![the name of Michael, whose first trade had been that of a money-
changer; and Romanus, either from gratitude or equity, connived at their
criminal intercourse, or accepted a slight assurance of their innocence.
But Zoe soon justified the Roman maxim, that every adulteress is
capable of poisoning her husband; and the death of Romanus was
instantly followed by the scandalous marriage and elevation of Michael
IV.
The expectations of Zoe were, however, disappointed; instead of a
vigorous and grateful lover, she had placed in her bed a miserable
wretch whose health and reason were impaired by epileptic fits, and
whose conscience was tormented by despair and remorse. The most
skilful physicians of the mind and body were summoned to his aid; and
his hopes were aroused by frequent pilgrimages to the baths, and to the
tombs of the most popular saints; the monks applauded his penance,
and, except restitution (but to whom should he have restored?) Michael
sought every method of expiating his guilt. While he groaned and
prayed in sackcloth and ashes, his brother, the eunuch Joannes, smiled
at his remorse, and enjoyed the harvest of a crime of which himself was
the secret and most guilty author. His administration[71] was only the art
of satiating his avarice, and Zoe became a captive in the palace of her
fathers and in the hands of her slaves. When he perceived the
irretrievable decline of his brother’s health, he introduced his nephew,
another Michael, who derived the surname of Calaphates from his
father’s occupation in the careening of vessels; at the command of the
eunuch, Zoe adopted for her son the son of a mechanic; and this
fictitious heir was invested with the title and purple of the Cæsars, in the
presence of the senate and clergy.
So feeble was the character of Zoe, that she was oppressed by the
liberty and power which she recovered by the death of the
Paphlagonian; and at the end of four days, she placed the crown on the
head of Michael V who had protested, with tears and oaths, that he
should ever reign the first and most obedient of her subjects. The only
act of his short reign was his base ingratitude to his benefactors, the
eunuch and the empress. The disgrace of the former was pleasing to the
public; but the murmurs, and at length the clamours, of Constantinople
deplored the exile of Zoe, the daughter of so many emperors; her vices](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-51-320.jpg)
![[1042-1053 a.d.]
were forgotten, and Michael was taught that there is a period in which
the patience of the tamest slaves rises into fury and revenge. The
citizens of every degree assembled in a formidable tumult which lasted
three days; they besieged the palace, forced the gates, recalled their
mothers—Zoe from her prison, Theodora from her monastery, and
condemned the son of Calaphates to the loss of his eyes or of his life.
For the first time the Greeks beheld with surprise the two royal sisters
seated on the same throne, presiding in the senate, and giving audience
to the ambassadors of the nations. But this singular union subsisted no
more than two months; the two sovereigns, their tempers, interests,
and adherents, were secretly hostile to each other; and as Theodora
was still adverse to marriage, the indefatigable Zoe, at the age of sixty,
consented, for the public good, to sustain the embraces of a third
husband, and the censures of the Greek church. His name and number
were Constantine X and the epithet of Monomachus,[72] the single
combatant, must have been expressive of his valour and victory in some
public or private quarrel.[73] But his health was broken by the tortures of
the gout, and his dissolute reign was spent in the alternative of sickness
and pleasure. A fair and noble widow had accompanied Constantine in
his exile to the isle of Lesbos, and Sclerena gloried in the appellation of
his mistress. After his marriage and elevation, she was invested with the
title and pomp of Augusta, and occupied a contiguous apartment in the
palace. The lawful consort (such was the delicacy or corruption of Zoe)
consented to this strange and scandalous partition; and the emperor
appeared in public between his wife and his concubine.h
SEPARATION OF GREEK AND LATIN CHURCHES
In looking back from modern times at the history
of the Byzantine Empire, the separation of the
Greek and Latin churches appears the most
important event in the reign of Constantine X; but its prominence is
owing, on the one hand, to the circumstance that a closer connection
began shortly after to exist between the Eastern and Western nations;
and on the other, to the decline in the power of the Byzantine Empire,
which gave ecclesiastical affairs greater importance than they would](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-52-320.jpg)
![[1053-1056 a.d.]
THE TRIUMPH OF CLOVIS
(AT THE PANTHEON, PARIS)
The people on both sides, who understood little of the points
contested by the clergy, adopted the simple rule, that it was their duty
to hate the members of the other church; and the Greeks, having their
nationality condensed in their ecclesiastical establishment, far exceeded
the Western nations in ecclesiastical bigotry, for the people in the
western nations of Europe were often not very friendly to papal
pretensions. The extreme bigotry of the Greeks soon tended to make
the people of the Byzantine Empire averse to all intercourse with the
Latins, as equals, and they assumed a superiority over nations rapidly
advancing in activity, wealth, power, and intelligence, merely because
they deemed them heretics. The separation of the two churches proved,
consequently, more injurious to the Greeks, in their stationary condition
of society, than to the Western Christians, who were eagerly pressing
forward in many paths of social improvement.
The empress Zoe died in the year 1050, at the
age of seventy. Constantine X survived to the year](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-54-320.jpg)
![[1057-1059 a.d.]
the family had long since been transported from Italy to Asia. Their
patrimonial estate was situate in the district of Castamona, in the
neighbourhood of the Euxine; and one of their chiefs, who had already
entered the paths of ambition, revisited with affection, perhaps with
regret, the modest though honourable dwelling of his fathers.
The first of their line was the illustrious Manuel,
who, in the reign of the second Basil, contributed
by war and treaty to appease the troubles of the
East: he left, in a tender age, two sons, Isaac and Joannes, whom, with
the consciousness of desert, he bequeathed to the gratitude and favour
of his sovereign. The noble youths were carefully trained in the learning
of the monastery, the arts of the palace, and the exercises of the camp;
and from the domestic service of the guards, they were rapidly
promoted to the command of provinces and armies. Their fraternal
union doubled the force and reputation of the Comneni, and their
ancient nobility was illustrated by the marriage of the two brothers with
a captive princess of Bulgaria, and the daughter of a patrician, who had
obtained the name of Charon from the number of enemies whom he
had sent to the infernal shades. The soldiers had served with reluctant
loyalty a series of effeminate masters; the elevation of Michael VI was a
personal insult to the more deserving generals; and their discontent was
inflamed by the parsimony of the emperor and the insolence of the
eunuchs. They secretly assembled in the sanctuary of St. Sophia, and
the votes of the military synod would have been unanimous in favour of
the old and valiant Catacalon, if the patriotism or modesty of the
veteran had not suggested the importance of birth as well as merit in
the choice of a sovereign. Isaac Comnenus was approved by general
consent, and the associates separated without delay to meet in the
plains of Phrygia at the head of their respective squadrons and
detachments.
The cause of Michael was defended in a single battle by the
mercenaries of the imperial guard, who were aliens to the public
interest, and animated only by a principle of honour and gratitude. After
their defeat, the fears of the emperor solicited a treaty, which was
almost accepted by the moderation of the Comnenian. But the former
was betrayed by his ambassadors, and the latter was prevented by his
friends. The solitary Michael submitted to the voice of the people; the](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-56-320.jpg)
![[1059-1067 a.d.]
patriarch annulled their oath of allegiance; and as he shaved the head of
the royal monk, congratulated his beneficial exchange of temporal
royalty for the kingdom of heaven; an exchange, however, which the
priest, on his own account, would probably have declined.
By the hands of the same patriarch, Isaac
Comnenus was solemnly crowned; the sword, which
he inscribed on his coins, might be an offensive
symbol, if it implied his title by conquest; but this sword would have
been drawn against the foreign and domestic enemies of the state.[74]
The decline of his health and vigour suspended the operation of active
virtue;[75] and the prospect of approaching death determined him to
interpose some moments between life and eternity. But instead of
leaving the empire as the marriage portion of his daughter, his reason
and inclination concurred in the preference of his brother Joannes, a
soldier, a patriot, and the father of five sons, the future pillars of an
hereditary succession. His first modest reluctance might be the natural
dictates of discretion and tenderness, but his obstinate and successful
perseverance, however it may dazzle with the show of virtue, must be
censured as a criminal desertion of his duty, and a rare offence against
his family and country. The purple which he had refused was accepted
by Constantine Ducas, a friend of the Comnenian house, and whose
noble birth was adorned with the experience and reputation of civil
policy. In the monastic habit, Isaac recovered his health, and survived
two years his voluntary abdication. At the command of his abbot, he
observed the rule of St. Basil, and executed the most servile offices of
the convent; but his latent vanity was gratified by the frequent and
respectful visits of the reigning monarch, who revered in his person a
benefactor and a saint.
If Constantine XI were indeed the subject most worthy of empire, we
must pity the debasement of the age and nation in which he was
chosen. In the labour of puerile declamations he sought, without
obtaining, the crown of eloquence, more precious, in his opinion, than
that of Rome; and, in the subordinate functions of a judge, he forgot the
duties of a sovereign and a warrior. Ducas was anxious only to secure,
even at the expense of the republic, the power and prosperity of his
children. His three sons, Michael VII, Andronicus I, and Constantine XII,](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-57-320.jpg)
![[1067-1070 a.d.]
were invested, at a tender age, with the equal title of Augustus; and the
succession was speedily opened by their father’s death. His widow,
Eudocia, was entrusted with the administration.
Before the end of seven months, the wants of Eudocia, or those of the
state, called aloud for the male virtues of a soldier; and her heart had
already chosen Romanus Diogenes, whom she raised from the scaffold
to the throne. The discovery of a treasonable attempt had exposed him
to the severity of the laws; his beauty and valour absolved him in the
eyes of the empress, and Romanus, from a mild exile, was recalled on
the second day to the command of the oriental armies. Her royal choice
was yet unknown to the public, and the promise which would have
betrayed her falsehood and levity was stolen by a dexterous emissary
from the ambition of the patriarch. Xiphilin at first alleged the sanctity of
oaths and the sacred nature of a trust; but a whisper that his brother
was the future emperor relaxed his scruples, and forced him to confess
that the public safety was the supreme law. He resigned the important
paper; and when his hopes were confounded by the nomination of
Romanus, he could no longer regain his security, retract his declarations,
nor oppose the second nuptials of the empress. Yet a murmur was
heard in the palace; and the barbarian guards had raised their battle-
axes in the cause of the house of Ducas, till the young princes were
soothed by the tears of their mother and the assurances of the fidelity
of their guardian, who filled the throne with dignity and honour.
ROMANUS IN THE FIELD (1067-1071)
The false or genuine magnanimity of Mahmud the
Ghaznavide was not imitated by Alp Arslan; and he
attacked without scruple the Greek empress
Eudocia and her children.[76] His alarming progress compelled her to
give herself and her sceptre to the hand of a soldier; and Romanus
Diogenes had been invested with the imperial purple. His patriotism, and
perhaps his pride, urged him from Constantinople within two months
after his accession; and the next campaign he most scandalously took
the field during the holy festival of Easter. In the palace, Diogenes was
no more than the husband of Eudocia; in the camp he was the emperor
of the Romans, and he sustained that character with feeble resources](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-58-320.jpg)
![and invincible courage. By his spirit and success, the soldiers were
taught to act, the subjects to hope, and the enemies to fear. The Turks
had penetrated into the heart of Phrygia; but the sultan himself had
resigned to his emirs the prosecution of the war; and their numerous
detachments were scattered over Asia in the security of conquest. Laden
with spoil and careless of discipline, they were separately surprised and
defeated by the Greeks; the activity of the emperor seemed to multiply
his presence; and while they heard of his expedition to Antioch, the
enemy felt his sword on the hills of Trebizond.
In three laborious campaigns[77] the Turks were driven beyond the
Euphrates; in the fourth and last, Romanus undertook the deliverance of
Armenia. The desolation of the land obliged him to transport a supply of
two months’ provisions; and he marched forwards to the siege of
Manzicert, an important fortress in the midway between the modern
cities of Erzerum and Van. His army amounted, at the least, to one
hundred thousand men. The troops of Constantinople were reinforced
by the disorderly multitudes of Phrygia and Cappadocia; but the real
strength was composed of the subjects and allies of Europe, the legions
of Macedonia, and the squadrons of Bulgaria; the Uzi, a Moldavian
horde, who were themselves of the Turkish race, and above all, the
mercenary and adventurous bands of French and Normans. Their lances
were commanded by the valiant Ursel of Baliol, the kinsman or father of
the Scottish kings, and were allowed to excel in the exercise of arms, or,
according to the Greek style, in the practice of the Pyrrhic dance.](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-59-320.jpg)
![Byzantine Emperor in the
Costume of a General
[1071 a.d.]
On the report of this
bold invasion, which
threatened his
hereditary dominions, Alp Arslan flew to the
scene of action at the head of forty
thousand horse. His rapid and skilful
evolutions distressed and dismayed the
superior numbers of the Greeks; and in the
defeat of Basilacius, one of their principal
generals, he displayed the first example of
his valour and clemency. The imprudence of
the emperor had separated his forces after
the reduction of Manzicert. It was in vain
that he attempted to recall the mercenary
Franks; they refused to obey his summons;
he disdained to await their return; the
desertion of the Uzi filled his mind with
anxiety and suspicion; and against the most
salutary advice he rushed forwards to
speedy and decisive action.
Had he listened to the fair proposals of
the sultan, Romanus might have secured a
retreat, perhaps a peace; but in these
overtures he supposed the fear or
weakness of the enemy, and his answer was conceived in the tone
of insult and defiance. “If the barbarian wishes for peace, let him
evacuate the ground which he occupies for the encampment of the
Romans, and surrender his city and palace of Rei as a pledge of his
sincerity.” Alp Arslan smiled at the vanity of the demand, but he
wept the death of so many faithful Moslems; and, after a devout
prayer, proclaimed a free permission to all who were desirous of
retiring from the field. With his own hands he tied up his horse’s tail,
exchanged his bow and arrows for a mace and scimitar, clothed
himself in a white garment, perfumed his body with musk, and](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-60-320.jpg)
![[1071-1081 a.d.]
defeated him. Bari capitulated in April, 1071, and the direct authority
of the Roman Empire in Italy was gone forever.]
THE SONS OF CONSTANTINE XI AND NICEPHORUS III
(1071-1081 A.D.)
The defeat and captivity of Romanus IV
inflicted a deadly wound on the Byzantine
monarchy of the East; and after he was
released from the chains of the sultan, he vainly sought his wife and
subjects. His wife had been thrust into a monastery, and the
subjects of Romanus had embraced the rigid maxim of the civil law,
that a prisoner in the hands of the enemy is deprived, as by the
stroke of death, of all public and private rights of a citizen. In the
general consternation, the cæsar Joannes asserted the indefeasible
right of his three nephews. Constantinople listened to his voice, and
the Turkish captive was proclaimed in the capital, and received on
the frontier, as an enemy of the republic. Romanus was not more
fortunate in domestic than in foreign war: the loss of two battles
compelled him to yield, on the assurance of fair and honourable
treatment; but his enemies were devoid of faith or humanity, and,
after the cruel extinction of his sight, his wounds were left to bleed
and corrupt, till in a few days he was relieved from a state of misery.
Under the triple reign of the house of Ducas, the two younger
brothers were reduced to the vain honours of the purple; but the
eldest, the pusillanimous Michael, was incapable of sustaining the
Roman sceptre; and his surname of Parapinaces denotes the
reproach which he shared with an avaricious favourite, who
enhanced the price, and diminished the measure, of wheat. In the
school of Psellus, and after the example of his mother, the son of
Eudocia made some proficiency in philosophy and rhetoric; but his
character was degraded, rather than ennobled, by the virtues of a
monk and the learning of a sophist.](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-64-320.jpg)
![choicest gifts both of mind and body; they were cultivated by a
liberal education, and exercised in the school of obedience and
adversity. The youth was dismissed from the perils of the Turkish
War,[78] by the paternal care of the emperor Romanus; but the
mother of the Comneni, with her aspiring race, was accused of
treason, and banished, by the sons of Ducas, to an island in the
Propontis. The two brothers soon emerged into favour and action,
fought by each other’s side against the rebels and barbarians, and
adhered to the emperor Michael, till he was deserted by the world
and by himself.
In his first interview with Botaniates, “Prince,” said Alexius, with a
noble frankness, “my duty rendered me your enemy; the decrees of
God and of the people have made me your subject. Judge of my
future loyalty by my past opposition.” The successor of Michael
entertained him with esteem and confidence; his valour was
employed against three rebels, who disturbed the peace of the
empire, or at least of the emperors. Ursel, Bryennius, and Basilacius
were formidable by their numerous forces and military fame: they
were successively vanquished in the field, and led in chains to the
foot of the throne; and whatever treatment they might receive from
a timid and cruel court, they applauded the clemency, as well as the
courage, of their conqueror. But the loyalty of the Comneni was soon
tainted by fear and suspicion; nor is it easy to settle between a
subject and a despot the debt of gratitude, which the former is
tempted to claim by a revolt, and the latter to discharge by an
executioner. The refusal of Alexius to march against a fourth rebel,
the husband of his sister, destroyed the merit or memory of his past
services; the favourites of Botaniates provoked the ambition which
they apprehended and accused; and the retreat of the two brothers
might be justified by the defence of their life or liberty.
The women of the family were deposited in a sanctuary, respected
by tyrants; the men, mounted on horseback, sallied from the city,
and erected the standard of civil war. The soldiers, who had been
gradually assembled in the capital and the neighbourhood, were](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-66-320.jpg)
![[1081-1084 a.d.]
A Byzantine Soldier
empire was accumulated on his reign by the justice of heaven and
the vices of his predecessors.
TROUBLES OF ALEXIUS
In the East, the
victorious Turks had
spread from Persia to
the Hellespont the reign of the Koran and
the crescent; the West was invaded by the
adventurous valour of the Normans; and, in
the moments of peace, the Danube poured
forth new swarms, who had gained in the
science of war what they had lost in the
ferociousness of manners. The sea was not
less hostile than the land; and while the
frontiers were assaulted by an open enemy,
the palace was distracted with secret
treason and conspiracy.h
One of the earliest acts of the reign of
Alexius was to conclude a treaty of peace
with the Seljuk emir Suleiman, who acted in
Asia Minor as if he were completely
independent of the grand sultan Malekshah.
The treachery of Nicephorus Melissenos had
placed Suleiman in possession of Nicæa, and his troops occupied
several posts on the shores of the Bosporus and the Sea of
Marmora; while Alexius, who required the whole forces of the empire
to resist the invasion of Robert Guiscard, was compelled to purchase
peace at any price. Under such circumstances, it was only to be
expected that the immediate neighbourhood of Constantinople could
be kept free from the Turks, and accordingly the boundaries of the
Roman Empire in Asia Minor were by this treaty reduced to very
narrow limits. The country immediately opposite the capital, as far
as the mouth of the river Sangarius and the head of the Gulf of](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-68-320.jpg)
![[1084-1118 a.d.]
compelled to return to Italy, to obtain supplies of money and fresh
troops. Brienne, the constable of Apulia, who commanded in his
absence, found himself compelled to surrender Kastoria to the
emperor Alexius, and to engage not to bear arms again against the
Byzantine Empire.
While Bohemund was carrying on the war against the emperor of
the East, Robert Guiscard had driven the emperor of the West out of
Rome; and after vanquishing Henry IV, he had plundered the Eternal
City like another Genseric. He was now ready to resume his schemes
of ambition in the East. Collecting a powerful fleet to carry over his
victorious army into Epirus, he raised the siege of Corfu (Corcyra),
which was invested by the combined naval forces of the Byzantine
Empire and the Venetian Republic. The united fleets were completely
defeated in a great naval battle, in which, according to Anna
Comnena,i they lost thirteen thousand men. But in the month of
July, 1085, Robert died in the island of Cephallenia, and with him
perished all the Norman projects of conquest in the Byzantine
Empire. Dyrrhachium was recovered by Alexius with the assistance
of the Venetian and Amalphitan merchants established in the place,
and the services of the Venetians in this war were rewarded by
many commercial privileges which were conferred on them by a
golden bull.e
The Norman War was scarcely finished when
the Patzinaks invaded the empire (1086). This
war lasted five years, until, in fact, Alexius
concluded a treaty with the Komans, allies of the Patzinaks, and then
dealt the latter a crushing blow at Levounion in 1091. Minor wars
with Servia and Dalmatia do not deserve mention, but the progress
of the Seljuk Turks continued to hasten the decline of the empire.
They dared everything, and in 1092 Tzachas, emir of Smyrna,
assumed the title of emperor. He was put down, but retained
sufficient strength to besiege Abydos in 1093. But Alexius
accomplished his murder the same year. The relations of Alexius and
the First Crusade will be fully treated in the account of the Holy](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-72-320.jpg)
![[1118-1143 a.d.]
In his last hours, when he was pressed by his wife Irene to alter
the succession, he raised his head, and breathed a pious ejaculation
on the vanity of this world. The indignant reply of the empress may
be inscribed as an epitaph on his tomb—“You die, as you have lived
—a hypocrite!” (1118).
JOANNES (II) COMNENUS (CALO-JOANNES) (1118-1143
A.D.)
It was the wish of Irene to supplant the
eldest of her surviving sons, in favour of her
daughter, the princess Anna, whose philosophy
would not have refused the weight of a diadem. But the order of
male succession was asserted by the friends of their country; the
lawful heir drew the royal signet from the finger of his insensible or
unconscious father, and the empire obeyed the master of the palace.
Anna Comnena was stimulated by ambition and revenge to conspire
against the life of her brother; and when the design was prevented
by the fears or scruples of her husband, she passionately exclaimed,
that nature had mistaken the two sexes, and had endowed
Bryennius with the soul of a woman.
The two sons of Alexius, Joannes and Isaac, maintained the
fraternal concord, the hereditary virtue of their race; and the
younger brother was content with the title of Sebastocrator, which
approached the dignity, without sharing the power, of the emperor.
In the same person, the claims of primogeniture and merit were
fortunately united; his swarthy complexion, harsh features, and
diminutive stature, had suggested the ironical surname of Calo-
Joannes, or John the Handsome, which his grateful subjects more
seriously applied to the beauties of his mind.
After the discovery of her treason, the life and fortune of Anna
were justly forfeited to the laws. Her life was spared by the
clemency of the emperor; but he visited the pomp and treasures of
her palace, and bestowed the rich confiscation on the most](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-74-320.jpg)
![[1143-1180 a.d.]
of Syria, and the conquest of Jerusalem, the thread of his life and of
the public felicity was broken by a singular accident. He hunted the
wild boar in the valley of Anazarbus, and had fixed his javelin in the
body of the furious animal; but, in the struggle, a poisoned arrow
dropped from his quiver, and a slight wound in his hand, which
produced a mortification, was fatal to the best and greatest of the
Comnenian princes.
MANUEL I (1143-1180 A.D.)
A premature death had swept away the two
eldest sons of John the Handsome; of the two
survivors, Isaac and Manuel, his judgment or
affection preferred the younger; and the choice of their dying prince
was ratified by the soldiers, who had applauded the valour of his
favourite in the Turkish War. The faithful Axuch hastened to the
capital, secured the person of Isaac in honourable confinement, and
purchased with a gift of two hundred pounds of silver the leading
ecclesiastics of St. Sophia, who possessed a decisive voice in the
consecration of an emperor. With his veteran and affectionate
troops, Manuel soon visited Constantinople; his brother acquiesced
in the title of Sebastocrator; his subjects admired the lofty stature
and martial graces of their new sovereign, and listened with credulity
to the flattering promise, that he blended the wisdom of age with
the activity and vigour of youth. By the experience of his
government, they were taught, that he emulated the spirit, and
shared the talents, of his father, whose social virtues were buried in
the grave. A reign of thirty-seven years is filled by a perpetual
though various warfare against the Turks, the Christians, and the
hordes of the wilderness beyond the Danube. The arms of Manuel
were exercised on Mount Taurus, in the plains of Hungary, on the
coast of Italy and Egypt, and on the seas of Sicily and Greece; the
influence of his negotiations extended from Jerusalem to Rome and
Russia; and the Byzantine monarchy, for a while, became an object
of respect or terror to the powers of Asia and Europe.](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-76-320.jpg)
![[1180-1183 a.d.]
he deplored with tears and groans the guilt of his past rebellion; nor
would he presume to arise unless some faithful subject would drag
him to the foot of the throne.
This extraordinary penance excited the wonder and pity of the
assembly; his sins were forgiven by the church and state; but the
just suspicion of Manuel fixed his residence at a distance from the
court, at Œnoe, a town of Pontus, surrounded with rich vineyards,
and situate on the coast of the Euxine. The death of Manuel, and
the disorders of the minority, soon opened the fairest field to his
ambition.
ALEXIUS II (1180-1183 A.D.)
The emperor was a boy of twelve or fourteen
years of age, without vigour, or wisdom, or
experience; his mother, the empress Mary,
abandoned her person and government to a favourite of the
Comnenian name; and his sister, another Mary, whose husband, an
Italian, was decorated with the title of Cæsar, excited a conspiracy,
and at length an insurrection, against her odious stepmother. The
provinces were forgotten, the capital was in flames, and a century of
peace and order was overthrown in the vice and weakness of a few
months. A civil war was kindled in Constantinople; the two factions
fought a bloody battle in the square of the palace, and the rebels
sustained a regular siege in the cathedral of St. Sophia. The
patriarch laboured with honest zeal to heal the wounds of the
republic, the most respectable patriots called aloud for a guardian
and avenger, and every tongue repeated the praise of the talents
and even the virtues of Andronicus. In his march from Œnoe to
Constantinople, his slender train insensibly swelled to a crowd and
an army; his professions of religion and loyalty were mistaken for
the language of his heart; and the simplicity of a foreign dress,
which showed to advantage his majestic stature, displayed a lively
image of his poverty and exile. All opposition sank before him; he
reached the straits of the Thracian Bosporus; the Byzantine navy](https://image.slidesharecdn.com/32316-250402093533-d1a84c8d/85/Machine-Learning-Big-Data-and-IoT-for-Medical-Informatics-Pardeep-Kumar-84-320.jpg)
Machine Learning, Big Data, and IoT for Medical Informatics Pardeep Kumar
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- 6. Machine Learning, Big Data, and IoT for Medical Informatics FIRST EDITION Pardeep Kumar Department of CSE & IT, JUIT, Solan, Himachal Pradesh, India Yugal Kumar Department of CSE & IT, JUIT, Solan, Himachal Pradesh, India Mohamed A. Tawhid Department of Mathematics and Statistics, Thompson Rivers University, Kamloops, BC, Canada
- 8. Table of Contents Cover image Title page Copyright Contributors Preface Outline of the book and chapter synopses Special acknowledgments Chapter 1: Predictive analytics and machine learning for medical informatics: A survey of tasks and techniques Abstract 1: Introduction: Predictive analytics for medical informatics 2: Background 3: Techniques for machine learning
- 9. 4: Applications 5: Experimental results 6: Conclusion: Machine learning for computational medicine Chapter 2: Geolocation-aware IoT and cloud-fog-based solutions for healthcare Abstract 1: Introduction 2: Related work 3: Proposed framework 4: Performance evaluation 5: Conclusion and future work Chapter 3: Machine learning vulnerability in medical imaging Abstract Acknowledgment 1: Introduction 2: Computer vision 3: Adversarial computer vision 4: Methods to produce adversarial examples 5: Adversarial attacks
- 10. 6: Adversarial defensive methods 7: Adversarial computer vision in medical imaging 8: Adversarial examples: How to generate? 9: Conclusion Chapter 4: Skull stripping and tumor detection using 3D U-Net Abstract 1: Introduction 2: Overview of U-net architecture 3: Materials and methods 4: Results 5: Conclusion Chapter 5: Cross color dominant deep autoencoder for quality enhancement of laparoscopic video: A hybrid deep learning and range-domain filtering-based approach Abstract Acknowledgments 1: Introduction 2: Range-domain filtering 3: Cross color dominant deep autoencoder (C2 D2 A) leveraging color spareness and saliency
- 11. 4: Experimental results 5: Conclusion Chapter 6: Estimating the respiratory rate from ECG and PPG using machine learning techniques Abstract Acknowledgments 1: Introduction 2: Related work 3: Methods 4: Experimental results 5: Discussion and conclusion Chapter 7: Machine learning-enabled Internet of Things for medical informatics Abstract 1: Introduction 2: Applications and challenges of H-IoT 3: Machine learning 4: Future research directions 5: Conclusion
- 12. Chapter 8: Edge detection-based segmentation for detecting skin lesions Abstract 1: Introduction 2: Previous works 3: Materials and methods 4: Proposed method 5: Experiment and results 6: Conclusion Chapter 9: A review of deep learning approaches in glove-based gesture classification Abstract 1: Introduction 2: Data gloves 3: Gesture taxonomies 4: Gesture classification 5: Discussion and future trends 6: Conclusion Chapter 10: An ensemble approach for evaluating the cognitive performance of human population at high altitude
- 13. Abstract Acknowledgment 1: Introduction 2: Methodology 3: Results and discussion 4: Future opportunities 5: Conclusions Chapter 11: Machine learning in expert systems for disease diagnostics in human healthcare Abstract Acknowledgment 1: Introduction 2: Types of expert systems 3: Components of an expert system 4: Techniques used in expert systems of medical diagnosis 5: Existing expert systems 6: Case studies 7: Significance and novelty of expert systems 8: Limitations of expert systems 9: Conclusion
- 14. Chapter 12: An entropy-based hybrid feature selection approach for medical datasets Abstract 1: Introduction 2: Background of the present research 3: Methodology 4: Experiment and experimental results 5: Discussion 6: Conclusions and future works Conflict of interest Appendix A Chapter 13: Machine learning for optimizing healthcare resources Abstract 1: Introduction 2: The state of the art 3: Machine learning for health data analysis 4: Feature selection techniques 5: Machine learning classifiers 6: Case studies 7: Case study 2: COVID-19 data analysis
- 15. 8: Summary and future directions Chapter 14: Interpretable semisupervised classifier for predicting cancer stages Abstract Acknowledgments 1: Introduction 2: Self-labeling gray box 3: Data preparation 4: Experiments and discussion 5: Conclusions Chapter 15: Applications of blockchain technology in smart healthcare: An overview Abstract 1: Introduction 2: Blockchain overview 3: Proposed healthcare monitoring framework 4: Blockchain-enabled healthcare applications 5: Potential challenges 6: Concluding remarks
- 16. Chapter 16: Prediction of leukemia by classification and clustering techniques Abstract 1: Introduction 2: Motivation 3: Literature review 4: Description of proposed system 5: Simulation results and discussion 6: Conclusion and future directions Chapter 17: Performance evaluation of fractal features toward seizure detection from electroencephalogram signals Abstract Acknowledgments 1: Introduction 2: Fractal dimension 3: Dataset 4: Experiments 5: Results and discussion 6: Conclusion
- 17. Chapter 18: Integer period discrete Fourier transform-based algorithm for the identification of tandem repeats in the DNA sequences Abstract 1: Introduction 2: Related work 3: Algorithm for detection of TRs 4: Performance analysis of the proposed algorithm 5: Conclusion Chapter 19: A blockchain solution for the privacy of patients’ medical data Abstract 1: Introduction 2: Stakeholders of healthcare industry 3: Data protection laws for healthcare industry 4: Medical data management 5: Issues and challenges of healthcare industry 6: Blockchain technology 7: Blockchain applications in healthcare 8: Blockchain-based framework for privacy protection of patient’s data
- 18. 9: Conclusion Chapter 20: A novel approach for securing e-health application in a cloud environment Abstract 1: Introduction 2: Motivation 3: Proposed system 4: Conclusion Chapter 21: An ensemble classifier approach for thyroid disease diagnosis using the AdaBoostM algorithm Abstract 1: Introduction 2: Data analytics 3: Machine learning 4: Approaching ensemble learning 5: Understanding bagging 6: Exploring boosting 7: Discovering stacking 8: Processing drug discovery with machine learning 9: Conclusion
- 19. Chapter 22: A review of deep learning models for medical diagnosis Abstract 1: Motivation 2: Introduction 3: MRI Segmentation 4: Deep learning architectures used in diagnostic brain tumor analysis 5: Deep learning tools applied to MRI images 6: Proposed framework 7: Conclusion and outlook 8: Future directions Chapter 23: Machine learning in precision medicine Abstract 1: Precision medicine 2: Machine learning 3: Machine learning in precision medicine 4: Future opportunities 5: Conclusions Index
- 20. Copyright Academic Press is an imprint of Elsevier 125 London Wall, London EC2Y 5AS, United Kingdom 525 B Street, Suite 1650, San Diego, CA 92101, United States 50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom Copyright © 2021 Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
- 21. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN: 978-0-12-821777-1 For information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals Publisher: Mara Conner
- 22. Acquisitions Editor: Sonnini R. Yura Editorial Project Manager: Chiara Giglio Production Project Manager: Nirmala Arumugam Cover Designer: Victoria Pearson Typeset by SPi Global, India
- 23. Contributors Rashid Ali School of Intelligent Mechatronics Engineering, Sejong University, Seoul, Republic of Korea Majed Alsadhan Department of Computer Science, Kansas State University, Manhattan, KS, United States Emmanuel Ayodele School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom Praveen Chakravarthy Bhallamudi Lumirack Solutions, Chennai, India Dilip Kumar Choubey Department of Computer Science & Engineering, Indian Institute of Information Technology, Bhagalpur, India Giuseppe Ciaburro Department of Architecture and Industrial Design, Università degli Studi della Campania Luigi Vanvitelli, Aversa, Italy Anup Das Electrical and Computer Engineering, Drexel University, Philadelphia, PA, United States Apurba Das Department of CSE, PES University Computer Vision (IoT), Tata Consultancy Services, Bangalore, India Jaydeep Das Advanced Technology Development Center, Indian Institute of Technology Kharagpur, West Bengal, India Parneeta Dhaliwal Department of Computer Science and Technology, Manav Rachna University, Faridabad, India
- 24. Haytham Elmiligi Computing Science Department, Thompson Rivers University, Kamloops, BC, Canada Ahmed A. Ewees Department of Computer, Damietta University, Damietta, Egypt Department of e-Systems, University of Bisha, Bisha, Saudi Arabia O.K. Fasil Department of Computer Science, Central University of Kerala, Kerala, India Marwa A. Gaheen Department of Computer, Damietta University, Damietta, Egypt Pardeep Garg Department of Electronics and Communication Engineering, Jaypee University of Information Technology, Solan, India Isel Grau Artificial Intelligence Lab, Free University of Brussels (VUB), Brussels, Belgium Rahul Gupta National Institute of Technology, Hamirpur, Himachal Pradesh, India Sunil Kumar Hota DIHAR, Defense Research & Development Organization, Leh, Jammu & Kashmir, India William H. Hsu Department of Computer Science, Kansas State University, Manhattan, KS, United States Enas Ibrahim Department of Computer, Damietta University, Damietta, Egypt Muhammad Taimoor Khan Medical Department, University of Debrecen, Debrecen, Hungary Sung Won Kim Department of Information and Communication Engineering, Yeungnam University, Gyeongsan, Republic of Korea Dipesh Kumar Department of ECE, IIT(ISM), Dhanbad, India Vijay Kumar National Institute of Technology, Hamirpur, Himachal Pradesh, India
- 25. Yugal Kumar Department of CSE & IT, JUIT, Solan, Himachal Pradesh, India Seshadri Sastry Kunapuli Xinthe Technologies PVT LTD, Visakhapatnam, India Deepti Lamba Department of Computer Science, Kansas State University, Manhattan, KS, United States Theodore V. Maliamanis HUman-MAchines INteraction Laboratory (HUMAIN-Lab), Department of Computer Science, International Hellenic University, Kavala, Greece Nirupama Mandal Department of ECE, IIT(ISM), Dhanbad, India Des McLernon School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom Pradeep Kumar Naik School of Life Sciences, Sambalpur University, Sambalpur, Orissa, India Ali Nauman Department of Information and Communication Engineering, Yeungnam University, Gyeongsan, Republic of Korea Muhammad Hassan Nawaz Electrical Engineering Department, University of Debrecen, Debrecen, Hungary Ann Nowe Artificial Intelligence Lab, Free University of Brussels (VUB), Brussels, Belgium George A. Papakostas HUman-MAchines INteraction Laboratory (HUMAIN-Lab), Department of Computer Science, International Hellenic University, Kavala, Greece Advika Parthvi School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India Yazdan Ahmad Qadri Department of Information and Communication Engineering, Yeungnam University, Gyeongsan, Republic of Korea Rakesh Raja Department of Computer Science and Engineering, Birla Institute of Technology, Mesra, Ranchi, India
- 26. R. Rajesh Department of Computer Science, Central University of Kerala, Kerala, India Kartik Rawal School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India Riya Sapra Department of Computer Science and Technology, Manav Rachna University, Faridabad, India Bikash Kanti Sarkar Department of Computer Science and Engineering, Birla Institute of Technology, Mesra, Ranchi, India Jane Scott School of Architecture, Planning and Landscape, Newcastle University, Newcastle, United Kingdom Dipankar Sengupta PGJCCR, Queens University Belfast, Belfast, United Kingdom Artificial Intelligence Lab, Free University of Brussels (VUB), Brussels, Belgium Isha Sharma National Institute of Technology, Hamirpur, Himachal Pradesh, India Sunil Datt Sharma Department of Electronics and Communication Engineering, Jaypee University of Information Technology, Solan, India Vijay Kumar Sharma DIHAR, Defense Research & Development Organization, Leh, Jammu & Kashmir, India Rohit Shukla Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology (JUIT), Solan, Himachal Pradesh, India Vaibhav Shukla Tech Mahindra Ltd., Mumbai, Maharastra, India S.S. Shylaja Department of CSE, PES University, Bangalore, India Tiratha Raj Singh Centre of Excellence in Healthcare Technologies and Informatics (CHETI), Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology (JUIT), Solan, Himachal Pradesh, India
- 27. Ravi B. Srivastava DIHAR, Defense Research & Development Organization, Leh, Jammu & Kashmir, India Wenhan Tan Electrical and Computer Engineering, Drexel University, Philadelphia, PA, United States Abdalrahman Tawhid Computing Science Department, Thompson Rivers University, Kamloops, BC, Canada Tanya Teotia Computing Science Department, Thompson Rivers University, Kamloops, BC, Canada Arvind Kumar Yadav Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology (JUIT), Solan, Himachal Pradesh, India Syed Ali Raza Zaidi School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom Zhiqiang Zhang School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
- 28. Preface Dr. Pardeep Kumar, Solan, India Dr. Yugal Kumar, Solan, India Dr. Mohammad A. Tawhid, Kamloops, BC, Canada Medical informatics, also known as healthcare analytics, is a useful tool that can assess and monitor health-related behavior and conditions of individuals outside the clinic. The benefits of medical informatics are significant, including improving life expectancy, disease diagnosis, and quality of life. In many individual situations, a patient requires continuous monitoring to identify the onset of possible life-threatening conditions or to diagnose potentially dangerous diseases. Traditional healthcare systems fall short in this regard. Meanwhile, rapid growth and advances have occurred in the digitization of information, retrieval systems, and wearable devices and sensors. Our times demand the design and development of new effective prediction systems using machine learning approaches, big data, and the Internet of Things (IoT) to meet health and life quality expectations. Furthermore, there is a need for monitoring systems that can monitor the health issues of elderly and remotely located people. In recent times, big data and IoT have played a vital role in health-related applications, mainly in disease identification and diagnosis. These techniques can provide possible solutions for healthcare analytics, in which both structured and unstructured data are collected through IoT-based devices and sensors. Machine learning and big data techniques can be applied to collected data for predictive diagnostic systems. However, designing and developing an effective diagnostic system is still challenging due to various issues
- 29. like security, usability, scalability, privacy, development standards, and technologies. Therefore machine learning, big data, and IoT for medical informatics are becoming emerging research areas for the healthcare community.
- 30. Outline of the book and chapter synopses This book presents state-of-the-art intelligent techniques and approaches, design, development, and innovative uses of machine learning, big data, and IoT for demanding applications of medical informatics. This book also focuses on different data collection methods from IoT-based systems and sensors, as well as preprocessing and privacy preservation of medical data. We have provided potential thoughts and methodologies to help senior undergraduate and graduate students, researchers, programmers, and healthcare industry professionals create new knowledge for the future to develop intelligent machine learning, big data, and IoT- based novel approaches for medical informatics applications. Further, the key roles and great importance of machine learning, big data, and IoT techniques as mathematical tools are elaborated in the book. A brief and orderly introduction to the chapters is provided in the following paragraphs. The book contains 23 chapters. Chapter 1 presents a survey of machine learning and predictive analytics methods for medical informatics. This chapter focuses on deep neural networks with typical use cases in computational medicine, including self-supervised learning scenarios: these include convolutional neural networks for image analysis, recurrent neural networks for time series, and generative adversarial models for correction of class imbalance in differential diagnosis and anomaly detection. The authors then continue by assessing salient connections between the current state of machine learning research and data-centric healthcare analytics, focusing specifically on diagnostic imaging and multisensor integration as crucial research topics within predictive analytics. Finally, they conclude by relating open problems of machine learning for prediction-based medical informatics surveyed in this article to the impact of big data and its associated challenges, trends, and limitations of current work, including privacy and security of sensitive patient data. Chapter 2 presents a proposed model for geolocation aware healthcare facility with IoT, Fog, and Cloud-based diagnosis in
- 31. emergency cases. An end-to-end infrastructure has been modeled for the healthcare system using geolocation-enabled IoT, fog, and cloud computing technology to identify the nearest hospital or medical facility available to the patient. It has also achieved 25%– 27% less delay and 27%–29% less power consumption than the cloud-only environment. Chapter 3 aims to capture the status of medical computer vision threats and the recent defensive techniques proposed by researchers. This chapter intends to shed light on the vulnerability of machine learning models in medical image analysis, e.g., disease diagnosis, and to become a guide for any researcher working in medical image analysis toward the development of more secure machine learning-based computer-aided diagnosis systems. Chapter 4 demonstrates a model for skull stripping and tumor detection from brain images using 3D U-Net. The demonstrated model has been tested over 373 MRIs of the LCG Segmentation Dataset, showing good standard performance over metrics of dice coefficient, and the accuracy results are competitive with the existing methods. Chapter 5 addresses the issue of corrupted laparoscopy video by haze, noise, oversaturated illumination, etc., in minimally invasive surgery. To effectively address the issue, the authors have proposed a novel algorithm to ensure the enhancement of video with faster performance. The proposed C2 D2 A (Cross Color Dominant Deep Autoencoder) uses the strength of (a) a bilateral filter, which addresses the one-shot filtering of images both in the spatial neighborhood domain and psycho-visual range; and (b) a deep autoencoder, which can learn salient patterns. The domain-based color sparseness has further improved the performance, modulating the classical deep autoencoder to a color dominant deep autoencoder. The work has shown promise toward providing a generic framework of quality enhancement of video streams and addressing performance. This, in turn, improves the image/video analytics like segmentation, detection, and tracking the objects or regions of interest.
- 32. Chapter 6 presents an alternative way of estimating respiratory rate from ECG and PPG by using machine learning to improve estimation accuracy. The proposed methods are based on respiratory signals extracted from raw signals and use a support vector machine (SVM) and neural network (NN) to estimate respiratory rate. The proposed methods achieve comparable accuracy to current methods when the number of classes is low. Once the number of classes increases, the accuracy drops significantly. Chapter 7 serves as an introductory guideline to address the challenges and opportunities while designing machine learning- enabled Healthcare Internet of Things (H-IoT) networks. It provides a discussion on traditional H-IoT, challenges, and opportunities in the Network 2030 paradigm. It also discusses potential machine learning techniques compatible with H-IoT and points out open issues and future research directions. Chapter 8 presents a skin lesion segmentation approach based on the Elitist-Jaya optimization algorithm. The proposed method contains two stages: image preprocessing and edge detection. The experimental sample consists of a set of 320 images from the skin lesion dataset. The outcomes proved that the proposed approach improved the segmentation accuracy of the affected skin lesion area and outperformed the compared methods. Chapter 9 provides its readers with an all-encompassing review that will enable a clear understanding of the current trends in glove- based gesture classification and provide new ideas for further research. The authors have analyzed deep learning approaches in terms of their current performance, advantages over classical machine learning algorithms, and limitations in specific classification scenarios. Furthermore, they present other deep learning approaches that may outperform current algorithms in glove-based gesture classification. Chapter 10 presents an ensemble approach for evaluating the cognitive performance of the human population at high altitude. The authors identify the key multidomain cognitive screening test (MDCST) and clinical features among the lowlander (≤350 m) and highlander (≥ 1500 but < 4300 m) populations, staying at an
- 33. altitude ≥ 4300 m for a prolonged duration. A goodness-of-fit test was applied to the two population cohorts for identifying significant independent measures. Rule-based mining was followed to discover associative rules between the clinical, behavioral, and cognitive screening parameters. Conclusively, a unique set of association rules have been identified with at least 30% support and more than 60% confidence in behavioral and clinical features associated with the cognitive parameters. Chapter 11 presents the role of machine learning in expert systems for disease diagnostics in human healthcare. The authors discuss essential existing expert systems for human disease diagnosis in detail. They also provide a brief evaluation of various techniques used for the development of expert systems. Chapter 12 presents an entropy-based hybrid feature selection approach for medical datasets. A stable linear-time entropy-based ensembled feature selection approach is introduced, mainly focusing on medical datasets of several sizes. The suggested approach is validated using three state-of-the-art classifiers, namely C4.5, naïve Bayes, and JRIP, over 14 benchmark medical datasets (drawn from the UCI machine learning repository). The empirical results achieved from the datasets demonstrate that the proposed ensemble model outperforms the selected learners. Chapter 13 shows how to utilize machine learning algorithms to create models that can predict healthcare systems’ critical issues. The chapter’s discussion relates to the COVID-19 pandemic and highlights the solutions offered by machine learning in such scenarios. The chapter also highlights the significance of feature engineering and its impact on machine learning models’ accuracy. The chapter ends with two case studies. The first case study shows how to build a prediction model that can predict the number of diabetic patients who will visit certain hospitals in a specific geographic location in future years. The second case study analyzes health records during the COVID-19 pandemic. Chapter 14 presents an interpretable semisupervised classifier for predicting cancer stages. Authors illustrate the self-labeling gray-box applications on the omics and clinical datasets from the cancer
- 34. genome atlas. They show that the self-labeling gray-box is accurate in predicting cancer stages of rare cancers by leveraging the unlabeled instances from more common cancer types. They discuss insights, the features influencing prediction, and a global representation of the knowledge through decision trees or rule lists, which can aid clinicians and researchers. Chapter 15 presents an overview of applications of blockchain technology in smart healthcare. The authors overviewed the fundamental blockchain concepts and applications to be used for different aspects of the smart healthcare industry and proposed a live patient monitoring system by deploying blockchain technology in the model. Keeping an eye on recent technologies in connected healthcare, they finally presented various research factors and potential challenges where blockchain technologies can play an outstanding role in realizing the concept of smart optimization in the healthcare industry. Chapter 16 focuses on clustering and classification techniques for the prediction of leukemia. The proposed work consists of Phase I, which will be dealing with the collection of datasets and visualization of datasets, whereas Phase II will be dealing with the machine learning and data mining techniques for the prediction of leukemia disease. The authors claim that the proposed techniques would give higher performance than the existing techniques. Chapter 17 presents a performance evaluation of fractal features toward seizure detection from electroencephalogram signals. The authors have evaluated the ability of three well-known fractal dimension feature extraction methods (the Katz fractal dimension, Higuchi fractal dimension, and Petrosian fractal dimension) to classify epileptic and nonepileptic electroencephalogram signals. The features are fed to an SVM classifier for the classification of epileptic and nonepileptic electroencephalogram signals. The SVM classifier results show that the fractal features are good measures to characterize the complex information of epileptic signals. Chapter 18 presents an integer period discrete Fourier transform- based algorithm to identify tandem repeats in the DNA sequences. The authors have discussed the importance of tandem repeats in
- 35. diverse applications. They proposed an integer period discrete Fourier transform (IPDFT)-based algorithm to detect the tandem repeats in DNA sequences. A comparison of the proposed algorithm’s performance has also been made with existing methods. Chapter 19 discusses the scope, applicability, and usage of blockchain technology to preserve patients’ sensitive medical data. A framework is also proposed that allows patients and hospitals to store medical records. The framework allows patients to share the information by providing access to their data and by invoking smart contracts for automatic payments for their medical claims. Chapter 20 presents a novel approach to securing e-health applications in the cloud environment. The authors provide an algorithm to secure data in e-health applications in the cloud environment. A new architecture for e-health applications in the cloud environment is proposed, which will provide application-level security and server-level security using certificates. Chapter 21 presents different ensemble learning algorithms and explains how these algorithms can be used to classify health disorders. The authors have discussed an ensemble classifier approach for thyroid disease diagnosis using the AdaBoostM algorithm. Chapter 22 presents a review of the latest artificial intelligence research in this immense medical science field, including various architectures and approaches, with special attention given to brain tumor analysis. The authors discuss various deep learning architectures used to diagnose brain tumors and compare results with existing architectures. They have examined case studies from basic clustering techniques such as K-means clustering to fuzzy and neurotrophic C-means clustering techniques and kernel graph cuts (KGC) to advanced artificial intelligence techniques such as deep convolution neural networks (DCNs), atrous convolution neural networks (ACNs), and unit architectures to find the area of interest in the coherent/incoherent regions. Finally, Chapter 23 focuses on machine learning in precision medicine. An overview of how machine learning is used in precision medicine and its potential use in the detection, diagnosis, prognosis,
- 36. risk assessment, therapy response, and discovery of new biomarkers and drug candidates is presented in this chapter. We especially thank the Intelligent Data-Centric Systems: Sensor Collected Intelligence Series Editor, Prof. Fatos Xhafa, for his continuous support and insightful guidance. We would also like to thank the publishers at Elsevier, in particular, Chiara Giglio, Editorial Project Manager, and Sonnini Ruiz Yura, Acquisitions Editor–Biomedical Engineering, for their helpful guidance and encouragement during this book’s creation. We are sincerely thankful to all authors, editors, and publishers whose works have been cited directly/indirectly in this manuscript. Special acknowledgments The first editor gratefully acknowledges the authorities of the Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, India, for their kind support for this book. The second editor gratefully acknowledges the authorities of the Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, India, for their kind support for this book. The third editor would like to acknowledge the Natural Sciences and Engineering Research Council of Canada and Thompson River University, Kamloops, Canada, for their kind support of his research on this book.
- 37. Chapter 1: Predictive analytics and machine learning for medical informatics: A survey of tasks and techniques Deepti Lamba; William H. Hsu; Majed Alsadhan Department of Computer Science, Kansas State University, Manhattan, KS, United States Abstract In this chapter, we survey machine learning and predictive analytics methods for medical informatics. We begin by surveying the current state of practice, key task definitions, and open research problems related to predictive modeling in diagnostic medicine. This follows the traditional supervised, unsupervised, and reinforcement learning taxonomy. Next, we review current research on semisupervised, active, and transfer learning, and on differentiable computing methods such as deep learning. The focus of this chapter is on deep neural networks with common use cases in computational medicine, including self- supervised learning scenarios: these include convolutional neural networks for image analysis, recurrent neural networks for time series, and generative adversarial models for correction of class imbalance in differential diagnosis and anomaly detection. We then continue by assessing salient connections between the current state of machine learning research and data-centric healthcare analytics, focusing specifically on diagnostic imaging and multisensor integration as crucial research topics within predictive analytics. This section includes synthesis experiments on analytics and multisensor data fusion within a diagnostic test bed. Finally, we conclude by relating open problems of machine learning for prediction-based medical informatics surveyed in this chapter to the impact of big data and its associated challenges, trends, and limitations of current work, including privacy and security of sensitive patient data. Keywords Predictive analytics; Machine learning; Deep learning; Medical informatics; Health informatics; Prognosis; Diagnosis; Health recommender systems; Integrative medicine CHAPTER OUTLINE 1 Introduction: Predictive analytics for medical informatics
- 38. 1.1 Overview: Goals of machine learning 1.2 Current state of practice 1.3 Key task definitions 1.4 Open research problems 2 Background 2.1 Diagnosis 2.2 Predictive analytics 2.3 Therapy recommendation 2.4 Automation of treatment 2.5 Integrating medical informatics and health informatics 3 Techniques for machine learning 3.1 Supervised, unsupervised, and semisupervised learning 3.2 Reinforcement learning 3.3 Self-supervised, transfer, and active learning 4 Applications 4.1 Test beds for diagnosis and prognosis 4.2 Test beds for therapy recommendation and automation 5 Experimental results 5.1 Test bed 5.2 Results and discussion 6 Conclusion: Machine learning for computational medicine 6.1 Frontiers: Preclinical, translational, and clinical 6.2 Toward the future: Learning and medical automation References 1: Introduction: Predictive analytics for medical informatics Medical informatics is a broad domain at the intersection of technology and health care which aims to (1) make medical data of patients available to them and to healthcare providers, thus enabling them to make timely medical decisions; and (2) manage this data for educational and research purposes. According to Morris Collen, the first articles on medical informatics appeared in the 1950s (Collen, 1986). However, it was first identified as a new specialty in the 1970s (Hasman et al., 2014). This section surveys goals, the state of practice, and specific task definitions for machine learning in medical fields and the practice of health care. These sectors produce an enormous amount of data which is highly complex and comes from heterogeneous sources: electronic health records (EHRs) (Thakkar and Davis, 2006), medical equipment and devices, wearable technologies, handwritten notes, lab results, prescriptions, and clinical information. The application of predictive analytics to this data offers potential benefits such as improved standards of care for patients, lower medical costs, and higher resultant patient satisfaction with healthcare providers. 1.1: Overview: Goals of machine learning
- 39. Predictive analytics is a branch of data science that applies various techniques including statistical inference, machine learning, data mining, and information visualization toward the ultimate goal of forecasting, modeling, and understanding the future behavior of a system based on historical and/or real-time data. This chapter focuses on machine learning (Samuel, 1959; Jordan and Mitchell, 2015) algorithms for building predictive models. In addition, we will survey applications of machine learning to automation and computer vision, especially image classification, which in some medical domains has achieved accuracy comparable to that of a human expert (Esteva et al., 2017). Sidey-Gibbons and Sidey-Gibbons (2019) provided an introduction to machine learning using a publicly available data set for cancer diagnosis. In recent years, deep learning (LeCun et al., 2015; Goodfellow et al., 2016) has attained technical success and scientific attention in application domains including medicine (Miotto et al., 2018) and health care (Kwak and Hui, 2019). Deep neural networks such as convolutional neural nets (ConvNets or CNNs) have become the predominant state-of-the-art method for analysis of images such as magnetic resonance imaging (MRI) scans, to predict diseases such as Alzheimer’s disease (Liu et al., 2014). Deep learning models face several challenges in medical domains which hinder their acceptability to the medical community—temporality of data, domain complexity, and lack of interpretability (Miotto et al., 2018). According to Miotto et al. (2018), the most used deep architectures in the health domain, briefly discussed in Section 3, include recurrent neural networks (RNNs) (Schuster and Paliwal, 1997), ConvNets (Lawrence et al., 1997), restricted Boltzmann machines (Nair and Hinton, 2010; Fischer and Igel, 2012), autoencoders (Baldi, 2012; Baxter, 1995), and variations thereof. This chapter focuses on five tasks of medical informatics: differential diagnosis (Sajda, 2006), prediction (Chen and Asch, 2017), therapy recommendation (Gräßer et al., 2017), automation of treatment (Mayer et al., 2008a), and analytics in integrative medicine (Kawanabe et al., 2016). 1.2: Current state of practice A trend forecast study (Healthcare, 2021) published by the Society of Actuaries indicates a growing usage of predictive analytics for health care. In 2019, 60% of healthcare organizations were already using predictive analytics, and 20% indicated that they would be using the same in the following year. Among those that currently use predictive analytics, 39% reported a decrease in healthcare costs and 42% improvement in patient satisfaction. These statistics demonstrate the interest of organizations in using predictive analytics in medical domain for improving their services. 1.3: Key task definitions This section provides an overview of machine learning goals in health informatics. The goals of prediction are introduced in Section 1.1. 1.3.1: Diagnosis Differential diagnosis is defined as the process of differentiating between probability of one disease versus that of other diseases with similar symptoms that could possibly account for illness in a patient. A technical series published by World Health Organization (WHO) in 2016 states that the most important task performed by primary care providers is diagnosis (World Health Organization, 2016). Machine learning tools have been used primarily for disease diagnosis throughout the history of medical informatics. Graber et al. (2005) conducted a
- 40. study to determine the causes of diagnostic errors and to develop a comprehensive taxonomy for the classification of these errors. Miller (1994) provided a representative bibliography of the state of the art and history of medical diagnostic decision support systems (MDDSS) at the time. These systems can be divided into several subcategories, among which expert systems have been used most often (Shortliffe et al., 1979). Many of the earliest rule-based expert systems (Giarratano and Riley, 1998) were developed for medical diagnosis. Shortliffe (1986) gave insights into the design of expert systems for diagnostic medicine developed during the 1970s and 1980s, including: (1) MYCIN (Shortliffe and Buchanan, 1985; Shortliffe, 2012), which focused on infectious diseases; (2) INTERNIST-1 (Miller et al., 1982); (3) QMR (Miller and Masarie, 1989; Rassinoux et al., 1996); (4) DXplain (Barnett et al., 1987; mghlcs, n.d.; Bartold and Hannigan, 2002), a diagnostic decision support system developed continuously between 1986 and the early 2000s. The most prominent limitation of expert systems was the acquisition of knowledge (Gaines, 2013) or building a knowledge base, which is both, time-consuming and a complex process that requires access to expert domain knowledge. In addition, updating the knowledge base requires significant human effort. These systems were usually designed to support users with an expert level of medical knowledge. A more recent review of expert systems is presented by Abu-Nasser (2017). Expert systems are still around but their limitations led to advances in rule learning and classification for differential diagnosis. Salman and Abu-Naser (2020) developed a diagnostic system for COVID-19 using medical websites for the knowledge base. COVID-19 is a novel viral disease that has affected millions of people around the world. The system was tested by a group of doctors and they were satisfied with its performance and ease of use. Another expert system for COVID-19 was built by Almadhoun and Abu-Naser (2020) for helping patients determine if they have been infected with COVID-19. The system gives instructions to the user based on the symptoms. The knowledge base was compiled using medical sites such as NHS Trust. Kononenko (2001) provided an historical overview of ML methods used in medical domain and a discussion about state-of-the-art algorithms: Assistant-R and Assistant-I (Kononenko and Simec, 1995), lookahead feature construction (Ragavan and Rendell, 1993), naïve Bayesian classifier (Rish et al., 2001), seminaïve Bayesian classifier (Kononenko, 1991), k- nearest neighbors (k-NN) (Dudani, 1976), and back propagation with weight elimination (Weigend et al., 1991). The paper’s experimental findings show that most classifiers have a comparable performance which makes model explainability a deciding factor behind the choice of classifier. 1.3.2: Predictive analytics Prognosis is defined as a forecast of the probable course and/or outcome of a disease. It is an important task in clinical patient management. Cruz and Wishart (2006) outlined the focal predictive tasks of prognosis/predictions for cancer. Based on these predictive tasks, the general definition of the prognosis task comprises these variants: (1) prediction of disease susceptibility (or likelihood of developing any disease prior to the actual occurrence of the disease); (2) prediction of disease recurrence (or predicting the likelihood of redeveloping the disease after its resolution); and (3) prediction of survivability (or predicting an outcome after the diagnosis of the disease in terms of life expectancy, survivability, disease progression, etc.). Ohno-Machado (2001) defined prognosis as “an estimate of cure, complication, recurrence of disease, level of function, length of stay in healthcare facilities, or survival for a patient.” The author focused on techniques that are used to model prognosis—especially the survival
- 41. analysis methods. A detailed discussion of survival analysis methods is beyond the scope of this chapter. We refer the interested readers to the book (Cantor et al., 2003) and a review of survival analysis techniques (Prinja et al., 2010). Prognostic tasks are categorized as (1) prediction for a single point in time and (2) time-related predictions. Methods used to build prognostic models include Cox proportional hazards (Cox and Oakes, 1984), logistic regression (LR) (Kleinbaum et al., 2002), and neural networks (Hassoun et al., 1995). Mendez-Tellez and Dorman (2005) published an article that states that intensive care units (ICUs) have increased the critical care being provided to injured or critically ill patients. However, the costs for the ICU treatments are very high, which has given rise to prediction models, which are classified as disease-specific or generic models. These systems work by employing a scoring system that assigns points according to illness severity and then generate a probability estimate as an outcome of the model. We do not discuss scoring systems in this chapter. We refer the interested reader to a compendium of scoring systems for outcome distributions (Rapsang and Shyam, 2014). A few of the outcome prediction models used for intensive care predictions include Mortality Probability Model II (Lemeshow et al., 1993), Simplified Acute Physiology Score (SAPS) II (Le Gall et al., 1993), Acute Physiology and Chronic Health Evaluation (APACHE) II (Knaus et al., 1985), and APACHE III (Knaus et al., 1991). These systems build LR models to predict hospital mortality by using a set of clinical and physiology variables. Another important application of learning is cancer prognosis and prediction. Early diagnosis and prognosis of any life-threatening disease, especially cancer, presents crucial real-time requirements and poses research challenges. Machine learning is being used to build classification models for categorization of cases by risk level. This is essential for clinical management of cancer patients. Kourou et al. (2015) reviewed methods that have been used to model the progression of cancer. The methods used for this task include artificial neural networks (ANNs) (Hassoun et al., 1995) and decision trees (Brodley and Utgoff, 1995), which have been used for three decades for cancer detection. The authors also noticed a growing trend of using methods such as support vector machines (SVMs) (Suykens and Vandewalle, 1999; Vapnik, 2013) and Bayesian networks (BN) (Friedman et al., 1997) for cancer prediction and prognosis. 1.3.3: Therapy recommendation A classic example of a machine learning application is a recommender system (Portugal et al., 2018; Melville and Sindhwani, 2010). Recommender systems are widely used to recommend items, services, merchandise, and users to each other based on similarity. However, the use of recommender systems in health and medical domain has not been widespread. The earliest article on recommender system in health is from the year 2007 and by 2016 only 17 articles were found for the query “recommender system health” in web of science (Valdez et al., 2016). Valdez et al. (2016) argued that the lack of popularity of recommender systems in the medical domain is due to several reasons: (1) the benchmarking criteria in medical scenarios, (2) domain complexity, (3) the different end-user groups. The end users or target users for recommender systems can be patients, medical professionals, or people who are healthy. Recommender systems can be designed to recommend therapies, sports or physical activities, medication, diagnosis, or even food or other nutritional information. This chapter also outlines major challenges faced by recommender systems in the medical domain. Challenges include a lack of clear task definition for recommender systems in the health domain. The definition depends on the target user and the item being recommended.
- 42. Wiesner and Pfeifer (2014) proposed a health recommender system (HRS) that recommend relevant medical information to the patient by using the graphical user interface of the personal health record (PHR) (Tang et al., 2006). The HRS uses the PHR to build a user profile and the authors argued that collaborative filtering is an appropriate approach for building such a system. Gräßer et al. (2017) proposed two methods for recommending therapies for patients suffering from psoriasis: a collaborative recommender and a hybrid demographic- recommender. The two are compared and combined to form an ensemble of recommender systems in order to combat drawbacks of the individual systems. The data for the experiments were acquired from University Hospital Dresden. Collaborative filtering (Sarwar et al., 2001; Su and Khoshgoftaar, 2009) is applied, where therapies are items and therapy responses are treated as user preferences. Stark et al. (2019) presented a systematic literature review on recommender systems in medicine that covers existing systems and compares them on the basis of various features. Some interesting finds from the review include the following observations: (1) most studies attempt to develop the general-purpose recommender systems (i.e., one system for all diseases); (2) disease-specific systems focus on drug recommendation for diabetes. The review points to several future research directions that include building a recommender system for recommending dosage of medicine and finding highly scalable solutions. Recommender systems can be used to suggest drugs for treatment. A popular commercial solution is IBM’s AI machine Watson Health (IBM Watson AI Healthcare Solutions, 2021), which is used by healthcare providers and researchers to make suitable decisions about providing treatment to patients based on insights from the system. 1.3.4: Automation of treatment In surgical area, research focus has been on automating tasks such as surgical suturing, implantation, and biopsy procedures. Taylor et al. (2016) presented a broad overview of medical robot systems within the context of computer integrated surgery. This article also provides a high-level classification of such systems: (1) surgical CAD/CAM systems and (2) surgical assistants. The former refers to the process of preoperative planning involving the analysis of medical images and other patient information to produce a model of the patient. This article presents examples of both kinds of robotic systems. Mayer et al. (2008b) developed an experimental system for automating recurring tasks in minimal invasive surgery by extending the learning by demonstration paradigm (Schaal, 1997; Atkeson and Schaal, 1997; Argall et al., 2009). The system consists of four robotic arms which can be equipped with minimally invasive instruments or a camera. The benchmark task selected for this work is minimally invasive knot-tying. Moustris et al. (2011) presented a literature review of commercial medical systems and surgical procedures. This work solely focuses on systems that have been experimentally implemented on real robots. Automation has also been used for simulating treatment plans on virtual surrogates of patients called phantoms (Xu, 2014). The phantoms represent the anatomy of a patient but they are too generic and hence cannot accurately represent individuals. These phantoms are especially used in pediatric oncology to study the effects of radiation treatment and late adverse effects. Virgolin et al. (2020) proposed an approach to build automatic phantoms by combining machine learning with imaging data. The problem of structuring a pediatric phantom is divided into three prediction tasks: (1) prediction of a representative body segmentation, (2) prediction of center of mass of the organ at risk, and (3) prediction of representative segmentation. Machine learning algorithms used for all three prediction tasks are least angle regression (Efron et al., 2004), least absolute shrinkage and
- 43. selection operator (Tibshirani, 1996), random forests (RFs) (Breiman, 2001), traditional genetic programming (GP-Trad) (Koza, 1994), and genetic programming—gene pool optimal mixing evolutionary algorithm (Virgolin et al., 2017). 1.3.5: Other tasks in integrative medicine The Consortium of Academic Health Centers for Integrative Medicine (imconsortium, 2020) defines the term integrative medicine as “an approach to the practice of medicine that makes use of the best-available evidence taking into account the whole person (body, mind, and spirit), including all aspects of lifestyle.” There are many definitions for integrative medicine in the literature, but all share the commonalities that reaffirm the importance of focusing on the whole person and lifestyle rather than just physical healing. According to Maizes et al. (2009), integrative medicine gained recognition due to the realization that people spend only a fraction of time on prevention of disease and maintaining good health. The authors presented a data- driven example to promote the importance of integrative medicine—walking every day for 2 h for adults afflicted with diabetes reduces mortality by 39%. It is important to note that integrative medicine is not synonymous with complementary and alternative medicine (CAM) (Snyderman and Weil, 2002). We refer interested readers to Baer (2004), which chronicles the evolution of conventional and integrative medicine in the United States. CAM refers to medical products and practices that are not part of standard medical care. Ernst (2000) presented examples of techniques used in CAM which include but are not limited to the following: acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, massage, spiritual healing, and traditional Chinese medicine (TCM). Zhao et al. (2015) presented an overview of machine learning approaches used in TCM. TCM specialists have established four diagnostic methods for TCM: observation, auscultation and olfaction, interrogation, and palpation. This article explains each of the four diagnostic methods and provides a list of machine learning methods used for each task. The most common methods are kNNs and SVM. Other methods include decision trees, Naïve Bayes (NB), and ANNs. 1.4: Open research problems A recently published editorial by Bakken (2020) highlights five clinical informatics articles that reflect a consequentialist perspective. One of the articles that we discuss here focuses on a methodological concern, that is, predictive model calibration (Vaicenavicius et al., 2019). Predictive models are an important research topic as discussed in Section 1.3.2, but many studies continue to focus on model discrimination rather than calibration. Ghassemi et al. (2020) outlined several promising research directions, specifically highlighting issues of data temporality, model interpretability, and learning appropriate representations. Machine learning models in most of the existing literature have been trained on large amount of historical data and fail to account for temporality of data in the medical domain, where patient symptoms and or treatment procedures change with time. The authors cited Google Flu Trends as an example of the need to update machine learning models to account for this data temporality, as it persistently overestimated flu (Lazer et al., 2014). Another promising research area is model interpretability (Ahmad et al., 2018; Chakraborty et al., 2017). The authors suggested many directions toward the achievement of this goal: (1) model justification to justify the predictive path rather than just explaining a specific prediction; (2) building collaborative systems, where humans and machines work together. A final research topic is representation learning, which can improve predictive performance and account for conditional relationships of interest in the medical domain.
- 44. 1.4.1: Learning for classification and regression Classification is the identification of one or more categories or subpopulations to which a new observation belongs, on the basis of a training data set containing observations, or instances. In the data sciences of statistics and machine learning, classification may be supervised (where class labels are known) (Caruana and Niculescu-Mizil, 2006), unsupervised (where they are not and assignment is based on cohesion and similarity among instances) (Ghahramani, 2003), or semisupervised. Dreiseitl and Ohno-Machado (2002) surveyed early work using LR (particularly the binomial logit model) and ANNs (particularly multilayer perceptrons or MLP) for dichotomous classification, also known as binary classification or concept learning, on diagnostic and prognostic tasks from 72 papers in the existing literature. In parallel with this broad study of discriminative approaches to diagnosis and prognosis, Dybowski and Roberts (2005) compiled a comprehensive anthology of probabilistic models primarily for generative classification. In contrast with these broad surveys, which are included for completeness and historical breadth, application papers tend to focus on specific use cases for classification, such as prediction of mortality. Eftekhar et al. (2005) presented one such paper which addresses the task of predicting head trauma mortality rate based on initial clinical data, and focuses methodologically on LR and MLP, as do Dreiseitl and Ohno-Machado (2002). Regression is the problem of mapping an input instance to a real-valued scalar or tuple, which in data science is defined as an estimation task. In medical informatics, many predictive applications can be formulated as risk analysis tasks, that is, tasks requiring estimation of syndrome probability, given data from electronic medical records. Typical examples include estimating risk of a particular form of cancer, such as in a study by Ayer et al. (2010), where they use LR and MLP to estimate risk of breast cancer. In some additional use cases, the predictive task requires estimation of a continuous value such as the size (widest diameter) of a cancer mass, rather than a probability of occurrence. Royston and Sauerbrei (2008) presented a methodological introduction to numerical estimation methods for such tasks. 1.4.2: Learning to act: Control and planning Another general category of tasks falls under the rubric of learning to act, or intelligent control and planning in engineering terminology. This includes the application of machine learning to the overlapping subarea of optimal control, the branch of mathematical optimization that deals with maximizing an objective function such as cost-weighted proximity to a target. One example of an optimal control task, which was investigated by Vogelzang et al. (2005), is maintaining a patient’s blood glucose level via automatic control of an insulin pump. The functional requirement of the system is to regulate the change in pump rate as a function of past pump rate, target glucose level, and past blood glucose measurements. The Glucose Regulation in Intensive care Patients (GRIP) system developed by Vogelzang et al. (2005) used a fixed weighted optimal control function based on previous clinical studies. Other optimal control tasks include prolonging the onset of drug resistance in treatment applications such as chemotherapy, a task studied by Ledzewicz and Schättler (2006), who formulated a dynamical system for the development of drug resistance over time and applied ordinary differential equation solvers to the task. Such numerical models can also be developed for therapeutic objectives such as minimizing tumor volume as a function of angiogenic inhibitors administered over time, an optimal control task studied by Ledzewiecz et al. (2008). By formulating parametric models for problems such as maintaining a patient’s healthcare characteristics (e.g., blood glucose level, tumor size) within desired ranges while minimizing the total cost of doing so, optimization methods from industrial engineering and operations
- 45. research, such as control charts, can be used. For example, Dobi and Zempléni (2019) applied Markov chain models and a variety of control charts to this cost-optimal control task (Dobi and Zempléni, 2019). Yet another family of intelligent control approaches originates from classical planning, particularly the inverse problem of plan recognition (mapping from observed action sequences to individual plan steps, preconditions, and desired postconditions) and the problem of plan revision, which entails modifying a plan (such as a course of drug therapy) due to an identified complication (such as a toxic episode or other adverse reaction or interaction). Such systems are discussed by Shahar and Musen (1995). Plan revision may be necessitated as a consequence of historical observation (case studies), predictive simulation, or inference using a domain theory. Finally, enterprise resource planning (ERP) is an integrative planning task of managing business processes (in health care, these include sales and marketing, patient services, provider human resources, specialist referrals, procurement of equipment and materials, treatment, billing, and insurance). van Merode et al. (2004) surveyed ERP requirements and systems for hospitals. 1.4.3: Toward greater autonomy: Active learning and self-supervision Machine learning depends on availability of a training experience, but this experience needs not come in the form of labeled data, which is expensive to acquire even with copious available resources such as expertise and nonexpert annotator time, whose cost may be reduced by gamification or other means of crowd sourcing to volunteers. In this section, we survey three species of learning without full supervision that help to free machine learning users from some aspects of these data requirements and other experiential requirements. These are 1. active learning (Settles, 2009), the problem of developing a learning system that can seek out its own experiences; 2. transfer learning (Pan and Yang, 2009), training on a set of experiences for one or more tasks or domains and using the resulting representations to facilitate learning, reasoning, and problem solving in new tasks and domains; and 3. self-supervised learning (Ross et al., 2018), the generalized task of learning with unlabeled data and inducing intrinsic labels by discovering relationships between subcomponents of the training input (such as views or parts of an object in computer vision tasks). Active learning in medical informatics spans a gamut of experiential domains from text to case studies, to controllers and policies. An example of active learning in text is the work of Druck et al. (2009), who applied categorical feature labels to words. This is a typical methodology in biomedical texts, where domain lexicons are organized into syndromic, pharmaceutical, and anatomical hierarchies, among others. Chen et al. (2012) used active learning with labels on two text categorization tasks. The first of these is at the sentence level, on the ASSERTION data set, a clinical healthcare text corpus for the 2010 i2b2/VA natural language processing (NLP) challenge. The second is at the whole-document level, on the NOVA data set, an email corpus with labels corresponding to a generic “religion versus politics” topic classification task. In subsequent work, Chen et al. (2017) applied a conditional random field (CRF)-based active learning system to the corpus of the 2010 i2b2/VA NLP challenge to show how annotation time could be reduced: by using latent Dirichlet allocation
- 46. for sentential topic modeling (sentence-level clustering) and by bootstrapping the process of set expansion for the named entity recognition (NER) task using active learning. Dligach et al. (2013) also developed an active learning system for the i2b2 task, but focused on document- level phenotyping (prefiltering of ICD-9 codes, CPT codes, laboratory results, medication orders, etc. followed by category labeling). In their work, a document consists of EHRs and all associated data for a given patient, which may be generated at multiple stages of an admission and treatment workflow. Transfer learning is typically defined as task to task or domain to domain but what constitutes a domain in medical informatics can vary. Wiens et al. (2014) investigated interhospital transfer learning by training on subsets of 132,853 admissions at three different hospitals, among which 1348 positive cases of Clostridium difficile infection were diagnosed, to boost hospital-specific precision and recall as measured holistically using the area under the receiver operating characteristic curve. As with active learning, transfer learning can be based on natural language features, typically at the word, sentence, or document level for medical informatics. For example, Lee et al. (2018) outlined a neural network approach to deidentification in patient notes, which is an instance of NER and crucial for compliance with patient confidentiality laws such as the Health Insurance Portability and Accountability Act in the United States. They applied a long short-term memory (LSTM), a type of deep learning neural network for sequence modeling, to classify named entities that represented protected health information. The transfer learning task, training on a large labeled data set to a smaller one with fewer labels, is another case of interdomain transfer. Yet another NER transfer learning problem for EHRs is defined and studied by Wang et al. (2018), who applied a bidirectional LSTM (Bi-LSTM) on a shared training corpus to create a shared representation (specifically, a word embedding) for text classification that is then fine-tuned for source and target domains by training a CRF model with labeled training data as available, to achieve label-aware NER. The experimental corpus, in this case, is a Chinese-language medical NER corpus (CM-NER) consisting of 1600 anonymized EHRs across four departments: cardiology (500), respiratory (500), neurology (300), and gastroenterology (300). Wang et al. (2018) demonstrated effective interdepartmental NER (domain-to-domain) transfer through experiments on CM-NER. Similar deep learning approaches for NLP are applied by Du et al. (2018), who demonstrated transfer using RNNs from clinical notes on psychological stressors to tweets on Twitter, to detect posts by users at risk of suicide. New architectures for implementing transfer are demonstrated by Peng et al. (2019), who used the deep bidirectional transformers BERT and ELMo to achieve cross-domain transfer among 10 benchmarking data sets from the Biomedical Language Understanding Evaluation (BLUE) compendium. Self-supervised learning consists of generating labels by means of (1) comparing objects (e.g., clustering), (2) extracting relationships, or (3) designing experiments (especially model selection). The first approach applies similarity or distance metrics over entire instances (unlabeled examples) and has traditionally been similar to unsupervised learning for classification tasks in general, while the second involves using relational patterns and/or probabilistic inference over structured data models to capture new relationships, and the third involves generating multiple candidate models (by random sampling or parameter optimization methods such as identifying support vectors for large margin discriminative classifiers), and then applying model selection. Hoffmann et al. (2010) took the second approach, introducing LUCHS, a self-supervised, relation-specific system for information extraction (IE) from text. Roller and Stevenson (2014) also used a relation-specific, ontology-aware approach to relation extraction; rather than being
- 47. based on lexicon expansion, however, it uses the curated Unified Medical Language System, a biomedical knowledge base. Stewart et al. (2011) presented an application of the third approach to the task of event detection in the domain of social media-based epidemic intelligence, where self-supervised learning consists of tokenizing text corpora, namely ProMED-Mail and WHO outbreak reports, to obtain bag of words (BOW or word vector space) embeddings. An SVM classifier is then trained, to which the authors applied model selection, testing the result against an avian flu text corpus. As Blendowski et al. (2019) noted, self-supervision in medical imaging applications is a necessity because of the comparatively high cost of supervision for medical images and video versus general computer vision and video. In medical domains, annotation may require specialization in radiology and other medical subdisciplines, whereas generic images and videos may be annotated via microwork systems such as Amazon Mechanical Turk, or even via volunteer crowdsourcing. Blendowski et al. presented a modern, deep learning-based approach to self-supervision, applying convolutional neural networks (CNNs) to capture 3D context features. 2: Background 2.1: Diagnosis 2.1.1: Diagnostic classification and regression tasks Nadeem et al. (2020) presented a very comprehensive survey on classification of brain tumor. Jha et al. (2019) evaluated 32 supervised learning methods across 17 classification data sets (in domains that include cancer, tumors, and heart and liver diseases) to determine that decision tree-based methods perform better than others on these data sets. Mostafa et al. (2018) used three classification methods (decision trees, ANNs, and NB) to determine the presence of Parkinson’s disease by using features extracted from human voice recordings, reaching a similar conclusion that decision trees performed best on this data set. Polat and Güneş (2007) presented a binary classification task for categorizing breast cancer as malignant or benign. The authors used least square support vector machine (LS-SVM) (Suykens and Vandewalle, 1999) for classification. Another machine learning task used for diagnosis is regression. Kayaer et al. (2003) used general regression neural network (GRNN) (Specht et al., 1991) for diagnosing diabetes using the Pima Indian diabetes data set (http://archive.ics.uci.edu/ml). The results show that it performs better than standard MLP and radial basis function (RBF) feedforward neural networks (Broomhead and Lowe, 1988) that have been used by other studies using the same data set. Hannan et al. (2010) have also used GRNN and RBF for heart disease diagnosis. Jeyaraj and Nadar (2019) proposed a regression-based partitioned deep CNN for the classification of oral cancer as malignant or benign. The network obtains accuracy comparable to that of a human expert oncologist. 2.1.2: Diagnostic policy-learning tasks Yu et al. (2019b) presented the first comprehensive survey of reinforcement learning (RL) applications in health care. The aim of the survey is to provide the research community with an understanding of the foundations, methodologies, existing challenges, and recent applications of RL in healthcare domain. The range of applications vary from dynamic treatment regimes (DTRs) in chronic diseases and critical care, automated clinical diagnosis, to other tasks such as clinical resource allocation and scheduling.
- 48. Early RL systems for medical informatics were predominantly designed for medical image processing and analysis (as a specialized application of computer vision). Sahba et al. (2006) developed such a system, based on Q-learning, for ultrasound image analysis, focusing on tasks such as local thresholding, feature extraction, and segmentation of organs (in this case, the prostate gland). In subsequent work, Sahba et al. (2007) extended this Q-learning system for organ segmentation to an adversarial framework that they termed “Opposition-Based Learning.” This framework allowed for more flexible formulation of utility gradients for RL problems such as balancing exploration versus exploitation. Peng et al. (2018) introduced REFUEL, a deep Q-network (DQN)-based system for reward shaping and feature construction (“rebuilding”) in differential diagnosis of diseases. Such systems are examples of reinforcement-based metalearning and can potentially incorporate aspects of both self-supervision and active learning of representation. DQN has also been used by researchers such as Al and Yun (2019) to learn policies for recognizing anatomical landmarks in X-ray-based computerized tomography (CT) and MRI images. In addition, DQN has recently been applied to learn control policies for clinical decision support tasks such as guiding a healthcare professional or first responder, especially an emergency medical technician, in obtaining ultrasound images as a remote sensing step before administering treatment. Milletari et al. (2019) presented a novel application of this method to Point of Care Ultrasound (POCUS) for scanning the left ventricle of the heart. Utility functions for deep RL in medical informatics may be tied to anatomical mapping and other automation tasks of internal medicine. Examples of such mapping include the context maps of Tu and Bai (2009), which are based on learning, i.e., parameter estimation, in Markov random fields and CRFs. In this work, the authors trained and applied inference using these models to solve high-level vision tasks such as image segmentation, configuration estimation (orientation), and region labeling of 3D brain images. A key family of RL applications is that of control policies for medical treatment. Weng et al. (2017) described a deep RL method using a sparse autoencoder for glycemic control in septic patients. While experimental validation of this system was performed using historical data, the RL framework presented can include medical devices and mixed-initiative systems. Finally, RL can also be applied to interactive differential diagnosis using natural language (i.e., dialogue). Liu et al. (2018) described a dialogue-based system for disease phenotype identification (eliciting observable characteristics or traits of diseases, such as the presentation and development of symptoms, morphology, biochemical or physiological properties, or patient behavior). The dialogue policy formulated here is a Markov decision process (MDP). The RL problem is that of detecting symptoms of any or all four known pediatric diseases by simulating query-based dialogue using an annotated corpus. The authors showed that DQN for dialogue outperforms SVM for supervised classification learning, random dialogue generation, and a rule-based dialogue agent. 2.1.3: Active, transfer, and self-supervised learning Sánchez et al. (2010) proposed a computer aided diagnosis (CAD) (Castellino, 2005) system for diabetic retinopathy screening using active learning approaches. There are four components that constitute the DR screening process: quality verification, normal anatomy detection, bright lesion detection, and red lesion detection (Niemeijer et al., 2009). The findings from these four components need to be fused in order to generate an outcome for a patient. The outcome is in the form of a likelihood that the patient will be referred to an ophthalmologist. The output from the four components of the DR screening are used to extract some features which are further used to train a kNN classifier. Active learning is applied in the training phase to select an unlabeled sample from the pool of samples and pose a query
- 49. to the expert in order to acquire a label for the sample. This is an iterative process that only stops when a stopping criterion has been reached. This work used two different query functions: uncertainty sampling (Lewis and Gale, 1994) and query-by-bagging (QBB) sampling (Abe, 1998). Apostolopoulos and Mpesiana (2020) used a transfer learning approach for the classification of medical images to diagnose COVID-19. This study uses publicly available thoracic X-rays of healthy people as well as patients suffering from COVID-19 to build an automatic diagnostic system. The aim of their work is to evaluate the effectiveness of state-of-the-art pretrained CNN models for the diagnosis of COVID-19. The CNN used for this study include VGG19 (Simonyan and Zisserman, 2015), MobileNetv2 (Sandler et al., 2018), Inception (Szegedy et al., 2015), Xception (Chollet, 2017), and InceptionResNet v2 (Szegedy et al., 2017). The study formulates the task as a multiclass classification problem with three classes: normal people, pneumonia patients, and COVID-19 patients. The study does accomplish its goals of establishing the benefits of transfer learning by using state-of-the-art CNN models. Bai et al. (2019) used a semisupervised approach for learning features from unlabeled data for the task of cardiac MR image segmentation. This segmentation is important for characterizing the function of the heart. The authors discussed the different angulated planes at which the MR images are acquired. For brevity, we refer the readers to Bai et al. (2019). Specific views of the scans and their labels have been traditionally used to train a network from scratch. The authors used a standard U-Net architecture (Ronneberger et al., 2015) with three variations to it. The results of their work show that by using self-supervised learning even a small data set is able to outperform a standard U-Net that has been trained from scratch. 2.2: Predictive analytics 2.2.1: Prediction by classification and regression We start by discussing prediction of disease susceptibility: Kim and Kim (2018) tried to predict an individual’s susceptibility to cancer by using genomic data. The authors used kNN for building a multiclass classification model. Next we move on to prediction of survivability: Choi et al. (2009) proposed a hybrid ANN and BN model to predict 5-year survival rates for breast cancer patients. The model combines the best of both worlds using black box ANN for their higher accuracy and BNs for their explainability. The survivability of a cancer patient depends on the stage of cancer, which is based on tumor size, location, spread, and other factors. Machine learning models that predict survivability in breast cancer research usually use breast cancer stage as a feature for training the model. Kate and Nadig (2017) referred to such a model as a joint model. Their work used the SEER data set (SEER Incidence Database—SEER Data & Software, 2021), which classifies cancer into four stages: in situ, localized, regional, and distant. Mobadersany et al. (2018) proposed an approach called Survival Convolutional Neural Network (SCNN), which uses a CNN integrated with Cox survival analysis technique for the task of survivability prediction for patients with brain tumors. The CNN includes a Cox proportional hazards layer that models overall survival. The proposed approach surpasses the prognostic accuracy of human experts. The final task that we discuss is prediction of recurrence: The task involves correctly predicting the recurrence of disease with a binary outcome. Abreu et al. (2016) presented a literature review to evaluate the performance of machine learning methods for the task of predicting breast cancer recurrence. The review covers literature during the years 2007–14
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- 51. the name of Michael, whose first trade had been that of a money- changer; and Romanus, either from gratitude or equity, connived at their criminal intercourse, or accepted a slight assurance of their innocence. But Zoe soon justified the Roman maxim, that every adulteress is capable of poisoning her husband; and the death of Romanus was instantly followed by the scandalous marriage and elevation of Michael IV. The expectations of Zoe were, however, disappointed; instead of a vigorous and grateful lover, she had placed in her bed a miserable wretch whose health and reason were impaired by epileptic fits, and whose conscience was tormented by despair and remorse. The most skilful physicians of the mind and body were summoned to his aid; and his hopes were aroused by frequent pilgrimages to the baths, and to the tombs of the most popular saints; the monks applauded his penance, and, except restitution (but to whom should he have restored?) Michael sought every method of expiating his guilt. While he groaned and prayed in sackcloth and ashes, his brother, the eunuch Joannes, smiled at his remorse, and enjoyed the harvest of a crime of which himself was the secret and most guilty author. His administration[71] was only the art of satiating his avarice, and Zoe became a captive in the palace of her fathers and in the hands of her slaves. When he perceived the irretrievable decline of his brother’s health, he introduced his nephew, another Michael, who derived the surname of Calaphates from his father’s occupation in the careening of vessels; at the command of the eunuch, Zoe adopted for her son the son of a mechanic; and this fictitious heir was invested with the title and purple of the Cæsars, in the presence of the senate and clergy. So feeble was the character of Zoe, that she was oppressed by the liberty and power which she recovered by the death of the Paphlagonian; and at the end of four days, she placed the crown on the head of Michael V who had protested, with tears and oaths, that he should ever reign the first and most obedient of her subjects. The only act of his short reign was his base ingratitude to his benefactors, the eunuch and the empress. The disgrace of the former was pleasing to the public; but the murmurs, and at length the clamours, of Constantinople deplored the exile of Zoe, the daughter of so many emperors; her vices
- 52. [1042-1053 a.d.] were forgotten, and Michael was taught that there is a period in which the patience of the tamest slaves rises into fury and revenge. The citizens of every degree assembled in a formidable tumult which lasted three days; they besieged the palace, forced the gates, recalled their mothers—Zoe from her prison, Theodora from her monastery, and condemned the son of Calaphates to the loss of his eyes or of his life. For the first time the Greeks beheld with surprise the two royal sisters seated on the same throne, presiding in the senate, and giving audience to the ambassadors of the nations. But this singular union subsisted no more than two months; the two sovereigns, their tempers, interests, and adherents, were secretly hostile to each other; and as Theodora was still adverse to marriage, the indefatigable Zoe, at the age of sixty, consented, for the public good, to sustain the embraces of a third husband, and the censures of the Greek church. His name and number were Constantine X and the epithet of Monomachus,[72] the single combatant, must have been expressive of his valour and victory in some public or private quarrel.[73] But his health was broken by the tortures of the gout, and his dissolute reign was spent in the alternative of sickness and pleasure. A fair and noble widow had accompanied Constantine in his exile to the isle of Lesbos, and Sclerena gloried in the appellation of his mistress. After his marriage and elevation, she was invested with the title and pomp of Augusta, and occupied a contiguous apartment in the palace. The lawful consort (such was the delicacy or corruption of Zoe) consented to this strange and scandalous partition; and the emperor appeared in public between his wife and his concubine.h SEPARATION OF GREEK AND LATIN CHURCHES In looking back from modern times at the history of the Byzantine Empire, the separation of the Greek and Latin churches appears the most important event in the reign of Constantine X; but its prominence is owing, on the one hand, to the circumstance that a closer connection began shortly after to exist between the Eastern and Western nations; and on the other, to the decline in the power of the Byzantine Empire, which gave ecclesiastical affairs greater importance than they would
- 53. otherwise have merited. Had the successors of Constantine X continued to possess the power and resources of the successors of Leo III or Basil I, the schism would never have acquired the political importance it actually attained; for as it related to points of opinion on secondary questions, and details of ecclesiastical practice, the people would have abandoned the subject to the clergy and the church, as one not affecting the welfare of Christians, nor the interest of Christianity. The emperor Basil II, who was bigoted as well as pious, had still good sense to view the question as a political rather than a religious one. He knew that it would be impossible to reunite the two churches; he saw the disposition of the Greek clergy to commence a quarrel, to avoid which he endeavoured to negotiate the amicable separation of the Byzantine ecclesiastical establishment from the papal supremacy. He proposed that the pope should be honoured as the first Christian bishop in rank, but that he should receive a pecuniary indemnity, and admit the right of the Eastern church to govern its own affairs according to its own constitution and local usages, and acknowledge the patriarch of Constantinople as its head. This plan, reasonable as it might appear to statesmen, had little chance of success. The claim of the bishop of Rome to be the agent of the theocracy which ruled the Christian church, was too generally admitted to allow any limits to be put to his authority. The propositions of Basil II were rejected, but the open rupture with Rome did not take place until 1053, when it was caused by the violent and unjust conduct of the Greek patriarch, Michael Cerularius. He ordered all the Latin churches in the Byzantine Empire, in which mass was celebrated according to the rites of the Western church, to be closed; and, in conjunction with Leo, bishop of Achrida, the patriarch of Bulgaria, addressed a controversial letter to the bishop of Trani, which revived all the old disputes with the papal church, adding the question about the use of unleavened bread in the holy communion.
- 54. [1053-1056 a.d.] THE TRIUMPH OF CLOVIS (AT THE PANTHEON, PARIS) The people on both sides, who understood little of the points contested by the clergy, adopted the simple rule, that it was their duty to hate the members of the other church; and the Greeks, having their nationality condensed in their ecclesiastical establishment, far exceeded the Western nations in ecclesiastical bigotry, for the people in the western nations of Europe were often not very friendly to papal pretensions. The extreme bigotry of the Greeks soon tended to make the people of the Byzantine Empire averse to all intercourse with the Latins, as equals, and they assumed a superiority over nations rapidly advancing in activity, wealth, power, and intelligence, merely because they deemed them heretics. The separation of the two churches proved, consequently, more injurious to the Greeks, in their stationary condition of society, than to the Western Christians, who were eagerly pressing forward in many paths of social improvement. The empress Zoe died in the year 1050, at the age of seventy. Constantine X survived to the year
- 55. 1054. When the emperor felt his end approaching, he ordered himself, according to the superstitious fashion of the time, to be transported to the monastery of Mangana, which he had constructed. His ministers, and especially his prime-minister, Joannes the logothetes, and president of the senate, urged him to name Nicephorus Bryennius, who commanded the Macedonian troops, his successor. The forms of the imperial constitution rendered it necessary that the sovereign should be crowned in Constantinople, and a courier was despatched to summon Bryennius to the capital. But as soon as Theodora heard of this attempt of her brother-in-law to deprive her of the throne she had been compelled to cede to him, she hastened to the imperial palace, convoked the senate, ordered the guards to be drawn out, and, presenting herself as the lawful empress, was proclaimed sovereign of the empire with universal acclamations. The news of this event embittered the last moments of the dying voluptuary, who hated Theodora for the respect her conduct inspired.e In her name, and by the influence of four eunuchs, the Eastern world was peaceably governed about nineteen months; and as they wished to prolong their dominion, they persuaded the aged princess to nominate for her successor Michael VI. The surname of Stratioticus declares his military profession; but the crazy and decrepit veteran could only see with the eyes and execute with the hands of his ministers. Whilst he ascended the throne, Theodora sank into the grave—the last of the Macedonian or Basilian dynasty. We have hastily reviewed, and gladly dismiss, this shameful and destructive period of twenty-eight years, in which the Greeks, degraded below the common level of servitude, were transferred like a herd of cattle by the choice or caprice of two impotent females. THE COMNENI From this night of slavery, a ray of freedom, or at least of spirit, begins to emerge; the Greeks either preserved or revived the use of surnames, which perpetuate the fame of hereditary virtue; and we now discern the rise, succession, and alliance, of the last dynasties of Constantinople and Trebizond. The Comneni, who upheld for a while the fate of the sinking empire, assumed the honour of a Roman origin; but
- 56. [1057-1059 a.d.] the family had long since been transported from Italy to Asia. Their patrimonial estate was situate in the district of Castamona, in the neighbourhood of the Euxine; and one of their chiefs, who had already entered the paths of ambition, revisited with affection, perhaps with regret, the modest though honourable dwelling of his fathers. The first of their line was the illustrious Manuel, who, in the reign of the second Basil, contributed by war and treaty to appease the troubles of the East: he left, in a tender age, two sons, Isaac and Joannes, whom, with the consciousness of desert, he bequeathed to the gratitude and favour of his sovereign. The noble youths were carefully trained in the learning of the monastery, the arts of the palace, and the exercises of the camp; and from the domestic service of the guards, they were rapidly promoted to the command of provinces and armies. Their fraternal union doubled the force and reputation of the Comneni, and their ancient nobility was illustrated by the marriage of the two brothers with a captive princess of Bulgaria, and the daughter of a patrician, who had obtained the name of Charon from the number of enemies whom he had sent to the infernal shades. The soldiers had served with reluctant loyalty a series of effeminate masters; the elevation of Michael VI was a personal insult to the more deserving generals; and their discontent was inflamed by the parsimony of the emperor and the insolence of the eunuchs. They secretly assembled in the sanctuary of St. Sophia, and the votes of the military synod would have been unanimous in favour of the old and valiant Catacalon, if the patriotism or modesty of the veteran had not suggested the importance of birth as well as merit in the choice of a sovereign. Isaac Comnenus was approved by general consent, and the associates separated without delay to meet in the plains of Phrygia at the head of their respective squadrons and detachments. The cause of Michael was defended in a single battle by the mercenaries of the imperial guard, who were aliens to the public interest, and animated only by a principle of honour and gratitude. After their defeat, the fears of the emperor solicited a treaty, which was almost accepted by the moderation of the Comnenian. But the former was betrayed by his ambassadors, and the latter was prevented by his friends. The solitary Michael submitted to the voice of the people; the
- 57. [1059-1067 a.d.] patriarch annulled their oath of allegiance; and as he shaved the head of the royal monk, congratulated his beneficial exchange of temporal royalty for the kingdom of heaven; an exchange, however, which the priest, on his own account, would probably have declined. By the hands of the same patriarch, Isaac Comnenus was solemnly crowned; the sword, which he inscribed on his coins, might be an offensive symbol, if it implied his title by conquest; but this sword would have been drawn against the foreign and domestic enemies of the state.[74] The decline of his health and vigour suspended the operation of active virtue;[75] and the prospect of approaching death determined him to interpose some moments between life and eternity. But instead of leaving the empire as the marriage portion of his daughter, his reason and inclination concurred in the preference of his brother Joannes, a soldier, a patriot, and the father of five sons, the future pillars of an hereditary succession. His first modest reluctance might be the natural dictates of discretion and tenderness, but his obstinate and successful perseverance, however it may dazzle with the show of virtue, must be censured as a criminal desertion of his duty, and a rare offence against his family and country. The purple which he had refused was accepted by Constantine Ducas, a friend of the Comnenian house, and whose noble birth was adorned with the experience and reputation of civil policy. In the monastic habit, Isaac recovered his health, and survived two years his voluntary abdication. At the command of his abbot, he observed the rule of St. Basil, and executed the most servile offices of the convent; but his latent vanity was gratified by the frequent and respectful visits of the reigning monarch, who revered in his person a benefactor and a saint. If Constantine XI were indeed the subject most worthy of empire, we must pity the debasement of the age and nation in which he was chosen. In the labour of puerile declamations he sought, without obtaining, the crown of eloquence, more precious, in his opinion, than that of Rome; and, in the subordinate functions of a judge, he forgot the duties of a sovereign and a warrior. Ducas was anxious only to secure, even at the expense of the republic, the power and prosperity of his children. His three sons, Michael VII, Andronicus I, and Constantine XII,
- 58. [1067-1070 a.d.] were invested, at a tender age, with the equal title of Augustus; and the succession was speedily opened by their father’s death. His widow, Eudocia, was entrusted with the administration. Before the end of seven months, the wants of Eudocia, or those of the state, called aloud for the male virtues of a soldier; and her heart had already chosen Romanus Diogenes, whom she raised from the scaffold to the throne. The discovery of a treasonable attempt had exposed him to the severity of the laws; his beauty and valour absolved him in the eyes of the empress, and Romanus, from a mild exile, was recalled on the second day to the command of the oriental armies. Her royal choice was yet unknown to the public, and the promise which would have betrayed her falsehood and levity was stolen by a dexterous emissary from the ambition of the patriarch. Xiphilin at first alleged the sanctity of oaths and the sacred nature of a trust; but a whisper that his brother was the future emperor relaxed his scruples, and forced him to confess that the public safety was the supreme law. He resigned the important paper; and when his hopes were confounded by the nomination of Romanus, he could no longer regain his security, retract his declarations, nor oppose the second nuptials of the empress. Yet a murmur was heard in the palace; and the barbarian guards had raised their battle- axes in the cause of the house of Ducas, till the young princes were soothed by the tears of their mother and the assurances of the fidelity of their guardian, who filled the throne with dignity and honour. ROMANUS IN THE FIELD (1067-1071) The false or genuine magnanimity of Mahmud the Ghaznavide was not imitated by Alp Arslan; and he attacked without scruple the Greek empress Eudocia and her children.[76] His alarming progress compelled her to give herself and her sceptre to the hand of a soldier; and Romanus Diogenes had been invested with the imperial purple. His patriotism, and perhaps his pride, urged him from Constantinople within two months after his accession; and the next campaign he most scandalously took the field during the holy festival of Easter. In the palace, Diogenes was no more than the husband of Eudocia; in the camp he was the emperor of the Romans, and he sustained that character with feeble resources
- 59. and invincible courage. By his spirit and success, the soldiers were taught to act, the subjects to hope, and the enemies to fear. The Turks had penetrated into the heart of Phrygia; but the sultan himself had resigned to his emirs the prosecution of the war; and their numerous detachments were scattered over Asia in the security of conquest. Laden with spoil and careless of discipline, they were separately surprised and defeated by the Greeks; the activity of the emperor seemed to multiply his presence; and while they heard of his expedition to Antioch, the enemy felt his sword on the hills of Trebizond. In three laborious campaigns[77] the Turks were driven beyond the Euphrates; in the fourth and last, Romanus undertook the deliverance of Armenia. The desolation of the land obliged him to transport a supply of two months’ provisions; and he marched forwards to the siege of Manzicert, an important fortress in the midway between the modern cities of Erzerum and Van. His army amounted, at the least, to one hundred thousand men. The troops of Constantinople were reinforced by the disorderly multitudes of Phrygia and Cappadocia; but the real strength was composed of the subjects and allies of Europe, the legions of Macedonia, and the squadrons of Bulgaria; the Uzi, a Moldavian horde, who were themselves of the Turkish race, and above all, the mercenary and adventurous bands of French and Normans. Their lances were commanded by the valiant Ursel of Baliol, the kinsman or father of the Scottish kings, and were allowed to excel in the exercise of arms, or, according to the Greek style, in the practice of the Pyrrhic dance.
- 60. Byzantine Emperor in the Costume of a General [1071 a.d.] On the report of this bold invasion, which threatened his hereditary dominions, Alp Arslan flew to the scene of action at the head of forty thousand horse. His rapid and skilful evolutions distressed and dismayed the superior numbers of the Greeks; and in the defeat of Basilacius, one of their principal generals, he displayed the first example of his valour and clemency. The imprudence of the emperor had separated his forces after the reduction of Manzicert. It was in vain that he attempted to recall the mercenary Franks; they refused to obey his summons; he disdained to await their return; the desertion of the Uzi filled his mind with anxiety and suspicion; and against the most salutary advice he rushed forwards to speedy and decisive action. Had he listened to the fair proposals of the sultan, Romanus might have secured a retreat, perhaps a peace; but in these overtures he supposed the fear or weakness of the enemy, and his answer was conceived in the tone of insult and defiance. “If the barbarian wishes for peace, let him evacuate the ground which he occupies for the encampment of the Romans, and surrender his city and palace of Rei as a pledge of his sincerity.” Alp Arslan smiled at the vanity of the demand, but he wept the death of so many faithful Moslems; and, after a devout prayer, proclaimed a free permission to all who were desirous of retiring from the field. With his own hands he tied up his horse’s tail, exchanged his bow and arrows for a mace and scimitar, clothed himself in a white garment, perfumed his body with musk, and
- 61. declared that if he were vanquished, that spot should be the place of his burial. The sultan himself had affected to cast away his missile weapons; but his hopes of victory were placed in the arrows of the Turkish cavalry, whose squadrons were loosely distributed in the form of a crescent. Instead of the successive lines and reserves of the Grecian tactics, Romanus led his army in a single and solid phalanx, and pressed with vigour and impatience the artful and yielding resistance of the barbarians. In this desultory and fruitless combat he wasted the greater part of a summer’s day, till prudence and fatigue compelled him to return to his camp. But a retreat is always perilous in the face of an active foe; and no sooner had the standard been turned to the rear, than the phalanx was broken by the base cowardice, or the baser jealousy, of Andronicus, a rival prince, who disgraced his birth and the purple of the cæsars. The Turkish squadrons poured a cloud of arrows on this moment of confusion and lassitude; and the horns of their formidable crescent was closed in the rear of the Greeks. In the destruction of the army and pillage of the camp, it would be needless to mention the number of slain or captives. The Byzantine writers deplore the loss of an inestimable pearl; they forget to mention that in this fatal day the Asiatic provinces of Rome were irretrievably sacrificed. As long as a hope survived, Romanus attempted to rally and save the relics of his army. When the centre, the imperial station, was left naked on all sides and encompassed by the victorious Turks, he still, with desperate courage, maintained the fight till the close of day, at the head of the brave and faithful subjects who adhered to his standard. They fell around him; his horse was slain; the emperor was wounded; yet he stood alone and intrepid, till he was oppressed and bound by the strength of multitudes. The glory of this illustrious prize was disputed by a slave and a soldier; a slave who had seen him on the throne of Constantinople, and a soldier whose extreme deformity had been excused on the promise of some signal service. Despoiled of his arms, his jewels, and his purple, Romanus spent a
- 62. dreary and perilous night on the field of battle, amidst a disorderly crowd of the meaner barbarians. CAPTIVITY OF THE EMPEROR In the morning the royal captive was presented to Alp Arslan, who doubted of his fortune, till the identity of the person was ascertained by the report of his ambassadors, and by the more pathetic evidence of Basilacius, who embraced with tears the feet of his unhappy sovereign. The successor of Constantine, in a plebeian habit, was led into the Turkish divan, and commanded to kiss the ground before the lord of Asia. He reluctantly obeyed; and Alp Arslan, starting from his throne, is said to have planted his foot on the neck of the Roman emperor. But the fact is doubtful; and if, in this moment of insolence, the sultan complied with a national custom, the rest of his conduct has extorted the praise of his bigoted foes, and may afford a lesson to the most civilised ages. He instantly raised the royal captive from the ground; and thrice clasping his hand with tender sympathy, assured him that his life and dignity should be inviolate in the hands of a prince who had learned to respect the majesty of his equals and the vicissitudes of fortune. From the divan, Romanus was conducted to an adjacent tent, where he was served with pomp and reverence by the officers of the sultan, who, twice each day, seated him in the place of honour at his own table. In a free and familiar conversation of eight days, not a word, not a look, of insult escaped from the conqueror; but he severely censured the unworthy subjects who had deserted their valiant prince in the hour of danger, and gently admonished his antagonist of some errors which he had committed in the management of the war. In the preliminaries of negotiation, Alp Arslan asked him what treatment he expected to receive, and the calm indifference of the emperor displays the freedom of his mind. “If you are cruel,” he said, “you will take my life; if you listen to pride, you will drag me at your chariot wheels; if you consult your interest you will accept a ransom, and restore me to my country.” “And what,” continued the sultan, “would have been your own
- 63. behaviour, had fortune smiled on your arms?” The reply of the Greek betrays a sentiment which prudence, and even gratitude, should have taught him to suppress. “Had I vanquished,” he fiercely said, “I would have inflicted on thy body many a stripe.” The Turkish conqueror smiled at the insolence of his captive; observed that the Christian law inculcated the love of enemies and forgiveness of injuries; and nobly declared that he would not imitate an example which he condemned. After mature deliberation, Alp Arslan dictated the terms of liberty and peace—a ransom of a million, an annual tribute of 360,000 pieces of gold, the marriage of the royal children, and the deliverance of all the Moslems who were in the power of the Greeks. Romanus, with a sigh, subscribed this treaty, so disgraceful to the majesty of the empire; he was immediately invested with a Turkish robe of honour; his nobles and patricians were restored to their sovereign; and the sultan, after a courteous embrace, dismissed him with rich presents and a military guard. No sooner did he reach the confines of the empire, than he was informed that the palace and provinces had disclaimed their allegiance to a captive; a sum of two hundred thousand pieces was painfully collected; and the fallen monarch transmitted this part of his ransom, with a sad confession of his impotence and disgrace. In the treaty of peace, it does not appear that Alp Arslan extorted any province or city from the captive emperor; and his revenge was satisfied with the trophies of his victory and the spoils of Anatolia, from Antioch to the Black Sea. The fairest part of Asia was subject to his laws; twelve hundred princes, or the sons of princes, stood before his throne; and two hundred thousand soldiers marched under his banners. The sultan disdained to pursue the fugitive Greeks; but he meditated the more glorious conquest of Turkestan, the original seat of the house of Seljuk. [While the Turks were getting control of Asia Minor the Byzantine Empire lost its last hold on Italy. Robert Guiscard had taken, one after another, the cities of the empire, and in 1068 laid siege to Bari. Romanus sent a fleet under Gosselin, but Guiscard’s brother Roger
- 64. [1071-1081 a.d.] defeated him. Bari capitulated in April, 1071, and the direct authority of the Roman Empire in Italy was gone forever.] THE SONS OF CONSTANTINE XI AND NICEPHORUS III (1071-1081 A.D.) The defeat and captivity of Romanus IV inflicted a deadly wound on the Byzantine monarchy of the East; and after he was released from the chains of the sultan, he vainly sought his wife and subjects. His wife had been thrust into a monastery, and the subjects of Romanus had embraced the rigid maxim of the civil law, that a prisoner in the hands of the enemy is deprived, as by the stroke of death, of all public and private rights of a citizen. In the general consternation, the cæsar Joannes asserted the indefeasible right of his three nephews. Constantinople listened to his voice, and the Turkish captive was proclaimed in the capital, and received on the frontier, as an enemy of the republic. Romanus was not more fortunate in domestic than in foreign war: the loss of two battles compelled him to yield, on the assurance of fair and honourable treatment; but his enemies were devoid of faith or humanity, and, after the cruel extinction of his sight, his wounds were left to bleed and corrupt, till in a few days he was relieved from a state of misery. Under the triple reign of the house of Ducas, the two younger brothers were reduced to the vain honours of the purple; but the eldest, the pusillanimous Michael, was incapable of sustaining the Roman sceptre; and his surname of Parapinaces denotes the reproach which he shared with an avaricious favourite, who enhanced the price, and diminished the measure, of wheat. In the school of Psellus, and after the example of his mother, the son of Eudocia made some proficiency in philosophy and rhetoric; but his character was degraded, rather than ennobled, by the virtues of a monk and the learning of a sophist.
- 65. Strong in the contempt of their sovereign and their own esteem, two generals, at the head of the European and Asiatic legions, assumed the purple at Hadrianopolis and Nicæa. Their revolt was in the same month; they bore the same name of Nicephorus; but the two candidates were distinguished by the surnames of Bryennius and Botaniates: the former in the maturity of wisdom and courage, the latter conspicuous only by the memory of his past exploits. While Botaniates advanced with cautious and dilatory steps, his active competitor stood in arms before the gates of Constantinople. The name of Bryennius was illustrious; his cause was popular; but his licentious troops could not be restrained from burning and pillaging a suburb; and the people, who would have hailed the rebel, rejected and repulsed the incendiary of his country. This change of the public opinion was favourable to Botaniates, who at length, with an army of Turks, approached the shores of Chalcedon. A formal invitation, in the name of the patriarch, the synod, and the senate, was circulated through the streets of Constantinople; and the general assembly, in the dome of St. Sophia, debated with order and calmness on the choice of their sovereign. The guards of Michael would have dispersed this unarmed multitude; but the feeble emperor, applauding his own moderation and clemency, resigned the ensigns of royalty, and was rewarded with the monastic habit and the title of archbishop of Ephesus. He left a son, a Constantine, born and educated in the purple; and a daughter of the house of Ducas illustrated the blood, and confirmed the succession, of the Comnenian dynasty. Joannes Comnenus, the brother of the emperor Isaac, survived in peace and dignity his generous refusal of the sceptre. By his wife Anne, a woman of masculine spirit and policy, he left eight children; the three daughters multiplied the Comnenian alliances with the noblest Greeks; of the five sons, Manuel was stopped by a premature death; Isaac and Alexius restored the imperial greatness of their house, which was enjoyed without toil or danger by the two younger brethren, Adrian and Nicephorus. Alexius, the third and most illustrious of the brothers, was endowed by nature with the
- 66. choicest gifts both of mind and body; they were cultivated by a liberal education, and exercised in the school of obedience and adversity. The youth was dismissed from the perils of the Turkish War,[78] by the paternal care of the emperor Romanus; but the mother of the Comneni, with her aspiring race, was accused of treason, and banished, by the sons of Ducas, to an island in the Propontis. The two brothers soon emerged into favour and action, fought by each other’s side against the rebels and barbarians, and adhered to the emperor Michael, till he was deserted by the world and by himself. In his first interview with Botaniates, “Prince,” said Alexius, with a noble frankness, “my duty rendered me your enemy; the decrees of God and of the people have made me your subject. Judge of my future loyalty by my past opposition.” The successor of Michael entertained him with esteem and confidence; his valour was employed against three rebels, who disturbed the peace of the empire, or at least of the emperors. Ursel, Bryennius, and Basilacius were formidable by their numerous forces and military fame: they were successively vanquished in the field, and led in chains to the foot of the throne; and whatever treatment they might receive from a timid and cruel court, they applauded the clemency, as well as the courage, of their conqueror. But the loyalty of the Comneni was soon tainted by fear and suspicion; nor is it easy to settle between a subject and a despot the debt of gratitude, which the former is tempted to claim by a revolt, and the latter to discharge by an executioner. The refusal of Alexius to march against a fourth rebel, the husband of his sister, destroyed the merit or memory of his past services; the favourites of Botaniates provoked the ambition which they apprehended and accused; and the retreat of the two brothers might be justified by the defence of their life or liberty. The women of the family were deposited in a sanctuary, respected by tyrants; the men, mounted on horseback, sallied from the city, and erected the standard of civil war. The soldiers, who had been gradually assembled in the capital and the neighbourhood, were
- 67. devoted to the cause of a victorious and injured leader; the ties of common interest and domestic alliance secured the attachment of the house of Ducas; and the generous dispute of the Comneni was terminated by the decisive resolution of Isaac, who was the first to invest his younger brother with the name and ensigns of royalty. They returned to Constantinople, to threaten rather than besiege that impregnable fortress; but the fidelity of the guards was corrupted; a gate was surprised, and the fleet was occupied by the active courage of George Palæologus, who fought against his father, without foreseeing that he laboured for his posterity. Alexius ascended the throne; and his aged competitor disappeared in a monastery. An army of various nations was gratified with the pillage of the city; but the public disorders were expiated by the tears and fasts of the Comneni, who submitted to every penance. ANNA COMNENA’S HISTORY The life of the emperor Alexius has been delineated by a favourite daughter, who was inspired by a tender regard for his person, and a laudable zeal to perpetuate his virtues. Conscious of the just suspicion of her readers, the princess Anna Comnenai repeatedly protests, that, besides her personal knowledge, she had searched the discourse and writings of the most respectable veterans; that, after an interval of thirty years, forgotten by, and forgetful of, the world, her mournful solitude was inaccessible to hope and fear; and that truth, the naked, perfect truth, was more dear and sacred than the memory of her parent. Yet, instead of the simplicity of style and narrative which wins our belief, an elaborate affectation of rhetoric and science betrays in every page the vanity of a female author. The genuine character of Alexius is lost in a vague constellation of virtues; and the perpetual strain of panegyric and apology awakens our jealousy, to question the veracity of the historian and the merit of the hero. We cannot, however, refuse her judicious and important remark, that the disorders of the times were the misfortune and the glory of Alexius; and that every calamity which can afflict a declining
- 68. [1081-1084 a.d.] A Byzantine Soldier empire was accumulated on his reign by the justice of heaven and the vices of his predecessors. TROUBLES OF ALEXIUS In the East, the victorious Turks had spread from Persia to the Hellespont the reign of the Koran and the crescent; the West was invaded by the adventurous valour of the Normans; and, in the moments of peace, the Danube poured forth new swarms, who had gained in the science of war what they had lost in the ferociousness of manners. The sea was not less hostile than the land; and while the frontiers were assaulted by an open enemy, the palace was distracted with secret treason and conspiracy.h One of the earliest acts of the reign of Alexius was to conclude a treaty of peace with the Seljuk emir Suleiman, who acted in Asia Minor as if he were completely independent of the grand sultan Malekshah. The treachery of Nicephorus Melissenos had placed Suleiman in possession of Nicæa, and his troops occupied several posts on the shores of the Bosporus and the Sea of Marmora; while Alexius, who required the whole forces of the empire to resist the invasion of Robert Guiscard, was compelled to purchase peace at any price. Under such circumstances, it was only to be expected that the immediate neighbourhood of Constantinople could be kept free from the Turks, and accordingly the boundaries of the Roman Empire in Asia Minor were by this treaty reduced to very narrow limits. The country immediately opposite the capital, as far as the mouth of the river Sangarius and the head of the Gulf of
- 69. Nicomedia, was evacuated by the Turks, as well as the coasts of the Sea of Marmora, from the little stream called Draco, which falls into the Gulf of Nicomedia, westward to the city of Prusias. Already the mountains of the Turkish territory were visible from the palace of Alexius and the dome of St. Sophia; but the Crusades were destined to repel the Mohammedan invasion from the shores of Europe for several centuries. THE NORMAN INVASION The spirit of enterprise and conquest which, when placed under the guidance of religious enthusiasm, carried the bravest warriors of western Europe as crusaders to the East, had, in the preceding generation, under the direction of civil wisdom, produced the conquest of England and southern Italy by the Normans. These conquests had raised their military reputation and self-confidence to the highest pitch; and Robert Guiscard, who was lord of dominions in Italy far superior in wealth to the duchy of Normandy, hoped to eclipse the exploits of Duke William in England by conquering the Byzantine Empire. But as he knew that he must expect a more prolonged resistance than England had offered to its conqueror, he sought a pretext for commencing the war which would conceal his own object, and have a tendency to induce a party in the country to take up arms against the government he was anxious to overthrow. His daughter Helena had been betrothed to Constantine Ducas, the son of Michael VII, and was still so young that she was residing in the imperial palace at Constantinople, to receive her education, when Michael was dethroned. Nicephorus III sent the child to a convent, and Robert her father stood forward as the champion of Michael’s right to recover the throne from which he had been expelled. Under the cover of this pretext, the Norman expected to render himself master of Constantinople, or at all events to gain possession of the rich provinces on the eastern shore of the Adriatic. The preparations of Robert Guiscard were far advanced when Alexius ascended the throne. To inflame the zeal of his troops, he
- 70. persuaded Pope Gregory VII that a Greek monk, who had assumed the character of Michael VII, was really the dethroned emperor, and thus induced the pope to approve of his expedition, and to grant absolution to all the invaders of the Byzantine Empire, as if they had been about to commence a holy war. The soldiers were impressed with a deep conviction of the justice of their cause and were inflamed with hopes of plunder and glory. In the month of June, 1081, Robert Guiscard sailed from Brindisi with a well-appointed fleet of a hundred and fifty ships, carrying an army of thirty thousand chosen troops. His first operation was to render himself master of the rich island of Corcyra (Corfu), which then yielded an annual revenue of fifteen hundred pounds’ weight of gold to the Byzantine government. He then seized the ports of Butrinto, Avlona, and Kanino, on the mainland, and laid siege to the important city of Dyrrhachium, the strongest fortress on the eastern coast of the Adriatic, and the capital of Byzantine Illyria. It was fortunate for the empire that George Palæologus, one of its bravest officers, had entered the place before Robert commenced the siege. The interests of Venice bound them to the cause of the Byzantine government at this time. They were alarmed lest their lucrative trade with Greece and the Levant should be placed at the mercy of the rapacious Normans, in case Robert Guiscard should succeed in gaining possession of the entrance to the Adriatic. They plunged, therefore, into the war without hesitation or reserve. The doge Dominic Sylvio sailed from Venice with a powerful fleet to attack the Normans before the emperor Alexius could collect his army and march to the relief of Dyrrhachium. The Norman fleet, which was commanded by Bohemund, the illustrious son of Robert Guiscard, suffered a complete defeat, and the communications of the invading army with Italy were cut off. This difficulty only excited Robert to press the siege with additional vigour. He employed every device then known for the attack of towns. The military proceedings of Alexius, when he reached the neighbourhood of Dyrrhachium,
- 71. were very injudicious. The battle which took place was as disgraceful to the Byzantine arms as to the emperor’s judgment. In the month of February, 1082, a Venetian, who guarded one of the towers, betrayed the city to Robert, who had previously put his army into winter quarters at Glabinitza and Joanina, in order to escape the severe cold of the winter farther north. Alexius collected the remains of the Byzantine army at Deavolis, and repaired himself to Thessalonica, where he passed the winter collecting a second army, which he was enabled to do, as he had replenished his military chest from the church plate of the richest cathedrals and monasteries in his dominions. The affairs of Italy, before the opening of the second campaign, fortunately compelled Robert Guiscard to quit Illyria, and leave his son Bohemund in command of the Norman army. In the spring of 1083, Alexius had collected an army so powerful that he again marched forward to attack the Normans. In order to break the terrible charge of their cavalry, which no Byzantine horse could resist, the emperor placed a number of chariots before his own troops, armed with barbed poles extending in front like a line of lances, and in these chariots he stationed a strong body of heavy- armed infantry. Bohemund, however, on reconnoitring this strange unwieldy measure of defence, broke up his line of cavalry into two columns, and leaving the centre of the Byzantine army with the chariots unassailed, fell with fury on the extremity of the two wings. The resistance was short, and the emperor Alexius again fled. Alexius, having procured a subsidiary force of seven thousand light cavalry from Suleiman and the sultan of Nicæa, again took the field in the spring of 1084. He formed his army into two divisions, and advanced to engage the Normans before Larissa. His preparation for a battle was on this occasion made with considerable skill. Bohemund, seeing that he was in danger of being cut off from his resources, retreated to Kastoria. As soon as the Norman army was cut off from plunder, and without any hope of making further conquests, it began to display a mutinous spirit; and Bohemund was
- 72. [1084-1118 a.d.] compelled to return to Italy, to obtain supplies of money and fresh troops. Brienne, the constable of Apulia, who commanded in his absence, found himself compelled to surrender Kastoria to the emperor Alexius, and to engage not to bear arms again against the Byzantine Empire. While Bohemund was carrying on the war against the emperor of the East, Robert Guiscard had driven the emperor of the West out of Rome; and after vanquishing Henry IV, he had plundered the Eternal City like another Genseric. He was now ready to resume his schemes of ambition in the East. Collecting a powerful fleet to carry over his victorious army into Epirus, he raised the siege of Corfu (Corcyra), which was invested by the combined naval forces of the Byzantine Empire and the Venetian Republic. The united fleets were completely defeated in a great naval battle, in which, according to Anna Comnena,i they lost thirteen thousand men. But in the month of July, 1085, Robert died in the island of Cephallenia, and with him perished all the Norman projects of conquest in the Byzantine Empire. Dyrrhachium was recovered by Alexius with the assistance of the Venetian and Amalphitan merchants established in the place, and the services of the Venetians in this war were rewarded by many commercial privileges which were conferred on them by a golden bull.e The Norman War was scarcely finished when the Patzinaks invaded the empire (1086). This war lasted five years, until, in fact, Alexius concluded a treaty with the Komans, allies of the Patzinaks, and then dealt the latter a crushing blow at Levounion in 1091. Minor wars with Servia and Dalmatia do not deserve mention, but the progress of the Seljuk Turks continued to hasten the decline of the empire. They dared everything, and in 1092 Tzachas, emir of Smyrna, assumed the title of emperor. He was put down, but retained sufficient strength to besiege Abydos in 1093. But Alexius accomplished his murder the same year. The relations of Alexius and the First Crusade will be fully treated in the account of the Holy
- 73. Wars. The ancient enmity of Alexius and Bohemund was rekindled when the latter entered into his principality of Antioch. The war lasted from 1103 to 1108, or until Bohemund’s death. The last years of Alexius’ reign were occupied with hostilities with the crusaders and again with the Seljuk Turks. The latter sustained a succession of heavy losses, and in 1116 were glad to make peace. This was the end of Alexius’ military career.a In the tempest of the Crusades Alexius steered the imperial vessel with dexterity and courage. At the head of his armies, he was bold in action, skilful in stratagem, patient of fatigue, ready to improve his advantages, and rising from his defeats with inexhaustible vigour. In his intercourse with the Latins, Alexius was patient and artful; his discerning eye pervaded the new system of an unknown world; and we shall hereafter describe the superior policy with which he balanced the interests and passions of the champions of the First Crusade. In a long reign of thirty-seven years, he subdued and pardoned the envy of his equals; the laws of public and private order were restored; the arts of wealth and science were cultivated; the limits of the empire were enlarged in Europe and Asia; and the Comnenian sceptre was transmitted to his children of the third and fourth generation. Anna is a faithful witness that his happiness was destroyed, and his health was broken, by the cares of a public life; the patience of Constantinople was fatigued by the length and severity of his reign; and before Alexius expired, he had lost the love and reverence of his subjects. The clergy could not forgive his application of the sacred riches to the defence of the state; but they applauded his theological learning and ardent zeal for the orthodox faith, which he defended with his tongue, his pen, and his sword. His character was degraded by the superstition of the Greeks; and the same inconsistent principle of human nature enjoined the emperor to found a hospital for the poor and infirm, and to direct the execution of a heretic, who was burned alive in the square of St. Sophia.
- 74. [1118-1143 a.d.] In his last hours, when he was pressed by his wife Irene to alter the succession, he raised his head, and breathed a pious ejaculation on the vanity of this world. The indignant reply of the empress may be inscribed as an epitaph on his tomb—“You die, as you have lived —a hypocrite!” (1118). JOANNES (II) COMNENUS (CALO-JOANNES) (1118-1143 A.D.) It was the wish of Irene to supplant the eldest of her surviving sons, in favour of her daughter, the princess Anna, whose philosophy would not have refused the weight of a diadem. But the order of male succession was asserted by the friends of their country; the lawful heir drew the royal signet from the finger of his insensible or unconscious father, and the empire obeyed the master of the palace. Anna Comnena was stimulated by ambition and revenge to conspire against the life of her brother; and when the design was prevented by the fears or scruples of her husband, she passionately exclaimed, that nature had mistaken the two sexes, and had endowed Bryennius with the soul of a woman. The two sons of Alexius, Joannes and Isaac, maintained the fraternal concord, the hereditary virtue of their race; and the younger brother was content with the title of Sebastocrator, which approached the dignity, without sharing the power, of the emperor. In the same person, the claims of primogeniture and merit were fortunately united; his swarthy complexion, harsh features, and diminutive stature, had suggested the ironical surname of Calo- Joannes, or John the Handsome, which his grateful subjects more seriously applied to the beauties of his mind. After the discovery of her treason, the life and fortune of Anna were justly forfeited to the laws. Her life was spared by the clemency of the emperor; but he visited the pomp and treasures of her palace, and bestowed the rich confiscation on the most
- 75. deserving of his friends. That respectable friend, Axuch, a slave of Turkish extraction, presumed to decline the gift, and to intercede for the criminal; his generous master applauded and imitated the virtue of his favourite, and the reproach or complaint of an injured brother was the only chastisement of the guilty princess. After this example of clemency, the remainder of his reign was never disturbed by conspiracy or rebellion; feared by his nobles, beloved by his people, Joannes was never reduced to the painful necessity of punishing, or even of pardoning, his personal enemies. During his government of twenty-five years, the penalty of death was abolished in the Roman Empire, a law of mercy most delightful to the humane theorist, but of which the practice, in a large and vicious community, is seldom consistent with the public safety. Severe to himself, indulgent to others, chaste, frugal, abstemious, the philosophic Marcus would not have disdained the artless virtues of his successor, derived from his heart, and not borrowed from the schools. He despised and moderated the stately magnificence of the Byzantine court, so oppressive to the people, so contemptible to the eye of reason. Under such a prince, innocence had nothing to fear, and merit had everything to hope; and without assuming the tyrannic office of a censor, he introduced a gradual though visible reformation in the public and private manners of Constantinople. The only defect of this accomplished character was the frailty of noble minds—the love of arms and military glory. Yet the frequent expeditions of John the Handsome may be justified, at least in their principle, by the necessity of repelling the Turks from the Hellespont and the Bosporus. The sultan of the Iconium was confined to his capital, the barbarians were driven to the mountains, and the maritime provinces of Asia enjoyed the transient blessings of their deliverance. From Constantinople to Antioch and Aleppo, he repeatedly marched at the head of a victorious army, and in the sieges and battles of this holy war his Latin allies were astonished by the superior spirit and prowess of a Greek. As he began to indulge the ambitious hope of restoring the ancient limits of the empire, as he revolved in his mind, the Euphrates and the Tigris, the dominion
- 76. [1143-1180 a.d.] of Syria, and the conquest of Jerusalem, the thread of his life and of the public felicity was broken by a singular accident. He hunted the wild boar in the valley of Anazarbus, and had fixed his javelin in the body of the furious animal; but, in the struggle, a poisoned arrow dropped from his quiver, and a slight wound in his hand, which produced a mortification, was fatal to the best and greatest of the Comnenian princes. MANUEL I (1143-1180 A.D.) A premature death had swept away the two eldest sons of John the Handsome; of the two survivors, Isaac and Manuel, his judgment or affection preferred the younger; and the choice of their dying prince was ratified by the soldiers, who had applauded the valour of his favourite in the Turkish War. The faithful Axuch hastened to the capital, secured the person of Isaac in honourable confinement, and purchased with a gift of two hundred pounds of silver the leading ecclesiastics of St. Sophia, who possessed a decisive voice in the consecration of an emperor. With his veteran and affectionate troops, Manuel soon visited Constantinople; his brother acquiesced in the title of Sebastocrator; his subjects admired the lofty stature and martial graces of their new sovereign, and listened with credulity to the flattering promise, that he blended the wisdom of age with the activity and vigour of youth. By the experience of his government, they were taught, that he emulated the spirit, and shared the talents, of his father, whose social virtues were buried in the grave. A reign of thirty-seven years is filled by a perpetual though various warfare against the Turks, the Christians, and the hordes of the wilderness beyond the Danube. The arms of Manuel were exercised on Mount Taurus, in the plains of Hungary, on the coast of Italy and Egypt, and on the seas of Sicily and Greece; the influence of his negotiations extended from Jerusalem to Rome and Russia; and the Byzantine monarchy, for a while, became an object of respect or terror to the powers of Asia and Europe.
- 77. Educated in the silk and purple of the East, Manuel possessed the iron temper of a soldier, which cannot easily be paralleled, except in the lives of Richard I of England, and of Charles XII of Sweden. Such was his strength and exercise in arms, that Raymond, surnamed the Hercules of Antioch, was incapable of wielding the lance and buckler of the Greek emperor. In a famous tournament, he entered the lists on a fiery courser, and overturned in his first career two of the stoutest of the Italian knights. The first in the charge, the last in the retreat, his friends and his enemies alike trembled, the former for his safety and the latter for their own. After posting an ambuscade in a wood, he rode forwards in search of some perilous adventure, accompanied only by his brother and the faithful Axuch, who refused to desert their sovereign. Eighteen horsemen, after a short combat, fled before them; but the numbers of the enemy increased; the march of the reinforcement was tardy and fearful, and Manuel, without receiving a wound, cut his way through a squadron of five hundred Turks. In a battle against the Hungarians, impatient of the slowness of his troops, he snatched a standard from the head of the column, and was the first, almost alone, who passed a bridge that separated him from the enemy. In the same country, after transporting his army beyond the Save, he sent back the boats with an order, under pain of death, to their commander, that he should leave him to conquer or die on that hostile land. In the siege of Corfu, towing after him a captive galley, the emperor stood aloft on the poop, opposing against the volleys of darts and stones a large buckler and a flowing sail; nor could he have escaped inevitable death, had not the Sicilian admiral enjoined his archers to respect the person of a hero. In one day, he is said to have slain above forty of the barbarians with his own hand; he returned to the camp, dragging along four Turkish prisoners, whom he had tied to the rings of his saddle; he was ever the foremost to provoke or to accept a single combat; and the gigantic champions, who encountered his arm, were transpierced by the lance, or cut asunder by the sword, of the invincible Manuel. The story of his exploits, which appear as a model or copy of the romances of chivalry, may induce a reasonable suspicion of the veracity of the Greeks; yet we may observe, that, in
- 78. the long series of their annals, Manuel is the only prince who has been the subject of similar exaggeration. With the valour of a soldier, he did not unite the skill or prudence of a general; his victories were not productive of any permanent or useful conquest; and his Turkish laurels were blasted in his last unfortunate campaign, in which he lost his army in the mountains of Pisidia, and owed his deliverance to the generosity of the sultan. But the most singular feature in the character of Manuel, is the contrast and vicissitude of labour and sloth, of hardiness and effeminacy. In war he seemed ignorant of peace; in peace he appeared incapable of war. In the field he slept in the sun or in the snow, tired in the longest marches the strength of his men and horses, and shared with a smile the abstinence or diet of the camp. No sooner did he return to Constantinople, than he resigned himself to the arts and pleasures of a life of luxury; the expense of his dress, his table, and his palace, surpassed the measure of his predecessors, and whole summer days were idly wasted in the delicious isles of the Propontis, in the incestuous love of his niece Theodora. The double cost of a warlike and dissolute prince exhausted the revenue, and multiplied the taxes; and Manuel, in the distress of his last Turkish campaign, endured a bitter reproach from the mouth of a desperate soldier. As he quenched his thirst, he complained that the water of a fountain was mingled with Christian blood. “It is not the first time,” exclaimed a voice from the crowd, “that you have drunk, O emperor! the blood of your Christian subjects.” Manuel Comnenus was twice married; to the virtuous Bertha or Irene of Germany, and to the beauteous Maria, a French or Latin princess of Antioch. The only daughter of his first wife was destined for Bela, a Hungarian prince, who was educated at Constantinople, under the name of Alexius; and the consummation of their nuptials might have transferred the Roman sceptre to a race of free and warlike barbarians. But as soon as Maria of Antioch had given a son and heir to the empire, the presumptive rights of Bela were
- 79. abolished, and he was deprived of his promised bride; but the Hungarian prince resumed his name and the kingdom of his fathers, and displayed such virtues as might excite the regret and envy of the Greeks. The son of Maria was named Alexius; and at the age of ten years, he ascended the Byzantine throne, after his father’s decease had closed the glories of the Comnenian line. The fraternal concord of the two sons of the great Alexius had been sometimes clouded by an opposition of interest and passion. By ambition, Isaac the Sebastocrator was excited to flight and rebellion, from whence he was reclaimed by the firmness and clemency of John the Handsome. The errors of Isaac, the father of the emperors of Trebizond, were short and venial; but Joannes, the elder of his sons, renounced forever his religion. Provoked by a real or imaginary insult of his uncle, he escaped from the Roman to the Turkish camp; his apostacy was rewarded with the Sultan’s daughter, the title of Chelebi, or noble, and the inheritance of a princely estate; and in the fifteenth century Muhammed II boasted of his imperial descent from the Comnenian family. The Adventures of Andronicus Andronicus, the younger brother of Joannes, son of Isaac, and grandson of Alexius Comnenus, is one of the most conspicuous characters of the age; and his genuine adventures might form the subject of a very singular romance. To justify the choice of three ladies of royal birth, it must be observed, that their fortunate lover was cast in the best proportions of strength and beauty; and that the want of the softer graces was supplied by a manly countenance, a lofty stature, athletic muscles, and the air and deportment of a soldier. The preservation, in his old age, of health and vigour, was the reward of temperance and exercise. A piece of bread and a draught of water was often his sole and evening repast; and if he tasted of a wild boar, or a stag, which he had roasted with his own hands, it was the well-earned fruit of a laborious chase. Dexterous in arms, he was ignorant of fear; his persuasive eloquence could bend
- 80. to every situation and character of life; his style, though not his practice, was fashioned by the example of St. Paul: and, in every deed of mischief, he had a heart to resolve, a head to contrive, and a hand to execute. In his youth, after the death of the emperor Joannes, he followed the retreat of the Roman army; but in the march through Asia Minor, design or accident tempted him to wander in the mountains; the hunter was encompassed by the Turkish huntsmen, and he remained some time a reluctant or willing captive in the power of the Sultan. His virtues and vices recommended him to the favour of his cousin; he shared the perils and the pleasures of Manuel; and while the emperor lived in public incest with his niece Theodora, the affections of her sister Eudocia were seduced and enjoyed by Andronicus. Above the decencies of her sex and rank, she gloried in the name of his concubine; and both the palace and the camp could witness that she slept or watched in the arms of her lover. She accompanied him to his military command of Cilicia, the first scene of his valour and imprudence. He pressed, with active ardour, the siege of Mopsuestia; the day was employed in the boldest attacks, but the night was wasted in song and dance, and a band of Greek comedians formed the choicest part of his retinue. Andronicus was surprised by the sally of a vigilant foe; but while his troops fled in disorder, his invincible lance transpierced the thickest ranks of the Armenians. On his return to the imperial camp in Macedonia, he was received by Manuel with public smiles and a private reproof; but the duchies of Naissus, Braniseba, and Kastoria were the reward or consolation of the unsuccessful general. Eudocia still attended his motions; at midnight, their tent was suddenly attacked by her angry brothers, impatient to expiate her infamy in his blood; his daring spirit refused her advice, and the disguise of a female habit; and, boldly starting from his couch, he drew his sword, and cut his way through the numerous assassins. It was here that he first betrayed his ingratitude and treachery; he engaged in a treasonable correspondence with the king of Hungary and the German emperor, approached the royal tent at a suspicious hour
- 81. with a drawn sword, and under the mask of a Latin soldier, avowed an intention of revenge against a mortal foe; and imprudently praised the fleetness of his horse as an instrument of flight and safety. The monarch dissembled his suspicions; but, after the close of the campaign, Andronicus was arrested, and strictly confined in a tower of the palace of Constantinople. In this prison he was left above twelve years, a most painful restraint, from which the thirst of action and pleasure perpetually urged him to escape. Alone and pensive, he perceived some broken bricks in a corner of the chamber, and gradually widened the passage, till he had explored a dark and forgotten recess. Into this hole he conveyed himself and the remains of his provisions, replacing the bricks in their former positions, and erasing with care the footsteps of his retreat. At the hour of the customary visit, his guards were amazed with the silence and solitude of the prison, and reported, with shame and fear, his incomprehensible flight. The gates of the palace and city were instantly shut: the strictest orders were despatched into the provinces for the recovery of the fugitive; and his wife, on the suspicion of a pious act, was basely imprisoned in the same tower. At the dead of night she beheld a spectre: she recognised her husband; they shared their provisions; and a son was the fruit of the stolen interviews; which alleviated the tediousness of their confinement. In the custody of a woman, the vigilance of the keepers was insensibly relaxed; and the captive had accomplished his real escape, when he was discovered, brought back to Constantinople, and loaded with a double chain. At length he found the moment and the means of his deliverance. A boy, his domestic servant, intoxicated the guards, and obtained in wax the impression of the keys. By the diligence of his friends, a similar key, with a bundle of ropes, was introduced into the prison, in the bottom of a hogshead. Andronicus employed, with industry and courage, the instruments of his safety, unlocked the doors, descended from the tower, concealed himself all day among the
- 82. A Byzantine Soldier bushes, and without difficulty scaled in the night the garden-wall of the palace. A boat was stationed for his reception; he visited his own house, embraced his children, cast away his chain, mounted a fleet horse, and directed his rapid course towards the banks of the Danube. At Anchialus in Thrace an intrepid friend supplied him with horses and money; he passed the river, traversed with speed the desert of Moldavia and the Carpathian hills, and had almost reached the town of Haliez, in Polish Russia, when he was intercepted by a party of Wallachians, who resolved to convey their important captive to Constantinople. His presence of mind again extricated him from this danger. Under the pretence of sickness, he dismounted in the night, and was allowed to step aside from the troop; he planted in the ground his long staff; clothed it with his cap and upper garment; and, stealing into the wood, left a phantom to amuse, for some time, the eyes of the Wallachians. From Halicz he was honourably conducted to Kieff, the residence of the great duke; the subtle Greek soon obtained the esteem and confidence of Yaroslaff; his character could assume the manners of every climate; and the barbarians applauded his strength and courage in the chase of the elks and bears of the forest. In this northern region he deserved the forgiveness of Manuel, who solicited the Russian prince to join his arms in the invasion of Hungary. The influence of Andronicus achieved this important service; his private treaty was signed with a promise of fidelity on one side, and of oblivion on the other; and he marched, at the head of the Russian cavalry, from the Borysthenes to the Danube. In his resentment, Manuel had ever sympathised with the martial and dissolute character of his cousin; and his free pardon was sealed in
- 83. the assault of Zemlin, in which he was second, and second only, to the valour of the emperor. He was removed from the royal presence by an honourable banishment, a second command of the Cilician frontier, with the absolute disposal of the revenues of Cyprus. In this station, the Armenians again exercised his courage, and exposed his negligence; and the same rebel, who baffled all his operations, was unhorsed and almost slain by the vigour of his lance. But Andronicus soon discovered a more easy and pleasing conquest, the beautiful Philippa, sister of the empress Maria, and daughter of Raymond of Poitou, the Latin prince of Antioch. For her sake he deserted his station, and wasted the summer in balls and tournaments; to his love she sacrificed her innocence, her reputation, and the offer of an advantageous marriage. But the resentment of Manuel for this domestic affront interrupted his pleasures. The emperor still thirsted for revenge; and his subjects and allies of the Syrian frontier were repeatedly pressed to seize the person, and put out the eyes, of the fugitive. In Palestine he was no longer safe; but the tender Theodora revealed his danger and accompanied his flight. After a long circuit round the Caspian Sea and the mountains of Georgia, he finally settled among the Turks of Asia Minor, the hereditary enemies of his country. The sultan of Colonia afforded a hospitable retreat to Andronicus, his mistress, and his band of outlaws; the debt of gratitude was paid by frequent inroads in the Roman province of Trebizond, and he seldom returned without an ample harvest of spoil and of Christian captives. His vigilance had eluded or repelled the open and secret persecution of the emperor; but he was at length ensnared by the captivity of his female companion. The governor of Trebizond succeeded in his attempt to surprise the person of Theodora; the queen of Jerusalem and her two children were sent to Constantinople, and their loss embittered the tedious solitude of banishment. The fugitive implored and obtained a final pardon, with leave to throw himself at the feet of his sovereign, who was satisfied with the submission of this haughty spirit. Prostrate on the ground,
- 84. [1180-1183 a.d.] he deplored with tears and groans the guilt of his past rebellion; nor would he presume to arise unless some faithful subject would drag him to the foot of the throne. This extraordinary penance excited the wonder and pity of the assembly; his sins were forgiven by the church and state; but the just suspicion of Manuel fixed his residence at a distance from the court, at Œnoe, a town of Pontus, surrounded with rich vineyards, and situate on the coast of the Euxine. The death of Manuel, and the disorders of the minority, soon opened the fairest field to his ambition. ALEXIUS II (1180-1183 A.D.) The emperor was a boy of twelve or fourteen years of age, without vigour, or wisdom, or experience; his mother, the empress Mary, abandoned her person and government to a favourite of the Comnenian name; and his sister, another Mary, whose husband, an Italian, was decorated with the title of Cæsar, excited a conspiracy, and at length an insurrection, against her odious stepmother. The provinces were forgotten, the capital was in flames, and a century of peace and order was overthrown in the vice and weakness of a few months. A civil war was kindled in Constantinople; the two factions fought a bloody battle in the square of the palace, and the rebels sustained a regular siege in the cathedral of St. Sophia. The patriarch laboured with honest zeal to heal the wounds of the republic, the most respectable patriots called aloud for a guardian and avenger, and every tongue repeated the praise of the talents and even the virtues of Andronicus. In his march from Œnoe to Constantinople, his slender train insensibly swelled to a crowd and an army; his professions of religion and loyalty were mistaken for the language of his heart; and the simplicity of a foreign dress, which showed to advantage his majestic stature, displayed a lively image of his poverty and exile. All opposition sank before him; he reached the straits of the Thracian Bosporus; the Byzantine navy
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