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Saturday,. June 22. 2013 - external `technical check´ for the Jiu-Jitsu athletes from the Sports clubs: "SF Wüsting-Altmoorhausen", "TuS Bloherfelde", "PSV Oldenburg" and "VfL Rastede", in Wüsting / near the city Oldenburg, in the State Lower Saxony, Germany.

Ju-Jutsu Gürtelprüfung am 22. 06. 2013 beim `SF Wüsting-Altmoorhausen´, mit dabei der `TuS Blohrfelde´, der `PSV Oldenburg´ und der `VfL Rastede´.

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This image is taken from United States Naval Medical Bulletin Vol. 3, Nos. 1-4, 1909 by Medical Heritage Library, Inc.

Go to the Book with image in the Internet Archive

Title: United States Naval Medical Bulletin Vol. 3, Nos. 1-4, 1909

Creator: U.S. Navy. Bureau of Medicine and Surgery

Publisher:

Sponsor:

Contributor:

Date: 1909

Language: eng

Table of Contents

Number 1

Preface vii

Special articles 1

The artificial illumination of naval vessels (a study in naval

hygiene), by J. D. Gatewood 1

A simple operation for hemorrhoids, by H. F. Hull 22

Suggested devices 25

A metal suspensory, by W. B. Grove 25

A short and accurate method of calculating the age in years and months,

by E. M. Brown 25

Card for index system to be used in preparing smooth quarterly form

"X" at recruiting stations, etc., by C. R. Keen 27

Clinical notes 29

A case of angina Ludovici, by W. S. Pugh 29

A case of Vincent's angina, by G. F. Clark 31

Rupture of the iris; two cases, by R. K. Riggs 32

Wood alcohol poisoning; 13 cases, 3 deaths, by R. A. Baehmann 33

A case of virulent chancroids, by D. C. Gather 36

A case of septicemia successfully treated with Steam's streptolytic

serum by M. F. Gates . 39

An unusual case of undescended testicle, by E. M. Brown 39

Current comment 41

United States Pharmacopeial Convention 41

Concerning extracts or abstracts for publication 4l

Measuring the height of recruits 43

Suggestions for the study of heat exhaustion 44

Perfected routine of dosage, etc., in the treatment of tuberculosis by

the administration of mercury, by B. L. Wright 46

Has the chemical examination of water practical value to the military medical

officer? by P. '.T'. Waldner 47

An aid in throat and laryngeal examinations, by E. M. Brown 50

Progress in medical sciences 51

Laboratory —An anatomical peculiarity noted in specimens of hook worm

from Culebra 51

Preliminary note on the lesions of anchylostomiasis in the intestines of

dogs, by O. J. Mink 51

Preliminary note on nematode found in the liver of a wild rat, by O.

J.Mink 52

Chemistry and pharmacy — Note on the disintegration of tablets;

influence of benzoic acid and benzoates on digestion and health: address on the

clinical examination of urine, with especial reference to estimation of urea;

determination of pepsin by the edestin test, E. W. Brown and P. J. Waldner 52

Surgery —Review of advances; the operative treatment of recent

fractures of the femoral shaft; the treatment of fractures by mobilization and massage;

has surgical treatment lessened mortality from appendicitis; when to operate

for appendicitis; diffuse septic peritonitis, due to appendicitis; local

anesthesia of a limb by venous transfusion after expulsion of blood; on

narcosis under an artificially restricted circulation; the correlation of

glands with internal secretion; improved technique for the detection of

tubercle bacilli in the urine; relief of the wounded during battle, H. C. Curl

and H. W. Smith 54

Pathology and bacteriology —On the so-called fatty degeneration of the adrenals;

three cases of squamous celled carcinoma of the gall bladder; the practical

value of the demonstration of spirochaeta pallida in the early diagnosis of

syphilis; C. 8. Butler and O. J. Mink 65

Medical zoology — Plague in ground squirrels (a review); the prevalence

and distribution of the animal parasites of man in the Philippine Islands, with

a consideration of their possible influence on the public'

health; preliminary note on a protozoan in yaws; the intestinal protozoa

of man, R. C. Holcomb • 67

Tropical medicine — Ankylostomiasis in the Tropics; bilharziasis among women

and girls in Egypt; a report of several cases with unusual symptoms caused by

contact with some unknown variety of jellyfish; the diagnosis of latent

malaria; haemolysins and antihaemolytic substances in the blood of malarial

patients, E. R. Stitt 73

General medicine —The direct inspection of the gastric mucous membrane;

toxemia from the standpoint of perverted metabolism; a rapid method of

test-meal removal, lavage, and inflation; the therapeutics of diseases which

involve the internal secretions (mercury in the treatment of tuberculosis — its

mode of action —a warning); Flexner's serum in the treatment of epidemic

cerebrospinal meningitis; vascular crises; the curative influence of extracts

of leucocytes upon infections in animals, R. M. Kennedy 77

Hygiene and sanitation —Koch's standpoint with reference to the

question of the relation between human and bovine tuberculosis; the prevention of

tuberculosis; tropical lands and white races; sanitary report of the operations

of the naval expeditionary corps (German) in southwest Africa and in east

Africa; growth and naval military service; a study in measurements of cadets at

the naval school; on growth in height of youths serving their time in the army;

the value of fencing as a sport from hygienic and ethical point* of view; on-

the significance of the ophthalmo-reaction for the army; hematuria caused by a

parasite akin to bilharzia; the complex nature of typhoid etiology and the role

played by animals and man in the spread of the typhoid group of diseases; amoebae

carriers, H. G. Beyer 90

Reports and letters 195

Annual meeting of the American Pharmaceutical Association, Alrik Hammar,

delegate 105

Report of an epidemic of typhoid on the U.S.S. Maine, by M. S.

Elliott. 106

Report of an epidemic of grippe on the U. S. S. Charleston, by M. F.

Gates. 109

Number 2

Preface vii

Special articles 111

The treatment of tuberculosis and the results observed during the year 1908

(at the United States Naval Hospital, Las Animas, Colo.), by B. L. Wright 111

Laboratory studies and observations during the year 1908 (at the United

States Naval Hospital, Las Animas, Colo.), by A. B. Clifford 114

Tonsillar hypertrophy; a menace to the service, by B. F. Jenness 120

The ice bag in the treatment of typhoid fever, by G. Tucker Smith 122

Treatment of typhoid fever by colon irrigations, by the late C. G.

Alderman 124

Suggested devices 129

Description of a pit incinerator furnace, by R. C. Holcomb 129

Clinical notes 131

Report of a case of malignant endocarditis, following chancroid, by I.

Franklin Cohn 131

A case of multiple infected wounds from bear bite, by C. C. Grieve 132

A case presenting successive liver abscesses, by H. C. Curl and H. W. Smith

134

Cerebro-spinal fever, by J. G. Field 135

Current comment 141

Gangosa in Haiti 141

Hookworm disease in recruits from the Southern States 141

Care of ears and eyes in the Japanese navy 142

The question of ear protection in the British navy 142

Report relative to a series of experiments conducted on board the U. S.

S. Ohio during target practice, with "Plasticine" for the protection

of the ear drums during heavy gun fire, by W. M. Garton 142

Hygienic rules, with particular reference to venereal prophylaxis, in

the Austro-Hungarian navy 144

Experiments with gonococcic vaccine, by W. M. Garton 145

Thyroidal enlargement among applicants for enlistment in the Northwest,

by W. A. Angwin 147

Progress in medical sciences 148

Laboratory — Sterilization of catgut, by H. W. Smith 148

Chemistry and pharmacy — Fluidglycerates, pharmaceutical and physiological

aspect; the importance and significance of the chemical examination of the

gastric contents after a test meal, with a new method for estimating the

ferment activity of the gastric contents; demonstrations of enzymes and

antienzymes; studies on the chemistry of anaphylaxis; the clinical value of

viscosity determination; the viscosity of the blood; the detection and

quantitative determination of B-oxybutyric acid in the urine; a new method for

the quantitative estimation of albumin in the urine; concerning the diagnostic

value of Cammidge crystals in pancreatic diseases, E. W. Brown and P. J.

Waldner 150

Surgery — Review of advances; cerebral decompression; operative treatment

of acute gonorrheal epididymitis; appendectomy in diffuse septic peritonitis;

concerning technique of skin grafting; treatment of hypertrophy of the prostate

by injections of alien blood; the value of the Cammidge reaction in the diagnosis

of pancreatic disease; the Cammidge reaction in experimental pancreatitis; the

syphilis case sheet; the thymus in Basedow's disease; the effect of mammalian

pituitary on tetany after parathyreoidectomy, and upon the pupil; hemorrhage in

jaundice controlled by blood transfusion; on the haematogenic origin of

purulent nephritis through the staphylococcus; the snapping hip; three cases of

liver abscess treated by aspiration and injection of quinine, H. C. Curl and H.

\V. Smith: 156

Pathology and bacteriology — Widal’s

reaction with sterilized cultures; a new medium for typhoid work; report on a

further series of blood cultures from seventy-four cases of typhoid and

paratyphoid fever; the histology of liver tissue regeneration; typhoid bacilli

and gall bladder; the occurrence and distribution of the spirochaeta pallida in

congenital syphilis; experiments on the differentiation of cholera and

cholera-like vitrios by complement fixation;

C. S. Butler and O. J. Mink 166

Medical zoology —What is "schistosoma mansoni;" pulmonary

bilharziasis; filariasis and elephantiasis in southern Luzon; the diagnosis of African

tick fever from the examination of the blood; the parasite of

Kula Azar and allied organisms; a new human nematode-strongylus gibsoni;

report of the Permanent Commission for the Suppression of Uncinariasis; on the

supposed occurrence of the filaria immitis in man, R. C. Holcomb 174

Tropical medicine —An inquiry concerning the etiology of beriberi; have

trypanosomes an ultramicroscopical stage in their life history?; atoxyl as a

curative agent in malaria, E. R. Stitt 179

General medicine —The treatment of acute inflammatory conditions by

Bier's hypertemia; treatment of tetanus with subarachnoid injections of

magnesium sulphate; the serum diagnosis of syphilis; tubercle bacilli in the

sputum; a summary of the most recently published work on the doctrine of

opsonins; experimental investigation on "simple continued fever," H.

M. Kennedy 182

Hygiene and sanitation —On the application of heat for the purification

of water with troops in the field; catarrhal icterus of eberthian origin; the epidemic

of typhoid fever on H. M. S. Regina Elena; the treatment of sweat-foot in the

army; a contribution to our knowledge of the spread of cerebro-spinal

meningitis; on book disinfection on the large scale; the etiology of impetigo

contagiosa; tuberculosis in the British army and its prevention; symptoms that

may be attributed to soldering with the oxyhydrogen

flame; tactics and the health of the army, H. G. Beyer 189

Reports and letters 203

Seventeenth annual meeting of the Association of Military Surgeons,

Manley H. Simons, delegate 203

Report and recommendations of a board of officers, convened at the navy-yard,

Mare Island, Cal., on the precautionary methods to be taken to prevent the invasion of bubonic

plague at that station 205

Number 3

Preface VII

Special articles 211

Notes on the treatment of elephantiasis by the internal administration

of tinctuia ferri cbloridi, by P. S. Rossiter 211

A few notes on syphilis, by W. J. Zalesky 215

A note on the pathology of epidemic asthma, by O. J. Mink 222

Report on sixteen cases of heat prostration, with remarks on etiology,

by A. G. Grunwell 223

Reviews 231

Liver abscess from the point of view of etiology and prophylaxis; pathology

and differential diagnosis; and treatment (3 papers), by G. B. Crow,, J. A. B.

Sinclair, and J. F. Cottle 231

Suggested devices 245

Appliances improvised on sick bay bunks, by C. M. De Valin 245

Clinical notes 247

A case of fracture of patella, with operation at sea, by N. J.

Blackwood.. 247

A case of n current nasal hemorrhage, by Raymond Spear 250

A case of traumatic pneumonia, by C. F. Sterne 252

A case of liver abscess, by M. A. Stuart 254

Current comment 255

Hospital corps efficiency report 255

Physical defects found on reexamination of recruits 255

Some observations on the berthing of enlisted men of the navy, with suggestions

for improvement, by L. W. Curtis 256

The value of a chemical examination of water, by E. R. Noyes 257

Progress in medical sciences 267

Laboratory —A method for the preparation of flat worms for study, by O.

J. Mink and A. H. Ebeling .. 267

The formalin method for the clinical estimation of ammonia in the

urine, by E. W. Brown 269

Bang's method for estimation of sugar in the urine; the Edestin method for

the estimation of pepsin in stomach contents 273

Chemistry and pharmacy — Concerning the fractional precipitation of

albumin in the spinal fluid of normal cases luetics, functional and organic nervous

diseases and their bearing upon the differential diagnosis of dementia

paralytica, tabes dorsalis, tertiary and late syphilis; quantitative determination

of several sugars in the presence of each other in diabetic urines; the butyric

reaction for syphilis in man and in the monkey; excretion of amino acids in

pregnancy and after parturition; the relation between the protein content of

the blood serum and that of serous fluids; the further separation of antitoxin

from its associated proteins in horse serum, E. W. Brown and P. J. Waldner...276-279

Surgery —The Hodgen splint; surgical anemia and resuscitation; mechanism

underlying artificial respiration; a new theory of surgical shock; carbon

dioxide snow in the treatment of augioma; bursitis subacromialis, or

periarthritis of the shoulder joint; report on the local anesthetics recommended

as substitutes for cocaine; further researches on the etiology of endemic

goiter; auto- and iso-transplantation, in dogs, of the parathyroid glandules;

partial, progressive, and complete occlusion of the aorta and other large

arteries in the dog by means of the metal band; C. F. Stokes, R. Spear, and H.

W. Smith 279-289

Pathology and bacteriology —A simple method for the diagnosis of

syphilis; differential methods for detecting the typhoid bacilli in infected

water and milk; a peculiar intralobular cirrhosis of the liver produced by the protozoal

parasite of kala azar; the pathological anatomy of atoxyl poisoning; an

observation on the fate of B. Bulgaricus in the digestive tract of a monkey; a

contribution to the pathology of the spleen; a note, on the histology of a caue

of myelomatosis with Bence-Jones protein in

the urine; a new method for the recognition of indol in media; the rapid

diagnosis of rabies (a new stain for negri bodies); C. S. Butler and O. J. Mink

289-297

Medical zoology —Anew intestinal trematodeof man; some applications of the

precipitin reaction in the diagnosis of hydatid disease; bilharzia, hematobia,

and circumcision; trichocephaliasis; R. C. Holcomb ...... 297-306

Tropical medicine — Rice and beriberi; on the etiology of ulcerative

granuloma of the pudenda; amaebic dysentery with abscess of the liver in a patient

who had never been out of England; E. R. Stitt 306-308

General medicine —The dietetic treatment of diabetes; artificial

hyperemia in the treatment of pulmonary tuberculosis; remarks on the treatment of

gastric ulcer by immediate feeding; present status of the tuberculin tests; T.

W. Richards S0S-315

Hygiene and sanitation — On 'a new and practical method of securing bodily

cleanliness for our men on board ship; on the heat-conducting power of linoleum

as compared to that of floors made of wood or of

betone; on the discrimination of unrecognized diseases and on a disease

of overcrowding in ships, especially at

Malta; H. G. Beyer 315-320

Reports and letters 321

Guam; reports on health and sanitation for the years 1907 and 1908, by F.

E. McCullough and G. L. Angeny. 321

Number 4

Preface vii

Special articles 335

The hospital camp at Norfolk, Va., by P. A. Lovering 335

The teaching of tropical medicine outside of the Tropics, by E. R.

Stitt 308

Ethyl chloride as a general anaesthetic, by L. W. Johnson 344

Chronic nephritis in recruits, by B. F. Jenness 347

Supplementary report on the investigation of Samoan conjunctivitis, by P.

S. Rossiter 349

Points on embalming practicable on board ship, by C. Schaffer 351

Reviews 355

Surgical shock; a review of recent literature, by H. W. Smith 355

Suggested devices 365

Installation of an X-ray apparatus on the U. S. S. Maryland, by A.

Farenholt 365

Method of fumigation of vessels at Hamburg 368

An oxygen apparatus 370

An easily constructed bunk tray, by C. M. Oman 371

Clinical notes 373

Operations upon the kidney. United States naval hospital, New York, by G.

T. Smith 373

A report on two cases of dentigerous cysts, by D. N. Carpenter 374

A case of mammary development in the male, by E. M. Brown 376

Operative treatment of epididymitis, by W. S. Pugh, Jr 376

Two cases from report of U. S. S. Hancock—1908: (1) Retinal hemorrhage,

(2) myocarditis with rupture, by P. Leach 377

A case of fracture of the skull; operation and recovery, by F. W. F.

Wieber. 378

Carron oil in the treatment of otitis media suppurativa (acuta), by R.

E. Riggs 379

Fracture of skull and gunshot wound of lung, with recovery, by W. S.

Pugh, Jr ..... 381

Two unusual appendix cases, by R. R. Richardson 382

Proctoclysis in typhoid fever, by C. F. Stokes 384

Current comment 385

Subscription price of the Bulletin 385

Note on New York Post-Graduate Medical School 385

Note on contributions to the Bulletin 385

Note on annual meeting of American Medical Association on revision of pharmacopeia

386

Note on inquiry concerning clothing in the Tropics 386

Note on publicity concerning venereal disease in California 387

Review of Gatewood's Naval Hygiene 387

Note on the work at Tay Tay 388

Medical examination of army recruits, by A. E. Peck 389

Notes on the treatment of syphilis, by W. S. Hoen 391

Views on the treatment of typhoid fever, by H. A. May 393

Progress in medical sciences 397

Laboratory —Benedict's method for the estimation of glucose in the

urine; estimation of uric acid in the urine, Folin-Schaffer; clinical method

for the estimation of uric acid, modification of the Folin-Schaffer process; test

for blood in the urine; two methods for the estimation of albumin in the urine,

by O. J. Mink and E. W. Brown 397

Chemistry and pharmacy —The excretion in urine of sugars other than

glucose; experiments and experiences, pharmacological and clinical, with

digitalis, squill, and strophanthus; a reagent for the detection of reducing

sugars; on the antagonism of alcohol to carbolic acid ; the antitoxic activity

of iodine in tuberculosis; new experiments on the physiological action of

sulphuric ether; contribution to the physiology of the glands —further

contributions on the function of the spleen as an organ of iron metabolism;

modifications in the chemical composition of the blood serum in victims of

carbon dioxide poisoning, by P. J. Waldnerand C. Schaffer 402

Pathology and bacteriology —Studies on typhoid fever; chloroform

poisoning — liver necrosis and repair; the importance of blood cultures in the

study of infections of otitic origin; the cultivation of the spirocheeta

pallidum; the cultivation of the bacillus leprae; the chemistry of the liver in

chloroform necrosis; the present status of the whooping-cough question; the

conveyance of whooping cough from man to animals by direct experiment; serology

of syphilis, by C. S. Butler and O. J. Mink 407

Medical zoology — Schistosomiasis at Bahia; contribution to the study

of schistosomiasis in Bahia, Brazil; notes on malaria and kala-azar; endemic

amoebic dysentery in New York, with a review of its istribution in North America; filaria

(microfilaria) philippinensis; the distribution of filaria in the Philippine

Islands; acariens and cancers—acariens and leprosy; necator americanus in

Ceylon; anaemia due to trichocephalus dispar; study of the protozoa of J. H.

Wright in sixteen cases of Aleppo boil, by R. C. Holcomb 411

Tropical medicine — Infantile kala-azar; on the identity of beri-beri

and epidemic dropsy; Malta fever in South Africa; leprosy in the Philippine

Islands and its treatment; the various types of plague and their clinical

manifestations, by C. S. Butler 417

Hygiene and sanitation —The means by which infectious diseases are

transmitted; a critical study of the value of the measurements of chest expansion

and lung capacity; notes on the sanitation of yellow fever and malaria; the

house fly as a disease carrier, by H. G. Beyer 419

General medicine —A study of the aural and laryngeal complications of

typhoid fever, especially as observed in hospital practice; the problem of

cancer considered from the standpoint of immunity; nine cases of typhoid fever

treated with an antiendotoxic serum, by T. W. Richards 425

Surgery —Some practical points in the application of the bismuth paste

in chronic suppurative diseases; the sequence of the pathological changes in appendiceal

peritonitis; direct blood transfusion by means of paraffin-coated glass tubes;

the use of animal membrane in producing mobility in ankylosed joints, by C. F.

Stokes and R. Spear 431

Reports and letters 489

American Medical Association, by M. F. Gates 439

Report on the Second International Conference for Revision of Nomenclature

of Diseases and Causes of Death, by F. L. Pleadwell 445

Report upon medical relief measures at Messina, Sicily, by M. Donelson.

. 449

Reports of medical relief measures at Adana, Turkey, by J. T. Miller

and L. W. McGuire 452

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China - Kashgar - Shop - 3 by Manfred Sommer

Kashgar is an oasis city with an approximate population of 350,000 (500.000 in 2010 - 711.300 in 2019). It is the westernmost city in China, located near the border with Tajikistan and Kyrgyzstan. Kashgar has a rich history of over 2,000 years and served as a trading post and strategically important city on the Silk Road between China, the Middle East, and Europe. Kashgar is part of the China–Pakistan Economic Corridor.

Located historically at the convergence point of widely varying cultures and empires, Kashgar has been under the rule of the Chinese, Turkic, Mongol, and Tibetan empires. The city has also been the site of an extraordinary number of battles between various groups of people on the steppes.

Now administered as a county-level unit of the People's Republic of China, Kashgar is the administrative centre of its eponymous prefecture in the Xinjiang Uyghur Autonomous Region which has an area of 162,000 square kilometres and a population of approximately 3.5 million. The city's urban area covers 15 km2, though its administrative area extends over 555 km2.

NAME

The modern Chinese name is 喀什 (Kāshí), a shortened form of the longer and less-frequently used (simplified Chinese: 喀什噶尔; traditional Chinese: 喀什噶爾; pinyin: Kāshígé’ěr; Uyghur: قەشقەر‎). Ptolemy (AD 90-168), in his Geography, Chapter 15.3A, refers to Kashgar as “Kasi”. Its western and probably indigenous name is the Kāš ("rock"), to which the East Iranian -γar ("mountain"); cf. Pashto and Middle Persian gar/ġar, from Old Persian/Pahlavi girīwa ("hill; ridge (of a mountain)") was attached. Alternative historical Romanizations for "Kashgar" include Cascar and Cashgar.

Non-native names for the city, such as the old Chinese name Shule 疏勒 and Tibetan Śu-lig may have originated as an attempts to transcribe the Sanskrit name for Kashgar, Śrīkrīrāti ("fortunate hospitality")

Variant transcriptions of the official Uyghur: يېڭىشەھەر‎ include: K̂äxk̂är or Kaxgar, as well as Jangi-schahr, Kashgar Yangi Shahr, K’o-shih-ka-erh, K’o-shih-ka-erh-hsin-ch’eng, Ko-shih-ka-erh-hui-ch’eng, K’o-shih-ko-erh-hsin-ch’eng, New Kashgar, Sheleh, Shuleh, Shulen, Shu-lo, Su-lo, Su-lo-chen, Su-lo-hsien, Yangi-shaar, Yangi-shahr, Yangishar, Yéngisheher, Yengixəh̨ər and Еңишәһәр.

HISTORY

HAN DYNASTY

The earliest mention of Kashgar occurs when a Chinese Han dynasty envoy traveled the Northern Silk Road to explore lands to the west.

Another early mention of Kashgar is during the Former Han (also known as the Western Han dynasty), when in 76 BC the Chinese conquered the Xiongnu, Yutian (Khotan), Sulei (Kashgar), and a group of states in the Tarim basin almost up to the foot of the Tian Shan range.

Ptolemy speaks of Scythia beyond the Imaus, which is in a “Kasia Regio”, probably exhibiting the name from which Kashgar and Kashgaria (often applied to the district) are formed. The country’s people practised Zoroastrianism and Buddhism before the coming of Islam.

In the Book of Han, which covers the period between 125 BC and 23 AD, it is recorded that there were 1,510 households, 18,647 people and 2,000 persons able to bear arms. By the time covered by the Book of the Later Han (roughly 25 to 170 AD), it had grown to 21,000 households and had 3,000 men able to bear arms.

The Book of the Later Han provides a wealth of detail on developments in the region:

"In the period of Emperor Wu [140-87 BC], the Western Regions1 were under the control of the Interior [China]. They numbered thirty-six kingdoms. The Imperial Government established a Colonel [in charge of] Envoys there to direct and protect these countries. Emperor Xuan [73-49 BC] changed this title [in 59 BC] to Protector-General.

Emperor Yuan [40-33 BC] installed two Wuji Colonels to take charge of the agricultural garrisons on the frontiers of the king of Nearer Jushi [Turpan].

During the time of Emperor Ai [6 BC-AD 1] and Emperor Ping [AD 1-5], the principalities of the Western Regions split up and formed fifty-five kingdoms. Wang Mang, after he usurped the Throne [in AD 9], demoted and changed their kings and marquises. Following this, the Western Regions became resentful, and rebelled. They, therefore, broke off all relations with the Interior [China] and, all together, submitted to the Xiongnu again.

The Xiongnu collected oppressively heavy taxes and the kingdoms were not able to support their demands. In the middle of the Jianwu period [AD 25-56], they each [Shanshan and Yarkand in 38, and 18 kingdoms in 45], sent envoys to ask if they could submit to the Interior [China], and to express their desire for a Protector-General. Emperor Guangwu, decided that because the Empire was not yet settled [after a long period of civil war], he had no time for outside affairs, and [therefore] finally refused his consent [in AD 45].

In the meantime, the Xiongnu became weaker. The king of Suoju [Yarkand], named Xian, wiped out several kingdoms. After Xian’s death [c. AD 62], they began to attack and fight each other. Xiao Yuan [Tura], Jingjue [Cadota], Ronglu [Niya], and Qiemo [Cherchen] were annexed by Shanshan [the Lop Nur region]. Qule [south of Keriya] and Pishan [modern Pishan or Guma] were conquered and fully occupied by Yutian [Khotan]. Yuli [Fukang], Danhuan, Guhu [Dawan Cheng], and Wutanzili were destroyed by Jushi [Turpan and Jimasa]. Later these kingdoms were re-established.

During the Yongping period [AD 58-75], the Northern Xiongnu forced several countries to help them plunder the commanderies and districts of Hexi. The gates of the towns stayed shut in broad daylight."

And, more particularly in reference to Kashgar itself, is the following record:

"In the sixteenth Yongping year of Emperor Ming 73, Jian, the king of Qiuci (Kucha), attacked and killed Cheng, the king of Shule (Kashgar). Then he appointed the Qiuci (Kucha) Marquis of the Left, Douti, King of Shule (Kashgar). ‹See TfD›

In winter 73, the Han sent the Major Ban Chao who captured and bound Douti. He appointed Zhong, the son of the elder brother of Cheng, to be king of Shule (Kashgar). Zhong later rebelled. (Ban) Chao attacked and beheaded him."

THE KUSHANS

The Book of the Later Han also gives the only extant historical record of Yuezhi or Kushan involvement in the Kashgar oasis:

"During the Yuanchu period (114-120) in the reign of Emperor, the king of Shule (Kashgar), exiled his maternal uncle Chenpan to the Yuezhi (Kushans) for some offence. The king of the Yuezhi became very fond of him. Later, Anguo died without leaving a son. His mother directed the government of the kingdom. She agreed with the people of the country to put Yifu (lit. “posthumous child”), who was the son of a full younger brother of Chenpan on the throne as king of Shule (Kashgar). Chenpan heard of this and appealed to the Yuezhi (Kushan) king, saying:

"Anguo had no son. His relative (Yifu) is weak. If one wants to put on the throne a member of (Anguo’s) mother’s family, I am Yifu’s paternal uncle, it is I who should be king."

The Yuezhi (Kushans) then sent soldiers to escort him back to Shule (Kashgar). The people had previously respected and been fond of Chenpan. Besides, they dreaded the Yuezhi (Kushans). They immediately took the seal and ribbon from Yifu and went to Chenpan, and made him king. Yifu was given the title of Marquis of the town of Pangao [90 li, or 37 km, from Shule].

‹See TfD›

Then Suoju (Yarkand) continued to resist Yutian (Khotan), and put themselves under Shule (Kashgar). Thus Shule (Kashgar), became powerful and a rival to Qiuci (Kucha) and Yutian (Khotan)."

However, it was not very long before the Chinese began to reassert their authority in the region:

“In the second Yongjian year (127), during Emperor Shun’s reign, Chenpan sent an envoy to respectfully present offerings. The Emperor bestowed on Chenpan the title of Great Commandant-in-Chief for the Han. Chenxun, who was the son of his elder brother, was appointed Temporary Major of the Kingdom. ‹See TfD›

In the fifth year (130), Chenpan sent his son to serve the Emperor and, along with envoys from Dayuan (Ferghana) and Suoju (Yarkand), brought tribute and offerings.”

From an earlier part of the same text comes the following addition:

“In the first Yangjia year (132), Xu You sent the king of Shule (Kashgar), Chenpan, who with 20,000 men, attacked and defeated Yutian (Khotan). He beheaded several hundred people, and released his soldiers to plunder freely. He replaced the king [of Jumi] by installing Chengguo from the family of [the previous king] Xing, and then he returned.”[38]

Then the first passage continues:

“In the second Yangjia year (133), Chenpan again made offerings (including) a lion and zebu cattle. ‹See TfD›

Then, during Emperor Ling’s reign, in the first Jianning year, the king of Shule (Kashgar) and Commandant-in-Chief for the Han (i.e. presumably Chenpan), was shot while hunting by the youngest of his paternal uncles, Hede. Hede named himself king.

‹See TfD›

In the third year (170), Meng Tuo, the Inspector of Liangzhou, sent the Provincial Officer Ren She, commanding five hundred soldiers from Dunhuang, with the Wuji Major Cao Kuan, and Chief Clerk of the Western Regions, Zhang Yan, brought troops from Yanqi (Karashahr), Qiuci (Kucha), and the Nearer and Further States of Jushi (Turpan and Jimasa), altogether numbering more than 30,000, to punish Shule (Kashgar). They attacked the town of Zhenzhong [Arach − near Maralbashi] but, having stayed for more than forty days without being able to subdue it, they withdrew. Following this, the kings of Shule (Kashgar) killed one another repeatedly while the Imperial Government was unable to prevent it.”

THREE KINGDOMS TO THE SUI

These centuries are marked by a general silence in sources on Kashgar and the Tarim Basin.

The Weilüe, composed in the second third of the 3rd century, mentions a number of states as dependencies of Kashgar: the kingdom of Zhenzhong (Arach?), the kingdom of Suoju (Yarkand), the kingdom of Jieshi, the kingdom of Qusha, the kingdom of Xiye (Khargalik), the kingdom of Yinai (Tashkurghan), the kingdom of Manli (modern Karasul), the kingdom of Yire (Mazar − also known as Tágh Nák and Tokanak), the kingdom of Yuling, the kingdom of Juandu (‘Tax Control’ − near modern Irkeshtam), the kingdom of Xiuxiu (‘Excellent Rest Stop’ − near Karakavak), and the kingdom of Qin.

However, much of the information on the Western Regions contained in the Weilüe seems to have ended roughly about (170), near the end of Han power. So, we can’t be sure that this is a reference to the state of affairs during the Cao Wei (220-265), or whether it refers to the situation before the civil war during the Later Han when China lost touch with most foreign countries and came to be divided into three separate kingdoms.

Chapter 30 of the Records of the Three Kingdoms says that after the beginning of the Wei Dynasty (220) the states of the Western Regions did not arrive as before, except for the larger ones such as Kucha, Khotan, Kangju, Wusun, Kashgar, Yuezhi, Shanshan and Turpan, who are said to have come to present tribute every year, as in Han times.

In 270, four states from the Western Regions were said to have presented tribute: Karashahr, Turpan, Shanshan, and Kucha. Some wooden documents from Niya seem to indicate that contacts were also maintained with Kashgar and Khotan around this time.

In 422, according to the Songshu, ch. 98, the king of Shanshan, Bilong, came to the court and "the thirty-six states in the Western Regions" all swore their allegiance and presented tribute. It must be assumed that these 36 states included Kashgar.

The "Songji" of the Zizhi Tongjian records that in the 5th month of 435, nine states: Kucha, Kashgar, Wusun, Yueban, Tashkurghan, Shanshan, Karashahr, Turpan and Sute all came to the Wei court.

In 439, according to the Weishu, ch. 4A, Shanshan, Kashgar and Karashahr sent envoys to present tribute.

According to the Weishu, ch. 102, Chapter on the Western Regions, the kingdoms of Kucha, Kashgar, Wusun, Yueban, Tashkurghan, Shanshan, Karashahr, Turpan and Sute all began sending envoys to present tribute in the Taiyuan reign period (435-440).

In 453 Kashgar sent envoys to present tribute (Weishu, ch. 5), and again in 455.

An embassy sent during the reign of Wencheng Di (452-466) from the king of Kashgar presented a supposed sacred relic of the Buddha; a dress which was incombustible.

In 507 Kashgar, is said to have sent envoys in both the 9th and 10th months (Weishu, ch. 8).

In 512, Kashgar sent envoys in the 1st and 5th months. (Weishu, ch. 8).

Early in the 6th century Kashgar is included among the many territories controlled by the Yeda or Hephthalite Huns, but their empire collapsed at the onslaught of the Western Turks between 563 and 567 who then probably gained control over Kashgar and most of the states in the Tarim Basin.

TANG DYNASTY

The founding of the Tang dynasty in 618 saw the beginning of a prolonged struggle between China and the Western Turks for control of the Tarim Basin. In 635, the Tang Annals reported an emissary from the king of Kashgar to the Tang capital. In 639 there was a second emissary bringing products of Kashgar as a token of submission to the Tang state.

Buddhist scholar Xuanzang passed through Kashgar (which he referred to as Ka-sha) in 644 on his return journey from India to China. The Buddhist religion, then beginning to decay in India, was active in Kashgar. Xuanzang recorded that they flattened their babies heads, tattooed their bodies and had green eyes. He reported that Kashgar had abundant crops, fruits and flowers, wove fine woolen stuffs and rugs. Their writing system had been adapted from Indian script but their language was different from that of other countries. The inhabitants were sincere Buddhist adherents and there were some hundreds of monasteries with more than 10,000 followers, all members of the Sarvastivadin School.

At around the same era, Nestorian Christians were establishing bishoprics at Herat, Merv and Samarkand, whence they subsequently proceeded to Kashgar, and finally to China proper itself.

In 646, the Turkic Kagan asked for the hand of a Tang Chinese princess, and in return the Emperor promised Kucha, Khotan, Kashgar, Karashahr and Sarikol as a marriage gift, but this did not happen as planned.

In a series of campaigns between 652 and 658, with the help of the Uyghurs, the Chinese finally defeated the Western Turk tribes and took control of all their domains, including the Tarim Basin kingdoms. Karakhoja was annexed in 640, Karashahr during campaigns in 644 and 648, and Kucha fell in 648.

In 662 a rebellion broke out in the Western Regions and a Chinese army sent to control it was defeated by the Tibetans south of Kashgar.

After another defeat of the Tang Chinese forces in 670, the Tibetans gained control of the whole region and completely subjugated Kashgar in 676-8 and retained possession of it until 692, when the Tang dynasty regained control of all their former territories, and retained it for the next fifty years.

In 722 Kashgar sent 4,000 troops to assist the Chinese to force the "Tibetans out of "Little Bolu" or Gilgit.

In 728, the king of Kashgar was awarded a brevet by the Chinese emperor.

In 739, the Tangshu relates that the governor of the Chinese garrison in Kashgar, with the help of Ferghana, was interfering in the affairs of the Turgesh tribes as far as Talas.

In 751 the Chinese were defeated by an Arab army in the Battle of Talas. The An Lushan Rebellion led to the decline of Tang influence in Central Asia due to the fact that the Tang dynasty was forced to withdraw its troops from the region to fight An Lushan. The Tibetans cut all communication between China and the West in 766.

Soon after the Chinese pilgrim monk Wukong passed through Kashgar in 753. He again reached Kashgar on his return trip from India in 786 and mentions a Chinese deputy governor as well as the local king.

BATTLES WITH ARAB CALIPHATE

In 711, the Arabs invaded Kashgar, but did not hold the city for any length of time. Kashgar and Turkestan lent assistance to the reigning queen of Bukhara, to enable her to repel the Arabs. Although the Muslim religion from the very commencement sustained checks, it nevertheless made its weight felt upon the independent states of Turkestan to the north and east, and thus acquired a steadily growing influence. It was not, however, till the 10th century that Islam was established at Kashgar, under the Kara-Khanid Khanate.

THE TURKIC RULE

According to the 10th-century text, Hudud al-'alam, "the chiefs of Kashghar in the days of old were from the Qarluq, or from the Yaghma." The Karluks, Yaghmas and other tribes such as the Chigils formed the Karakhanids. The Karakhanid Sultan Satuq Bughra Khan converted to Islam in the 10th century and captured Kashgar. Kashgar was the capital of the Karakhanid state for a time but later the capital was moved to Balasaghun. During the latter part of the 10th century, the Muslim Karakhanids began a struggle against the Buddhist Kingdom of Khotan, and the Khotanese defeated the Karakhanids and captured Kashgar in 970. Chinese sources recorded the king of Khotan offering to send them a dancing elephant captured from Kashgar. Later in 1006, the Karakhanids of Kashgar under Yusuf Kadr Khan conquered Khotan.

The Karakhanid Khanate however was beset with internal strife, and the khanate split into two, the Eastern and Western Karakhanid Khanates, with Kashgar falling within the domain of the Eastern Karakhanid state. In 1089, the Western Karakhanids fell under the control of the Seljuks, but the Eastern Karakhanids was for the most part independent.

Both the Karakhanid states were defeated in the 12th century by the Kara-Khitans who captured Balasaghun, however Karakhanid rule continued in Kashgar under the suzerainty of the Kara-Khitans. The Kara-Khitan rulers followed a policy of religious tolerance, Islamic religious life continued uninterrupted and Kashgar was also a Nestorian metropolitan see. The last Karakhanid of Kashgar was killed in a revolt in 1211 by the city's notables. Kuchlug, a usurper of the throne of the Kara-Khitans, then attacked Kashgar which finally surrendered in 1214.

THE MONGOLS

The Kara-Khitai in their turn were swept away in 1219 by Genghis Khan. After his death, Kashgar came under the rule of the Chagatai Khans. Marco Polo visited the city, which he calls Cascar, about 1273-4 and recorded the presence of numerous Nestorian Christians, who had their own churches. Later In the 14th century, a Chagataid khan Tughluq Timur converted to Islam, and Islamic tradition began to reassert its ascendancy.

In 1389−1390 Tamerlane ravaged Kashgar, Andijan and the intervening country. Kashgar endured a troubled time, and in 1514, on the invasion of the Khan Sultan Said, was destroyed by Mirza Ababakar, who with the aid of ten thousand men built a new fort with massive defences higher up on the banks of the Tuman river. The dynasty of the Chagatai Khans collapsed in 1572 with the division of the country among rival factions; soon after, two powerful Khoja factions, the White and Black Mountaineers (Ak Taghliq or Afaqi, and Kara Taghliq or Ishaqi), arose whose differences and war-making gestures, with the intermittent episode of the Oirats of Dzungaria, make up much of recorded history in Kashgar until 1759. The Dzungar Khanate conquered Kashgar and set up the Khoja as their puppet rulers.

QING CONQUEST

The Qing dynasty defeated the Dzungar Khanate during the Ten Great Campaigns and took control of Kashgar in 1759. The conquerors consolidated their authority by settling other ethnics emigrants in the vicinity of a Manchu garrison.

Rumours flew around Central Asia that the Qing planned to launch expeditions towards Transoxiana and Samarkand, the chiefs of which sought assistance from the Afghan king Ahmed Shah Abdali. The alleged expedition never happened so Ahmad Shah withdrew his forces from Kokand. He also dispatched an ambassador to Beijing to discuss the situation of the Afaqi Khojas, but the representative was not well received, and Ahmed Shah was too busy fighting off the Sikhs to attempt to enforce his demands through arms.

The Qing continued to hold Kashgar with occasional interruptions during the Afaqi Khoja revolts. One of the most serious of these occurred in 1827, when the city was taken by Jahanghir Khoja; Chang-lung, however, the Qing general of Ili, regained possession of Kashgar and the other rebellious cities in 1828.

The Kokand Khanate raided Kashgar several times. A revolt in 1829 under Mahommed Ali Khan and Yusuf, brother of Jahanghir resulted in the concession of several important trade privileges to the Muslims of the district of Altishahr (the "six cities"), as it was then called.

The area enjoyed relative calm until 1846 under the rule of Zahir-ud-din, the local Uyghur governor, but in that year a new Khoja revolt under Kath Tora led to his accession as the authoritarian ruler of the city. However, his reign was brief—at the end of seventy-five days, on the approach of the Chinese, he fled back to Khokand amid the jeers of the inhabitants. The last of the Khoja revolts (1857) was of about equal duration, and took place under Wali-Khan, who murdered the well-known traveler Adolf Schlagintweit.

1862 CHINESE HUI REVOLT

The great Dungan revolt (1862–1877) involved insurrection among various Muslim ethnic groups. It broke out in 1862 in Gansu then spread rapidly to Dzungaria and through the line of towns in the Tarim Basin.

Dungan troops based in Yarkand rose and in August 1864 massacred some seven thousand Chinese and their Manchu commander. The inhabitants of Kashgar, rising in their turn against their masters, invoked the aid of Sadik Beg, a Kyrgyz chief, who was reinforced by Buzurg Khan, the heir of Jahanghir Khoja, and his general Yakub Beg. The latter men were dispatched at Sadik’s request by the ruler of Khokand to raise what troops they could to aid his Muslim friends in Kashgar.

Sadik Beg soon repented of having asked for a Khoja, and eventually marched against Kashgar, which by this time had succumbed to Buzurg Khan and Yakub Beg, but was defeated and driven back to Khokand. Buzurg Khan delivered himself up to indolence and debauchery, but Yakub Beg, with singular energy and perseverance, made himself master of Yangi Shahr, Yangi-Hissar, Yarkand and other towns, and eventually became sole master of the country, Buzurg Khan proving himself totally unfit for the post of ruler.

With the overthrow of Chinese rule in 1865 by Yakub Beg (1820–1877), the manufacturing industries of Kashgar are supposed to have declined.

Yaqub Beg entered into relations and signed treaties with the Russian Empire and the British Empire, but when he tried to get their support against China, he failed.

Kashgar and the other cities of the Tarim Basin remained under Yakub Beg’s rule until May 1877, when he died at Korla. Thereafter Kashgaria was reconquered by the forces of the Qing general Zuo Zongtang during the Qing reconquest of Xinjiang.

QING RULE

There were eras in Xinjiang's history where intermarriage was common, "laxity" which set upon Uyghur women led them to marry Chinese men and not wear the veil in the period after Yaqub Beg's rule ended, it is also believed by Uyghurs that some Uyghurs have Han Chinese ancestry from historical intermarriage, such as those living in Turpan.

Even though Muslim women are forbidden to marry non-Muslims in Islamic law, from 1880-1949 it was frequently violated in Xinjiang since Chinese men married Muslim Turki (Uyghur) women, a reason suggested by foriengers that it was due to the women being poor, while the Turki women who married Chinese were labelled as whores by the Turki community, these marriages were illegitimate according to Islamic law but the women obtained benefits from marrying Chinese men since the Chinese defended them from Islamic authorities so the women were not subjected to the tax on prostitution and were able to save their income for themselves. Chinese men gave their Turki wives privileges which Turki men's wives did not have, since the wives of Chinese did not have to wear a veil and a Chinese man in Kashgar once beat a mullah who tried to force his Turki Kashgari wife to veil. The Turki women also benefited in that they were not subjected to any legal binding to their Chinese husbands so they could make their Chinese husbands provide them with as much their money as she wanted for her relatives and herself since otherwise the women could just leave, and the property of Chinese men was left to their Turki wives after they died. Turki women considered Turki men to be inferior husbands to Chinese and Hindus. Because they were viewed as "impure", Islamic cemeteries banned the Turki wives of Chinese men from being buried within them, the Turki women got around this problem by giving shrines donations and buying a grave in other towns. Besides Chinese men, other men such as Hindus, Armenians, Jews, Russians, and Badakhshanis intermarried with local Turki women. The local society accepted the Turki women and Chinese men's mixed offspring as their own people despite the marriages being in violation of Islamic law. Turki women also conducted temporary marriages with Chinese men such as Chinese soldiers temporarily stationed around them as soldiers for tours of duty, after which the Chinese men returned to their own cities, with the Chinese men selling their mixed daughters with the Turki women to his comrades, taking their sons with them if they could afford it but leaving them if they couldn't, and selling their temporary Turki wife to a comrade or leaving her behind.

An anti-Russian uproar broke out when Russian customs officials, 3 Cossacks and a Russian courier invited local Turki (Uyghur) prostitutes to a party in January 1902 in Kashgar, this caused a massive brawl by the inflamed local Turki Muslim populace against the Russians on the pretense of protecting Muslim women because there was anti-Russian sentiment being built up, even though morality was not strict in Kashgar, the local Turki Muslims violently clashed with the Russians before they were dispersed by guards, the Chinese sought to end to tensions to prevent the Russians from building up a pretext to invade.

After the riot, the Russians sent troops to Sarikol in Tashkurghan and demanded that the Sarikol postal services be placed under Russian supervision, the locals of Sarikol believed that the Russians would seize the entire district from the Chinese and send more soldiers even after the Russians tried to negotiate with the Begs of Sarikol and sway them to their side, they failed since the Sarikoli officials and authorities demanded in a petition to the Amban of Yarkand that they be evacuated to Yarkand to avoid being harassed by the Russians and objected to the Russian presence in Sarikol, the Sarikolis did not believe the Russian claim that they would leave them alone and only involved themselves in the mail service.

Many of the young Kashgari women were most attractive in appearance, and some of the little girls quite lovely, their plaits of long hair falling from under a jaunty little embroidered cap, their big dark eyes, flashing teeth and piquant olive faces reminding me of Italian or Spanish children. One most beautiful boy stands out in my memory. He was clad in a new shirt and trousers of flowered pink, his crimson velvet cap embroidered with gold, and as he smiled and salaamed to us I thought he looked like a fairy prince. The women wear their hair in two or five plaits much thickened and lengthened by the addition of yak's hair, but the children in several tiny plaits.

The peasants are fairly well off, as the soil is rich, the abundant water-supply free, and the taxation comparatively light. It was always interesting to meet them taking their live stock into market. Flocks of sheep with tiny lambs, black and white, pattered along the dusty road; here a goat followed its master like a dog, trotting behind the diminutive ass which the farmer bestrode; or boys, clad in the whity-brown native cloth, shouted incessantly at donkeys almost invisible under enormous loads of forage, or carried fowls and ducks in bunches head downwards, a sight that always made me long to come to the rescue of the luckless birds.

It was pleasant to see the women riding alone on horseback, managing their mounts to perfection. They formed a sharp contrast to their Persian sisters, who either sit behind their husbands or have their steeds led by the bridle; and instead of keeping silence in public, as is the rule for the shrouded women of Iran, these farmers' wives chaffered and haggled with the men in the bazar outside the city, transacting business with their veils thrown back.

Certainly the mullas do their best to keep the fair sex in their place, and are in the habit of beating those who show their faces in the Great Bazar. But I was told that poetic justice had lately been meted out to one of these upholders of the law of Islam, for by mistake he chastised a Kashgari woman married to a Chinaman, whereupon the irate husband set upon him with a big stick and castigated him soundly.

That a Muslim should take in marriage one of alien faith is not objected to; it is rather deemed a meritorious act thus to bring an unbeliever to the true religion. The Muslim woman, on the other hand, must not be given in marriage to a non-Muslim; such a union is regarded as the most heinous of sins. In this matter, however, compromises are sometimes made with heaven: the marriage of a Turki princess with the emperor Ch'ien-lung has already been referred to; and, when the present writer passed through Minjol (a day's journey west of Kashgar) in 1902, a Chinese with a Turki wife (? concubine) was presented to him.

FIRST EAST TURKESTAN REPUBLIC

Kashgar was the scene of continual battles from 1933 to 1934. Ma Shaowu, a Chinese Muslim, was the Tao-yin of Kashgar, and he fought against Uyghur rebels. He was joined by another Chinese Muslim general, Ma Zhancang.

BATTLE OF KASHGAR (1933)

Uighur and Kirghiz forces, led by the Bughra brothers and Tawfiq Bay, attempted to take the New City of Kashgar from Chinese Muslim troops under General Ma Zhancang. They were defeated.

Tawfiq Bey, a Syrian Arab traveler, who held the title Sayyid (descendent of prophet Muhammed) and arrived at Kashgar on August 26, 1933, was shot in the stomach by the Chinese Muslim troops in September. Previously Ma Zhancang arranged to have the Uighur leader Timur Beg killed and beheaded on August 9, 1933, displaying his head outside of Id Kah Mosque.

Han chinese troops commanded by Brigadier Yang were absorbed into Ma Zhancang's army. A number of Han chinese officers were spotted wearing the green uniforms of Ma Zhancang's unit of the 36th division, presumably they had converted to Islam.

BATTLE OF KASHGAR (1934)

The 36th division General Ma Fuyuan led a Chinese Muslim army to storm Kashgar on February 6, 1934, attacking the Uighur and Kirghiz rebels of the First East Turkestan Republic. He freed another 36th division general, Ma Zhancang, who was trapped with his Chinese Muslim and Han Chinese troops in Kashgar New City by the Uighurs and Kirghiz since May 22, 1933. In January, 1934, Ma Zhancang's Chinese Muslim troops repulsed six Uighur attacks, launched by Khoja Niyaz, who arrived at the city on January 13, 1934, inflicting massive casualties on the Uighur forces. From 2,000 to 8,000 Uighur civilians in Kashgar Old City were massacred by Tungans in February, 1934, in revenge for the Kizil massacre, after retreating of Uighur forces from the city to Yengi Hisar. The Chinese Muslim and 36th division Chief General Ma Zhongying, who arrived at Kashgar on April 7, 1934, gave a speech at Id Kah Mosque in April, reminding the Uighurs to be loyal to the Republic of China government at Nanjing. Several British citizens at the British consulate were killed or wounded by the 36th division on March 16, 1934.

PEOPLE´S REPUBLIC OF CHINA

Kashgar was incorporated into the People's Republic of China in 1949. During the Cultural Revolution, one of the largest statues of Mao in China was built in Kashgar, near People's Square. In 1986, the Chinese government designated Kashgar a "city of historical and cultural significance". Kashgar and surrounding regions have been the site of Uyghur unrest since the 1990s. In 2008, two Uyghur men carried out a vehicular, IED and knife attack against police officers. In 2009, development of Kashgar's old town accelerated after the revelations of the deadly role of faulty architecture during the 2008 Sichuan earthquake. Many of the old houses in the old town were built without regulation, and as a result, officials found them to be overcrowded and non-compliant with fire and earthquake codes. When the plan started, 42% of the city's residents lived in the old town. With compensation, residents of faulty buildings are being counseled to move to newer, safer buildings that will replace the historic structures in the $448 million plan, including high-rise apartments, plazas, and reproductions of ancient Islamic architecture. The European Parliament issued a resolution in 2011 calling for "culture-sensitive methods of renovation." The International Scientific Committee on Earthen Architectural Heritage (ISCEAH) has expressed concern over the demolition and reconstruction of historic buildings. ISCEAH has, additionally, urged the implementation of techniques utilized elsewhere in the world to address earthquake vulnerability.

Following the July 2009 Urumqi riots, the government focused on local economic development in an attempt to ameliorate ethnic tensions in the greater Xinjiang region. Kashgar was made into a Special Economic Zone in 2010, the first such zone in China's far west. In 2011, a spate of violence over two days killed dozens of people. By May 2012 two-thirds of the old city had been demolished, fulfilling "political as well as economic goals." In July 2014 the Imam of the Id Kah Mosque, Juma Tayir, was assassinated in Kashgar.

CLIMATE

Kashgar features a desert climate (Köppen BWk) with hot summers and cold winters, with large temperature differences between those two seasons: The monthly 24-hour average temperature ranges from −5.3 °C in January to 25.6 °C in July, while the annual mean is 11.84 °C. Spring is long and arrives quickly, while fall is somewhat brief in comparison. Kashgar is one of the driest cities on the planet, averaging only 64 millimetres of precipitation per year. The city’s wettest month, July, only sees on average 9.1 millimetres of rain. Because of the extremely arid conditions, snowfall is rare, despite the cold winters. Records have been as low as −24.4 °C in January and up to 40.1 °C in July. The frost-free period averages 215 days. With monthly percent possible sunshine ranging from 50% in March to 70% in September, the city receives 2,726 hours of bright sunshine annually.

DEMOGRAPHICS

Kashgar is predominately peopled by Muslim Uyghurs. Compared to Ürümqi, Xinjiang's capital and largest city, Kashgar is less industrial and has significantly fewer Han Chinese residents.

ECONOMICS AND SOCIETY

The city has a very important Sunday market. Thousands of farmers from the surrounding fertile lands come into the city to sell a wide variety of fruit and vegetables. Kashgar’s livestock market is also very lively. Silk and carpets made in Hotan are sold at bazaars, as well as local crafts, such as copper teapots and wooden jewellery boxes.

In order to boost the economy in Kashgar region, the government classified the area as the sixth Special Economic Zone of China in May 2010.

Mahmud al-Kashgari (Turkish: Kâşgarlı Mahmud) (Mahmut from Kashgar) wrote the first Turkic–Arabic Exemplary Dictionary called Divan-ı Lugat-it Türk[citation needed]

The movie The Kite Runner was filmed in Kashgar. Kashgar and the surrounding countryside stood in for Kabul and Afghanistan, since filming in Afghanistan was not possible due to safety and security reasons.

SIGHTS

Kashgar's Old City has been called "the best-preserved example of a traditional Islamic city to be found anywhere in Central Asia". It is estimated to attract more than one million tourists annually.

- Id Kah Mosque, the largest mosque in China, is located in the heart of the city.

- People's Park, the main public park in central Kashgar.

- An 18 m high statue of Mao Zedong in Kashgar is one of the few large-scale statues of Mao remaining in China.

- The tomb of Afaq Khoja in Kashgar is considered the holiest Muslim site in Xinjiang. Built in the 17th century, the tiled mausoleum 5 km northeast of the city centre also contains the tombs of five generations of his family. Abakh was a powerful ruler, controlling Khotan, Yarkand, Korla, Kucha and Aksu as well as Kashgar. Among some Uyghur Muslims, he was considered a great Saint (Aulia).

- Sunday Market in Kashgar is renowned as the biggest market in central Asia; a pivotal trading point along the Silk Road where goods have been traded for more than 2,000 years. The market is open every day but Sunday is the largest.

TRANSPORTATION

AIR

Kashgar Airport serves mainly domestic flights, the majority of them from Urumqi. The only scheduled international flights are passenger and cargo services with Pakistan's capital Islamabad.

RAIL

Kashgar has the westernmost railway station in China. It is connected to the rest of China's rail network via the Southern Xinjiang Railway, which was built in December 1999. Kashgar–Hotan Railway opened for passenger traffic in June 2011, and connected Kashgar with cities in the southern Tarim Basin including Shache (Yarkand), Yecheng (Kargilik) and Hotan. Travel time to Urumqi from Kashgar is approximately 25 hours, while travel time to Hotan is approximately ten hours.

The investigation work of a further extension of the railway line to Pakistan has begun. In November 2009, Pakistan and China agreed to set up a joint venture to do a feasibility study of the proposed rail link via the Khunjerab Pass.

Proposals for a rail connection to Osh in Kyrgyzstan have also been discussed at various levels since at least 1996.

In 2012, a standard gauge railway from Kashgar via Tajikistan and Afghanistan to Iran and beyond has been proposed.

ROAD

The Karakorum highway (KKH) links Islamabad, Pakistan with Kashgar over the Khunjerab Pass. The China–Pakistan Economic Corridor is a multibillion-dollar project was that will upgrade transport links between China and Pakistan, including the upgrades to the Karakorum highway. Bus routes exist for passenger travel south into Pakistan. Kyrgyzstan is also accessible from Kashgar, via the Torugart Pass and Irkeshtam Pass; as of summer 2007, daily bus service connects Kashgar with Bishkek’s Western Bus Terminal. Kashgar is also located on China National Highways G314 (which runs to Khunjerab Pass on the Sino−Pakistani border, and, in the opposite direction, towards Ürümqi), and G315, which runs to Xining, Qinghai from Kashgar.

WIKIPEDIA

Ground Control by Nick Barrett

3 1

A Futuron-style space facility in microscale

Control of food and water intake, hunger and thirst https://t.co/ZSSIjphjq9 by Model 3D

Control of food and water intake, hunger and thirst t.co/ZSSIjphjq9 (via Twitter twitter.com/3danimacion1x/status/784976181233876992)

Control_Absolut_182800 by Toni Cabrera

Remote Control by James F Clay

Remote control.

Control Tower Reflection by EAA AirVenture Oshkosh

Photo by Laurie Goossens

Control point SALT by Dave Curtis

CSX local B769 heading for Baldwinsville, NY.

Bird Control Edinburgh Pest Control Co by Edinburgh Pest Control Co

Bird Control Edinburgh Pest Control Co

Ukrainian passport, pages 6-7 by Strooks-traveller1

1 2

In Control.. by Steve Burrows

A close up view of the CTC Control panel at The Australian Model Railway Association's Mortdale Clubrooms. This panel is fully operational and capable of detecting and routing trains using the same principles as are used on its full size counterparts.

by pentachoron

4 2

In this one, you can see the gross nutrient deficiency in my leaves and the accompanying spider mites.

I've been using neam oil to get them under control. It's working, but it's taking forever. I soak everything, except for the front of the plants. I'm on the third floor. I can't just stand out there and spray them. I try to hit them sideways to get the front. I think that helps. But I'm sure most of the mites that return in hoards are the offspring of the ones on the front of the leaf that didn't get sprayed.

It doesn't directly kill them. It makes it so their eggs can't hatch. They have a short lifespan - a few days - so if you keep hitting it every few days you can get it under control. I'm getting close.

Controlling Crowds by Damien.Fardel

6 11

The beautiful and timeless Porsche Carrera GT. One of my favorite cars.

Spotted at "The Zoute Grand Prix" @ Knokke Le Zoute - Belgium

Press F if you like and comment :)

Areas in Cyprus UN-Controlled Buffer Zone Untouched Since 1974 by United Nations Photo

Since fighting erupted between Greek and Turkish Cypriots in 1974, the area dividing Greek Cyprus from its Turkish counterpart, abandoned and left virtually untouched by human activity, has fallen within a buffer zone controlled by the United Nations Peacekeeping Force in Cyprus (UNFICYP).

03/02/2010. Nicosia, Cyprus. UN Photo/Eskinder Debebe. www.unmultimedia.org/photo/

gun by GunControlDebate

16 3

Nemerov Howard. " Gun Control Laws Cannot Prevent Youth Violence.” Detroit. Greenhaven Press. 20’. Opposing Viewpoints Resource Center. Web. 14 June 2010 This article touches on a lot of things but particularly on gun violence what harms the youth. After reading this article my perception about gun control laws have become even stronger. About 3,006 teens were killed in 2004 because of firearms? The article talkes about the millions of people that have died because of guns and listed out the death rates in America. According to the Children’s Defense Fund, they claim increasing gun control laws will save the lives of children. This article also talkes about how an experimented was conducted and found that the suicide rate in teens have increased in the past years all used with firearms found in homes. The article brought out a very good point to use in my defense that fire arms around children can be more harmful than people may think.

Remote Controlled Switcher by prr8814

6 4

Remote controlled switcher I found in Indiana. Canon Rebel, 3 exposures in Photomatix.

Hasta pronto mi fiel Doppy by Sandra Miranda Gonzalez

10 3

Fue un verano del año 2005, y yo tenia un gran mascota llamada Tshaikosky que había adoptado por medio de mi amiga Amparo.

Tshaiky ( cariñosamente le decíamos ), se le había producido una tos convirtiéndose en un cáncer agresivo y lo cual, nosotros ignorábamos.

Doppy era un boxer mestizo que le fue regalado a mi hermana, cuando vivía en mi casa temporalmente. Justo una semana después que Doppy entró a mi hogar, Tshaiky partió al cielo dejándome

un racimo de recuerdos y dolor profundo, mientras mi familia fueron emigrando a Estados Unidos.

Doppy no podía resistir verme llorar y corría desde la habitación de mi hermana hacia donde yo estaba para darme consuelo.

Para mi sorpresa, Doppy vino con una enfermedad quizás hereditaria llamada "epilepsia" , y justo antes de darle sus ataques, Doppy corria donde mi, y se estrechaba contra mis brazos hasta que todo pasara.

A partir de ahí, Doppy y yo comenzamos a tener un vinculo mas estrecho cada ves mas. Yo lo curaba y lo calmaba, mientras él me llenaba mi vida de un inmenso amor incondicional.

Al pasar los años Doppy mejoraba cada ves mas de salud,.. era un atleta,.. le encantaba correr en el campo o jardin , fué campeón en primer lugar en la carrera canina en categoría grande, y eso me llenó de mucho orgullo.

Una ves tuve que mudarme de la casa de mi familia a un apartamento,... que choque tan grande le di a mi Doppy!!!, ... ya no tenia jardin para saltar, correr y jugar. Ambos de nosotros nos sentíamos perdidos, pues, yo dejé aquel hogar de infancia, y Doppy el lugar que se sentía en plena libertad. Ambos ( en soledad) nos sentíamos perdidos.

Investigué con un amigo donde dejar a mi perro mientras yo trabajaba, y me recomendó a una guardería de animales, donde lo cuidarían como seres especiales. Doppy no pasó la prueba,.. se puso nervioso y comenzó a ladrar a todos los perros. El dueño del lugar me declaró a Doppy como un perro " agresivo", y no podía estar en la guardería.

Entre mas lágrimas,.. tomé a mi perro y me dirigí a mi apartamento, pero en ves de rechazarlo, ... me abracé a Doppy y le dije " lo superaremos juntos ".

Devastada y sin entender, llamé a otro amigo para pedirle un consejo de que hacer,.. y me recomendó hablar con el entrenador Ramon Molina ( de Molina K9 ).

Recuerdo que era un dia de lluvia, y estuve mas de media hora hablando con Molina ( como muchos lo llaman ) sobre la actitud que tenia Doppy con los otros perros. Y ese día lluvioso, tomé mi vehículo con Doppy para comenzar a tratar de entenderlo.

Doppito ( cariñosamente le decía ) no tenia socialización con otros perros. Desde ese día, yo tambien inicié mi proceso de aprendizaje de entender, aceptar, proteger y amar hasta que Dios lo permita a mi perro adoptivo Doppy.

Mi fiel amigo se quedo unos pocos dias con Molina en la finca, y luego recibí una llamada de parte de su entrenador para participar en las actividades con todo el resto de perros que habían en la finca.

Para mi sorpresa, mi perro Doppy era un perro feliz, sociable, corriendo con la manada de nuevos amigos perrunos,.. y yo entre lagrimas de alegría, me sentí orgullosa de nuevo, pues juntos estábamos superando todo.

Con unos cambios en mi actitud hacia mi fiel perro, y con el aprendizaje que Doppy había recibido.. fuimos cada ves mas compenetrándonos en un solo corazón.

Las crisis de epilepsia fueron muy pocas,.. quizas 2-3 veces al año pero todo controlable,.. Doppy vivia en perfecta salud, y corriendo en cada oportunidad que se le presentase.

Conocí a un chico que trabajaba en una veterinaria cerca del apartamento donde me ofreció pasear a Doppy 2 veces al dia para que hiciera sus necesidades , tal cual me habían comentado. "el pasear a tu mascota e identificar donde hacer sus necesidades es unos de los puntos principales de su entrenamiento y del vivir de los demás que lo cuidan "

Yo me integré a la pasión de la fotografía, y Doppy siempre estaba a la espera y emoción de irnos de safari fotográfico para disfrutar del campo y la playa. Cuantos viajes en solitario dimos Doppy y yo !!!,.. donde, mientras yo escribía poemas, él respiraba mirando al cielo contemplando la naturaleza. Definitivamente " éramos un solo corazón".

Luego integré a mi nueva pareja Hector, aceptándolo como un papá adoptivo y convidando nuestro vivir y costumbres, convirtiéndonos en una pequeña familia. Doppy tenia mamá y papá.

Me hablaron sobre la idea de un cementerio de mascota, donde personas podrían darle una sepultura digna aquellos animales que han entregado tanto amor a nuestras vidas. Y aunque nosotros no queremos enfrentar esa futura y triste realidad , reservar un espacio para Doppy, tuve la tranquilidad de saber donde estaría, me llenó de gran satisfacción y paz profunda.

Pasaron 11 años en la vida de Doppito, donde cientos de fotografías y videos me regalan su sonrisa, su travesuras, su inquieto juego en las mañanas, el compartir en lugares donde tomábamos fotografías hasta que una mañana del 9 de Diciembre del presente año , Doppy se levanta como es normal,.. busca su hueso de juguete y me invita a jugar. Yo, en la rapidez de mi dia, solo juego unos cuantos minutos con él.

Llegada la hora del almuerzo, mi fiel y alegre Doppy toma su alimento pero algo en él no estaba bien. Se le presentó un cuadro de indigestión llegando a su complicación patológica cerebral ( epilepsia ), y unido a su edad, mi Doppy se fué durmiendo como un niño de cuna.

Junto a él, se fueron corriendo un rosario de historias inolvidable de amor, de enseñanzas, de paciencia y entrega. Mi corazon se rompió en dos,.. y mi Doppito se llevo la mitad de él.

Un ciclo de mi vida se ha cerrado, por eso quiero motivar con mi historia, a aquellos que no han tenido la convivencia con una mascota a que adopten,.. que aprendan de ellas,.. que se comuniquen con su silencio, que se reten a entenderlas y sientan sus preocupaciones, tristezas y alegrias. Ellos son mensajeros de amor y paz de ese paraiso que nos tiene nuestro Dios en el cielo.

Yo sé que mi muchachito canino esta feliz corriendo pues su mision en la tierra terminó, mientras yo lo sigo extrañando.

Gracias le doy a Ramon Molina y Malin Reisenger, al Dr. Eduardo Pichardo ( veterinaria Arroyo Hondo ) , al Cementerio Parque del Prado, Por estar pendiente a la trayectoria de Doppy desde el principio hasta el final. A mi amado Hector Lachapelle por su entrega, amor y pasión hacia lo que era mi debilidad ... "mi Doppy" . Y a todos que me expresaron condolencias via Facebook, teléfono o correos.. muchas gracias de corazon

Hoy solo guardo silencio ante la admiración de la película de su vida y nuestra convivencia.. Gracias Doppy por ser tú y no otro, que marcó mi vida de semblanza, amor profundo y paz.

Te amaré siempre!

Tu mamá

Sandra Miranda Gonzalez

12/ Diciembre 2016

Controls by nate.stevens

Water By The Bridge 2013

Debach control tower, Suffolk by John Clouston

I've been planning to visit this place since first reading Roger Freeman's "Airfields of the Eighth, Then and Now" as a kid! Debach is a gem - not only has the control tower been carefully restored, there's still some runway, peritrack and other buildings to see. Taken with a Sony HDR SR10E.

Beyond Control by P F McFarland

That's the way it's been up here on the hill since 2010. I hope I can move away before the construction is finished and all the new residents move in.

To the victims of the earthquake in Italy by Daniel Cano Ott

6 17

EXPLORE #189 7/4/2009. Just imagine for a second that everything material you owe, your house, furniture, photos, books, CDs, computer, paintings, plants, your bed and favorite pillow, your clothes... everything... is gone. Think about becomin homeless in a few minutes. What would you fell if all your efforts for improving your quality of life and living standards were vain, futile. That is what has happened to thousands of our italian neighbours. Even worse, some of them are dead or lost somebody in their family.

And the reason couldn't be more stupid: there isn't any! An unpredictable earthquake reminded us that natural forces can't be controlled.

PD Have a look at this site and check how frequent are the earthquakes. It may also happen to us!

View my images in DARCKR or Flickriver.

Control Room 6 by Charles Bodi

6 8

Control by PSMania.net - All the latest PlayStation screenshots!

Control is Jesse Faden’s story. The main plot focuses on her personal search for answers as she grows into the role of the Director. The world of Control has its own story, as do the allies Jesse meets along the way. Side-quests and Secrets are everywhere. Jesse works with other Bureau agents, decodes cryptic ciphers and discovers strange Bureau experiments.

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Control by bobblackbird

Under control by theirhistory

Two Sisters in the children's home minding the younger group with another Sister taking a photo for the staff albums.

One of the old B&W photos now re-colourised automatically.

control by lee allen

Coach as every year was provided by Motts . UK15CRU a Mercedes Benz Tourismo C53FT seen at Showbus today. . Photo taken 17/09/17

Control Stand by NOYB #1

Inside the NEW BLET Headquarters

control panel by peter castleton

1 4

Control panel by Otola Photography

Shot with and edited on my iPhone

Control by Un zorro

4 1

A los que no estaban atentos les aguaron la fiesta.

Marcha por la legalización de la marihuana. 7 Mayo. Santiago, Chile 2011.

control. maschinenfest 2015 - 1876 by s.alt

control

Groung Control Lacrosse Club 2022-92.jpg by deadrise marine photo

Nikon D5200 - detail of body and controls by Doug

Nikon D5200 - detail of body and controls.

Control - Dont Get Lost by kaoZ.XeorY

Photo Mode + Range Remover, SRWE, CameraRAW

This image is taken from United States Naval Medical Bulletin Vol. 14, Nos. 1-4, 1920 by Medical Heritage Library, Inc.

Go to the Book with image in the Internet Archive

Title: United States Naval Medical Bulletin Vol. 14, Nos. 1-4, 1920

Creator: U.S. Navy. Bureau of Medicine and Surgery

Publisher:

Sponsor:

Contributor:

Date: 1920

Language: eng

Table of Contents

Number 1

PREFACE V

NOTICE TO SERVICE CONTRIBUTORS VI

SPECIAL ARTICLES:

ANTHROPOMETRIC STUDY AT ANNAPOLIS.

By Lieutenant L. B. Solhaug, Medical Corps, U. S. N 1

Medical and Hygienic Aspects of Submarine Service.

By Lieutenant Commander E. W. Brown, Medical Corps, U. S. N 8

Report on Facial and Jaw Injuries.

By Lieutenant Commander L. W. Johnson, Medical Corps, U. S. N 17

Military Orthopedic Hospitals in the British Isles.

By Lieutenant R. Hammond. Medical Corps, U. S. N. R. F. 65

HISTORICAL :

Medicine in Rome 103

EDITORIAL :

The New Year — Standards of Duty 127

IN MEMORIAM :

Edward Grahame Parker.

By Captain C. E. Riggs, Medical Corps, U. S. N 135

SUGGESTED DEVICES:

Changes in Scuttle Butts Aboard Ship.

By Lieutenant Commander J. A. B. Sinclair, Medical Corps,

U. S. N. R. F 137

An Emergency Evacuation Device 145

CLINICAL NOTES :

Bronchopulmonary Spirochetosis in an American.

By Lieutenant G. W. Lewis, Medical Corps, U. S. N 149

Encephalitis Lethargica.

By Lieutenant A. F. Kuhlman, Medical Corps, U. S. N 151

Defense of the Open-Air Treatment of Pneumonia.

By Lieutenant D. Ferguson, jr., Medical Corps, U. S. N 153

NOTES AND COMMENTS :

Carbon tetrachloride poisoning. —Civil service positions. — Serum treatment

in yellow fever. —" Deer-fly disease." — Request for specimens.—

Medical personnel of the French Navy.—Centenary celebrations. —Situs inversus.

—Italian view of prohibition. — Effects of prohibition In Chicago. — Treatment

of sterility. — Pilocarpine in influenza. —A death from anesthesia.- — Free

hospital service in Oklahoma City. —Birth rate of Manila. —Expansion of the

Faculty of Medicine, Paris. —Statistics on blindness. —French eight-hour law. —

Corporation philanthropy 155

REPORTS :

The Receiving Ship Barracks, New York.

By Commander W. G. Farwell and Lieutenant R. M. Krepps, Medical Corps,

U. S. N 163

Grounding of the U. S. S. Northern Pacific.

By Lieutenant J. C. Ruddock, Medical Corps, U. S. N 185

Impressions of a Reservist.

By Commander L. R. G. Crandon, Medical Corps, U. S. N. R. F 188

Number 2

PREFACE v

NOTICE TO SERVICE CONTRIBUTORS vi

SPECIAL ARTICLES:

Types of Neurological and Psychiatric Cases.

By Lieutenant Commander E. C Taylor, Medical Corps, U. S. N. R. F 191

Yellow Fever.

By Lieutenant Commander T. Wilson, Medical Corps, U. S. N 200

Asepsis of Abdominal Incisions.

By Lieutenant Commander F. H. Bowman, Medical Corps, U. S. N 208

Calcium Chloride Intravenously for Hemoptysis.

By Lieutenant Commander W. H. Fickel, Medical Corps, U. S. N 210

Hospital Records 213

HISTORICAL:

The Arabians and the First Revival of Learning 225

SUGGESTED DEVICES:

Hospital Garbage Disposal.

By Captain A. Farenholt, Medical Corps, U. S. N 237

The Flat-Foot Ladder 240

CLINICAL NOTES:

Chondrodysplasia with Exostoses.

By Lieutenant R. W. Hutchinson, Medical Corps, U. S. N 243

A Case of Vascular Syphilis.

By Lieutenant A. E. Kuhlmann, Medical Corps, U. S. N., and Lieutenant

Commander C. C. Ammerman, Medical Corps, U.S.N.R. F 245

Two Cases of Encephalitis Lethargica.

By Lieutenant Commander R. I. Longabaugh, Medical Corps, U. S. N 249

A Case of Foreign Body in the Head.

By Lieutenant Commander L. M. Schimdt, Medical Corps, U. S. N. 254

The Late Treatment of War Osteomyelitis.

By Lieutenant E. I. Salisbury, Medical Corps, U. S. N. R. F 255

Two Cases of Gas Gangrene.

By Lieutenant Commander L. M. Schmidt, Medical Corps. U. S. N 257

Gastric Ulcer with Perforation.

By Lieutenant G. G. Holladay, Medical Corps, U. S. N. R. F 259

Internal Ophthalmoplegia.

By Lieutenant Commander E. E. Woodland, Medical Corps, U.S.N 260

Open Treatment of a Fractured Metacarpal Bone.

By Lieutenant R. W. Auerbach, Medical Corps, U. S. N 263

Supernumerary Phalanx.

By Lieutenant R. S. Reeves, Medical Corps, U. S. N. R. F 265

A Cask of Ruptured Kidney.

By Commander K. It. Richardson, Medical Corps, U. S. N

Mustard Gas and the Cardiovascular System.

Ry Lieutenant Commander W. H. Michael, Medical Corps, U. S. N

A Case of Ulcer of the Sigmoid Flexure.

By Lieutenant H. R. Coleman, Medical Corps, U. S. N

A Case of Malposition.

By Lieutenant A. C. Toll inner, Dental Corps, U. S. N

PROGRESS IN MEDICAL SCIENCES :

General Medicine — Blood pressure and posture —Intramuscular Injections

of quinine in malaria — Vincent's disease Surgery — Appendicitis amongst

sailors— Transplanting of bone— Rectal ether anesthesia

Hygiene and Sanitation — Destruction of lice by steam

Eye, Ear. Nose, and Throat — Ocular phenomena in the psychoneuroses of

warfare —Ocular complications due to typhoid inoculations

NOTES AND COMMENTS:

Syphilis and the war—Bone surgery —National Research Council— Laboratories

in Poland— National Anaesthesia Research Society — Vanderbilt Medical School —

Municipal education in Detroit — Female medical matriculates— Degrees conferred

by Royal College of Surgeons of Edinburgh — Speech defects — Typhoid fever in

New York — Venereal diseases in California- — Omissions in the Annual Report of

the Surgeon General, 1919

REPORTS :

U. S. Navy Ambulance Boat No. 1.

By Chief Pharmacist's Mate D. V. De Witt, U. S. N

Physical Development in the Navy.

By Lieutenant B. G. Baker, Medical Corps, U. S. N

Venereal Prophylaxis at Great Lakes, III.

By Lieutenants D. It. Blender and L. A. Burrows, Medical Corps, U. S.

N. R. F

Report of 505 Tonsillectomies.

By Lieutenant W. P. Vail, Medical Corps, U. S. N. R. F

BOOK NOTICES

Number 3

PREFACE v

NOTICE TO SERVICE CONTRIBUTORS vi

SPECIAL ARTICLES :

History of the U. S. Naval Hospital, Chelsea, Mass.

By Captain N. J. Blackwood, Medical Corps, U. S. N 311

INSTRUCTION FOR THE HOSPITAL CORPS.

By Lieutenant Commander W. M. Kerr, Medical Corps, U. S. N. 338

Study of Two Cases of Diabetes Mellitus.

By Lieutenant L. F. Craver, Medical Corps, TJ. S. N 345

Flat Foot in the Navy.

By Lieutenant C. F. Painter, Medical Corps, U. S. N. R. F 359

Static Defects of the Lower Extremities.

By Lieutenant A. A. Marsteller, Medical Corps, U. S. N 365

Treatment of Malaria.

By Lieutenant Commander W. H. Michael, Medical Corps, U. S. N 367

Navy Recruiting.

By Lieutenant W. H. Cechla, Medical Corps, U. S. N 371

HISTORICAL:

American Founders of Gynecology 373

EDITORIAL :

"Bring Forth Your Dead "—Is Educational Prophylaxis Effective

381

William Martin —John Wolton Ross —Oliver Dwight Norton, Jr 389

CLINICAL NOTES:

Interdental Ligation for Jaw Fractures.

By Lieutenant W. F. Murdy, Dental Corps, U. S. N 391

A Temporary Stopping.

By Lieutenant Commander H. E. Harvey, Dental Corps, U. S. N 394

ASCARIASIS AND APPENDICITIS.

By Lieutenant Commander E. G. Hakansson, Medical Corps, U. S. N 394

Malarial Crescents.

By Lieutenant Commander W. H. Michael, Medical Corps, U. S. N_ 395

Poisoning by Jelly Fish.

By Commander A. H. Allen, Medical Corps, U. S. N 396

Traumatic Rupture of Kidney.

By Lieutenant Commander F. H. Bowman, Medical Corps, U. S. N 397

A Case of Erythema Multiforme.

By Lieutenant M. F. Czubak, Medical Corps, U. S. N 399

PROGRESS IN MEDICAL SCIENCES:

General Medicine. — Static back trouble—Benzyl benzoate —Relation of

anaphylaxis to asthma and eczema —High enema —Treatment of typhus —Thilerium

hominis 401

Mental and Nervous Diseases. —Insanity as a defense in crime —The nervousness

of the Jew— The Babinski reflex —Problems of delinquency —Encephalomyelitis in

Australia 408

Surgery. — Radium — Surgery of peripheral nerves — Referred symptoms in

diseases of gall-bladder and appendix—Intracranial pressure —Protection of the

skin in surgical operations—Anesthesia

from drugs administered by the mouth —A new skin-suture material —

Roentgen-ray problems , 414

Hygiene and Sanitation. — Birth control—Typhoid fever in vaccinated

troops —Detection of typhoid carriers —Streptococci in market milk

—Tuberculosis in San Francisco —An experiment in sanitary education —Oral

hygiene —Differential diagnosis between trachoma and follicular conjunctivitis

—Left - handedness —The Negritos of the Philippine Islands —Tropical Australia

425

NOTES AND COMMENTS :

American Society for the Control of Cancer — Pay of Italian medical officers

— The passing of the book worm— The neurotic girl —Control of druggists in

Michigan — English statistics on alcoholism —Prevention of simple goiter— Value

of quarantine against influenza in Australia —W. P. C. Barton, first chief of

the Bureau of Medicine and Surgery—Information on blood-pressure estimation

—Automobile accidents —Egyptian Medical School — Educational movement In U. S.

Army 443

REPORTS :

Health Conditions in Santo Domingo.

By Lieutenant Commander G. F. Cottle, Medical Corps, U. S. N 453

History of U. S. S. Pocahontas During the War,

By Lieutenant Commander M. Boland, Medical Corps, U. S. N 460

With the American Peace Commission.

By Commander A. D. McLean, Medical Corps, U. S. N 500

Testing Water for Storage Batteries.

502

Report from Naval Medical School Laboratory 505

BOOK NOTICES 505

Number 4

PREFACE V

NOTICE TO SERVICE CONTRIBUTORS VI

SURGICAL ACTIVITIES AT THE NAVAL

HOSPITAL, NEW YORK.

Interesting bone cases 512

Fractubes of the anterior tuberosity of the tibia and Osgood-Schlatter's

disease 516

Carrel-Dakin technique for empyema 527

Physical therapy 535

Occupational therapy 536

War wounds of the joints.

By Dr. L. Delrez, Faculty of Medicine Liege 537

A case or joint treatment by Willems's method 545

Chronic intestinal stasis 545

Carrel-Dakin technique in treatment of carbuncle 549

A case of sarcoma of the foot 550

A case of Jacksonian epilepsy with spastic contracture 551

A Case Of Osteoma Of The Humerus 552

A Case Of Bone Infection Resembling Sarcoma 552

Wound closures after Carrel-Dakin treatment 553

Ether in peritonitis 557

HISTORICAL:

The founders ok naval hygiene. Lind, Trotter, and Blane 563

EDITORIAL:

Hospital standards —As seen from within 629

SUGGESTED DEVICES :

Vision test apparatus.

By Lieutenant Commander H. W. Glltner, Medical Corps, U. S.N. R. F 637

Treatment of cement floors.

By Captain A. Farenholt, Medical Corps, U. S. N 638

CLINICAL NOTES:

Ophthalmitis in secondary syphilis.

By Lieutenant Commander W. H. Whitmore, Medical Corps, U. S. N 639

TWO CASES OF OPTIC ATROPHY.

By Lieutenant Commander C. B. Camerer, and Lieutenant G. L. McClintock,

Medical Corps, U. S. N 641

Arsphenamine in malaria.

By Lieutenant Commander W. H. Michael, Medical Corps, U. S. N 643

Ureteral calculus.

By Commander W. J. Zalesky and Lieutenant Commander P. F. Prioleau,

Medical Corps, U. S. N 644

PROGRESS IN MEDICAL SCIENCES :

General medicine. — Treatment of respiratory catarrhs.—Tests of thyroid

hypersensitiveness. —A diet sheet for nephritics.— Delayed arsenical poisoning

647

Surgery. —Open treatment of fractures. — Treatment of crushed extremities.

—Nerve injuries of the war 653

Hygiene and sanitation. —Disinfection of tubercular sputum. — Syphilis

in railroad employees 659

Tropical diseases. —Ulcerating granuloma 663

Eye, ear, .nose, and throat. — Frontal sinus drainage. —Anesthetics in throat

surgery. —Correction of nasal deformities

NOTES AND COMMENTS :

American Library Association.— Mental defects in the United States. —

"Tea-taster's " cough. — Scientific basis of carelessness. — "The

case against the prophylactic packet." —Treatment of leprosy. — Medical

training in London. —A new Army and Navy Club. — The Navy Mutual Aid

Association. — Medical school of the University of Virginia. —A new medical

quarterly. —Solar therapy. — Novarsenobenzol subcutaneously. —Economic loss

from rats. —The flight of mosquitoes. —A medical centenarian. — A French hospital

ship. — Potassium-mercuric-iodide.— Dermatitis in industrial work. —

Radium.— A twelfth century epitaph 663

REPORTS :

Arsenical preparations used intravenously.

By Captain E. S. Bogert, Medical Corps, U. S. N 679

Venereal disease in the Dominican Republic.

By Lieutenant J. W. Vann and Lieutenant B. Groesbeck, Medical Corps, U.

S. N 681

American legation guard, Managua, Nicaragua.

By Lieutenant Commander F. F. Murdock, Medical Corps, U. S. N_ 684

Sanitary conditions in Vladivostok.

By Lieutenant A S. Judy, Medical Corps, U. S. N 689

Hospital records.

Commander H. W. Smith, Medical Corps, U. S. N 698

HOSPITAL RECORDS.

By Commander E. U. Reed, Medical Corps, U. S. N 706

A DEATH FROM ETHER DUE TO STATUS LYMPHATICUS.

By Captain A. W. Dunbar, Medical Corps, U. S. N 714

Medical prophylaxis against venereal diseases.

By Lieutenant P. W. Dreifus, Medical Corps, U. S. N 715

BOOK NOTICES 718

INDEX 721

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31154 speeds through Bamford with the 0941 Manchester Piccadilly to Hull on 11th August 1984 by Jjm2009

At the time, Bamford signal box was still extant and one of the down Home signals can be seen on the left. The box closed in September 1989 and the signal in the shot was converted to a colour light IB signal controlled by Grindleford.

Annoyingly I didn't get a photograph of the attractive looking box behind me!

The 31 was withdrawn in May 2006 and cut up at Rotherham two months later.

A re-scanned slide.

Control_Absolut_93718 by Toni Cabrera

greg moody, ata mesa, mesa, chandler karate, karate, martial arts, www.karatebuilt (140) by Karate For Kids ATA Martial Arts

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Скульптор Иван Миско. Писатель Максим Горький. The sculptor Ivan Misko. Writer Maxim Gorky (3) by Space Sculpture Misko Ivan

Maxim Gorky

Alexei Maximovich Peshkov (Russian: Алексе́й Макси́мович Пешко́в or Пе́шков;[1] 28 March [O.S. 16 March] 1868 – 18 June 1936), primarily known as Maxim Gorky (Russian: Макси́м Го́рький), was a Russian and Soviet writer, a founder of the socialist realism literary method, and a political activist.[2] He was also a five-time nominee for the Nobel Prize in Literature.[3] Around fifteen years before success as a writer, he frequently changed jobs and roamed across the Russian Empire; these experiences would later influence his writing. Gorky's most famous works were The Lower Depths (1902), Twenty-six Men and a Girl (1899), The Song of the Stormy Petrel (1901), My Childhood (1913–1914), Mother (1906), Summerfolk (1904) and Children of the Sun (1905). He had an association with fellow Russian writers Leo Tolstoy and Anton Chekhov; Gorky would later mention them in his memoirs.

Gorky was active with the emerging Marxist social-democratic movement. He publicly opposed the Tsarist regime, and for a time closely associated himself with Vladimir Lenin and Alexander Bogdanov's Bolshevik wing of the party. For a significant part of his life, he was exiled from Russia and later the Soviet Union. In 1932, he returned to the USSR on Joseph Stalin's personal invitation and lived there until his death in June 1936.

Contents

1 Life

1.1 Early years

1.2 Political and literary development

1.3 Capri years

1.4 Return from exile

1.5 Povolzhye famine

1.6 Second exile

1.7 Death of Lenin

1.8 Return to Russia: last years

1.9 Apologist for the gulag

1.10 Hostility to gays

1.11 Conflicts[citation needed] with Stalinists

1.12 Death

2 Depictions and adaptations

3 Selected works

3.1 Novels

3.2 Novellas

3.3 Short stories

3.4 Drama

3.5 Non-fiction

3.6 Collections

4 See also

5 Notes

6 Sources

7 Further reading

8 External links

Life

Early years

Born as Alexei Maximovich Peshkov on 28 March [O.S. 16 March] 1868, in Nizhny Novgorod, Gorky became an orphan at the age of eleven. He was brought up by his grandmother[2] and ran away from home at the age of twelve in 1880. After an attempt at suicide in December 1887, he travelled on foot across the Russian Empire for five years, changing jobs and accumulating impressions used later in his writing.[2]

As a journalist working for provincial newspapers, he wrote under the pseudonym Иегудиил Хламида (Jehudiel Khlamida).[4] He started using the pseudonym "Gorky" (from горький; literally "bitter") in 1892, when his first short story, "Makar Chudra", was published by the newspaper Kavkaz (The Caucasus) in Tiflis, where he spent several weeks doing menial jobs, mostly for the Caucasian Railway workshops.[5][6][7] The name reflected his simmering anger about life in Russia and a determination to speak the bitter truth. Gorky's first book Очерки и рассказы (Essays and Stories) in 1898 enjoyed a sensational success, and his career as a writer began. Gorky wrote incessantly, viewing literature less as an aesthetic practice (though he worked hard on style and form) than as a moral and political act that could change the world. He described the lives of people in the lowest strata and on the margins of society, revealing their hardships, humiliations, and brutalisation, but also their inward spark of humanity.[2]

Political and literary development

Anton Chekhov and Gorky. 1900, Yalta

Gorky's reputation grew as a unique literary voice from the bottom strata of society and as a fervent advocate of Russia's social, political, and cultural transformation. By 1899, he was openly associating with the emerging Marxist social-democratic movement, which helped make him a celebrity among both the intelligentsia and the growing numbers of "conscious" workers. At the heart of all his work was a belief in the inherent worth and potential of the human person. In his writing, he counterposed individuals, aware of their natural dignity, and inspired by energy and will, with people who succumb to the degrading conditions of life around them. Both his writings and his letters reveal a "restless man" (a frequent self-description) struggling to resolve contradictory feelings of faith and scepticism, love of life and disgust at the vulgarity and pettiness of the human world.[citation needed]

In 1916, Gorky said that the teachings of the ancient Jewish sage Hillel the Elder deeply influenced his life: "In my early youth I read...the words of...Hillel, if I remember rightly: 'If thou art not for thyself, who will be for thee? But if thou art for thyself alone, wherefore art thou'? The inner meaning of these words impressed me with its profound wisdom...The thought ate its way deep into my soul, and I say now with conviction: Hillel's wisdom served as a strong staff on my road, which was neither even nor easy. I believe that Jewish wisdom is more all-human and universal than any other; and this not only because of its immemorial age...but because of the powerful humaneness that saturates it, because of its high estimate of man."[8]

He publicly opposed the Tsarist regime and was arrested many times. Gorky befriended many revolutionaries and became a personal friend of Vladimir Lenin after they met in 1902. He exposed governmental control of the press (see Matvei Golovinski affair). In 1902, Gorky was elected an honorary Academician of Literature, but Tsar Nicholas II ordered this annulled. In protest, Anton Chekhov and Vladimir Korolenko left the Academy.[9]

Leo Tolstoy with Gorky in Yasnaya Polyana, 1900

From 1900 to 1905, Gorky's writings became more optimistic. He became more involved in the opposition movement, for which he was again briefly imprisoned in 1901. In 1904, having severed his relationship with the Moscow Art Theatre in the wake of conflict with Vladimir Nemirovich-Danchenko, Gorky returned to Nizhny Novgorod to establish a theatre of his own.[10] Both Konstantin Stanislavski and Savva Morozov provided financial support for the venture.[11] Stanislavski believed that Gorky's theatre was an opportunity to develop the network of provincial theatres which he hoped would reform the art of the stage in Russia, a dream of his since the 1890s.[11] He sent some pupils from the Art Theatre School—as well as Ioasaf Tikhomirov, who ran the school—to work there.[11] By the autumn, however, after the censor had banned every play that the theatre proposed to stage, Gorky abandoned the project.[11]

As a financially successful author, editor, and playwright, Gorky gave financial support to the Russian Social Democratic Labour Party (RSDLP), as well as supporting liberal appeals to the government for civil rights and social reform. The brutal shooting of workers marching to the Tsar with a petition for reform on 9 January 1905 (known as the "Bloody Sunday"), which set in motion the Revolution of 1905, seems to have pushed Gorky more decisively toward radical solutions. He became closely associated with Vladimir Lenin and Alexander Bogdanov's Bolshevik wing of the party, with Bogdanov taking responsibility for the transfer of funds from Gorky to Vpered.[12] It is not clear whether he ever formally joined, and his relations with Lenin and the Bolsheviks would always be rocky. His most influential writings in these years were a series of political plays, most famously The Lower Depths (1902). While briefly imprisoned in Peter and Paul Fortress during the abortive 1905 Russian Revolution, Gorky wrote the play Children of the Sun, nominally set during an 1862 cholera epidemic, but universally understood to relate to present-day events. He was released from the prison after a European-wide campaign, which was supported by Marie Curie, Auguste Rodin and Anatole France, amongst others.[13]

In 1906, the Bolsheviks sent him on a fund-raising trip to the United States with Ivan Narodny. When visiting the Adirondack Mountains, Gorky wrote Мать (Mat', Mother), his notable novel of revolutionary conversion and struggle. His experiences in the United States—which included a scandal over his travelling with his lover (the actress Maria Andreyeva) rather than his wife—deepened his contempt for the "bourgeois soul" but also his admiration for the boldness of the American spirit.[citation needed]

Capri years

In 1909–1911 Gorky lived on the island of Capri in the burgundy-coloured "Villa Behring".

From 1906 to 1913, Gorky lived on the island of Capri in southern Italy, partly for health reasons and partly to escape the increasingly repressive atmosphere in Russia.[2] He continued to support the work of Russian social-democracy, especially the Bolsheviks and invited Anatoly Lunacharsky to stay with him on Capri. The two men had worked together on Literaturny Raspad which appeared in 1908. It was during this period that Gorky, along with Lunacharsky, Bogdanov and Vladimir Bazarov developed the idea of an Encyclopedia of Russian History as a socialist version of Diderot's Encyclopedia. During a visit to Switzerland, Gorky met Lenin, who he charged spent an inordinate amount of his time feuding with other revolutionaries, writing: "He looked awful. Even his tongue seemed to have turned grey".[14] Despite his atheism,[15] Gorky was not a materialist.[16] Most controversially, he articulated, along with a few other maverick Bolsheviks, a philosophy he called "God-Building" (богостроительство, bogostroitel'stvo),[2] which sought to recapture the power of myth for the revolution and to create a religious atheism that placed collective humanity where God had been and was imbued with passion, wonderment, moral certainty, and the promise of deliverance from evil, suffering, and even death. Though 'God-Building' was ridiculed by Lenin, Gorky retained his belief that "culture"—the moral and spiritual awareness of the value and potential of the human self—would be more critical to the revolution's success than political or economic arrangements.

Return from exile

An amnesty granted for the 300th anniversary of the Romanov dynasty allowed Gorky to return to Russia in 1913, where he continued his social criticism, mentored other writers from the common people, and wrote a series of important cultural memoirs, including the first part of his autobiography.[2] On returning to Russia, he wrote that his main impression was that "everyone is so crushed and devoid of God's image." The only solution, he repeatedly declared, was "culture".

After the February Revolution, Gorky visited the headquarters of the Okhrana (secret police) on Kronversky Prospekt together with Nikolai Sukhanov and Vladimir Zenisinov.[17] Gorky described the former Okhrana headquarters, where he sought literary inspiration, as derelict, with windows broken, and papers lying all over the floor.[18] Having dinner with Sukhanov later the same day, Gorky grimly predicated that revolution would end in "Asiatic savagery".[19] Initially a supporter of the Socialist-Revolutionary Alexander Kerensky, Gorky switched over to the Bolsheviks after the Kornilov affair.[20] In July 1917, Gorky wrote his own experiences of the Russian working class had been sufficient to dispel any "notions that Russian workers are the incarnation of spiritual beauty and kindness".[21] Gorky admitted to feeling attracted to Bolshevism, but admitted to concerns about a creed that made the entire working class "sweet and reasonable-I had never known people who were really like this".[22] Gorky wrote that he knew the poor, the "carpenters, stevedores, bricklayers", in a way that the intellectual Lenin never did, and he frankly distrusted them.[22]

During World War I, his apartment in Petrograd was turned into a Bolshevik staff room, and his politics remained close to the Bolsheviks throughout the revolutionary period of 1917. On the day after the Bolshevik coup of 7 November 1917, Gorky observed a gardener working the Alexander Park who had cleared snow during the February Revolution while ignoring the shots in the background, asked people during the July Days not to trample the grass and was now chopping off branches, leading Gorky to write that he was "stubborn as a mole, and apparently as blind as one too".[23] Gorky's relations with the Bolsheviks became strained, however, after the October Revolution. One contemporary remembered at how Gorky would turn "dark and black and grim" at the mere mention of Lenin.[24] Gorky wrote that Lenin together with Trotsky "have become poisoned with the filthy venom of power", crushing the rights of the individual to achieve their revolutionary dreams.[24] Gorky wrote that Lenin was a "cold-blooded trickster who spares neither the honor nor the life of the proletariat. ... He does not know the popular masses, he has not lived with them".[24] Gorky went on to compare Lenin to a chemist experimenting in a laboratory with the only difference being the chemist experimented with inanimate matter to improve life while Lenin was experimenting on the "living flesh of Russia".[24] A further strain on Gorky's relations with the Bolsheviks occurred when his newspaper Novaya Zhizn (Новая Жизнь, "New Life") fell prey to Bolshevik censorship during the ensuing civil war, around which time Gorky published a collection of essays critical of the Bolsheviks called Untimely Thoughts in 1918. (It would not be re-published in Russia until after the collapse of the Soviet Union.) The essays call Lenin a tyrant for his senseless arrests and repression of free discourse, and an anarchist for his conspiratorial tactics; Gorky compares Lenin to both the Tsar and Nechayev.[citation needed]

"Lenin and his associates," Gorky wrote, "consider it possible to commit all kinds of crimes ... the abolition of free speech and senseless arrests."[25]

In 1921, he hired a secretary, Moura Budberg, who later became his unofficial wife. In August 1921, the poet Nikolay Gumilev was arrested by the Petrograd Cheka for his monarchist views. There is a story that Gorky hurried to Moscow, obtained an order to release Gumilev from Lenin personally, but upon his return to Petrograd he found out that Gumilev had already been shot – but Nadezhda Mandelstam, a close friend of Gumilev's widow, Anna Akhmatova wrote that: "It is true that people asked him to intervene. ... Gorky had a strong dislike of Gumilev, but he nevertheless promised to do something. He could not keep his promise because the sentence of death was announced and carried out with unexpected haste, before Gorky had got round to doing anything."[26] In October, Gorky returned to Italy on health grounds: he had tuberculosis.

Povolzhye famine

In July 1921, Gorky published an appeal to the outside world, saying that millions of lives were menaced by crop failure. The Russian famine of 1921–22, also known as Povolzhye famine, killed an estimated 5 million, primarily affecting the Volga and Ural River regions.[27]

Second exile

Gorky left Russia in September 1921, for Berlin. There he heard about the impending Moscow Trial of 12 Socialist Revolutionaries, which hardened his opposition to the Bolshevik regime. He wrote to Anatole France denouncing the trial as a "cynical and public preparation for the murder" of people who had fought for the freedom of the Russian people. He also wrote to the Soviet vice-premier, Alexei Rykov asking him to tell Leon Trotsky that any death sentences carried out on the defendants would be "premeditated and foul murder."[28] This provoked a contemptuous reaction from Lenin, who described Gorky as "always supremely spineless in politics", and Trotsky, who dismissed Gorky as an "artist whom no-one takes seriously."[29] He was denied permission by Italy's fascist government to return to Capri, but was permitted to settle in Sorrento, where he lived from 1922 to 1932, with an extended household that included Moura Budberg, his ex-wife Andreyeva, her lover, Pyotr Kryuchkov, who acted as Gorky's secretary for the remainder of his life, Gorky's son Max Peshkov, Max's wife, Timosha, and their two young daughters.

He wrote several successful books while there,[30] but by 1928 he was having difficulty earning enough to keep his large household, and began to seek an accommodation with the communist regime. The Soviet dictator Joseph Stalin was equally keen to entice Gorky back to the USSR. He paid his first visit in May 1928 – at the very time when the regime was staging its first show trial since 1922, the so-called Shakhty Trial of 53 engineers employed in the coal industry, one of whom, Pyotr Osadchy, had visited Gorky in Sorrento. In contrast to his attitude to the trial of the Socialist Revolutionaries, Gorky accepted without question that the engineers were guilty, and expressed regret that in the past he had intervened on behalf of professionals who were being persecuted by the regime. During the visit, he struck up friendships with Genrikh Yagoda, the corrupt and murderous head of the Ogpu and two other Ogpu officers, Semyon Firin and Matvei Pogrebinsky, who held high office in the Gulag. Pogrebinsky was Gorky's guest in Sorrento for four weeks in 1930. The following year, Yagoda sent his brother-in-law, Leopold Averbakh to Sorrento, with instructions to induce Gorky to return to Russia permanently.[31]

Death of Lenin

After the death of Lenin in 1924, Gorky wrote the following:

Vladimir Lenin, a big, real man of this world, has passed away. His death is a painful blow to all who knew him, a very painful blow! But the black line of death shall only underscore his importance in the eyes of all the world - the importance of the leader of the world’s working people. If the clouds of hatred for him, the clouds of lies and slander woven round him were even denser, it would not matter, for there is no such force as could dim the torch he has raised in the stifling darkness of the world gone mad. Never has there been a man who deserves more to be remembered forever by the whole world. Vladimir Lenin is dead. But those to whom he bequeathed his wisdom and his will are living. They are alive and working more successfully than anyone on Earth has ever worked before.[32]

Return to Russia: last years

Avel Enukidze, Joseph Stalin and Maxim Gorky celebrate 10th anniversary of Sportintern. Red Square, Moscow USSR. Aug 1931

Gorky's return from Fascist Italy was a major propaganda victory for the Soviets. He was decorated with the Order of Lenin and given a mansion (formerly belonging to the millionaire Pavel Ryabushinsky, which was for many years the Gorky Museum) in Moscow and a dacha in the suburbs. The city of Nizhni Novgorod, and the surrounding province were renamed Gorky. Moscow's main park, and one of the central Moscow streets, Tverskaya, were renamed in his honour, as was the Moscow Art Theatre. The largest fixed-wing aircraft in the world in the mid-1930s, the Tupolev ANT-20 was named Maxim Gorky in his honour.

He was also appointed President of the Union of Soviet Writers, founded in 1932, to coincide with his return to the USSR. On 11 October 1931 Gorky read his fairy tale "A Girl and Death" to his visitors Joseph Stalin, Kliment Voroshilov and Vyacheslav Molotov, an event that was later depicted by Viktor Govorov in his painting. On that same day Stalin left his autograph on the last page of this work by Gorky: "Эта штука сильнее чем "Фауст" Гёте (любовь побеждает смерть)"[33] ["This piece is stronger than Goethe's Faust (love defeats death)]".

Apologist for the gulag

In 1933, Gorky co-edited, with Averbakh and Firin, an infamous book about the White Sea-Baltic Canal, presented as an example of "successful rehabilitation of the former enemies of proletariat". For other writers, he urged that one obtained realism by extracting the basic idea from reality, but by adding the potential and desirable to it, one added romanticism with deep revolutionary potential.[34] For himself, Gorky avoided realism. His denials that even a single prisoner died during the construction of the aforementioned canal were refuted by multiple accounts of thousands of prisoners who froze to death not only in the evenings from the lack of adequate shelter and food, but even in the middle of the day.[35]

On his definitive return to the Soviet Union in 1932, Maxim Gorky received the Ryabushinsky Mansion, designed in 1900 by Fyodor Schechtel for the Ryabushinsky family. The mansion today houses a museum about Gorky.

Hostility to gays

Gorky strongly supported efforts in getting a law passed in 1934, making homosexuality a criminal offense. His attitude was coloured by the fact that several leading members of the Nazi Sturmabteilung, or Brownshirts, were overtly homosexual. Writing in Pravda on 23 May 1934, Gorky claimed "exterminate all homosexuals and fascism will vanish."[36]

Conflicts[citation needed] with Stalinists

By the summer of 1934, Gorky was increasingly in conflict with the Soviet authorities. He was angry that Leopold Averbakh, whom he regarded as a protege, was denied a role in the newly created Writers Union, and objected to interference by the Central Committee staff in the affairs of the union. This conflict, which may have been exacerbated by Gorky's despair over the early death of his son, Max, came to a head just before the first Soviet Writers Congress, in August 1934. On 11 August, he submitted an article for publication in Pravda which attacked the deputy head of the press department, Pavel Yudin with such intemperate language that Stalin's deputy, Lazar Kaganovich ordered its suppression, but was forced to relent after hundreds of copies of the article circulated by hand. Gorky's draft of the keynote speech he was due to give at the congress caused such consternation when he submitted it to the Politburo that four of its leading members – Kaganovich, Vyacheslav Molotov, Kliment Voroshilov, and Andrei Zhdanov – were sent to persuade him to make changes.[37] Even in its toned-down version – very unusually for the Stalin era – he did not praise Stalin, did not mention any of the approved writers turning out 'socialist realist' novels, but singled out Fyodor Dostoevsky for "having painted with the most vivid perfection of word portraiture a type of egocentrist, a type of social degenerate in the person of the hero of his Memoirs from Underground. ... Dostoyevsky in the figure of his hero has shown the depths of whining despair that are reached by the individualist from among the young men of the nineteenth and twentieth centuries who are cut off from real life."[38]

Death

With the increase of Stalinist repression and especially after the assassination of Sergei Kirov in December 1934, Gorky was placed under unannounced house arrest in his house near Moscow. His long-serving secretary Pyotr Kryuchkov had been recruited by Yagoda as a paid informer.[39] Before his death from a lingering illness in June 1936, he was visited at home by Stalin, Yagoda, and other leading communists, and by Moura Budberg, who had chosen not to return to the USSR with him but was permitted to stay for his funeral.

The sudden death of Gorky's son Maxim Peshkov in May 1934 was followed by the death of Maxim Gorky himself in June 1936 from pneumonia. Speculation has long surrounded the circumstances of his death. Stalin and Molotov were among those who carried Gorky's coffin during the funeral. During the Bukharin trial in 1938 (one of the three Moscow Trials), one of the charges was that Gorky was killed by Yagoda's NKVD agents.[40]

In Soviet times, before and after his death, the complexities in Gorky's life and outlook were reduced to an iconic image (echoed in heroic pictures and statues dotting the countryside): Gorky as a great Soviet writer who emerged from the common people, a loyal friend of the Bolsheviks, and the founder of the increasingly canonical "socialist realism".

Depictions and adaptations

The Gorky Trilogy is a series of three films based on the three autobiographical books: The Childhood of Maxim Gorky, My Apprenticeship, and My Universities, directed by Mark Donskoy, filmed in the Soviet Union, released 1938–1940. The trilogy was adapted from Gorky's autobiography.[41]

The German modernist Bertolt Brecht based his epic play The Mother (1932) on Gorky's novel of the same name.

Gorky's novel was also adapted for an opera by Valery Zhelobinsky in 1938. In 1912, the Italian composer Giacomo Orefice based his opera Radda on the character of Radda from Makar Chudra. Our Father is the title given to Gorky's The Last Ones in its English translation by William Stancil.

The play[clarification needed] made its New York debut in 1975 at the Manhattan Theater Club, directed by Keith Fowler.

In 1985 Enemies was performed in London with a multi-national cast directed by Ann Pennington in association with Internationalist Theatre. The cast included South African Greek actress Angelique Rockas and Bulgarian Madlena Nedeva playing the parts of Tatiana, and Kleopatra respectively.[42] Tom Vaughan of The Morning Star affirmed "this is a great revolutionary play, by a great revolutionary writer, performed with elegance and style, great passion and commitment".[43] BBC Russian Service was no less complimentary.[44]

Selected works

Main article: Maxim Gorky bibliography

Source: Turner, Lily; Strever, Mark (1946). Orphan Paul; A Bibliography and Chronology of Maxim Gorky. New York: Boni and Gaer. pp. 261–270.

Novels

Goremyka Pavel, 1894. Published in English as Orphan Paul[45]

Foma Gordeyev (Фома Гордеев), 1899. Also translated as The Man Who Was Afraid

Three of Them (Трое), 1900. Also translated as Three Men

The Mother (Мать), 1907. First published in English, in 1906

The Life of a Useless Man (Жизнь ненужного человека), 1908

A Confession (Исповедь), 1908

Okurov City (Городок Окуров), 1908

The Life of Matvei Kozhemyakin (Жизнь Матвея Кожемякина), 1910

The Artamonov Business (Дело Артамоновых), 1927

Life of Klim Samgin (Жизнь Клима Самгина), unfinished:[46]

The Bystander, 1927

The Magnet, 1928

Other Fires, 1930

The Specter, 1936

Novellas

The Orlovs (Супруги Орловы), 1897

Creatures That Once Were Men (Бывшие люди), 1897

Varenka Olesova (Варенька Олесова), 1898

Summer (Лето), 1909

Great Love (Большая любовь), 1911

Short stories

"Makar Chudra" (Макар Чудра), 1892

"Old Izergil" (Старуха Изергиль), 1895

"Chelkash" (Челкаш), 1895

"Konovalov" (Коновалов), 1897

"Malva" (Мальва), 1897

"Twenty-six Men and a Girl" (Двадцать шесть и одна), 1899

"Song of a Falcon" (Песня о Соколе), 1902. Also referred to as a poem in prose

Drama

The Philistines (Мещане), translated also as The Smug Citizens and The Petty Bourgeois (Мещане), 1901

The Lower Depths (На дне), 1902

Summerfolk (Дачники), 1904

Children of the Sun (Дети солнца), 1905

Barbarians (Варвары), 1905

Enemies, 1906.

The Last Ones (Последние), 1908. Translated also as Our Father[47]

Children (Дети), 1910. Translated also as The Reception (and called originally "Встреча")

Queer People (Чудаки), 1910. Translated also as Eccentrics

Vassa Zheleznova (Васса Железнова), 1910, 1935 (revised version)

The Zykovs (Зыковы), 1913

Counterfeit Money (Фальшивая монета), 1913

The Old Man (Старик), 1915, Revised 1922, 1924. Translated also as The Judge

Workaholic Slovotekov (Работяга Словотеков), 1920

Somov and Others (Cомов и другие), 1930

Yegor Bulychov and Others (Егор Булычов и другие), 1932

Dostigayev and Others (Достигаев и другие), 1933

Non-fiction

Chaliapin, articles in Letopis, 1917[48]

Untimely Thoughts, articles, 1918

My Recollections of Tolstoy, 1919

Reminiscences of Tolstoy, Chekhov, and Andreyev, 1920–1928

V.I. Lenin (В.И. Ленин), reminiscence, 1924–1931

The I.V. Stalin White Sea – Baltic Sea Canal, 1934 (editor-in-chief)

Literary Portraits [c.1935].[49]

Poems

"The Song of the Stormy Petrel" (Песня о Буревестнике), 1901

Autobiography

My Childhood (Детство), Part I, 1913–1914

In the World (В людях), Part II, 1916

My Universities (Мои университеты), Part III, 1923

Collections

Sketches and Stories, three volumes, 1898–1899

Creatures That Once Were Men, stories in English translation (1905). This contained an introduction by G. K. Chesterton[50] The Russian title, Бывшие люди (literally "Former people") gained popularity as an expression in reference to people who severely dropped in their social status

Tales of Italy (Сказки об Италии), 1911–1913

Through Russia (По Руси), 1923

Control by Julián Ro Di

5 2

Controlled Chaos Tessellation by stacie

Big hexes and triangles

my inspiration / banawe landscape philippines / my crafts by craftworld phillipines

oktavdsaint.wordpress.com/

www.youtube.com/oktavdsaint

www.youtube.com/sjhon87

i love nature, i love photograph, love arts and crafts.

this is how i love to promote my crafts as a new medium and application in a arts and crafts world,

i love to promote this as a new line in a row

IF YOU LOVE THE FIRST LOOK OF MY CRAFTS

YOU WILL LOVE MOST OFMY COLLECTIONS

FEEL FREE TO EXPLORE MORE ON MY PHOTOSTREAM IN THIS WAY

CRAFT REVOLUTION / MOSAIC APPLICATION IN A PATCHWORK APPROACH, A TRULLY NEW LINE IN A ROW

Doing things like no other before is like walking in another line, why we need to do being different from them, how do we see things in another side? Is this possible to have a new line in a row?

I attend seminars about Quality Control, this seminars tackles the main cause of the real problem is in the organization itself, yes, and is true no need to attend seminar for this, if we know ourselves is our best enemy, but how we need to know more ourselves, our environment dictates us to be being with them, and our mind action accordingly in this way of thinking.

Working in an Export Company for long years as a research and product development officer is not a good job, but paying you a lot sometimes per project, and your Boss saying you always; “our sale will get high after this project out of the market! You can go to vacation after this! Yes vacation after finish the particular project, hmm sound nice, as I said this is not a good job after all. Vacation is also not good in this kind of works. Why I say this. How you can say you are free after your kids out in school and you are watching American idol and praying for the artist you want to be declared as a real winner,

How can we say we are free and in vacation with family and thinking what you can do to be more careful for the kids if all with you, or even if you alone and feel bored and open your pc for something else just to get out of your mind, how?

Being free is acceptance just live with them walk with them and feel with them, my master in this seminar put this thing in our mind , the second things he share to us is everybody need a free space for our self, as a person and different from the other person.

He share to us a line in a bible , I forgot the pages and the verses, but something like this I am not particular in the bible things and thoughts but the messages is clear, you are so special from the other person in your words ,in your thought , in your actions too,

And he shouting to all of us saying hey get out of the box his face look like red and I feel he is angry for what ever reason,

Then he put here things in the bag and walking outside the hall never turn back and go to small coffee table and put some head set on his ear, we all get shock we feel confuse, me I am thinking he get mad to someone , that time the seminar is running up to more hours and this person sitting , look like relax and we are thinking what s wrong , the company paying much for him, and the 2 long hours to wait him , feel more confusing , I see also he snap a bit and his eyes is close for almost 15 minute , and we are so silent , and no body want to talk , hey what’s wrong , I go to the other side of the room and I fall asleep, somebody doing that things and fall asleep too, but the only thing I notice no one get out of the room , we are all waiting for something, boring and everybody no one to talk just the eyes talking that time and our lips add some smile,

Time running and one of the participant decide to talk to all of us and saying we don’t need him in this kind of seminar , he never say anything to us just sip his coffee for long hours and we left nothing to do. and one of my colleagues saying , how can we say it in a nice way, everybody saying something ,suggesting , and one off the participant crumble the papers and want to throw to the master , that moment we are all smile and saying yes do it if you can! But after that no one, want to do that kind of things to his master after all,

Or maybe being polite much better that throwing things as our action for that particular situation and the message is clear , everybody even they have a good actions they don’t want to go out of the box,

New line in a row is a fresh and clear action ,as an artist , as a creator of this particular crafts , I love to share what I have after my long journey , this world is so fast in many particular , technology ,development, high-rise building new phone , everything that we can consider as our home outside our home or a chips on our big pockets , weight less but full of everything what we put inside that chips for our own purposes,

This new craft was born in this particular world of arts but I found out, this craft is out of the line , the material is there , the colors is in there, the meaning is there , the message is there , everything is there , and still I cannot fine the right line for this particular crafts,

I start doing craft on my early age, I still remembering cutting pages of full colored magazine cut in a small piece and paste it, collect all the colored papers and cut and paste it just my start, I love to draw plant animals flowers birds everything about nature, and this track considering of my actions whom I am now, in my own world,

I never finish college, as my root, but I take a fine arts courses in one best school in Philippines (U.S.T. University Of Santo Tomas) Manila the oldest School in Asia the school for Architecture and Fine Arts, that time I feel bless, it because I never dream to get enter in that school, I walk barefooted in my young age, I never dream one day I was in one of the room in there. In my teenage days I was always in a church I am a member of a choir group, but my voice is not good at that time, but I feel important when I am part of this group , our master telling me you are part of this group and your voice is to important to us, I joint also a theater club my master told me , here in our company money is hard to find and the only things I can share to you is how they praise you after the production is done, this group is a community base just for a public information and services, and that’s true I feel different from other person when I joint in this group I have many friends , they all like me as a devil in my characters I always portray , this group give ME more opportunity to explore my space more on the way I never do and think before, or maybe I get out of that box I never notice in this way, or I walk in a new line in a row ,

This group also sent me to college, and I walk out in this group and stop my study up to 2nd years in colleges of course the main reason is money, yes this is my hard times at that moment I need to decide which way I need to walk, to finish or make another way like a new line in a row, I need to force my self to work hard for my daily bread.

New line in a row is a formation of things on how we see and need to act patiently specially in our materials that surround us. Or a CALL on how we make a line in a way we can move perfectly, and this is what I want to share to you,

New line in a row is my greatest achievement, after searching and looking for arts and crafts, i look more books, searching more artist, looking for the master, site in the internet, regarding arts and crafts, and still I never see anything that need to compare on my crafts, but this crafts more on mosaic, patchwork, color pixel in our computer and idea coming from cross stitching, and how it make it different from them,?

Mosaic is a form of arts more on glass and stone or anything that form pattern and pastes it,

Patchwork is a form of arts too start from our old clothes recycled it and form pattern too.

Cross stitching is also form of arts that need to count and have pattern too.

Color pixel normally found in our computer if we want to see or using magnifying glass to see thing clear.

I never research much on this particular meaning (mosaic, patchwork, cross stitching, pixels,) suggestion is always welcome or comment to this particular is will help much,

This kind of words build my composition and remind me, where I start thinking and looking in different way, how can I called my crafts , or where can I place it , I thinking is there a room for me, the answer is YES , I can place it in a galleries of mosaic,

In a patchwork, in pixel room, but not in a wall that hangs cross stitching arts,

But more on more that way, my experiment get more wild and run, colored pixel is always many colors in his single square form, I decide to get out in this category,

I try more research about patchwork , and I see more clear things in this room , the next things I open my mind to the mosaic room and get involved more on more , and I notice a clear picture and help me to categories my craft more in this way.

I draw another line, a new line in a row

After fifteen years searching for the soul of my arts, I try to make room for them, I want to be different from them, I want to be more careful and I want to have a free form from them,

Arts is copying nature I thought, and maybe I think in this way, but copying is like doing things you admire and seeing things that guide us, copying is the only easy way to make us more competitive or maybe more to be exact, new line in a row starting in this way collect the things that have a connection on me make a clear picture and transform in a way I do now,

New line in a row is a form of arts with the relationship to the crafts world,

Arts is different from the crafts, arts is unique form and creation of human no same things have in common with out copying using special tools we have..

Crafts are more on copying have pattern to create more precise and get to perfectly conclusion.

New line in a row is my first step to get out of the box, I never notice for long way before.

New line in a row is a form of CRAFTS after all!

I called this crafts MOSAIC CLOTH IN A PATCHWORK APPROACH

A truly NEW LINE IN A RAW

Only the dead man can make his canvass clear and white

I choice freedom that make my life to be complicated and open for more restriction after all

Oktavdsaint

The author

Additional information about me:

Look what I post in www.flickr.com type oktavdsaint and search

or just log on to youtube type SJHON87 and search

Comments and suggestion is open to help this topic more informative itself

www.youtube.com/oktavdsaint

PINK CAPITAL / MARIKINA CITY, PHILLIPINES

CONTROL TOWER 2 by CML

6 1

The Control Freak by Breville | Commercial

Toasting spices

control room by Daniel Cascaddan

5 7

Brief Control by riffsyphon1024

Médecine non conventionnelle... rebirth, multiples « pratiques énergétiques », diverses psychothérapies telles que la « thérapie primale », l'« analyse bioénergétique »34 ou encore la programmation neurolinguistique by Hughes Songe

Mise en place d'aiguilles au niveau de points d'acupuncture du poignet.

Les médecines non conventionnelles (encore appelées médecines alternatives, médecines parallèles, médecines holistiques, médecines naturelles, médecines douces) regroupent plusieurs centaines de pratiques thérapeutiques dont l'efficacité n'est pas démontrée, c'est-à-dire non testée, non supérieure au placebo, ou bien insuffisamment démontrée1 d'où le qualificatif de pseudo-médecines qui peut leur être appliqué2. Elles se distinguent donc de la médecine fondée sur les faits, parfois dite « conventionnelle », dont l'efficacité est prouvée scientifiquement. En France, le terme de thérapies complémentaires (ThC) est recommandé par l'Académie nationale de médecine3. Le Conseil de l'Ordre des médecins utilise l'expression médecines alternatives et complémentaires (MAC)4 tout en indiquant que « l'utilisation médiatique [de ces termes], concernant notamment l’homéopathie, entretient une ambigüité qui est source de confusion et de litiges d’interprétation5 ».

Un certain nombre de médecines non conventionnelles se réclament de traditions anciennes et sont alors considérées comme médecines traditionnelles (par exemple la phytothérapie, l'acupuncture ou la médecine ayurvédique), mais d'autres sont apparues à la fin du xviiie siècle ou au cours du xixe siècle (comme l'hypnose, l'ostéopathie, l'homéopathie, la naturopathie ou l'oligothérapie). Certaines thérapies se revendiquent comme « holistiques », déclarant examiner l'individu dans sa « globalité », y compris son histoire et mode de vie.

Ces pratiques non conventionnelles sont dénuées de fondement scientifique et ne sauraient se comparer, ni se substituer, à la médecine proprement dite, bien que pouvant être parfois utilisées en complément, en tant que « techniques empiriques » ou « méthodes adjuvantes »3. Elles sont diversement contrôlées par des instances officielles et, selon les pays, leurs traditions et législations sont plus ou moins répandues et reconnues6. Elles se développent en complément ou en alternative à la médecine et sont utilisées par 20 à 50 % des populations de plusieurs pays de la Communauté européenne selon les résultats d'enquêtes d'opinion de la fin du xxe siècle7, voire par près de 4 Français sur 10, en particulier les patients atteints de cancer3. Elles sont parfois utilisées dans des hôpitaux, cela ne valant toutefois pas reconnaissance de leur validité.

Le concept de « médecine intégrative » a été inventé pour désigner le recours simultané à la médecine dont l'efficacité est avérée et aux thérapies alternatives dans la prise en charge d'un patient. Ces dernières n'ont cependant, par définition, pas d'effet bénéfique au-delà de l'effet placebo8,9,10, à très peu d'exceptions près ayant montré une efficacité spécifique mais faible11. Leur action spécifique peut entraîner des effets secondaires12, et elles peuvent avoir des effets négatifs en interférant avec les traitements efficaces, notamment dans le traitement de cancer13,14. Des problèmes peuvent survenir lors du recours à des traitements alternatifs en lieu et place de soins ayant fait leurs preuves d'efficacité, d'autant plus en fonction de la gravité de la maladie.

Des mouvances font l'objet de surveillance de la part des autorités du fait du risque d'escroquerie, d'abus de faiblesse et de dérive sectaire lié à l'utilisation de certaines méthodes, régimes alimentaires et thérapies alternatives : « charlatanisme et amateurisme peuvent avoir des conséquences graves pour des personnes fragilisées physiquement et psychologiquement par des pathologies lourdes et/ou chroniques15 ».

Sommaire

1Origines

1.1Origine de l'appellation

1.2Origines et histoire des médecines regroupées sous cette appellation

1.2.1Influences antiques et orientalistes

1.2.2Fin XVIIe - début XXe siècles

1.2.3Du New Age à l'époque contemporaine (XXe - début XXIe siècles)

2Typologie de pratiques

3Conventionnelle, non conventionnelle, une approche différente

3.1Le naturel et la tradition ancienne

3.2L'interprétation des troubles

3.3Les postulats

4Aspect légal

4.1Union européenne

4.2France

4.2.1Cas de l'herboristerie et de la phytothérapie

4.3Suisse

4.4Allemagne

5Utilisation des médecines non conventionnelles

5.1France

5.2États-Unis

5.3Pays en développement

5.4En Europe

6Pratique des médecines non conventionnelles en France

6.1Par des médecins, en milieu hospitalier

6.2Caractéristiques problématiques de certaines thérapies

7Une économie publique

8Recherches

8.1L'approche scientifique

8.2Relations entre médecins conventionnels et non-conventionnels

9Affaires

10Notes et références

11Voir aussi

11.1Bibliographie

11.2Articles connexes

11.3Liens externes

Origines[modifier | modifier le code]

Origine de l'appellation[modifier | modifier le code]

Le terme « médecine non conventionnelle » est celui retenu par la Commission européenne7 . Ce terme désigne selon le rapport du Parlement européen :

"L'ensemble des systèmes médicaux et disciplines thérapeutiques couverts par la dénomination "médecines non conventionnelles" ont en commun le fait que leur validité n'est pas reconnue ou n'est que partiellement reconnue".

L'appellation « médecine non conventionnelle » se bâtit aussi par opposition à la définition de la « médecine conventionnelle », une médecine à l'efficacité prouvée, telle que définie par le Ministère des Solidarités et de la Santé16 :

« La médecine « conventionnelle » s’appuie sur des traitements qui ont toujours obtenu une validation scientifique, soit par des essais cliniques, soit parce qu’ils bénéficient d’un consensus professionnel fort. Les essais cliniques sont soumis à des autorisations et à des contrôles rigoureux sur le plan de l’éthique, des conditions de réalisation et de la pertinence scientifique . Les consensus professionnels, quant à eux, sont obtenus après plusieurs années de recul, avec l’accord et l’expérience de la majorité des professionnels de la discipline concernée. Les conditions d’utilisation des techniques y sont définies avec précision. En s’appuyant sur cette méthodologie rigoureuse, l’efficacité de la médecine conventionnelle est prouvée. »

Ce terme qualifie donc des méthodes de soin parfois également appelées « médecine douce », « médecine complémentaire », « médecine naturelle », « médecine alternative », « médecine parallèle » ou encore « médecine holistique ». La médecine conventionnelle est généralement désignée par les tenants de certaines médecines non conventionnelles sous le terme de médecine allopathique (terme provenant de l'homéopathie).

L'Organisation mondiale de la santé (OMS) inclut les médecines complémentaires et alternatives dans les médecines traditionnelles. Elle précise : « Le terme « médecine complémentaire » ou « médecine alternative » est utilisé de manière interchangeable avec « médecine traditionnelle » dans certains pays. Elles concernent une large gamme de pratiques de soins qui ne font pas partie des traditions du pays et qui ne sont pas intégrées dans le système de santé dominant17. »

Cependant, le choix des termes induit souvent des partis-pris. En effet, parler de « médecine parallèle » semble signifier qu’il y aurait deux conceptions équivalentes de la médecine impliquant deux systèmes de soins fonctionnant indépendamment l’un de l’autre, avec le même degré d’efficience et de scientificité : les patients auraient donc le choix entre deux thérapeutiques qu’ils peuvent envisager comme alternatives et concurrentes ou comme complémentaires l’une de l’autre. D'autre part, l’appellation « médecine douce » semble considérer comme agressives les pratiques de la médecine conventionnelle : selon Jean Brissonet « l’utilisation de l’adjectif « douce » n’étant là que pour faire paraître « dure » la médecine moderne. En fait une technique médicale n’est ni « dure », ni « douce », elle est, ou n’est pas, efficace. Ensuite, tout est question d’utilisation et de rapport efficacité/risque. »18. L'idée de « médecine naturelle » s'appuie sur un présupposé rousseauiste selon lequel la nature est bonne et les œuvres de l'Homme mauvaises, et que certaines méthodes thérapeutiques seraient plus proches de cette supposée harmonie naturelle18. En disant « médecine alternative », on envisage ces pratiques de soins comme substitutives, donc susceptibles de remplacer une démarche thérapeutique classique et conventionnelle. D'autres préféreront parler de pseudo-médecines ou pseudo-sciences afin d'éviter cet effet de rhétorique2.

Le terme « médecine complémentaire » privilégie l’idée d’associer des traitements impliquant des « philosophies thérapeutiques » différentes mais capables de coopérer dans l’intérêt du malade19,20.

L'Académie nationale de médecine française recommande dans un rapport de 2013 l'appellation « thérapies complémentaires » (« ThC ») : « L’ANM rappelle que les pratiques souvent dites médecines complémentaires ne sont pas des "médecines", mais des techniques empiriques de traitement pouvant rendre certains services en complément de la thérapeutique à base scientifique de la médecine proprement dite. Elle recommande de ce fait de les désigner par la dénomination de thérapies complémentaires, qui correspond mieux à leur nature3. »

Dans tous les cas, ces appellations regroupent un grand nombre de pratiques aux fondements scientifiques très variables, et rarement contrôlées par des instances officielles. La liste du MeSH comporte ainsi 17 catégories de thérapies complémentaires et la MIVILUDES dénombre 400 pratiques « à visée thérapeutique »3. Certaines d'entre elles sont étroitement surveillées par les pouvoirs publics en raison des éventuels dangers qu'elles présentent pour la santé ou du risque de dérive sectaire21.

Origines et histoire des médecines regroupées sous cette appellation[modifier | modifier le code]

Influences antiques et orientalistes[modifier | modifier le code]

Article détaillé : Histoire de la médecine.

L'Occident a été marqué pendant plusieurs siècles par la théorie des humeurs d'Hippocrate, qui reste considéré comme le « père de la médecine occidentale » aujourd'hui22. Un parallèle notable peut être fait entre la médecine européenne de l'époque médiévale et les systèmes de la médecine traditionnelle chinoise et d'ayurveda en Inde : des parties du corps et organes sont de façon similaire associés à des saisons, des signes astrologiques, ou des éléments23. Ces théories ont fait leur réapparition dans un certain nombre de pratiques paramédicales depuis le xixe siècle, et font l'objet d'un effet de mode dans certains milieux.

Un certain nombre de pratiques non conventionnelles disponibles en Europe déclarent aujourd'hui s'inspirer plus ou moins directement de traditions asiatiques antiques (chinoises, indiennes, tibétaines, etc.) ou parfois africaines ou amérindiennes, et se réclament des philosophies et cultures de ces pays. Leur promotion peut alors reposer sur l'argument fallacieux de l'« appel à la tradition » ou « argument d'historicité » qui prétend que comme ces pratiques existent depuis longtemps, elles on fait leur preuve et sont toujours valables aujourd'hui24.

Certains utilisent le terme « médecine occidentale » pour qualifier la médecine moderne, même si celle-ci a en réalité puisé à des sources extrêmement diverses pendant sa longue histoire, et pas uniquement occidentale (notamment égyptiennes et arabes). Par ailleurs, la plupart des asiatiques qui y ont accès ont largement recours à la médecine moderne, et des chercheurs de tous les pays contribuent aujourd'hui au progrès de la médecine mondiale : les notions de médecine « occidentale » ou « orientale » comme leur fixité dans le temps (les « traditions » évoluent) ne reflètent donc pas, pour certains auteurs, l'importante diversité interne des différentes traditions historiques des pays invoqués25.

Fin XVIIe - début XXe siècles[modifier | modifier le code]

À la fin du xviie siècle, la moxibustion fait son apparition en Europe, ses vertus étant vantées par des auteurs tels que Hermann Busschof (de) et Willem ten Rhijne (en) pour lutter contre la goutte26. L'acupuncture est également expliquée aux Européens par Willem ten Rhijne suite à ses observations au Japon sur des praticiens et des documents. Le naturaliste Engelbert Kaempfer étudiera de même ces deux thérapies, en constatant lui aussi leurs effets apparents, mais avec un regard beaucoup plus critique concernant la théorie des méridiens sur laquelle elles reposent27. L'historienne Roberta Bivins remarque que cette intégration de thérapies traditionnelles chinoises en dehors de leur cadre culturel d'origine aurait pu sembler improbable, pourtant elles sont encore utilisées aujourd'hui en Occident28.

Deux pseudo-médecines datant de la fin du xviiie siècle, l'homéopathie et le mesmérisme, particulièrement populaires au xixe siècle, sont des exemples de thérapies qui reposent sur la seule expérience subjective comme preuve d'efficacité29.

Malgré des appels récurrents à des héritages millénaires, la plupart des pratiques non conventionnelles qui subsistent de nos jours trouvent en fait leur origine dans des théories occidentales relativement récentes. Par exemple, la naturopathie naît en Allemagne en 1885, et se développe avec la mode de la lebensreform germanique du xixe siècle, qui sert de tribune à de nombreuses théories alternatives auparavant plus ou moins confidentielles ou expérimentales, qui voient le jour en Occident entre la fin du XIXe et le début du xxe siècle : ostéopathie (USA, 1874), chiropratique (USA, 1895), aromathérapie (France, 1910), médecine anthroposophique (Allemagne, années 1920), élixirs floraux de Bach (Angleterre, 1936)... Certaines para-médecines asiatiques populaires en Occident datent de la même époque, notamment au Japon avec le shiatsu (élaboré en 1919 par Tenpeki Tamai) ou le reiki (développé par l'homme d'affaires japonais Mikao Usui à partir de 1922).

La plupart des systèmes médicaux qui étaient encore utilisés au xixe siècle ne survivent pas à l'essor de la médecine scientifique moderne qui débute à la fin du xixe siècle pour s'industrialiser au xxe siècle30. Cependant, un certain nombre ont eu le temps de pénétrer les États-Unis, pays encore très arriéré sur le plan médical31, et où médecines archaïques et charlatans prospèrent : c'est là que naissent la chiropratique et l'ostéopathie, et que la naturopathie connait un second essor (et devient rapidement une marque déposée, par l'homme d'affaires d'origine allemande Benedict Lust). En 1910, la Fondation Carnegie pour la promotion de l'enseignement mandate un vaste audit des pratiques de santé aux États-Unis, condensé dans le Rapport Abraham Flexner31 : celui-ci est accablant, et met en évidence l'énorme écart de santé entre les Américains encore essentiellement sous l'emprise d'une médecine pré-scientifique et les Européens qui commençaient à bénéficier à cette époque de nombreux médicaments modernes (comme la pénicilline), permettant de réduire drastiquement la plupart des maladies et la mortalité. Les progrès fulgurants de la médecine moderne importée d'Europe conduisent donc progressivement les Américains de l'Est à délaisser une partie de leurs pratiques hasardeuses, même si celles-ci perdurent dans l'ouest et sur la côte pacifique.

En Allemagne, un certain nombre de pratiques alternatives reconquièrent pendant les années 1920-30 une partie du public germanique à la faveur de la vogue post-romantique et anti-scientifique, préparée par l'idéologie de la lebensreform et l'ésotérisme théosophique, culminant dans les divers courants mystiques en vogue à cette époque comme l'anthroposophie de Rudolf Steiner qui développe une médecine anthroposophique. Mettant fin à la « liberté de soigner » (kurierfreiheit) alors en vigueur depuis 1871 et permettant à toute personne de prodiguer des soins médicaux sans formation particulière, l'Allemagne nazie est le premier État européen à institutionnaliser la pratique de médecines non-scientifiques à travers une loi de 1939 (Heilpraktikergesetz (de)) qui institue la profession de « heilpraktiker »32,33. Après-guerre, naturopathie et homéopathie demeurent populaires en Suisse et en Bavière, et s'installent progressivement en Angleterre et en France, avec tout un cortège de théories associées.

Du New Age à l'époque contemporaine (XXe - début XXIe siècles)[modifier | modifier le code]

Une seconde vague de création de théories alternatives a lieu aux États-Unis eu lieu à partir des années 1960, en se diffusant par la côte Ouest sous l'impulsion du mouvement New Age : rebirth, multiples « pratiques énergétiques », diverses psychothérapies telles que la « thérapie primale », l'« analyse bioénergétique »34 ou encore la programmation neurolinguistique (PNL). De très nombreuses pratiques nouvelles prolifèrent ainsi, malgré des critiques toujours constantes de la part des institutions médicales face à l'absence d'effet démontré pour la plupart des soins proposés35. En 1968, un rapport du Département de la Santé et des Services sociaux des États-Unis dénonce ainsi l'absence de fondements empiriques comme théoriques de la plupart des théories alternatives alors en vogue en Amérique, ainsi que leur absence d'efficacité clinique, et invite à leur éviction des systèmes de sécurité sociale36.

Seule une partie de ces théories survit aux années 1980, qui voit aussi passer une mode des thérapies à prétention high-tech (comme la soi-disant « médecine quantique »), ainsi que l'essor des régimes pseudo-thérapeutiques et du coaching en « développement personnel », à grand renfort de marketing.

Au début du xxie siècle, on constate en Occident une structuration de l'offre autour, d'une part, d'un certain nombre de disciplines assez populaires (homéopathie, ostéopathie, acuponcture, etc.) et en quête de respectabilité institutionnelle (création d'écoles, de diplômes, de certification, utilisation dans les hôpitaux en tant que « thérapie complémentaire »3), souvent soutenues par un appareil industriel très lucratif37 malgré l'absence de résultats cliniques réellement satisfaisants, et d'autre part d'une prolifération de sous-disciplines plus ou moins ésotériques souvent fondées sur une opposition dogmatique à la médecine scientifique, et de plus en plus liées à la mouvance complotiste (notamment autour de la controverse sur la vaccination) ou à diverses dérives sectaires21. Entre les deux, on trouve une grande diversité de pratiques thérapeutiques plus ou moins bien identifiées, et à durée d’existence souvent courte car fondée essentiellement sur le charisme de leur promoteur, qui donne parfois son nom à la discipline (comme la « technique Alexander », la « méthode Vodder » ou encore la sophrologie caycédienne d'Alfonso Caycedo)38.

Typologie de pratiques[modifier | modifier le code]

Plus de 400 pratiques thérapeutiques « alternatives », « complémentaires » ou « traditionnelles » sont recensées par l’OMS4.

L’OMS et l’Inserm distinguent quatre familles de pratiques4 :

Les thérapies biologiques, utilisant des produits naturels issus de plantes, de minéraux ou d’animaux (ex : phytothérapie, aromathérapie).

Les thérapies manuelles (ex : ostéopathie, chiropraxie, réflexologie).

Les approches corps-esprit (ex : hypnose médicale, méditation, sophrologie).

Les systèmes reposant sur des fondements théoriques propres (ex : acupuncture, homéopathie).

Conventionnelle, non conventionnelle, une approche différente[modifier | modifier le code]

Le naturel et la tradition ancienne[modifier | modifier le code]

Il existe deux principes fréquemment mis en avant par les promoteurs des médecines non conventionnelles et qui feraient la différence avec la médecine conventionnelle :

le recours à la « Nature », la référence au naturel ; le fait qu’une substance est « naturelle » serait un gage de qualité. Cependant les catastrophes naturelles, les maladies, les champignons vénéneux et la plupart des toxines sont également naturels, et pas bienfaisants pour autant. De fait, de nombreux médicaments ont pour principe actif des molécules extraites des plantes ou d'autres organismes, simplement isolés, purifiés et plus ou moins concentrés (l'aspirine en est un exemple)18. Inversement, la notion de « médecine naturelle » (conçue comme traitement basé sur l'utilisation d'un organisme tel quel, comme une plante) a des limites thérapeutiques, la substance active étant, soit diluée parmi les autres composés parfois toxiques ou inhibiteurs, soit présente à des concentrations non thérapeutiques, c'est-à-dire toxiques ou insuffisantes pour entraîner un bénéfice pour le patient ;

la référence à la « tradition » ; il s'agit principalement des traditions attribuées à plus ou moins juste titre à l'Asie (Chine, Inde, Tibet...), à l'Afrique ou à l'Amérique latine, liées aux philosophies et aux cultures de ces pays et dont l'ancienneté annoncée serait garante d'efficacité (voir tradipraticien, médecine traditionnelle). Le journaliste scientifique Florian Gouthière rappelle toutefois que « l’ancienneté d’une pratique n’est jamais une preuve, en soi, de sa validité »39, et qu'il peut y avoir une fixation à des principes pseudo-scientifiques comme la théorie des méridiens dans le cas de l'acuponcture, laquelle a d'ailleurs connu un siècle de désuétude, au xixe siècle, face au progrès de la dissection, avant d'être « ressuscitée » au xxe siècle (dans un but politique et patriotique)39.

L'interprétation des troubles[modifier | modifier le code]

Les thérapies non conventionnelles et la médecine classique diffèrent sur l'interprétation des troubles. Par exemple, la naturopathie élabore les concepts de détoxication/détoxination (les toxines en question n'étant pas toujours spécifiées), alors que ceux-ci n'ont pas de définition en médecine classique40. D'autres parleront en termes de karma, d'« énergie » ou encore d'humeurs, se plaçant donc dans un cadre conceptuel sans fondement scientifique.

Les postulats[modifier | modifier le code]

Cette section est vide, insuffisamment détaillée ou incomplète. Votre aide est la bienvenue ! Comment faire ?

Les médecines non conventionnelles reposent sur certains postulats :

les médecines énergétiques (acupuncture, qi gong, shiatsu…) partent du principe que l'être humain possède un influx vital (prana en indien, ki en japonais ou qi en chinois) qui peut circuler de manière harmonieuse, la maladie étant une perturbation de cette harmonie qu'il convient de ré-équilibrer ;

l'homéopathie est fondée sur des principes selon lesquels :

le mal provient d'un problème inhérent à la personne[réf. nécessaire], le « terrain » est ce qui assure la guérison, et c'est ce terrain qu'il faut traiter,

le traitement se fait selon le principe de similitude : on administre une substance réputée provoquer un symptôme pour soigner ledit symptôme,

plus un produit est dilué et « dynamisé » (secoué vigoureusement) plus il est actif,

l'ostéopathie part du principe que le trouble provient d'un blocage des structures anatomiques entre elles, d'un mauvais fonctionnement « mécanique ». Elle se fonde sur quatre principes : la structure gouverne la fonction, la fonction modèle la structure, l'unité du corps, et l'artère est suprême.

la balnéothérapie postule les bienfaits de l'eau et des bains, méthode à rapprocher du thermalisme.

D'autres font appel à des théories pré-scientifiques comme la théorie des humeurs, ou à des principes plus ou moins occultes (comme le Karma).

Aspect légal[modifier | modifier le code]

Circle-icons-globe.svg

Cette section adopte un point de vue régional ou culturel particulier et doit être internationalisée (septembre 2017).

Selon les pays, les médecines non conventionnelles sont reconnues ou seulement tolérées41. Certains pays exigent toutefois un titre médical ou paramédical pour la pratique de certaines approches.

Union européenne[modifier | modifier le code]

Selon la Commission des questions sociales, de la santé et de la famille du Conseil de l’Europe :

« Les médecines alternatives sont devenues à présent de véritables industries. Dès lors, des abus et des dérives sont possibles, certains étant toujours tentés, par goût du pouvoir ou esprit de lucre, d’utiliser ces médecines à des fins détournées. Il existe donc des risques certains de voir ces médecines exploitées par des charlatans, des groupes sectaires etc…, tous voyant en elles un profit immédiat.

Pour les sectes, la santé est un thème porteur : elles s ’en servent pour attirer de nouveaux adeptes, et sont tentées d’utiliser ces médecines parallèles pour couper les adeptes du monde médical extérieur à la secte. Dans la mesure où elles prônent l’inutilité de la médecine traditionnelle et la nécessité d’arrêter tout traitement, y compris dans le cas de maladies graves comme le cancer et le SIDA, les dangers sont considérables pour les individus. Les médias se sont fait l’écho de plusieurs cas d’adeptes atteints de cancer et décédés après avoir abandonné toute thérapie37. »

France[modifier | modifier le code]

La commission Nicolas de 2002 a permis la reconnaissance de l'acupuncture et de l'homéopathie comme des pratiques médicales légales. Le titre professionnel d'ostéopathe a lui été reconnu, de même que celui de chiropracteur, par la loi du 4 mars 200242. Cependant, ces reconnaissances de titres professionnels ne sont pas pour autant des validations de ces théories, et l'Académie de Médecine considère que « l’insertion des ThC [thérapies complémentaires, en l'occurrence pour ce document l'acupuncture, l'hypnose, l'ostéopathie et le tai-chi] dans les soins dispensés par les hôpitaux, notamment les CHU, semble présenter un réel intérêt si elle est comprise non comme une reconnaissance et une valorisation de ces méthodes, mais comme un moyen de préciser leurs effets, de clarifier leurs indications et d’établir de bonnes règles pour leur utilisation3. ». De ce fait, un certain nombre de ces pratiques thérapeutiques se sont ajoutées à la liste des médecines à exercice particulier, pratiquées à titre subsidiaire par des médecins généralistes, mais non reconnues par la Sécurité sociale. Parmi celles-ci, nous pouvons notamment compter l'acupuncture, l'homéopathie, la médecine gériatrique ou la nutrition.

Selon l'article 39 du code de déontologie médicale et l'article R4127-39 du code de la santé publique43 : « Les médecins ne peuvent proposer aux malades ou à leur entourage comme salutaire ou sans danger un remède ou un procédé illusoire ou insuffisamment éprouvé. Toute pratique de charlatanerie est interdite44 ». Le code de déontologie et le code de santé publique impliquent de potentielles sanctions ordinales comme pénales pour la pratique de méthodes insuffisamment éprouvées, même si certaines pratiques alternatives sans risque restent de fait tolérées.

Selon la Question Parlementaire no 11662 intitulée « Médecines douces et risques de dérives sectaires »45 : « Le ministère rappelle que les pratiques dites de « médecines douces », si elles ne sont pas exercées par des membres du corps médical, doivent strictement rester dans le champ du bien-être et de la détente. Tout acte à visée diagnostique ou thérapeutique ne peut être pratiqué que par les membres du corps médical. »

Cas de l'herboristerie et de la phytothérapie[modifier | modifier le code]

En raison de l'existence de composants actifs potentiellement dangereux dans de nombreuses plantes, l'usage des plantes médicinales est très réglementé en France46. « En France, les médicaments à base de plantes sont dispensés exclusivement dans les officines pharmaceutiques du fait de l’existence du monopole pharmaceutique. Il existe toutefois une possibilité de laisser certains de ces médicaments en libre accès pour les clients ; le libre accès est limité à certaines spécialités pharmaceutiques ayant des indications thérapeutiques bien précises définies par décret. [...] Certaines plantes très actives, donc potentiellement toxiques, sont inscrites sur l’une des listes (I ou II) des substances vénéneuses et ne peuvent de ce fait être délivrées en pharmacie que sur prescription médicale47. » Les plantes sont donc à utiliser avec précaution : une huile essentielle peut contenir jusqu'à 2 000 principes actifs48. Un certain nombre de ces principes actifs possèdent des propriétés médicalement intéressantes, mais leur usage doit être contrôlé car comme pour toute substance ayant un effet sur le métabolisme, un mauvais dosage ou une mauvaise utilisation peuvent avoir des effets indésirables graves. Il est donc important de respecter la posologie et la durée de la prise, et d'être encadré si possible par un spécialiste diplômé. Ainsi, le millepertuis, le ginkgo ou le pamplemousse peuvent provoquer une diminution ou une augmentation de l’effet thérapeutique d’autres médicaments par interaction médicamenteuse. De même, l’absinthe ou le thuya peuvent être toxiques pour le système nerveux : c’est pourquoi en France certaines huiles essentielles ne peuvent être délivrées que par un pharmacien49.

Un régime dérogatoire est prévu pour les herboristes, et près d’un tiers des plantes médicinales inscrites à la pharmacopée, jugées sans risque à dosage raisonnable, a été libéralisé en 200850.

La plupart des médicaments de phytothérapie sont disponibles sans ordonnance en France mais ils peuvent aussi être prescrits47.

Suisse[modifier | modifier le code]

La Suisse a décidé, en juillet 1999, d’intégrer à l’essai cinq nouvelles médecines parallèles (après le succès de la chiropratique) dans le remboursement de l’assurance maladie obligatoire : l’homéopathie, la thérapie neurale, la phytothérapie, la médecine anthroposophique et la médecine traditionnelle chinoise. Après évaluation, ces médecines se sont avérées inefficaces et l’essai a été stoppé en juin 200551,52. En outre, l’usage de ces médecines ne réduisait pas la consommation des autres médecines. Ainsi, le 3 juin 2005, Pascal Couchepin (Conseiller fédéral) a donc décidé d’exclure ces méthodes de l’assurance de base. Selon l’ATS — Le Temps53, « il n’a pas été suffisamment prouvé que les cinq méthodes complémentaires satisfaisaient aux critères d’économicité, mais surtout d’efficacité et d’adéquation selon la loi sur l’assurance maladie (LAMal). »

Après une interruption du remboursement en juin 200551, il a été décidé de recommencer à rembourser temporairement ces médecines complémentaires à partir de 2012, pour une période d'essai de 5 ans54. La proposition d'inscrire la « prise en compte des médecines complémentaires » dans la Constitution a en outre été acceptée par 67 % des votants lors de la votation populaire du 17 mai 200955.

Par décision du Conseil fédéral du 16 juin 2017, les prestations médicales de la médecine anthroposophique, de l'homéopathie classique, de la médecine traditionnelle chinoise, de la phytothérapie et de l'acupuncture devaient être définitivement remboursées par l’assurance maladie de base à partir du 1er août 2017. Les nouvelles dispositions mettent ainsi sur un pied d’égalité les médecines complémentaires administrées par des médecins avec les autres disciplines médicales conventionnelles. Par cette décision, le gouvernement reconnaît que la médecine complémentaire remplit les exigences légales, notamment celles de l’article 32 de la loi sur l’assurance-maladie qui « permet de rembourser uniquement des prestations efficaces, appropriées et économiques ». Les prestations controversées et/ou nouvelles seront examinées sur demande, en cas de problème ou de doute, par une Commission fédérale des prestations générales et des principes (CFPP)56,57.

Allemagne[modifier | modifier le code]

Article détaillé : Heilpraktiker.

En Allemagne et dans certains cantons suisses existe depuis 1939 un statut officiel de « Heilpraktiker », regroupant les praticiens de diverses écoles alternatives sélectionnés sur la base d'un examen d'admission (essentiellement utilisé par des naturopathes et certains psychanalystes d'écoles marginales).

Utilisation des médecines non conventionnelles[modifier | modifier le code]

France[modifier | modifier le code]

Il existe peu de statistiques sur l'usage de ces médecines par la population. Un sondage SOFRES en 1985, CSA en 1988, une enquête chez des personnes hospitalisées en 1993, une étude réalisée par le CREDES en 1997 et les chiffres du rapport de l’OMS en 2002 sur la médecine traditionnelle sont les points de référence pour cette question58. Les résultats sont fluctuants, l’OMS donne un taux de 75 % et de 49 % dans le même rapport, mais il est généralement avancé que la moitié de la population française a recours à une médecine non conventionnelle et que les femmes sont les plus nombreuses à les utiliser.

La revue Science et Vie de janvier 2015 montre que « la mesure scientifique de l’efficacité des médecines alternatives se heurte à de nombreuses difficultés que la multiplication des études ne parvient pas vraiment à résoudre. Mais cette incertitude scientifique ne semble nullement entamer la confiance des français envers ces thérapies. Ainsi, 40 % d’entre eux y font appel et 78 % les jugent efficaces lorsqu’elles sont utilisées en prévention et 72 % estiment que, même dans le cas du cancer, les médecines complémentaires sont importantes en plus des traitement médicaux classiques59. »

L'Académie de médecine française a publié en 2013 un rapport intitulé « Thérapies complémentaires - acupuncture, hypnose, ostéopathie, tai-chi - leur place parmi les ressources de soin »3. Ce rapport, qui se fonde sur une synthèse de la bibliographie disponible sur le sujet, constate que « l’intérêt qui leur est porté dont témoigne le grand nombre de publications qui leur sont relatives, la croissance en nombre dans notre pays des projets de recherche clinique les concernant, et les connaissances en neurobiologie qui permettent d’en approcher le mécanisme obligent à les considérer avec sérieux, quand bien même leur efficacité n’est évoquée que dans un nombre limité de situations et fondée sur un niveau de preuve insuffisant. Cela ne justifie pas pour autant l'engouement probablement excessif du public en leur faveur. Ces pratiques doivent rester à leur juste place : celle de méthodes adjuvantes pouvant compléter les moyens de la médecine. »

La Mission interministérielle de vigilance et de lutte contre les dérives sectaires (MIVILUDES) a mis gratuitement à disposition dans son Guide santé et dérives sectaires21 une fiche intitulée « Comment reconnaître un charlatan ou un pseudo thérapeute sectaire ? ». Parmi les principaux traits récurrents qui définissent un pseudo-thérapeute, la mission note le dénigrement systématique de la médecine conventionnelle, la promesse d'une guérison miracle, la mise en valeur de bienfaits impossibles à évaluer ou mesurer (en termes de karma, d'aura, d'énergétique, etc.), la promesse d'une prise en charge globale (prétention holiste) agissant autant sur le corps que l'esprit voire l'âme, et l'utilisation d'un vocabulaire technique opaque (« ondes cosmiques, cycles lunaires, dimension vibratoire, purification, énergies, cosmos, conscience... »).

Le médecin et criminologue Jean-Marie Abgrall est l'auteur de plusieurs enquêtes sur le sujet (comme La mécanique des sectes en 1996 ou Les Charlatans de la santé en 1998). Il décrit ainsi le phénomène :

« Profitant de l’attirance grandissante du public pour les thérapies alternatives et les médecines douces, les groupes les plus divers investissent, depuis plusieurs décennies mais plus encore aujourd’hui dans des proportions inquiétantes, le domaine de la santé et du bien-être par une multitude d’offres de soins et d’accompagnement au développement personnel, assorties de promesses de guérison et de vie harmonieuse ici-bas et même au-delà.

Ce succès génère des risques divers, depuis l’escroquerie pure et simple jusqu’à la dérive « thérapeutique », voire sectaire au sens des critères retenus par les pouvoirs publics60. »

En mars 2018, 124 médecins et professionnels de santé publient un appel « contre les « médecines alternatives » qu'ils qualifient de « fake médecine » (« fausse médecine ») mettant en garde contre le risque d'arnaque, de charlatanerie et de dérive sectaire, et dénonçant le manque d'éthique des personnes proposant des soins dont l'efficacité n'est pas prouvée. Ils demandent l'exclusion de ces disciplines du champ médical, face au constat d'un entrisme de plus en plus prononcé61,62. Le philosophe Roger-Pol Droit indique en conclusion d'une analyse sur le sujet :

« En fait, derrière le débat « vraie médecine » contre « fausses médecines », plus de questions se profilent qu'on ne le voit d'abord. Il se pourrait qu'il indique un symptôme majeur de la crise contemporaine de la pratique médicale. Décider si la médecine est une science ou un art est une question qui traverse les siècles. Oublier qu'elle doit être les deux est un trait du nôtre63. »

États-Unis[modifier | modifier le code]

Aux États-Unis, cinquante-sept pour cent des femmes atteintes de cancer du sein auraient recours aux médecines non conventionnelles et plus la personne se sent malade plus elle aurait tendance à multiplier ces traitements. À côté des traitements biologiques (fortifiants), les méthodes les plus habituelles sont les thérapies de relaxation tête et corps, les cassettes de musique ou de vidéo64.

Toujours dans le cadre du cancer du sein, des études préliminaires portent sur la classique Grande Camomille de nos grands-mères dont une substance, le parthénolide, permettrait in vivo la lutte contre la résistance des cellules au tamoxifène65.

En 2008 l'American Hospital Association (en) faisait état de 37 % des hôpitaux qui rendent disponible l'utilisation de thérapies alternatives et complémentaires. Bien qu'appréciées de certains patients, ces pratiques ne sont pas toujours bien accueillies par les médecins dans les hôpitaux66.

Une étude clinique de 2017 a pointé que dans le cadre de cancers traitables, le recours aux médecines non conventionnelles (« alternative medicines ») sans aucun traitement conventionnel du cancer (« conventional cancer treatment ») diminuait drastiquement les chances de survies. Ce cas de figure reste cependant rare67.

Pays en développement[modifier | modifier le code]

Selon l'OMS : « Jusqu’à 80 % des populations des pays en développement s’en remettent à la médecine traditionnelle pour les soins de santé primaires, par tradition culturelle ou faute d’autres alternatives68. »

En Europe[modifier | modifier le code]

Une revue systématique publiée en 2018 a identifié les facteurs prédictifs qui font que les personnes issues de la population générale en Europe se tournent vers les médecines alternatives et complémentaires69. Les facteurs prédictifs de recours à des praticiens de ces médecines sont le fait d'être de sexe féminin et le fait de reporter être atteint d'une maladie chronique. Le statut marital n'est cependant pas un facteur prédictif. Le fait d'être de sexe féminin est aussi un facteur prédictif du recours à des produits issus des médecines alternatives et complémentaires. Les auteurs concluent cependant que ces facteurs prédictifs ne sont pas différents de ceux concernant le recours à des praticiens de santé plus conventionnels.

Pratique des médecines non conventionnelles en France[modifier | modifier le code]

Par des médecins, en milieu hospitalier[modifier | modifier le code]

Le serment d'Hippocrate réactualisé indique que le médecin doit respecter « toutes les personnes […] sans aucune discrimination selon leur état ou leurs convictions70. » Pour autant, l'utilisation d'une médecine non-conventionnelle par un médecin, éventuellement au sein d'un hôpital, n'est pas une forme de validation de la méthode. D'un point de vue juridique, les médecins ne doivent pas divulguer dans les milieux médicaux un procédé nouveau de diagnostic ou de traitement insuffisamment éprouvé sans accompagner leur communication des réserves qui s'imposent. Ils ne doivent pas faire une telle divulgation dans le public non médical71. Les médecins ne peuvent proposer aux malades ou à leur entourage comme salutaire ou sans danger un remède ou un procédé illusoire ou insuffisamment éprouvé. Toute pratique de charlatanisme est interdite43. D'un point de vue pragmatique, tant que la méthode apporte bien-être et réconfort au patient, le médecin peut parfois l'utiliser même s'il est convaincu que l'effet n'est que placebo (la médecine conventionnelle utilise d'ailleurs fréquemment des placebos). Dans le même ordre d'idées, la présence de lieux de prière et d'aumôneries au sein d'un hôpital n'indique pas que le personnel soignant soit croyant, mais qu'il respecte la croyance des patients et accepte de mettre en œuvre tout ce qui n'est pas néfaste et apporte du réconfort.

Certains professionnels de santé médicaux (médecin, sage-femme) et paramédicaux (infirmier, kinésithérapeute, etc.) ont parfois recours à des pratiques non conventionnelles en milieu hospitalier3. Mais ces pratiques peuvent aussi être proposées par des personnes qui ne sont ni médecins ni paramédicaux. Certains praticiens ne peuvent procéder à aucun acte médical, tel que le diagnostic, la thérapie ou la prescription de médicaments. Face à la diversité de ces pratiques non conventionnelles avec des praticiens très hétérogènes, des tentatives de réglementation et de contrôle tentent de se mettre en place, notamment pour surveiller les éventuelles dérives sectaires en dehors des établissements hospitaliers publics21. Le Pr Loïc Capron, président de la Commission médicale d’établissement de l’Assistance publique - Hôpitaux de Paris, déclare en 2015 : « Il existe une continuité entre ces pseudo-thérapies et les sectes, qui peuvent pénétrer par cette voie dans l’hôpital. En tant que responsable de la qualité et de la sécurité des soins, je lutte contre tout ce qui n’est pas evidence based72. »

D'après un rapport de l'Académie de médecine française, l'utilisation de ces pratiques dans les hôpitaux publics, « et notamment dans les CHU, est acceptable dans la mesure où l’hôpital n’est pas considéré comme garant de leur efficacité, mais comme lieu d’exemplarité de leur pratique et espace ouvert à la recherche les concernant. L’expérience de ces établissements devrait contribuer à terme à l’élaboration d’un guide de bonnes pratiques destiné à tous les intervenants publics ou privés ». Le rapport recommande que ces pratiques demeurent « à leur juste place : celle de méthodes adjuvantes pouvant compléter les moyens de la médecine. Elles ne doivent être préconisées que dans les cas où leur utilité est plausible, et au terme d’une démarche médicale par laquelle on se sera assuré qu’il n’y a pas, parmi les moyens éprouvés de la thérapeutique, une solution plus nécessaire ou plus recommandable. En conséquence, elles ne doivent jamais être choisies par le patient comme une solution de premier recours, ni comme une solution de remplacement qui exposerait à des erreurs ou retard de diagnostic et à des pertes de chance. Une attention particulière doit d’autre part être portée au risque de complications (notamment des manipulations cervicales), au risque de diffusion abusive de méthodes d’utilité improbable (telle l’ostéopathie crânienne préventive du nouveau né), et au risque de dérive sectaire avec éloignement définitif de la médecine conventionnelle, particulièrement redoutable en cancérologie3. »

Un état des lieux en 2013 des thérapies complémentaires utilisées à l'Assistance publique - Hôpitaux de Paris indique qu'elles sont « mises en pratique, dans 95 % des cas, par des professionnels de santé : médecins, sages-femmes, infirmières, infirmières anesthésistes, masseurs-kinésithérapeutes, psychomotriciens, psychologues. Les médecins titulaires qui sont impliqués dans ces soins ne les pratiquent qu'à temps partiel. On remarque toutefois que dans 5 % des cas, les pratiques complémentaires sont réalisées par des intervenants indéterminés, professionnels de santé ou non, exerçant éventuellement de façon bénévole3. »

Caractéristiques problématiques de certaines thérapies[modifier | modifier le code]

Certaines thérapies non-conventionnelles peuvent partager un certain nombre de caractéristiques21[travail inédit ?] :

absence de formation médicale des praticiens : si certaines méthodes bien établies comme l'ostéopathie bénéficient de nos jours de formations reconnues par l’État (ce qui n'implique cependant en aucun cas une reconnaissance d'efficacité de la méthode), un certain nombre de médecines non conventionnelles sont pratiquées par des personnes sans formation médicale (ou avec une formation sans rapport avec la technique concernée, ce qui est le cas des « médecins homéopathes »), et généralement formées elles-mêmes par une simple poignée de stages sans valeur institutionnelle15. Ainsi, « L’absence de reconnaissance par l’État des formations et des diplômes délivrés [...] peut induire un amateurisme de la part de certains pseudo-thérapeutes. D’autant que n’importe qui peut se déclarer « kinésiologue » ou « maître reiki » et enseigner ces techniques. [...] Il est possible de devenir maître reiki en trois ou quatre stages de formation accélérée les week-ends »15. Cette facilité à monter en grade fait partie pour la MIVILUDES de la stratégie de nombreuses mouvances suspectes : « On fait également miroiter à l’adepte la possibilité de devenir lui-même « praticien » voire formateur, ce qui est en soi très valorisant et réconfortant pour une personne en perte de repères »15. De fait, la plupart des médecines non-conventionnelles sont officiellement « accessible sans diplôme particulier » selon la fiche Rome K1103 de Pôle Emploi73, même si certains instituts délivrent des diplômes, souvent coûteux et sans valeur institutionnelle15.

Selon le ministère des Affaires sociales et de la Santé, « l’enseignement de ces pratiques [non conventionnelles] ne donne pas lieu à des diplômes nationaux, à l’exception de l’acupuncture. Cependant, certaines formations font l’objet de diplômes d’université (DU) ou de diplômes interuniversitaires (DIU) placés sous la seule responsabilité d’une ou de plusieurs universités. Ces diplômes ne signifient pas, ipso facto, que l’efficacité et l’innocuité de la technique sont prouvées. Ce sont des diplômes complémentaires qui, à eux seuls, ne donnent pas le droit à l’exercice d’une profession de santé. Certaines formations sont par ailleurs délivrées au sein d’organismes privés sans aucun contrôle des institutions publiques quant à leur contenu, et sans reconnaissance par l’Etat des diplômes délivrés74. » Le Canard enchaîné relève en 201575 certains diplômes universitaires éloignés de la médecine fondée sur les preuves et proposés à des prix élevés par quelques universités, et relate l’envoi d’une lettre la même année (restée sans réponse) aux ministres de la Santé et de l’Éducation nationale, signée par une douzaine de personnalités médicales et scientifiques76 demandant la suppression « de ces diplômes universitaires se rapportant au domaine médical, mis en place localement et donc sans évaluation nationale »72.

absence de preuves de l'efficacité du soin : toute méthode thérapeutique qui a prouvé son efficacité et son innocuité est rapidement intégrée à la médecine dite ici « conventionnelle ». Ainsi, la médecine non-conventionnelle regroupe des techniques dont l'efficacité n'a pas été démontrée, à quelques exceptions près, ou bien qui présentent des risques de blessure (voir la section « Recherche » ci-après). Par exemple comme dans le cas de l'homéopathie, l'inefficacité de la méthode a au contraire été démontrée à de multiples reprises, mais les promoteurs de la méthode trouvent toujours des artifices rhétoriques pour discréditer les preuves scientifiques (en).

utilisation de concepts sans définition : de nombreuses techniques reposent sur des concepts flous et sans définition concrète77, qu'ils soient empruntés à des religions asiatiques (karma, ki...), à des théories européennes des siècles passés (dynamisation, humeurs...) ou à un jargon scientifique détourné (onde, énergie, « mysticisme quantique »...). D'autres termes simplement vagues sont également utilisés, comme la prétention « holiste » ou « orientale », la promotion du « bien-être », une mystérieuse « purification » (ou « détoxication ») ou surtout l'appel à la « nature », qui peut justifier tout et son contraire. L'entretien de ce flou a pour effet de faire cohabiter sous des mêmes bannières de simples « remèdes de grand-mère », des arnaques organisées, des groupes New Age et des mouvances sectaires, souvent difficiles à distinguer. Un certain nombre de ces pratiques se sont structurées commercialement, et infiltrent notamment les réseaux écologistes et bio pour diffuser sous couvert de « naturel » des méthodes fantaisistes au mieux inefficace et au pire dangereuses : un véritable florilège y est notamment présent chaque année au Salon Marjolaine, à l'origine dédié à l'agriculture biologique78.

Avertissement des autorités françaises sur les dérives de certaines thérapies non conventionnelles : panneau affiché au salon Marjolaine, organisé par Nature et progrès.

recours à la pensée magique : face à l'absence de preuve scientifique de l'efficacité d'une technique, les promoteurs de « traitements miracles » vont souvent faire appel à la pensée magique, c'est-à-dire à la croyance en des mécanismes occultes que la science moderne ne parviendrait pas à détecter alors que le praticien, lui, en maîtrise les arcanes grâce à son processus initiatique79. Ce mécanisme permet de discréditer les études scientifiques portant sur la méthode concernée, et justifie l'absence de nécessité pour le thérapeute d'avoir à prouver ses affirmations. Enfin, cela constitue aussi une échappatoire ad hoc, puisque l'inefficacité de la méthode peut être reprochée au patient (« incrédule », porteur de « mauvaises ondes »...) plutôt qu'au praticien.

risque d'emprise psychologique ou de dérive sectaire : de nombreuses thérapies non conventionnelles se posent comme des alternatives non seulement thérapeutiques mais aussi ontologiques, assurant reposer sur un système de pensée radicalement différent de celui de la science, et invitent donc les patients à embrasser non pas une simple technique de soin mais toute une vision du monde, souvent qualifiée de « holiste » ou attribuée à l'« orient ». À partir de là, le risque d'emprise psychologique est majeur, et la Mission interministérielle de vigilance et de lutte contre les dérives sectaires met régulièrement en garde contre les nombreuses dérives existantes, consistant le plus souvent à « valoriser la victime pour mieux asseoir l’emprise du gourou thérapeute. Il s’agira de convaincre l’adepte qu’il est exceptionnel et que pour aller mieux et retrouver son énergie, sa joie de vivre et tout son potentiel, il devra se séparer de son conjoint, se couper de ses amis, et surtout suivre des stages, généralement coûteux, mais nécessaires pour accéder au bien-être. [...] Petit à petit la relation va se baser sur l’admiration du patient envers son thérapeute, qui pourra imposer toutes ses exigences, allant jusqu’à la soumission totale de l’adepte qui aura subi des pressions réitérées afin d’altérer son jugement »15.

Une économie publique[modifier | modifier le code]

Des études réalisées ces dernières années montrent une amélioration du confort des utilisateurs, une diminution au recours des méthodes conventionnelles et une diminution des dépenses de santé80,81.

Certains admettent que des pratiques non-conventionnelles soient remboursées par l'assurance maladie en France pour réaliser une diminution des dépenses de santé. Selon Frédéric Adnet, professeur de médecine d’urgence à l'université Paris-XIII : « Si la sécurité sociale rembourse certains traitements dénués de fondements scientifiques, cela résulte très probablement d’un calcul mercantile. Ces mêmes patients pourraient devenir – en cas de non-remboursement – des sur-consommateurs de soins lourds dans leur quête d’un soulagement psycho-affectif bien plus pénalisant en termes de finances publiques et probablement plus dangereux en termes de iatrogénie. Cet état de fait n’est donc, finalement, pas choquant82. »

L'expérience de la Suisse entre 1999 et 2005 semble montrer que le remboursement de médecines non-conventionnelles ne génère pas d'économie, ni de surcoût. Elles ne représentaient que 0,16 % des dépenses de l'assurance obligatoire, mais de nombreuses dépenses sont prises en charge par les patients ou de plus en plus par leurs assurances ou mutuelles complémentaires.

Il existe de possibles effets nuisibles : ainsi des malades se tournant exclusivement vers des thérapies dont l'efficacité n'a pas été prouvée ne pourront pas bénéficier d'un diagnostic précoce par la médecine scientifique, mettant leurs jours en danger3.

Recherches[modifier | modifier le code]

Selon l'OMS : « Il existe des données empiriques et scientifiques qui mettent en évidence les bénéfices de l’acupuncture, des médecines manuelles et de plusieurs plantes médicinales dans le traitement de maladies chroniques ou bénignes68. ».

Dans une notice de lecture de l'ouvrage Médecines douces : info ou intox ? de Simon Singh et Edzard Ernst, qui se présente comme « l’évaluation des médecines alternatives la plus honnête et la plus précise du monde » Martin Brunschwig pour Science et pseudo-sciences considère que « le défi est brillamment relevé : S. Sing et E. Ernst offrent en effet un travail d’une rigueur et d’une richesse exemplaire, émaillé d’explications et de références aux études qui ont permis d’apporter les preuves d’efficacité de certains traitements plus que d’autres11 » ; il indique par ailleurs que « les médecines alternatives sont en grande partie évaluées, et un nombre infime d’entre elles ont prouvé un effet spécifique mais faible. Les auteurs indiquent d’ailleurs fort justement que lorsque c’est le cas, au lieu de « s’accrocher » à une efficacité très faible, pour certains effets, à la limite du démontrable (que les tenants des médecines alternatives ne manqueront pas de monter en épingle), on ferait mieux, dans tous les cas, de se tourner vers les traitements conventionnels, plus efficaces11. »

Dans le cas de l'acupuncture, la collaboration Cochrane cite un cas où une efficacité est démontrée légèrement supérieure au placebo83 mais récuse ou ne peut conclure, faute de preuve pour les autres indications où l'acupuncture a été scientifiquement évaluée84. On sait en revanche que l'expérience qui a lancé la mode de l’acupuncture aux États-Unis dans les années 1970 avait été falsifiée par les services chinois39. On retrouve également dans la littérature des cas d'iatrogénie de l'acupuncture85.

Aux États-Unis le National Center for Complementary and Alternative Medicine (NCCAM) qui dépend des National Institutes of Health, a pour mission de financer et mener des recherches scientifiques rigoureuses dans le domaine des médecines complémentaires et alternatives. L'institut a été créé en 1991 sous le nom Office of Alternative Medicine (OAM) avant de devenir le NCCAM en 1998, son budget était de 2 millions de dollars à sa création, il a atteint 50 millions en 1999 et 128,8 millions en 201086. Les critiques reprochent au NCCAM l'absence de résultats significatifs malgré son budget important et la promotion des pseudo-sciences pour des raisons politiques et démagogiques87,88.

The Scientific Review of Alternative Medicine est un magazine américain évalué par les pairs, soutenu par la Commission for Scientific Medicine and Mental Health, consacré à l'étude des médecines non conventionnelles89.

Depuis les années 2000, la base de données MEDLINE a introduit une indexation facilitant les recherches sur le sujet des médecines complémentaires et alternatives. The Cochrane Library (en) dispose d'une importante base de données d'essais contrôlés ainsi que des revues systématiques1.

On trouve dans la littérature scientifique de plus en plus d'études sur les médecines non conventionnelles, cependant des méta-analyses montrent que certaines de ces études sont de qualité trop faible pour être scientifiquement significatives90, et sont parfois financées par des conglomérats de praticiens dans un but publicitaire (voir l'article junk science), voire dans le cas de la médecine traditionnelle chinoise par un État dans un but politique91.

L'approche scientifique[modifier | modifier le code]

La médecine conventionnelle applique un traitement si son efficacité est prouvée (ou dans certains cas semble prouvée, car la méthode scientifique peut parfois composer avec la logique mercantile ou culturelle92), s'il a une supériorité sur la physiologie de l'homéostasie mise dans les meilleures conditions (effet placebo). L'efficacité d'un traitement est mesuré à partir de critères de mesures : un paramètre biologique (ex : la glycémie), psychologique (ex : l'anxiété), épidémiologique (ex : la survie à cinq ans, la mortalité). On peut ainsi utiliser des molécules ayant réussi les tests expérimentaux sans connaître, dans un premier temps, les mécanismes biochimiques de l'action thérapeutique de ces substances (exemple : aspirine, la pénicilline) 93. L'explication de leur action évoluerait par l'avancée des connaissances scientifiques, cela ne changerait rien au résultat des mesures expérimentées.

D'une manière générale, le fait qu'une théorie, une conception a priori, soit vraie ou fausse est indépendant du résultat atteint ; on peut expliquer un fait réel par une théorie fausse, et le fait que la théorie soit fausse n'empêche pas le fait d'être vrai. Par exemple, au Moyen Âge, on savait fabriquer du fer et du savon, pourtant, la théorie qui expliquait les transformations de la matière, l'alchimie, n'est plus reconnue comme vérité aujourd'hui94.

Donc :

si l'on prouve que la théorie sous-jacente à une médecine donnée est fausse, cela n'implique pas que les traitements liés à cette médecine soient inefficaces (même principe épistémologique que celui évoqué pour le savon et l'alchimie) ;

le fait qu'un traitement soit efficace ne valide pas pour autant la théorie médicale qui le justifie (même principe épistémologique que celui évoqué pour le savon et l'alchimie) ;

la preuve de l'efficacité doit se faire par comparaison avec la physiologie dans les conditions d'un placebo positif, sur un nombre suffisant de cas pour que l'on puisse avoir une différence significative statistiquement (cf. Essai clinique)

L'efficacité visible d'une technique ne justifie pas forcément son utilisation, qui peut avoir des effets négatifs. Par exemple, on a longtemps soigné la syphilis avec du mercure ou en inoculant la malaria, ce qui donnait lieu à une rémission apparente, mais tua sans doute indirectement plus de patients que la maladie elle-même95 (cf. Autorisation de mise sur le marché).

Relations entre médecins conventionnels et non-conventionnels[modifier | modifier le code]

Des médecins ont été poursuivis en France pour avoir utilisé des méthodes thérapeutiques sans validation scientifique. La notion « d’exercice illégal de la médecine » condamne par ailleurs toute personne qui s’aventurerait à manipuler la santé d'un patient par des traitements ou méthodes invasifs sans qu’il en ait été prouvé l’innocuité et l’efficacité.

Les laboratoires pharmaceutiques sont alors soupçonnés de faire pression auprès des gouvernements pour avoir une législation restrictive. À l’inverse, est cité le cas des Laboratoires Boiron (France), des Laboratoires Lehning (France), Heel et DHU Schwabe (Allemagne), grands pourvoyeurs d’emplois en Europe, et qui ont obtenu du gouvernement français que les préparations homéopathiques soient remboursées en 198496, puis de l’Union européenne que les mêmes préparations puissent avoir une autorisation de mise sur le marché sans procéder à des essais cliniques97.

L’effet placebo et le réconfort sans danger qu’apportent, entre autres, certaines méthodes ont un certain intérêt. Les promoteurs de certaines médecines non-conventionnelles s’appuient sur cet effet placebo pour montrer que le psychisme est fondamental dans la guérison ; cependant, l’effet placebo peut agir alors même que l’on sait qu’il s’agit d’un effet placebo98.

Affaires[modifier | modifier le code]

Le recours aux médecines parallèles devrait être parcimonieux et adapté : le traitement d’une maladie grave et avancée nécessitant des soins médicaux importants peut être retardé par le recours exclusif à une médecine non conventionnelle3.

Au xxie siècle, il existe encore de nombreuses maladies incurables et parfois mal comprises, telles que certains cancers ou encore la maladie d'Alzheimer. Ces maladies peuvent entraîner une grande anxiété chez les malades et leurs familles, ainsi qu'un douloureux complexe d'impuissance99. Cette fragilité émotionnelle a attiré de nombreux thérapeutes para-médicaux malintentionnés et autres escrocs, qui face à l'impuissance de la médecine moderne proposent des méthodes « alternatives » soi-disant miracles, facturées à des prix souvent astronomiques99,100. On assiste ainsi à la prolifération de tout une pseudo-science autour de certaines maladies comme l'autisme, de leurs causes hypothétiques et de leur soi-disant traitement, impliquant autant de simples charlatans que de riches fondations, ainsi que certaines mouvances sectaires100, surfant sur des effets de mode (comme le régime sans gluten101) ou la théorie du complot (voir notamment la Controverse sur le rôle de la vaccination dans l'autisme102,103). Grâce aux importants revenus générés par ces pseudo-thérapies, de puissants instituts se sont formés aux États-Unis pour promouvoir et centraliser ce genre de méthodes (comme la Strategic Autism Initiative), appuyés par une communication et un lobbyisme actifs, impliquant des personnalités du show-business et certains politiciens populistes, jusqu'à Donald Trump104. Cette communication est généralement basée sur des témoignages isolés et invérifiables et une grande force de persuasion, parfois assortis de fausses études scientifiques99. En réponse, la FDA américaine a publié des guides d'aide aux victimes (comme le « Beware of False or Misleading Claims for Treating Autism [archive] »99), et des associations d'aide aux victimes se sont montées, comme la Autism Rights Watch. En France, c'est notamment la Mission interministérielle de vigilance et de lutte contre les dérives sectaires qui a été saisie du problème (voir par exemple son Guide santé et dérives sectaires21).

En France, le procès d’un couple, accusé de mauvais traitement sur son enfant décédé en 2000, à la suite d'une carence alimentaire (l'autopsie a révélé une « infection aiguë secondaire à une malnutrition chronique

fr.wikipedia.org/wiki/Médecine_non_conventionnelle

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