease when I called
attention to it. As soon as the mind of the patient was diverted to
some other subject the tremor would begin again.

As the disease progresses voluntary effort no longer controls the

tremor, or if it does at all it is only for a few seconds, when it begins
again. As the tremor increases in violence it extends to other parts of
the body. At first it may have been confined to the hand; now it
extends to the arm, a little later to the foot and leg on the same side.
Then the other arm will be affected, and finally all of the limbs will
succumb to the tremor.

Charcot speaks of decussated invasion—that is, the disease begins

in the right upper extremity, for example, and next passes to the left
lower extremity. This is a rare form; it is much more frequent to see
the hemiplegic type, which may persist for some time, or the
paraplegic type, when both legs are affected.

There is a progressive form of invasion when the tremor is not the

first symptom. The patient has neuralgic or rheumatic pains in the
limbs, which are afterward affected with tremor. Sometimes there is
some mechanical injury of the limb, which subsequently is the seat
of pain and tremor. The general health of the patient is at the same
time more or less impaired. There is a sense of general weakness
and lassitude; the temper is irritable, and there may be some vertigo.
The features and countenance are characteristic even at the earliest
periods of the disease. There is an absolute absence of expression,
and the features are fixed. The face looks like a mask, and although
the patient may smile or laugh, immediately after the features return
to the original blank expression. Amidon showed two cases of
paralysis agitans to the American Neurological Society in 1883, in
which there was no tremor whatever, but all the other features of the
disease were present.

After a great mental or moral shock the trembling begins suddenly,

abrupt invasion, as in Case I., or the case described by Charcot,
where the wife of a gendarme, seeing her husband's horse return
riderless to the barracks, received a shock of great severity, which
was followed on the same day by tremor. The tremor is at first
confined to one limb. It may even disappear for a time, but gradually
and slowly extends to the other limbs, and takes the same
progressive course.

Period of Stationary Intensity.—After the disease has become fully

developed the tremor is incessant. The intensity is not the same all
the time. It may be augmented by cold, over-excitement, or voluntary
effort, and is lessened by repose and sleep. The trembling ceases
during anæsthesia.

During this time all the characteristic movements are at their height.
The moving of the thumb and finger, already referred to, is present,
and seems like a partly co-ordinated movement. Charcot describes
these movements as being in some cases like the rolling of a pencil
or a paper ball between the thumb and finger, and in others the
movements, he says, are more complicated, and are like what occur
in crumbling a piece of bread.

The handwriting is almost illegible, and every letter shows the

excessive trembling of the hand, most marked in the up strokes of
the pen. All this time the head and neck are unaffected. There is no
nodding or shaking of the head to be observed on the closest
inspection. This is an important fact to bear in mind, for it is a
distinguishing feature between the disease under consideration and
disseminated sclerosis. There is no nystagmus, and the muscles of
the jaw are unaffected by tremor. The tongue, however, while lying
on the floor of the mouth undergoes tremor, and this is increased
when the organ is protruded.

The speech is slow and jerky, and the patient usually speaks in a low
tone of voice. He eats his food without difficulty, but in advanced
cases the saliva sometimes escapes from the mouth during
deglutition. A characteristic symptom of the disease is a rigidity of
the muscles of the extremities, trunk, and of the neck. When the
muscular stiffness first begins the patient complains of cramps
followed by a sense of rigidity. The flexor muscles are first affected.
This stiffness causes peculiarities in the patient's attitudes. The head
and neck are usually bent forward, and seem fixed in that position.
The body is inclined slightly forward in standing. The elbows are held
somewhat away from the chest, the forearms are flexed on the arms,
and the hands are flexed on the forearms. The thumb and forefinger
are extended and brought together as if holding a pencil. The other
fingers are also flexed. The attitude of the hand and the prominence
of the knuckles make it closely resemble the hand of rheumatoid
arthritis. In paralysis agitans, however, there are no bony deposits in
the joints, and no cracking is heard on bending the knuckles.

In the lower extremities there is often intense rigidity. Contractions

occur, and the legs are strongly flexed. The feet often are extended
in the position of equinus. It is this rigidity which causes the difficulty
in walking (Charcot).

The gait of the patient now becomes very striking. He gets up from
his seat slowly and with difficulty; hesitates a moment before starting
to walk; then, once having made a few steps, goes at a rapid pace.
The tendency is to fall forward; in order to preserve his equilibrium
the patient hurries forward as if to catch up with his centre of gravity.
This gait has been called paralysis festinans—festination or
propulsion.

Although propulsion is the usual form the gait assumes, sometimes

there is a tendency to fall or run backward. This tendency is not
always apparent even when it exists. Charcot has a method of
showing its existence which is very successful: when a patient is
standing he pulls her slightly backward by the skirt, and this is
sufficient to start a movement of retropulsion.

Propulsion and retropulsion are not necessarily always present.

Many cases progress to the end without these symptoms.

As the disease advances the muscles become more rigid and the
patient is confined to bed. He is, however, restless from a sense of
prostration and fatigue. He is unable to turn himself, and often calls
to his attendant to change his position. The sufferers from this
disease, although not having actual pain, complain of disagreeable
sensations. There is a constant sense of excessive heat whether the
temperature of the room be high or low. In winter they cannot bear
much bed-clothes at night, and prefer to wear very light clothing.
Associated with this sensation of heat is often profuse perspiration
(Charcot). Notwithstanding all these troublesome sensations the
sensibility of the skin is not changed. Heat and cold are readily felt,
and there is no anæsthesia or analgesia.

Terminal Period.—The duration of paralysis agitans is generally

great. The disease may extend over many years—even as long as
thirty years in some cases. As the tremors and rigidity increase in
intensity the patient becomes obliged to sit all day in a chair or is
confined to bed. Occasionally the tremor becomes less while the
rigidity increases. The nutrition suffers, and the muscles especially
become greatly wasted. Up to a certain point the intellect remains
unaffected, but late in the disease the mind fails. General prostration
of the whole system sets in, bed-sores occur, the urine and feces are
passed unconsciously, and the patient dies of exhaustion. It is not
often that the end comes in this way. It is much more frequent that
some intercurrent disease, like pneumonia, ends the life of the
patient. The disease is undoubtedly a most painful and trying one to
both patient and physician. It lasts for years, and there is no prospect
of relief. Charcot says that he has seen the terminal period last for
three or four years. The following case is a fair example of the
disease:

Case II.—Margaret Hays, aged fifty-four, single, applied for treatment

at the Infirmary for Nervous Diseases, Oct. 9, 1882. She is
housekeeper for her brother, who keeps a restaurant. She has had
to be up late at night, and has had very much washing to do for
many years. The kitchen in which she is most of the time is damp,
and opens into a yard into which she has often to go. About two
years ago she thought that she hurt herself in lifting something, and
soon after this, on putting her hands from hot into cold water,
suddenly felt a numbness in both forearms. One year ago she
noticed tremor in both hands and both legs. The tremor interfered
with her work, and has increased. She also felt as if there were loss
of power.
Present Condition.—The face is expressionless and looks as if it
were a mask. She articulates without using her lips to any extent,
and speaks in a low tone, scanning the syllables. The head is held
stiffly, and the attitude of the whole body is peculiar.

The tremor is fine, and is constant while the hands are at rest. On
voluntary effort the tremor ceases. On examination with the
dynamometer, right hand 95°, left hand 80°. She feels weak
generally, and says she cannot use her hands even to button her
clothes or to dress or undress without aid. She performs all
movements slowly and with great deliberation. The patellar reflex is
not excessive.

Sensation.—She has lost the sense of numbness she used to have,

but says she cannot feel a needle between the fingers when she
attempts to sew. There is loss of sensation in the finger-ends; the
compass points are not felt at less than three lines.

Her walk is slow and deliberate like all her movements, and there is
no festination. Her eyes were examined, and there was no decided
change in the fundus and vision was about normal. Pupillary reflexes
good.

This patient was under observation for several months, and steadily
grew worse. One peculiar feature was observed, however: it was
that at one time the tremor almost ceased, although all of the other
symptoms were worse.

ETIOLOGY.—As already mentioned, the causes which have been

observed are fright or sudden grief and prolonged exposure to cold
and dampness. A number of cases of the former are mentioned by
Charcot, and a case which I have related above is a good illustration
of paralysis agitans produced by fright. When caused in this way the
disease does not present any peculiar features in its progress or
termination. I have seen many cases in which the disease had been
preceded by more or less exposure to dampness. One of my
patients had worked in a basement room which was damp; another
(Case II.) was a great deal of the time in a kitchen which opened on
a wet yard, and she was constantly going in and out of doors, getting
her feet wet frequently. Sometimes irritation of a peripheral nerve
seems to have been the origin of the trouble. Charcot quotes several
cases of this kind.

Sex does not appear to exert any special influence in the production
of the disease. Some writers assert that it is more common in males
than in females, but Charcot in his large experience at La Salpêtrière
has not found this to be the case.

MORBID ANATOMY.—A number of autopsies have been made in cases

of paralysis agitans without any constant lesion of the nervous
system having been discovered. Charcot refers to three cases in
which he made careful post-mortem examinations in which the
results were negative. Parkinson and Oppolzer each report one case
in which was found induration of the pons, medulla, and cervical
portion of the cord. More recently, however, Charcot and Joffroy
have examined cases in which microscopic examination revealed
blocking up of the central canal of the cord by increase of the
epithelium of the ependyma and pigmentations of the ganglion-cells.

Leyden has reported a case in which the disease was confined to

the right arm, and on post-mortem examination a tumor of the left
optic thalamus was found.2
2 Quoted by Hamilton, Diseases of the Nervous System, p. 500.

Dowse and Kesteven found degeneration of the nerve-cells of the

anterior pyramids, changes in the olivary body, nucleus of the ninth
nerve, laminæ and corpus dentatum of the cerebellum and of the
anterior cornua of the spinal cord. Also cortical sclerosis of the right
lateral column of the cord and miliary changes in the white matter of
the corpus striatum and hemispheres.3
3 Ross, Diseases of the Nervous System, vol. ii. p. 797.

In this disease, as in chorea, there must be two classes of cases—

those in which there is no lesion to be discovered after death, and
others in which there are changes throughout the brain and spinal
cord more or less widespread. The cases in which the disease
comes on suddenly from some moral shock probably belong to the
former class; while in cases which have come on gradually during
senility one would expect to find organic changes in the nervous
system. Ross4 suggests that the cause of the tremor is probably a
diminution in the conductivity of the fibres of the pyramidal tract,
which prevents impulses from the cortex reaching the muscles in
sufficiently close proximity to produce a continuous contraction. This,
however, does not explain the cause of the tremor in the cases
where it began suddenly from fright.
4 Op. cit., p. 798.

DIAGNOSIS.—The only diseases with which paralysis agitans may be

confounded are disseminated sclerosis, senile tremor, and chorea in
the aged. From senile tremor it may be distinguished from the fact
that it begins before old age—that the tremor is more excessive and
the gait and facial expression are distinctive. Chorea in old persons
resembles paralysis agitans, but is not progressive, the tremor is not
lessened as a rule by voluntary effort, and the peculiar gait and
expression of the face are wanting.

There are many points of difference between paralysis agitans and

disseminated sclerosis, as can be seen below:

PARALYSIS AGITANS. DISSEMINATED SCLEROSIS.

Tremor ceases on voluntary Tremor induced by muscular
effort, or is not increased by it. effort, and ceases during repose.
Tremor regular and fine. Coarse tremor, becoming more so
during voluntary effort.
Face expressionless; tremor of Facial muscles affected;
face rare. nystagmus frequent.
No tremor of head. Tremor of head generally present.
Belongs to advanced age. Usually comes on before middle
age.
Propulsion (festination) and Staggering walk.
retrogression.

TREATMENT.—The results of treatment are not encouraging. Cases

have been reported in which cures were effected, but it is doubtful if
they were true instances of paralysis agitans. Hyoscyamus and
conium have been given with temporary relief to the tremor.
Trousseau recommends strychnia, but Charcot declares that it
aggravated the cases in which he gave it. Hammond advises the use
of galvanism, at the same time giving strychnia or phosphorus. I
have seen one case in which decided relief was obtained from
arsenic hypodermically, and another in which the patient was
benefited for a long time while taking small doses of strychnia
combined with iron and quinine, and at the same time static
electricity was applied.

CHOREA.

BY WHARTON SINKLER, M.D.

Chorea, or St. Vitus's dance, has been known for years, and the
literature of the subject, especially among the older writers, is as
extensive as that of any other disease.
It has been recognized by a variety of names, some of the most
common being derived from some saint who enjoyed a popular
reputation of power to cure the disease. For example, it has been
called St. John's dance, St. Guy's dance, St. Modestus's dance, and
St. Anthony's dance. Besides these names it has been termed
ballismus, paralysis vacillans, epilepsia saltatoria, and
orchestromania.

It will be observed that almost all of the names which have been
applied to the disease relate to a dancing movement. This arises
from the fact that the first notice of the affection dates back to the
fourteenth century, when a kind of religious mania appeared in
Southern Europe in the form of an epidemic. It was characterized by
excessive dancing and gesticulatory movements, and affected large
numbers of people at a time. In 1375 an epidemic which arose was
spoken of as St. John's dance, and in 1418, in another outbreak of
the disorder which occurred at Strasburg, by the order of the
authorities those suffering were conducted in troops to the chapel of
St. Vitus in Zabern, and there masses were said and other religious
ceremonies performed for its cure.

We are informed that St. Vitus removed from Sicily when a boy, at
the time of Diocletian's persecution of the Christians in the year 303,
and suffered martyrdom in Florence in company with Crescentia and
his tutor, Modestus.1
1 “Hecker's Epidemics of the Middle Ages,” Sydenham Society's Transactions,
contains full details of these outbreaks.

Von Ziemssen states that as a pandemic disease the dancing mania

died out in the fifteenth century, but that traces have remained on the
Rhine up to the present time.2
2 Cyclopædia of the Practice of Medicine, vol. xiv. p. 416.

In our own country there have been many epidemics of the same
disorder on a small scale, and we may regard the Shakers as
representing a type of the dancing mania. Weir Mitchell reports3 an
outbreak which occurred quite recently In a children's asylum in
Philadelphia. Prompt measures and separation of those affected
from the well children checked the disorder, which at one time
threatened to spread through the entire institution.
3 Lectures on Nervous Diseases, p. 69.

These epidemics were quite different from what we now call chorea,
and the individuals suffering were clearly affected by a psychical
disorder of an hysterical form. In time, however, the name has come
to be applied to a systematic disease characterized by irregular
spasmodic movements of the limbs and other parts of the body.

The disease has been divided by some writers into chorea magna
and chorea minor. The former, however, as described, is only an
aggravated variety of hysteria, and need not be considered in
connection with this subject.

Although the name chorea does not correctly describe the disease
under consideration, it has been used for so many years that it is
more convenient to retain it.

DEFINITION.—Chorea, as we now understand it, is a spasmodic

neurosis, characterized by constant involuntary and irregular jerkings
and twitchings of muscles or groups of muscles, which, in the
majority of cases, cease during sleep, and are accompanied by more
or less psychical disturbance in most instances.

ETIOLOGY.—Hereditary influence in the production of chorea is more

or less marked. In some cases the connection seems to be remote,
but in many instances it will be found that one of the parents has
suffered from some form of nervous disease or has inherited a
nervous diathesis.

George Huntington of Pomeroy, Ohio,4 has recorded some

remarkable instances of hereditary chorea. The affection, as he
describes it, differs in many features from chorea as ordinarily met
with, but it is apparently the same disease. It is found in the eastern
end of Long Island, and has been studied in several generations by
Huntington, his father, and grandfather. This part of Long Island is
remarkably free from the usual type of chorea, none of these
physicians having ever met with an example of it. The hereditary
chorea is confined to a few families. It occurs more frequently in
males than in females, and never attacks the patient until after
middle life. It comes on gradually and takes years to develop, but
when once established it yields to no form of treatment. In most
cases there is a marked tendency to insanity and suicide in the later
stages of the disease.
4 Medical and Surgical Reporter, April 13, 1872.

Some additional cases of hereditary chorea have been lately

recorded by Peretti in No. 52 of the Berliner klin. Wochenschrift,
1885, and others by Clarence King in the New York Medical Journal,
vol. i., 1885. The history of all these cases is strikingly like those of
Huntington, and establishes without question a distinct form of
chorea.

Mrs. N., one of Peretti's cases, had a mental affection with choreic
movements, and there was a history of a similar condition in her
parents and grandparents. Two of Mrs. N.'s four children, Mrs. A.
and Anton N., had chorea in adult life; some of these became
insane. Mrs. A. had five children; three of these became choreic; one
had tremors and one became insane. Anton N. had ten children; of
these six had chorea. In all of Peretti's cases the disease came on
after the age of forty years, and persisted. In several members of the
family insanity was associated with the chorea.

In the families where it occurs the nervous temperament

predominates. It sometimes will be found that neither of the parents
of the patient has had chorea or any other nervous disease, but that
an uncle or an aunt has had St. Vitus's dance in childhood.

Chorea may occur at any period of life, from infancy to extreme old
age. I have reported two cases in patients over eighty years of age5
—one at eighty-two and the other at eighty-six—who had
characteristic attacks of St. Vitus's dance. Robert Saundby has
collected twelve cases of chorea in the aged. The two cases just
referred to are included in the number. He considers the affection
very rare in old persons.6 The following case is an example of
congenital chorea, and I believe this to be very unusual. The
movements of all infants are choreic, so that it is difficult to say when
the chorea begins; still, it seems fair to infer that when a child has
never had any but choreic movements it is a case of congenital
chorea:

Case. I.—Jennie W——, aged nineteen years. Family history is good

as regards nervous diseases. Her mother was frightened by seeing a
case of chorea some time before the child was born. The
movements were observed at birth, and have continued always. The
patient was brought to my clinic at the Infirmary for Nervous
Diseases, and her condition noted as follows: The movements are
general and continuous; the arms and legs are in constant motion,
and the mouth is perpetually grimacing; there is tremor of the tongue
when it is protruded; volitional efforts increase the movements;
during sleep they cease entirely; tendon reflexes are normal; there is
no paralysis; heart-sounds are normal and the general health is
good; menstruation is regular, and the choreic movements were not
influenced in any way at the time of its first appearance.
5 Journal of Nervous and Mental Diseases, July, 1881.

6 Lancet, Nov. 24, 1884.

Chorea occurs most frequently during the period of approaching

puberty. Sée in an examination of 531 cases found 453 between the
ages of six and fifteen years.

I have examined the notes of 282 cases of chorea, most of which are
in the case-books of the Infirmary for Nervous Diseases; the rest are
from my own note-books. Of the 282 cases, 217 were between six
and fifteen years. They were distributed as follows:

Under 1 year 2At 7 years 23At 16 years 6

 At 2 years 6At 8 years 24At 17 years 10
At 3 years 4At 9 years 31At 18 years 5
At 4 years 7At 10 years 23At 19 years 5
At 5 years 9At 11 years 18At 20 years 1
At 6 years 24At 12 years 25At 21 years 3
At 22, 25, 27, 28, 35, 38, 82, and 86 years, each 1 case.

Sex exerts considerable influence on the disease. Sée states that

three-fourths of all the cases observed in the Children's Hospital in
Paris occurred in girls. Of 328 cases which I have examined in
reference to this point, 232 were females and 96 males.

Social condition has little or no effect on the production of chorea,

but it is more common in cities than in the country. Indeed,
everything which increases the excitability of the nervous system
during development adds to the tendency to the disease.

West and Hamilton point to over-study as a cause, and I have

frequently verified their observations. The annual examinations at
our public schools give a number of cases of chorea.

A. McLane Hamilton7 has recently investigated the frequency of St.

Vitus's dance among school-children in New York, and found that 20
per cent. of the children in the schools were affected with some
variety of the disorder.
7 American Psychological Journal, Feb., 1876.

Rheumatism is certainly a predisposing cause, in my experience, but

I have not found it associated with chorea as frequently as some
authors have. In 279 cases which I examined with regard to this
question, there was a clear history of rheumatism in but 37. Cardiac
complications were much more frequent. In 82 cases there was a
cardiac murmur heard. In some of these the murmur was no doubt
anæmic, but in the majority there had probably been a rheumatic
endocarditis. Many cases in which there is said by the friends of the
patient to have been a previous attack of acute rheumatism, on
investigation are found not to have had articular rheumatism, but
merely some muscular or joint pains which were not inflammatory.
Quite recently Joffroy and Saric have expressed the opinion that the
pains in the joints during an attack of chorea are to be regarded as
choreal arthropathies of nervous origin.

English and French writers have observed the relation between

rheumatism and chorea in a large proportion of cases. Hughes and
Burton Brown8 found that in 104 cases which they examined as to
rheumatism and affections of the heart, there were but 15 in which
some rheumatic condition had not preceded the attack or a cardiac
murmur did not exist.
8 Guy's Hospital Reports, 1856.

Sée and Roget consider the causal relation between the two
diseases so close as to make their connection almost a pathological
law.

On the other hand, Steiner made quite opposite observations in

Prague. He saw among 252 cases of chorea only four which
originated during the course of acute articular rheumatism.9 This
statement does not prove the absence of a relation between chorea
and rheumatism, for Steiner does not say what proportion of cases
occurred after an attack of rheumatism which had taken place some
time previous. Hammond10 believes “that the influence of
rheumatism upon chorea is not greater than that of a depressing
agent to the organism.”
9 Ziemssen's Cyclopædia, loc. cit., p. 427.

10 Dis. of the Nervous System, p. 715.

Octavius Sturges, physician to the Hospital for Sick Children,

Ormond St., London, says that in two years 219 cases of chorea
have been treated at that institution: 20 per cent. of them were
connected with rheumatism, but he does not believe in the rheumatic
origin of the disease, because 15 per cent. of all children have
rheumatism.11
11 Lancet, Sept. 20, 1884.

The following cases illustrate the direct sequence of chorea upon

acute rheumatism:

Case II.—Kate S——, æt. 17 years, came under my care in May,

1877, with an attack of acute rheumatism which lasted for two
weeks. She regained strength slowly, and about June 11th, not more
than two weeks after the subsidence of the rheumatic symptoms,
choreic movements were noticed in the right arm. The movements
were constant, and were worse when she was conscious of being
observed. She often dropped things. The right leg jerked often and
gave away under her in walking. Under the use of liq. arsenici
bromidi the patient was entirely well in one month. A sister had had
chorea.

Case III.—Rudolph C——, æt. 5 years, was placed under my care

May 12, 1883. He has had scarlatina, and in Dec., 1882, he had an
attack of inflammatory rheumatism, accompanied with slight choreic
movements, from which he recovered in a short time. Three or four
weeks before coming under my charge he had a return of
rheumatism from getting his feet wet, and at the same time choreic
trouble began again. He rapidly became worse, and in a short time
was utterly helpless. On examination he is found unable to sit up or
make any voluntary movements. He is unable to move the legs on
account of the intense pain in the knees and ankles from the
rheumatism. These joints are swollen and red. The right arm is in
constant and violent motion, swinging about or thrashing up and
down. The left arm lies motionless, and, although painless, he
seems unable to move it. The fingers are clenched, and they are
continually and rhythmically being pressed against the palm. He
cries if an attempt is made to open the fingers. The facial muscles
are contorted all the time, and there is a peculiar vermicular
movement of the upper lip. He cannot speak a word nor can he
protrude the tongue. He sleeps but little, and during sleep the
movements are occasionally seen. He is very fretful and irritable, but
is perfectly intelligent. The appetite is poor. Bowels regular; urine
phosphatic and contains no albumen. There is a loud but not harsh
cardiac murmur heard at the apex, replacing the first sound of the
heart. Temperature, May 12, evening, 100°; May 13, morning,
1002/5°. Pulse, 140. He was ordered sodii salicylat., gr. v. q. q. h., and
inunctions of cod-liver oil.

On May 18 the rheumatism was so much better that the salicylate

was stopped and Fowler's solution of arsenic was given instead. The
chorea had also become better. The arsenic was continued in
increasing doses, and the case convalesced steadily. On June 26 he
was able to return to his home in Maryland entirely well.

He remained well until July, 1884, when he had a slight attack of

chorea, which was preceded for about a week by rheumatism. The
cardiac murmur, which was almost absent after recovery from the
first attack, was now heard again, but faintly.

Scarlatina is sometimes the forerunner of an attack of chorea. Other

diseases, whooping cough or measles, may also be the immediate
cause of an attack of chorea, but it is generally in cases where there
is a predisposition to the disease.

The connection between pregnancy and chorea is of great interest.

Barnes12 has collected 58 cases, and Bodo-Wenzel13 has added 8
more, making 66 in all. Of 51 of these patients, 31 were primiparæ,
and in the majority of cases the ages were between twenty and
twenty-three years. Four cases which came under my own personal
observation were all young primiparæ, and were between the
second and fourth months of gestation when the disorder began.
The affection usually appears in the first half of pregnancy. It may
cease before the eighth month or may continue to the end of
gestation. Sometimes it persists after delivery. It does not
necessarily occur in patients who have had the disease in childhood,
but from the above cases it would seem that an attack in one
pregnancy would tend to its recurrence in another. Of the 66 cases,
14 had had chorea in previous pregnancies. Sometimes the chorea
appears only at the time of labor.
12 Obstet. Transactions, vol. x. p. 147.

13 Ziemssen's Cyclopædia, loc. cit., p. 428.

The immediate cause of chorea in pregnancy, when a cause can be

found, is most often fright or rheumatism. In two of my own cases the
patients were unmarried. Of the 66 cases of Barnes and Wenzel,
fright is named as a cause in 7, and in 7 more rheumatism and
endocarditis are stated to have preceded the attack.

Climate has been supposed to have a marked influence upon

chorea. It was thought to be less frequent in warm than in cold
regions; but Hirsch denies this, and Weir Mitchell14 states that it does
not appear to exist to any less extent in the southern than in the
northern portion of this country.
14 Loc. cit.

Season, according to Mitchell,15 largely affects the production of

chorea. He has gone to great pains to collect statistics on the
subject. He shows that the majority of attacks in his cases occurred
in spring. This agrees with Wicke,16 who found that among 35
relapses, 13 were in spring, 12 in winter, 9 in autumn, and 1 in
winter. On the contrary, Hammond17 found 54 attacks in the six
months from October to March, and but 28 in the remainder of the
year. Gerhard18 in a study of 80 cases found that of 68 attacks, 39
occurred in spring, 10 in summer, 7 in autumn, and 12 in winter. In
Mitchell's cases a study was made of 170 attacks. In the spring and
summer months there were 115 attacks against 55 in the winter and
autumn months. This observer does not find that rain or dampness
has any notable effect in causing the disease, but that the influence
of storms is probably great.
15 Loc. cit., p. 128.
 16 Ziemssen, loc. cit., p. 443.

17 American Journ. Med. Sciences, July, 1876.

18 Loc. cit., p. 715.

Mitchell has written upon the relation between race and chorea. He
states that in answer to a circular bearing on this question, sent out
by the Smithsonian Institution, he has received a large number of
letters from physicians in our Southern States and the West Indies.
The general testimony was that chorea is rare among negroes.

Among the exciting causes of chorea are fright or mental

apprehension of some kind. Of my 279 cases, 44 were ascribed to
fright.

Malaria has been pointed out as influencing the production and

course of chorea. Kinnecut has reported some cases in which the
movements were aggravated with a certain periodicity.

Chorea may also be brought on by reflex irritation from nerve-injury.

In a case which I saw in the practice of John H. Packard several
years ago there was an injury to one of the digital nerves of the
thumb from a splinter, which was the apparent cause of an attack of
chorea; a portion of the nerve was excised, and the chorea ceased
in a short time.

I have lately seen a case in which an attack of chorea came on

apparently in consequence of a severe mash of the finger. The finger
had been crushed by the runner of a sled, and the choreic
movements began before the wound was healed.

Hamilton19 has found chorea associated with eczema. He saw a

case in which eczema of the calves of the legs and of the scalp
developed at the same time with an attack of chorea. Both got well
about the same time.
19 Nervous Diseases, p. 490.