Business Process Management: 16th International Conference, BPM 2018, Sydney, NSW, Australia, September 9-14, 2018, Proceedings Mathias Weske

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Business Process Management: 16th International

Conference, BPM 2018, Sydney, NSW, Australia, September
9–14, 2018, Proceedings Mathias Weske
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management-16th-international-conference-bpm-2018-sydney-nsw-
australia-september-9-14-2018-proceedings-mathias-weske/
Business Process Management Forum: BPM Forum 2018,

Sydney, NSW, Australia, September 9-14, 2018,
Proceedings Mathias Weske
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Business Process Management Workshops: BPM 2018

International Workshops, Sydney, NSW, Australia,
September 9-14, 2018, Revised Papers Florian Daniel
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Symposium ASSRI 2018 Sydney NSW Australia September 6
2018 and Wollongong NSW Australia December 14 2018
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Conference, BPM 2019, Vienna, Austria, September 1–6,
2019, Proceedings Thomas Hildebrandt
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Conference, BPM 2020, Seville, Spain, September 13–18,
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Bahrurst NSW Australia November 28 30 2018 Revised
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Business Process Management 12th International

Conference BPM 2014 Haifa Israel September 7 11 2014
Proceedings 1st Edition Shazia Sadiq
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Mathias Weske
Marco Montali
Ingo Weber
Jan vom Brocke (Eds.)
LNCS 11080
Business Process
Management
16th International Conference, BPM 2018
Sydney, NSW, Australia, September 9–14, 2018
Proceedings
123
Lecture Notes in Computer Science 11080
Commenced Publication in 1973
Founding and Former Series Editors:
Gerhard Goos, Juris Hartmanis, and Jan van Leeuwen
Editorial Board
David Hutchison
Lancaster University, Lancaster, UK
Takeo Kanade
Carnegie Mellon University, Pittsburgh, PA, USA
Josef Kittler
University of Surrey, Guildford, UK
Jon M. Kleinberg
Cornell University, Ithaca, NY, USA
Friedemann Mattern
ETH Zurich, Zurich, Switzerland
John C. Mitchell
Stanford University, Stanford, CA, USA
Moni Naor
Weizmann Institute of Science, Rehovot, Israel
C. Pandu Rangan
Indian Institute of Technology Madras, Chennai, India
Bernhard Steffen
TU Dortmund University, Dortmund, Germany
Demetri Terzopoulos
University of California, Los Angeles, CA, USA
Doug Tygar
University of California, Berkeley, CA, USA
Gerhard Weikum
Max Planck Institute for Informatics, Saarbrücken, Germany
More information about this series at http://www.springer.com/series/7409
Mathias Weske Marco Montali
•
Ingo Weber Jan vom Brocke (Eds.)

•
Business Process
Management
16th International Conference, BPM 2018
Sydney, NSW, Australia, September 9–14, 2018
Proceedings
123
Editors
Mathias Weske Ingo Weber
Hasso-Plattner-Institute Data61
University of Potsdam CSIRO
Potsdam Eveleigh, NSW
Germany Australia
Marco Montali Jan vom Brocke
Free University of Bozen Bolzano University of Liechtenstein
Bolzano Vaduz
Italy Liechtenstein
ISSN 0302-9743 ISSN 1611-3349 (electronic)

Lecture Notes in Computer Science
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https://doi.org/10.1007/978-3-319-98648-7
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Preface
The 16th International Conference on Business Process Management provided a forum

for researchers and practitioners in the broad and diverse field of business process
management. To accommodate for the diversity of the field, this year the BPM con-
ference introduced a track structure, with tracks for foundations, engineering, and
management. These tracks cover not only different phenomena of interest and research
methods, but, consequently, also ask for different evaluation criteria. Each track had a
dedicated track chair and a dedicated Program Committee. The track chairs, together
with a consolidation chair, were responsible for the scientific program.
BPM 2018 was organized by the Service Oriented Computing Research Group,
School of Computer Science and Engineering, University of New South Wales, in
collaboration with research groups at Macquarie University, the University of Tech-
nology Sydney, and the Service Science Society. The conference was held in Sydney,
Australia, during September 9–14, 2018.
The conference received 140 full paper submissions, well distributed over the tracks.
Each paper was reviewed by at least three Program Committee members, and a Senior
Program Committee member who triggered and moderated scientific discussions and
reflected these in an additional meta-review. We accepted 27 excellent papers in the
main conference (acceptance rate 19%), nine in each track. 14 submissions appeared in
the BPM Forum, published in a separate volume of the Springer LNBIP series.
Implementing the track system, we can report that (i) BPM continued to attract
excellent papers from the core BPM community and (ii) BPM 2018 managed to attract
excellent papers from the management discipline. In the words of BPM conference
founder and long-time chair of the BPM Steering Committee Wil van der Aalst: “The
track system works”. There were also lessons learned, which we expose in a short
paper that can be found in these proceedings.
In the foundations track led by Marco Montali, core BPM topics including process
discovery and performance analysis were represented. There were also papers on
conceptual modeling aspects including domain-specific process modeling, process
collaborations, and aspects related to time in business processes. The engineering track
was led by Ingo Weber. Structurally quite similar to the foundations track, there were
papers related to phenomena that have been discussed at BPM in recent years, but there
were also papers that open the conference to new topics, for instance machine learning
aspects in BPM. The extension in breadth of the BPM conference can be found mainly
in the management track, led by Jan vom Brocke. It is interesting to see that several
papers concentrate on challenges related to method analysis and method selection. The
value of technical solutions is analyzed with respect to their impact and usability in a
concrete business context. This track also features papers about digital innovation and
the role of business process management in this context.
In his keynote, Manfred Reichert provided an engineering perspective on business
process management, by investigating the relationship of BPM technology and
VI Preface
Internet-of-Things scenarios. Brian Pentland took a management perspective on busi-

ness processes by looking at patterns of actions in organizations and by proposing a
novel role of BPM techniques. Sanjiva Weerawarana introduced Ballerina, a middle-
ware platform that can play an important role in future BPM integration scenarios.
Organizing a scientific conference is a complex process, involving many roles and
many more interactions. We thank all our colleagues involved for their excellent work.
The workshop chairs attracted 11 innovative workshops, the industry chairs organized
a top-level industry program, and the demo chairs attracted many excellent demos. The
panel chairs compiled an exciting panel, which opened doors to future research chal-
lenges. Without the publicity chairs, we could not have attracted such an excellent
number of submissions. Younger researchers benefited from excellent tutorials; doc-
toral students received feedback about their work from experts in the field at the
Doctoral Consortium. The mini-sabbatical program helped to bring additional col-
leagues to Australia. The proceedings chair professionally interacted with Springer and
with the authors to prepare excellent volumes of LNCS and LNBIP.
The members of the tracks’ Program Committees and of the Senior Program
Committees deserve particular acknowledgment for their dedication and commitment.
We are grateful for the help and expertise of sub-reviewers, who provided valuable
feedback during the reviewing process and engaged in deep discussions at times. BPM
2018 had a dedicated process to consolidate paper acceptance across tracks. During the
very intensive weeks of this phase, many Senior Program Committee members eval-
uated additional papers and were engaged in additional discussions. Special thanks
goes to these colleagues, who were instrumental during this decisive phase of the
reviewing process.
Finally, we thank the Organizing Committee and the Local Arrangements Com-
mittee, led by Boualem Benatallah and Jian Yang. The development of the program
structure was particularly challenging, because with the new track structure this year
many more papers were accepted than traditionally at BPM. Still, we managed to avoid
concurrency between main conference papers, while proving a packed, exciting pro-
gram. Through their generous support, the sponsors of the conference had a great share
in its success. We thank the conference partner Data61, the Platinum sponsor Signavio,
the Gold sponsors Celonis and IBM Research, and the Bronze sponsors Bizagi and
Springer for their support. We also thank the University of New South Wales and
Macquarie University for their enormous and high-quality support.
September 2018 Mathias Weske

Marco Montali
Ingo Weber
Jan vom Brocke
Organization
BPM 2018 was organized by the University of New South Wales, in collaboration with
Macquarie University, the University of Technology Sydney, and the Service Science
Society, and took place in Sydney, Australia.
Steering Committee
Mathias Weske (Chair) University of Potsdam, Germany
Boualem Benatallah University of New South Wales, Australia
Jörg Desel University of Hagen, Germany
Schahram Dustdar Vienna University of Technology, Austria
Marlon Dumas University of Tartu, Estonia
Wil van der Aalst RWTH Aachen University, Germany
Michael zur Muehlen Stevens Institute of Technology, USA
Stefanie Rinderle-Ma University of Vienna, Austria
Barbara Weber Technical University of Denmark, Denmark
Manfred Reichert Ulm University, Germany
Jan Mendling Vienna University of Economics and Business, Austria
Executive Committee
General Chairs
Boualem Benatallah University of New South Wales, Australia
Jian Yang Macquarie University, Australia
Program Chairs
Mathias Weske University of Potsdam, Germany
(Consolidation Chair)
Marco Montali University of Bolzano, Italy
(Chair Track I)
Ingo Weber Data61|CSIRO, Australia
(Chair Track II)
Jan vom Brocke University of Liechtenstein, Liechtenstein
(Chair Track III)
Industry Chairs
Fabio Casati University of Trento, Italy
Gero Decker Signavio, Germany
Surya Nepal Data61|CSIRO, Australia
VIII Organization
Workshops
Florian Daniel Politecnico di Milano, Italy
Hamid Motahari IBM, Almaden Research Center, San Jose, USA
Michael Sheng Macquarie University, Australia
Demo Chairs
Raffaele Conforti The University of Melbourne, Australia
Massimiliano de Leoni Eindhoven University of Technology, The Netherlands
Publicity Chairs
Cinzia Cappiello Politecnico di Milano, Italy
Daniela Grigori Université Paris Dauphine, France
Oktay Türetken Eindhoven University of Technology, The Netherlands
Lijie Wen Tsinghua University, China
Sponsorship and Community Liaison Chairs

François Charoy University of Lorraine, France
Onur Demirors Izmir Institute of Technology, Turkey and
UNSW Sydney, Australia
Fethi Rabhi UNSW Sydney, Australia
Daniel Schlagwein UNSW Sydney, Australia
Panel Chairs
Athman Bouguettaya The University of Sydney, Australia
Mohand-Saïd Hacid Université Claude Bernard Lyon 1, France
Tutorial Chairs
Marcello La Rosa The University of Melbourne, Australia
Farouk Toumani Blaise Pascale University, France
Doctoral Consortium Chairs

Yan Wang Macquarie University, Australia
Josep Carmona Universitat Politècnica de Catalunya, Spain
Mini-Sabbatical Program Chairs

Shazia Sadiq The University of Queensland, Australia
Moe Thandar Wynn Queensland University of Technology, Australia
Organization IX
Local Organization Liaison and Networking Chair

Ghassan Beydoun University of Technology Sydney, Australia
Local Arrangements Committee

Olivera Marjanovic University of Technology Sydney, Australia
(Co-chair)
Lina Yao (Co-chair) UNSW Sydney, Australia
Kyeong Kang University of Technology Sydney, Australia
Wei Zhang Macquarie University, Australia
Proceedings Chair
Luise Pufahl University of Potsdam, Germany
Web and Social Media Chair

Amin Beheshti Macquarie University, Australia
Track I (Foundations)
Senior Program Committee
Florian Daniel Politecnico di Milano, Italy
Dirk Fahland Eindhoven University of Technology, The Netherlands
Giancarlo Guizzardi Free University of Bozen-Bolzano, Italy
Thomas Hildebrandt IT University of Copenhagen, Denmark
Marcello La Rosa The University of Melbourne, Australia
John Mylopoulos University of Toronto, Canada
Jianwen Su University of California at Santa Barbara, USA
Hagen Völzer IBM Research - Zurich, Switzerland
Matthias Weidlich Humboldt-Universität zu Berlin, Germany
Program Committee
Ahmed Awad Cairo University, Egypt
Giuseppe De Giacomo Sapienza University of Rome, Italy
Jörg Desel Fernuniversität in Hagen, Germany
Claudio di Ciccio Vienna University of Economics and Business, Austria
Chiara Di Francescomarino Fondazione Bruno Kessler-IRST, Italy
Rik Eshuis Eindhoven University of Technology, The Netherlands
Hans-Georg Fill University of Bamberg, Germany
Guido Governatori Data61|CSIRO, Australia
Gianluigi Greco University of Calabria, Italy
Richard Hull IBM, USA
Irina Lomazova National Research University Higher School
of Economics, Russian Federation
Alessio Lomuscio Imperial College London, UK
X Organization
Fabrizio Maria Maggi University of Tartu, Estonia

Andrea Marrella Sapienza University of Rome, Italy
Heinrich C. Mayr Alpen-Adria-Universität Klagenfurt, Austria
Oscar Pastor Universitat Politècnica de València, Spain
Geert Poels Ghent University, Belgium
Artem Polyvyanyy Queensland University of Technology, Australia
Wolfgang Reisig Humboldt Universität zu Berlin, Germany
Arik Senderovich University of Toronto, Canada
Andreas Solti Vienna University of Economics and Business, Austria
Ernest Teniente Universitat Politècnica de Catalunya, Spain
Daniele Theseider Dupré Università del Piemonte Orientale, Italy
Victor Vianu University of California San Diego, USA
Lijie Wen Tsinghua University, China
Track II (Engineering)
Jan Mendling Vienna University of Economics and Business, Austria
Cesare Pautasso University of Lugano, Switzerland
Hajo A. Reijers Vrije Universiteit Amsterdam, The Netherlands
Pnina Soffer University of Haifa, Israel
Wil van der Aalst RWTH Aachen University, Germany
Boudewijn van Dongen Eindhoven University of Technology, The Netherlands
Jianmin Wang Tsinghua University, China
Program Committee
Marco Aiello University of Stuttgart, Germany
Amin Beheshti Macquarie University, Australia
Andrea Burattin Technical University of Denmark, Denmark
Cristina Cabanillas Vienna University of Economics and Business, Austria
Josep Carmona Universitat Politècnica de Catalunya, Spain
Fabio Casati University of Trento, Italy
Jan Claes Ghent University, Belgium
Francisco Curbera IBM, USA
Massimiliano de Leoni Eindhoven University of Technology, The Netherlands
Jochen De Weerdt Katholieke Universiteit Leuven, Belgium
Remco Dijkman Eindhoven University of Technology, The Netherlands
Marlon Dumas University of Tartu, Estonia
Schahram Dustdar Vienna University of Technology, Austria
Gregor Engels University of Paderborn, Germany
Joerg Evermann Memorial University of Newfoundland, Canada
Walid Gaaloul Télécom SudParis, France
Avigdor Gal Technion, Israel
Organization XI
Luciano García-Bañuelos University of Tartu, Estonia

Chiara Ghidini Fondazione Fondazione Bruno Kessler-IRST, Italy
Daniela Grigori University of Paris-Dauphine, France
Dimka Karastoyanova University of Groningen, The Netherlands
Christopher Klinkmüller Data61|CSIRO, Australia
Agnes Koschmider Karlsruhe Institute of Technology, Germany
Jochen Kuester Bielefeld University of Applied Sciences, Germany
Henrik Leopold Vrije Universiteit Amsterdam, The Netherlands
Raimundas Matulevicius University of Tartu, Estonia
Massimo Mecella Sapienza University of Rome, Italy
Hamid Motahari IBM, USA
Jorge Munoz-Gama Pontificia Universidad Católica de Chile, Chile
Hye-Young Paik The University of New South Wales, Australia
Luise Pufahl University of Potsdam, Germany
Manuel Resinas University of Seville, Spain
Shazia Sadiq The University of Queensland, Australia
Minseok Song Pohang University of Science and Technology,
South Korea
Stefan Tai Technical University of Berlin, Germany
Samir Tata IBM, USA
Arthur Ter Hofstede Queensland University of Technology, Australia
Farouk Toumani Blaise Pascal University, France
Moe Wynn Queensland University of Technology, Australia
Track III (Management)

Joerg Becker European Research Center for Information Systems,
Germany
Alan Brown University of Surrey, UK
Mikael Lind University of Borås, Sweden
Peter Loos Saarland University, Germany
Amy Looy Ghent University, Belgium
Olivera Marjanovic University of Technology, Sydney, Australia
Jan Recker University of Cologne, Germany
Maximilian Roeglinger University of Bayreuth, Germany
Michael Rosemann Queensland University of Technology, Australia
Schmiedel Theresa University of Liechtenstein, Liechtenstein
Peter Trkman University of Ljubljana, Slovenia
Program Committee
Peyman Badakhshan University of Liechtenstein, Liechtenstein
Alessio Braccini University of Tuscia, Italy
Patrick Delfmann University of Koblenz-Landau, Germany
XII Organization
Peter Fettke German Research Center for Artificial Intelligence

(DFKI) and Saarland University, Germany
Kathrin Figl Vienna University of Economics and Business, Austria
Thomas Grisold Vienna University of Economics and Business, Austria
Marta Indulska The University of Queensland, Australia
Mieke Jans Hasselt University, Belgium
Janina Kettenbohrer University of Bamberg, Germany
John Krogstie Norwegian University of Science and Technology,
Norway
Xin Li City University of Hong Kong, Hong Kong,
SAR China
Alexander Maedche Karlsruhe Institute of Technology, Germany
Willem Mertens Queensland University of Technology, Australia
Charles Moeller Aalborg University, Denmark
Oliver Mueller IT University of Copenhagen, Denmark
Markus Nuettgens University of Hamburg, Germany
Ferdinando Pennarola Università L. Bocconi, Italy
Flavia Santoro Universidade Federal do Estado do Rio de Janeiro,
Brazil
Anna Sidorova University of North Texas, USA
Silvia Inês Dallavalle de University of São Paulo, Brazil
Pádua
Vijayan Sugumaran Oakland University, USA
Oliver Thomas University of Osnabrück, Germany
Harry Wang University of Delaware, USA
Charlotte Wehking University of Liechtenstein, Liechtenstein
Axel Winkelmann University of Würzburg, Germany
Dongming Xu The University of Queensland, Australia
Weithoo Yue City University of Hong Kong, Hong Kong,
SAR China
Sarah Zelt University of Liechtenstein, Liechtenstein
Michael Zur Muehlen Stevens Institute of Technology, USA
Additional Reviewers
Alessio Cecconi Bian Yiyang

Alexey A. Mitsyuk Boris Otto
Alin Deutsch Brian Setz
Anna Kalenkova Carl Corea
Anton Yeshchenko Chiara Ghidini
Armin Stein Christoph Drodt
Azkario Rizky Pratama Daning Hu
Bastian Wurm David Sanchez-Charles
Benjamin Meis Fabio Patrizi
Benjamin Spottke Fabrizio Maria Maggi
Organization XIII
Florian Bär Nils Urbach

Francesco Leotta Peyman Badakhshan
Frank Blaauw Rene Abraham
Friedrich Holotiuk Riccardo De Masellis
Giorgio Leonardi Robin Bergenthum
Gottfried Vossen Roope Jaakonmäki
Gul Tokdemir Saimir Bala
Harris Wu Sebastian Steinau
Heerko Groefsema Sergey Shershakov
Jennifer Hehn Shan Jiang
Jiaqi Yan Stefan Oppl
Kieran Conboy Sven Radszuwill
Kimon Batoulis Thomas Friedrich
Kun Chen Tyge-F. Kummer
Laura Giordano Vladimir Bashkin
Lele Kang Vladimir Zakharov
Luciano García-Bañuelos Wei Wang
Mauro Dragoni Xavier Oriol
Michael Leyer Yuliang Li
Montserrat Estañol
XIV Organization
Sponsors
Keynotes
Business Process Management in the Digital
Era: Scenarios, Challenges, Technologies
Manfred Reichert
Institute of Databases and Information Systems, Ulm University, Germany

manfred.reichert@uni-ulm.de
Abstract. The Internet of Things (IoT) has become increasingly pervasive in

daily life as digitization plays a major role, both in the workplace and beyond.
Along with the IoT, additional technologies have emerged, such as augmented
reality, mobile and cognitive computing, blockchains or cloud computing,
offering new opportunities for digitizing business processes. For example, the
Industrial IoT is considered as essential for realizing the Industry 4.0 vision,
which targets at the digital transformation of manufacturing processes by inte-
grating smart machines, data analytics, and people at work. Though digitization
is a business priority in many application areas, the role of digital processes and
their relation with physical (i.e. real-world) ones have not been well understood
so far, often resulting in an alignment gap between digital and physical process.
In this keynote characteristic scenarios for digitizing processes in a
cyber-physical world are illustrated and the challenges to be tackled are dis-
cussed. Moreover, a link between the scenarios and contemporary BPM tech-
nologies is established, indicating the mutual benefits of combining BPM with
IoT and other digital technologies.
Beyond Mining: Theorizing About Processual
Phenomena
Brain T. Pentland
Department of Accounting and Information Systems,

Michigan State University, USA
pentland@broad.msu.edu
Abstract. For decades, process miners have been toiling deep in the event logs
of digitized organizations. Through this collective experience, the process
mining community has developed a powerful set of tools and a compelling set of
use cases for those tools (discovering, monitoring, improving, etc.)
In this talk, I want to suggest that some of these same tools may be useful for
other entirely different kinds of problems. In particular, recognizing and com-
paring patterns of action should be useful for theorizing about a wide range of
processual phenomena in organizational and social science.
Bringing Middleware to Everyday Developers
with Ballerina
Sanjiva Weerawarana
Founder, Chairman and Chief Architect of WSO2, Sri Lanka

sanjiva@wso2.com
Abstract. Middleware plays an important role in making applications secure,

reliable, transactional and scalable. Workflow management systems, transaction
mangers, enterprise service buses, identity gateways, API gateways, application
servers are some of the middleware tools that keep the world running. Yet
everyday programmers don’t have the luxury (or pain?) of such infrastructure
and end up creating fragile systems that we all suffer from.
Ballerina is a general purpose, concurrent, transactional and statically &
strongly typed programming language with both textual and graphical syntaxes.
Its specialization is integration - it brings fundamental concepts, ideas and tools
of distributed system integration into the language and offers a type safe, con-
current environment to implement such applications. These include distributed
transactions, reliable messaging, stream processing, workflows and container
management platforms. Ballerina’s concurrency model is built on the sequence
diagram metaphor and offers simple constructs for writing concurrent programs.
Its type system is a modern type system designed with sufficient power to
describe data that occurs in distributed applications. It also includes a distributed
security architecture to make it easier to write applications that are secure by
design. This talk will look at how Ballerina makes workflow and other mid-
dleware features into inherent aspects of a programming language and how it
can help bring middleware to everyday programmers to make all programs
better.
Contents
Reflections on BPM
BPM: Foundations, Engineering, Management . . . . . . . . . . . . . . . . . . . . . . 3

Mathias Weske, Marco Montali, Ingo Weber, and Jan vom Brocke
Bringing Middleware to Everyday Programmers with Ballerina. . . . . . . . . . . 12

Sanjiva Weerawarana, Chathura Ekanayake, Srinath Perera,
and Frank Leymann
Track I: Concepts and Methods in Business Process Modeling and Analysis
Open to Change: A Theory for Iterative Test-Driven Modelling . . . . . . . . . . 31

Tijs Slaats, Søren Debois, and Thomas Hildebrandt
Construction Process Modeling: Representing Activities,

Items and Their Interplay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Elisa Marengo, Werner Nutt, and Matthias Perktold
Feature-Oriented Composition of Declarative Artifact-Centric

Process Models. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Rik Eshuis
Animating Multiple Instances in BPMN Collaborations: From Formal

Semantics to Tool Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Flavio Corradini, Chiara Muzi, Barbara Re, Lorenzo Rossi,
and Francesco Tiezzi
Managing Decision Tasks and Events in Time-Aware Business

Process Models. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Roberto Posenato, Francesca Zerbato, and Carlo Combi
Track I: Foundations of Process Discovery
Interestingness of Traces in Declarative Process Mining: The Janus

LTLpf Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Alessio Cecconi, Claudio Di Ciccio, Giuseppe De Giacomo,
and Jan Mendling
Unbiased, Fine-Grained Description of Processes Performance

from Event Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Vadim Denisov, Dirk Fahland, and Wil M. P. van der Aalst
XXII Contents
Abstract-and-Compare: A Family of Scalable Precision Measures

for Automated Process Discovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Adriano Augusto, Abel Armas-Cervantes, Raffaele Conforti,
Marlon Dumas, Marcello La Rosa, and Daniel Reissner
Correlating Activation and Target Conditions in Data-Aware Declarative

Process Discovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Volodymyr Leno, Marlon Dumas, and Fabrizio Maria Maggi
Track II: Alignments and Conformance Checking
Efficiently Computing Alignments: Using the Extended Marking Equation. . . 197

Boudewijn F. van Dongen
An Evolutionary Technique to Approximate Multiple Optimal Alignments . . . 215

Farbod Taymouri and Josep Carmona
Maximizing Synchronization for Aligning Observed

and Modelled Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Vincent Bloemen, Sebastiaan J. van Zelst, Wil M. P. van der Aalst,
Boudewijn F. van Dongen, and Jaco van de Pol
Online Conformance Checking Using Behavioural Patterns . . . . . . . . . . . . . 250

Andrea Burattin, Sebastiaan J. van Zelst, Abel Armas-Cervantes,
Boudewijn F. van Dongen, and Josep Carmona
Track II: Process Model Analysis and Machine Learning
BINet: Multivariate Business Process Anomaly Detection Using

Deep Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Timo Nolle, Alexander Seeliger, and Max Mühlhäuser
Finding Structure in the Unstructured: Hybrid Feature Set Clustering

for Process Discovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Alexander Seeliger, Timo Nolle, and Max Mühlhäuser
act2vec, trace2vec, log2vec, and model2vec: Representation Learning

for Business Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Pieter De Koninck, Seppe vanden Broucke, and Jochen De Weerdt
Who Is Behind the Model? Classifying Modelers Based on Pragmatic

Model Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
Andrea Burattin, Pnina Soffer, Dirk Fahland, Jan Mendling,
Hajo A. Reijers, Irene Vanderfeesten, Matthias Weidlich,
and Barbara Weber
Contents XXIII
Finding the “Liberos”: Discover Organizational Models with Overlaps . . . . . 339

Jing Yang, Chun Ouyang, Maolin Pan, Yang Yu,
and Arthur H. M. ter Hofstede
Track III: Digital Process Innovation
On the Synergies Between Business Process Management

and Digital Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Amy Van Looy
Effective Leadership in BPM Implementations: A Case Study

of BPM in a Developing Country, Public Sector Context . . . . . . . . . . . . . . . 376
Rehan Syed, Wasana Bandara, and Erica French
Conceptualizing a Framework to Manage the Short Head and Long Tail

of Business Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
Florian Imgrund, Marcus Fischer, Christian Janiesch,
and Axel Winkelmann
Using Business Process Compliance Approaches for Compliance

Management with Regard to Digitization: Evidence from a Systematic
Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Stefan Sackmann, Stephan Kuehnel, and Tobias Seyffarth
Big Data Analytics as an Enabler of Process Innovation Capabilities:

A Configurational Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Patrick Mikalef and John Krogstie
Track III: Method Analysis and Selection
Assessing the Quality of Search Process Models . . . . . . . . . . . . . . . . . . . . . 445

Marian Lux, Stefanie Rinderle-Ma, and Andrei Preda
Predictive Process Monitoring Methods: Which One Suits Me Best? . . . . . . . 462

Chiara Di Francescomarino, Chiara Ghidini, Fabrizio Maria Maggi,
and Fredrik Milani
How Context-Aware Are Extant BPM Methods? - Development

of an Assessment Scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 480
Marie-Sophie Denner, Maximilian Röglinger, Theresa Schmiedel,
Katharina Stelzl, and Charlotte Wehking
Process Forecasting: Towards Proactive Business Process Management . . . . . 496

Rouven Poll, Artem Polyvyanyy, Michael Rosemann,
Maximilian Röglinger, and Lea Rupprecht
Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513

Reflections on BPM
BPM: Foundations, Engineering,
Management
Mathias Weske1(B) , Marco Montali2 , Ingo Weber3 , and Jan vom Brocke4
1
Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
mathias.weske@hpi.de
2
Free University of Bozen-Bolzano, Bolzano, Italy
montali@inf.unibz.it
3
Data61, CSIRO, Sydney, Australia
ingo.weber@data61.csiro.au
4
University of Liechtenstein, Vaduz, Liechtenstein
jan.vom.brocke@uni.li
Abstract. This paper reports on the introduction of a track system at

the BPM conference series and the experiences made during the orga-
nization of BPM 2018, the first issue implementing the track system.
By introducing dedicated tracks for foundations, engineering, and man-
agement, with dedicated evaluation criteria and program committees,
the BPM steering committee aims at providing a fair chance for accep-
tance to all submissions to the conference. By introducing a manage-
ment track, the conference reaches out to the management community,
which investigates phenomena in business process management from a
non-technical perspective that complements the technical orientation of
traditional BPM papers. We elaborate on the background of and moti-
vation for the track system, and we discuss the lessons learned in the
first iteration of the track structure at BPM 2018.
1 Introduction
This paper reports on the background of and motivation for introducing a track
system at the International Conference on Business Process Management (BPM)
conference series, and it discusses the experiences gathered during the organiza-
tion of BPM 2018, the first iteration in the conference series implementing that
structure.
The evolution of the BPM conference series towards the track structure is
based on two observations. The first observation relates to the increasingly tough
reviewing process that we could observe at BPM in recent years. There has been
the trend that reviewers were asking not only for a strong technical contribution,
but also for a convincing empirical evaluation. While these criteria are applicable
to research approaches based on the design science paradigm, these are not well
suited for papers looking at foundational aspects.
The second observation is concerned with the breadth of topics discussed
at BPM conferences. BPM has its roots in computer science and information
c Springer Nature Switzerland AG 2018
M. Weske et al. (Eds.): BPM 2018, LNCS 11080, pp. 3–11, 2018.
https://doi.org/10.1007/978-3-319-98648-7_1
4 M. Weske et al.
systems engineering, so that, traditionally, papers presented at BPM confer-

ences have a significant technical contribution. Looking at real-world scenarios in
business process management, however, an additional discipline plays an impor-
tant role: management. Since traditionally BPM papers are expected to have a
strong technical contribution, only few management-oriented submissions were
presented at the conference.
To provide a fair chance for all papers submitted to BPM conferences, dif-
ferent evaluation criteria have to be employed to review foundational papers,
to review papers with an engineering focus, and to review papers that investi-
gate management aspects of business process management. These considerations
have triggered the establishment of specific tracks covering foundational (Track
I), engineering (Track II), and management aspects (Track III).
The reminder of this paper is organized as follows. The next section elab-
orates on the background of and motivation for the track structure. We then
discuss the lessons learned in the first iteration while organizing BPM 2018, spe-
cific to each track. We close with an outlook on future iterations of the conference
and concluding remarks.
2 Background and Motivation
Since its inauguration in 2003, the International Conference on Business Process

Management has developed to a well-established conference that has shaped the
business process management community. It has been a conscious decision by
the BPM Steering Committee to position BPM as a conference with a technical
focus. This decision proved important to establish the conference as a respected
venue for research in computer science aspects of business process management.
As can be expected from an active research community and its flagship con-
ference, the topics being discussed at BPM conferences have changed in an evolu-
tionary manner over the years. The first issues of the conference mainly reported
on formal aspects of business processes. With the rise of service oriented com-
puting in the mid 2000s, topics like service composition and quality of service
emerged. With the establishment of process mining and the general interest in
data analytics, data-driven empirical research has become a major focus of BPM
over the last decade.
Two observations can be made, each of which can be regarded as a challenge
for the future development of the BPM conference series.
– With the shift in topics, a change in the evaluation criteria employed dur-
ing the reviewing phase came along; evaluation criteria that are important
in data-driven empirical research became the standard. This has led foun-
dational and innovative papers having lower chances of being accepted at
the conference, because these can typically not be empirically evaluated in a
conclusive way.
– There is a strong stream of research that has not been represented at the con-
ference in adequate strength, and this relates to management. Contributions
BPM: Foundations, Engineering, Management 5
in the management field of BPM typically do not have a strong technical con-
tribution. Since the typical reviewer at BPM conferences expect this, only few
papers by the management community have been accepted at the conference.
Last year, the steering committee has decided to address these challenges by
introducing a track system. It leads to a separation of foundational research,
engineering research, and management research. Since papers following different
research methods can only be evaluated fairly, if specific evaluation criteria are
used, each track comes with a set of dedicated evaluation criteria. To implement
these criteria, each track is led by a track chair, and each track has a dedicated
program committee. A consolidation chair is responsible for coordinating the
processes across the tracks. The reviewing process is enhanced with a dedicated
consolidation phase, in which paper acceptance is discussed between tracks.
3 Track Structure
BPM 2018 features three tracks, foundations, engineering, and management. The
tracks are characterized with respect to the phenomena studied, the research
methods used, and the evaluation criteria employed during the reviewing phase.
Notice that the following characterization is taken from the call for papers; we
repeat it here for reference, because it tries to characterize the tracks as concisely
as possible.
Track I [Foundations] invites papers that follow computer science research
methods. This includes papers that investigate the underlying principles of BPM
systems, computational theories, algorithms, and methods for modeling and ana-
lyzing business processes. This track also covers papers on novel languages, archi-
tectures, and other concepts underlying process aware information systems, as
well as papers that use conceptual modeling techniques to investigate problems
in the design and analysis of BPM systems. Papers in Track I are evaluated
according to computer science standards, including sound formalization, con-
vincing argumentation, and, where applicable, proof of concept implementation,
which shows that the concepts can be implemented as described. Since papers
typically do not have an immediate application in concrete business environ-
ments, empirical evaluation does not play a major role in Track I.
Track II [Engineering] invites papers that follow information systems engi-
neering methods. The focus is on the investigation of artifacts and systems in
business environments, following the design science approach. Papers in this
track are expected to have a strong empirical evaluation that critically tests cri-
teria like usefulness or added value of the proposed artifact. This track covers
business process intelligence, including process mining techniques, and the use of
process models for enactment, model-driven engineering, as well as interaction
with services and deployment architectures like the Cloud. It also covers BPM
systems in particular domains, such as digital health, smart mobility, or Inter-
net of Things. Empirical evaluations are important to show the merits of the
artifact introduced. A self-critical discussion of threats to validity is expected.
6 M. Weske et al.
Formalization of problems and solutions should be used where they add clarity
or are beneficial in other ways.
Track III [Management] invites papers that aim at advancing our under-
standing of how BPM can deliver business value, for instance how it builds orga-
nizational capabilities to improve, innovate or transform the respective business.
Papers that study the application and impact of BPM methods and tools in
use contexts based on empirical observation are highly welcome. Areas of inter-
est include a wide range of capability areas that are relevant for BPM, such as
strategic alignment, governance, methods, information technology, and human
aspects including people and culture. We seek contributions that advance our
understanding on how organizations can develop such capabilities in order to
achieve specific objectives in given organizational contexts. Papers may use var-
ious strategies of inquiry, including case study research, action research, focus
group research, big data analytics research, neuroscience research, econometric
research, literature review research, survey research or design science research.
Papers will be evaluated according to management and information systems
standards.
4 Track I: Foundations
The foundations track focuses on papers that follow computer science research
methods, with a strong emphasis on the core computing principles and methods
underlying the BPM field. This ranges from the investigation of BPM systems
and their extension through novel languages and functionalities, to the develop-
ment of theories, algorithms and methods for (conceptual) modeling of processes
and their (formal) analysis. In this respect, typical foundational papers show a
strong and sound formalization, with convincing argumentation and rigorous
exposition, but do not focus on an immediate, direct application of the pre-
sented results in concrete business environments. This is why proof-of-concept
implementations are welcome, but it is not expected that they come with an
empirical evaluation, as requested in the engineering track.
The accepted papers provide a quite fair coverage of recent developments of
the foundations of BPM, with particular emphasis on multi-perspective process
models, where decisions, data, temporal aspects, and multiple instances are con-
sidered alongside the traditional process dimensions. Some papers concentrate
on conventional process modeling notations such as BPMN, while others delve
into alternative modelling paradigms, with prominence of declarative, constraint-
based approaches. Interestingly, papers employ a quite wide range of techniques,
from computational logic to formal and statistical methods. Papers polarized
themselves in two phases of the BPM lifecycle: modeling/analysis, and mining.
In Track I, 9 papers were finally accepted at the main conference and 5 papers
were accepted at the BPM Forum.
By comparing the call for papers with the submissions, reviews, and conse-
quent discussion, the following critical points emerged:
BPM: Foundations, Engineering, Management 7
– The evaluation obsession: Even though the call for papers explicitly indicated
that evaluation is not the central focus of Track I, the lack of an extensive
or on-the-field evaluation has been one of the most frequent reasons to lean
towards rejection. During the discussion phase, this has been then clarified,
still with resistance in some cases. The track system certainly helped, but
more time is needed for the community to get acquainted with the fact that
good foundational papers do not necessarily come with an evaluation that is
based on data.
– The relevance question: We have observed a very diversified opinion of review-
ers on the relationship between relevance of the presented results, and the
targeted modeling notation. Some reviewers considered the choice of an
unconventional modeling notation, or even alternative notations to the well-
established ones, as a reason to consider the contribution weak, irrespective
of the actual results therein. This is another point of reflection for the com-
munity, given that especially for foundational papers it is very hard to predict
today what will be relevant in the future.
All in all, the initial reviews tended to be hypercritical about the submissions.
Intense discussions were often needed to single out explicitly also the positive
aspects of the contributions, and to assess them in their full generality. This was
partly expected, also considering that Track I received quite many more papers
than expected, consequently creating a quite heavy load for PC members.
In terms of covered topics, the main unifying theme among many of the
accepted papers is the simultaneous consideration of multiple process perspec-
tives. This witnesses the increasing maturity of the field, and the fact that it is
finally time to “bring the pieces together”. We expect this trend to continue in
the coming years. Some accepted papers reflect on previously engineered tech-
niques (in particular for process mining), witnessing that solid foundation papers
do not necessarily focus on the formalization of process notations, but can also
systematically study Track II contributions, creating a synergy between founda-
tions and engineering.
An open challenge for Track I is how to create a similar kind of synergy
towards Track II and Track III, so as to guarantee that strong foundation papers
are consequently subject to extensive evaluation both from the engineering and
management perspective.
5 Track II: Engineering

The engineering track of the BPM conference focuses on papers that follow the
design science approach. In short: a new artifact (algorithm, method, system, or
similar) is suggested and rigorously tested. Therefore the track has an emphasis
on a strong, self-critical evaluation. The evaluation should expose the artifact
to real or realistic conditions, and assess its merits relative to the objective of
the design, e.g., under which conditions a new process discovery algorithm is
better (or not) than the state of the art. In the call for papers, we also asked
for a critical discussion of threats to validity. The implementation of the artifact
8 M. Weske et al.
should typically have the maturity of a prototype, i.e., it can be evaluated in an

application context. This is in contrast to the foundations track, where proof-of-
concept implementations are sufficient, though not necessary.
In summary, the main topic of the set of accepted papers is conformance
checking, with various proposals on improving the efficiency or accuracy, or
applying it to online settings. As a new trend, it can be observed that machine
learning and deep learning in particular play a big role as underlying technolo-
gies. People-specific aspects are considered in two, and complexities of realistic
settings in all of the accepted papers.
Comparing the call for papers with the submissions received, we note that a
discussion of threats to validity is the exception, not the norm. The criteria in
the call for papers were formulated as hard targets, and only two submissions (or
less than 5%) were judged as meeting these by the PC with a recommendation
of direct acceptance – 7 papers were at first only accepted conditionally. Reviews
were in part hypercritical of the submissions, and emphasized flaws more than
positive aspects. In the reviews and discussions, the PC members made many
constructive remarks, which resulted in the final acceptance of 9 papers, and 5
BPM Forum papers.
A critical question for the community and Track II PCs of coming years is
where to place the bar on evaluation strength and quality: if the bar is as high
as for top journals, authors are often inclined to submit to these instead; if the
bar is too low, validity of the results may not be given, possibly invalidating
technical contributions. One step forward would be a broader uptake of valid-
ity discussions in submissions. While it is clear that the BPM community has
matured, professionalized, and also emancipated itself from other communities
since its inception, there is room for further development.
Among the five BPM Forum papers from this track, two discuss the ways to
integrate BPM and Internet of Things, which may be an indication that this topic
might play a bigger role in the future. Process mining, and conformance checking
in particular, are the topics attracting most submissions and accepted papers.
Conformance checking only moved in the last few years from foundational works
towards a phase of improvement and optimization of approaches, i.e., towards
the kinds of contributions that fit Track II well. Business process execution and
engineering of process-aware information systems, outside of process mining, did
not yield any accepted papers in the main track. Predictive process monitoring, a
topic that was present in previous BPM conferences, moved to the management
track this year. In summary there is some indication that certain themes actually
move from the foundations track to the engineering track and possibly further to
the management track, which nicely shows the relationships between the three
tracks.
6 Track III: Management

The management track focuses on applications of BPM in organizational set-
tings. Papers investigate the development and impact of BPM capabilities in
Another random document with
no related content on Scribd:
Ulcerative endocarditis, infectious osteomyelitis, pulmonary
gangrene, general pyæmia, and, as is claimed by a few authors,
typhoid fever, are often accompanied by multiple abscesses in the
brain-substance. Usually the foci are small, as may be readily
inferred from the fact that they are of embolic origin, the emboli being
usually so small as to lodge in very small vessels, and that the
fatality of the primary disease is so great as to cut short life before
the abscess can reach larger dimensions. For the same reasons the
symptoms they produce are rarely distinctive. In chronic lung
affections accompanied by putrescence in bronchiectatic or other
cavities cerebral abscesses are not uncommon occurrences. Under
these circumstances, although we must assume an embolic origin,
the abscess is rarely multiple, and the symptoms are as marked as
in the ordinary varieties. Thus a patient suffering from chronic
phthisis, with or without prodromal malaise or somnolence,
experiences formications and pain in his right leg; he then notices a
slight halt in walking; twitches appear in the affected extremity; it
becomes distinctly paretic. The arm then becomes affected in like
manner; the pupils become unequal; a severe chill occurs, followed
by delirium, convulsions, coma, and death.
DIAGNOSIS.—There is little difficulty in recognizing the existence of a

cerebral abscess in which well-marked focal and constitutional
symptoms coincide, or where a distinct abscess-producing cause,
such as an ear trouble, a head injury, or a putrid bronchiectasis,
coexists.59 But there are a number of cases, varying from the latent
form to forms with obscure general symptoms, whose recognition is
impossible or at best a matter of conjecture. Such cases may be
readily confounded with certain tumors. The existence of febrile
symptoms, although not excluding tumor, as some tumors are
accompanied by such, is greatly in favor of abscess. On the other
hand, choked disc, which is rare with abscess and found only with
the very largest, is in favor of tumor.
59 Yet a leading and careful authority was misled into making the diagnosis of
abscess in a case of ear disease complicated by a cerebral tumor.
PROGNOSIS AND TREATMENT.—The majority of cerebral abscesses
must, from the nature of the case, be regarded as not influenceable
by medicinal measures or surgical treatment. The miliary and other
abscesses due to general septic causes or to mycotic invasion,
being in the nature of the case but features of intrinsically dangerous
or fatal primary diseases, do not call for special measures. It is
different with those due to local trouble about the head and to
surgical causes. Remarkable advances have been made in the
operative treatment of cerebral abscesses, chiefly owing to the
increasing accuracy of the localization of the affected areas through
the disturbance of their function, and to the perfection of surgical
methods. A number of cases by Gussenbauer, Wernicke, and others
have shown that some abscesses may be accurately located during
life by the focal symptoms produced by their presence. Wernicke's
observation of a large abscess in the occipital lobe showed two
facts. First, it permitted the study of the effect of large abscesses on
the cerebral movements, as it was found after trephining that the
pulsation movement of the brain was lost and the dura tensely
bulging, thus indicating a high degree of cerebral pressure.
Secondly, the operation showed that an abscess can be emptied of
its contents, under moderate aseptic precautions, without provoking
contiguous inflammatory reaction or infecting the meninges.
Notwithstanding these favorable local conditions, the patient died.
Gussenbauer60 was more fortunate. He surmised from the fluctuation
of some symptoms and the predominance of others that his patient
had an abscess in the frontal lobe. The suspicion was verified: an
abscess of the size of an apple was found, opened, and emptied of
its contents. The patient recovered without any immediate untoward
symptom.61
60 Prager medizinische Wochenschrift, 1885, Nos. 1, 2, and 3.
61 Epileptic and focal spasms subsequently developed, which shows that a new
inflammatory or other destructive process may have set in in the vicinity of the
emptied sac.
The uncertainties of localization in some districts of the brain are so
great that a number of attempts to repeat the explorations and
aspiration of Wernicke and Gussenbauer have failed. In one case
recently operated on in New York City the aspirating-needle was run
into the brain-substance in several different directions without
striking the pus. It is a question under such circumstances whether
the chances of an abscess becoming latent, minimal though they be
in cases with pronounced signs, are not to be preferred to those
which an uncertain operation can give. The superficial encephalitic
foci offer far better opportunities for surgical triumphs. Here not only
the symptoms are much more constant, and point more unerringly to
the site of the morbid spot, but there are often other signs, such as
the evidences of impaction of a foreign body, local tenderness on
percussion, or bone disease, which aid in determining the proper
spot for the application of the trephine. Several operations where
traumatic encephalitis existed with or without leptomeningitis of the
convexity, followed by complete recovery, were performed by
Macewen.62
62 The Lancet, 1885, vol. i. p. 881.
The medicinal treatment of abscess of the brain is limited to

derivative methods, whose aim is the relief of pressure—an aim
whose fulfilment is more frequently illusory than otherwise.
Benefit has been claimed from the energetic use of mercury, chiefly
in the form of calomel, by older writers; and recently Handfield Jones
has endorsed its administration, attributing to it a remission in a case
in which it was employed. It must be remembered, however, that
remissions occur spontaneously in this disease, and that the
purgative action of calomel may act well for the time being in an
affection so apt to be associated with hyperæmia and increased
cerebral pressure as is an abscess of the brain.63 In the nature of the
case, even this latter momentarily beneficial effect is at the best
temporary.
63 Brain, October, 1884, p. 398.
The prophylaxis of cerebral abscess can be carried out only in cases
due to cranial and aural affections. The importance of treating all
scalp and cranial injuries under aseptic64 precautions is recognized
by all surgeons. It is generally admitted that the trephining of a bone
suspected to be the site of an ostitic or necrotic process involves
fewer risks than the allowing it to remain. Similar principles govern
the treatment of the inflammatory involvement of the mastoid cells
often complicating otitis media. If trephined at all, these should be
trephined at the earliest moment. It was a belief among the older
aurists that the sudden cessation of an aural discharge was of evil
augury, and that cerebral complications were more apt to follow
under such circumstances than when the ear discharged freely. Von
Tröltsch, Politzer, Gruber, and Toynbee have opposed the exclusive
application of the old dogma. In so far as the older ear-surgeons
regarded a profuse aural discharge as an encouraging sign, in this
respect they were of course wrong. But their observation of the
frequent concurrence of cerebral sequelæ with suppression of
discharge is, I think, borne out by a large number of cases. It does
not apply, however, to the suppression of discharge by the rational
employment of aseptic injections.
64 This term is used in its widest sense here.
Spinal Hyperæmia.
The spinal cord is found to vary considerably in color in different

individuals. To some extent this difference is influenced by the
position occupied by the body after death, but not as markedly as in
the case of the brain. Thus it will be paler in a body which has been
kept in the prone than in one which has been kept in the supine
position.65 It is usually found more injected in persons who have died
of febrile affection than in those who have died of exhausting
diseases; notably is this the case with typhus fever and with subjects
who die with congestive malarial chill. But the most intense
congestion, where the gray substance instead of having the normal
rosy hue appears like a blood-soaked sponge, and the white
substance instead of the tint to which it owes its name has a pink
shade, is found in subjects dying in convulsive disorders complicated
by asphyxia, such as epileptic status, tetanus, and certain toxic
disorders.
65 I have not seen it noticed anywhere, but it is a fact readily demonstrable in any
autopsy made in a well-preserved body that when a short segment of cord is
observed at the moment of section the section surface appears pale; but if it be again
examined after a few moments, it will show a reddish tinge, marked as a faint injection
would be; this tinge distinctly deepens under the eye. I have observed this in
specimens which were not held in the hand, so that the influence of pressure can be
excluded. Nor do I believe that the elasticity of the tissues is such as to account for
the phenomenon.
In attempting to apply the fact that varying degrees of vascular

injection are found on post-mortem examinations of the spinal cord
to the elucidation of certain clinical phenomena, we encounter the
same difficulties and sources of error that confronted us in the study
of nutritive brain disorders. The majority of writers have therefore
contented themselves with making a careful clinical study of the
mostly subjective signs of disorders which, once designated as
spinal anæmia and hyperæmia, are now classified under the non-
committal titles of spinal irritation and exhaustion (neurasthenia), as
in this volume. A number of these disorders, like the so-called
anæmic paralysis of Bouchut, Leroy d'Etiolles, Beroliet, Baimer, and
Brandis, would to-day be considered as hysterical or reflex; and a
few of the instances cited by their contemporaries as cases of spinal
hyperæmia have been since demonstrated to resemble the initial
phases of organic diseases of the cord.
The causes of active spinal hyperæmia are either direct, as when the
spinal centres are overtasked by muscular strain either through over-
exertion or through toxic convulsions, surprised by violent shocks,
such as concussion accidents, or collateral, as when a physiological
discharge (menstruation) or a pathological one (hemorrhoidal flux) is
suddenly checked. A few cases are reported where carbonic-oxide-
gas poisoning provoked spinal hyperæmia. But, like the alleged
cases of spinal hyperæmia after continued and exanthematic fevers,
they were probably cases of incipient or established myelitis.
Hammond claims that surface chilling exerts the same congesting
influence on the cord which he claims for the brain; but no definite
observations have been made in this direction.
Passive spinal hyperæmia has been attributed to obstructive cardiac

and chronic pulmonary affections. In such cases, as with most
causes acting on the circulation of blood in the nerve-centres, the
coexisting cerebral congestion usually masks the spinal. It is a
question how far the intense hyperæmia of the cord found in some
cases of tetanus, strychnia-poisoning, and the condition called
hydrophobia66 is primary and an indication of neural hyperexcitability,
and how far it is secondary to the asphyxia attending the last phases
of these convulsive states. The weight of opinion is in favor of an
acceptation of the latter as the chief or only factor.
66 In a case of hydrophobia clinically as well marked as has been recorded, which I
had the privilege of examining through the courtesy of Kretschmar, both brain and
cord were found remarkably anæmic.
Over-exertion and sexual excesses are frequently followed by a

sensation of fulness and tension in the sacral and lumbar regions,
which may be relieved by lying prone, while it is aggravated while
lying supine.67 From the location of this pain it is evident that it is not
due to congestion of the cord or its membranes, but to fulness of the
vertebral and spinal veins of the lower segment of the vertebral
column. A similar sensation, which may be relieved by the same
change in position or by a hemorrhoidal flux, is complained of by
patients suffering from portal obstruction. The veritable symptoms of
hyperæmia manifest themselves in the parts which receive their
nervous supply from the affected districts. The reflexes are usually
more active; paræsthesias of different kinds, such as formication,
tingling, and creeping sensations, are common; and there is more or
less motor weakness, the limbs feeling heavy and sometimes being
the seat of an acute pain. As a rule, these symptoms are limited to
the lower half of the body.
67 Although this fact has been questioned, I have no doubt whatever that it is true,
from a large number of observations. In many subjects suffering from the results of
excessive venery or masturbation, an intolerable, sometimes pulsating, feeling in the
lumbo-sacral region is only relieved by raising the lower end of the trunk with the back
up. This condition is influenced by a change of residence to a district having a
different level above the sea, and consequently a different barometric condition.
There is very little question when these symptoms exist for any
length of time, and become aggravated, that more subtle nutritive
changes than are covered by the single term hyperæmia become
responsible for them. In a pure hyperæmia the position-test of
Brown-Séquard, which shows relief when the patient is upright or
prone and aggravation when he is supine, particularly if the
gravitation of blood to the cord be facilitated by raising the head and
extremities, ought to yield constant results. But in some cases,
particularly those of long-standing, the very opposite is noted: the
patient's symptoms are aggravated by standing or sitting up, and
relieved by lying down. Here there is probably exhaustion or
malnutrition of the nerve-elements, rendering them abnormally
sensitive to exertion. This view is supported by the fact that
molecular disturbances, such as those which probably accompany
simple concussion, predispose the patient to the development of the
symptoms of spinal hyperæmia, and aggravate them if established
previous to such accident.
Hammond,68 who in his chapter on Spinal Congestion and Anæmia

follows rather the older authors, such as Ollivier, than the newer and
either more cautious or more sceptical writers on the subject,
describes the symptoms of congestion as comprising belt
sensations, paraplegia, erections of the penis, muscular twitches,
loss of expulsive power, and incontinence of the bladder, paralysis of
the abdominal muscles, paralysis of the anal sphincter, loss or
abolition of reflex excitability, diminution of electro-muscular
contractility, and occasionally hyperæsthesia and shooting pains. It is
not doubtful for a moment that if such a case were to occur in
hospital experience it would be regarded as one of organic disease,
and not incipient, but well-established organic disease of the cord.
Those making the diagnosis would have their opinion strengthened
if, as Hammond states, the process took place with great rapidity
and had a tendency to extend itself and eventually involve the whole
cord, or if, as Brown-Séquard is by him cited as stating, bed-sores
occurred in addition. Although Hammond describes certain
anatomical changes, such as increased development of blood-
vessels and distension and injection of them, I am unable to find any
cases recorded as spinal congestion during life, and carefully
examined with a due regard to sources of error after death, in which
such changes were found. It is true that after strychnine- and
cocaine-poisoning an intense hyperæmia69 of the cord is found. In
mammals it is of a far more pronounced character than in reptiles,
and usually more marked in proportion to the existing asphyxia. That
the characteristic toxic effects of these drugs is not to be sought for
in their direct or indirect congesting influence is shown by the fact
that exsanguinated frogs can be made to undergo strychnine tetanus
when their blood is replaced by a saline solution according to the
method of Salkowski. Little support, therefore, could be derived from
a pretended analogy between toxic and pathological hyperæmias,
even if the phenomena of both were similar; which is not the case.
68 Diseases of the Nervous System, 7th ed., p. 392.
69 It is true that in animals which are so organized that the congestion cannot be
attributed to asphyxia, as I showed (Hammond Prize Essay of the American
Neurological Association, 1878) in some experiments on strychnine, arterial
congestion and small foci of hemorrhage were found in the upper cervical cord of
frogs who had been kept in continuous strychnine tetanus for over seventy days.
The introduction of subaqueous caissons for workmen engaged in

the building of bridges, in which those employed labor under
abnormal atmospheric pressure, has led to the development of a
previously-unknown cerebro-spinal affection known as the caisson
disease, and in which, it is generally supposed, either congestion or
hemorrhage of the spinal cord occurs in consequence of sudden
changes of vascular pressure resulting from sudden diminution of
the barometric pressure. Clinically, this affection has been studied in
England, France, and above all in America in connection with the
building of the East River Bridge and the one over the Mississippi at
St. Louis.70 Experiments by Hoppe-Seyler, Bert, and I. Rosenthal
have shown that a sudden diminution of pressure leads to
hemorrhages in various tissues, and, according to the two first-
named, a development of gas occurs in the vascular and other fluids
of the body. A number of peculiar symptoms which do not specially
interest us here occur in conjunction with the so-called caisson
disease: these are—pain in the ear, with or without otitis sicca;
peculiar pains in the joints, which occur on leaving the caisson, and
are probably due to hyperæmia of the joint-surfaces and sudden
increase of the intra-articular fluid; and retardation of the pulse-rate.
In some cases cerebral hyperæmia is added, the patients tottering
about as if drunk. The spinal symptoms consist of a paraplegiform
affection. The paralysis is usually sudden; in some cases the patient
a few minutes after stepping from the air-chamber falls down
perfectly helpless as far as the lower half of the body is concerned.
The expulsive power of the bladder is usually weakened, and there
is anæsthesia to all forms of sensation in the affected limbs, as well
as diminished electro-cutaneous sensibility. The patient often
complains of a strange feeling, as if the lower half of his body were a
foreign substance. With this the electro-muscular reactions are
normal. In the majority of cases these symptoms disappear entirely
in from three to ten days, but occasionally they remain longer;
imperfect recovery of motion and sensation occurs, or, as happened
in a few cases, one of which was carefully examined during life by
Lehwess and after death by Leyden, death occurs as in myelitis. In
the only case where an autopsy and careful microscopical
examination were made under these circumstances71 peculiar
fissures were found in the substance of the spinal cord, surrounded
by areas of reactive myelitis and filled with granule-cells. The
absence of any pigmentary relics of a hemorrhage induced Leyden
to assume that the lacunæ were not of hemorrhagic origin. He
inclines to the view that they were due to the escape of gas from the
blood-plasma, and consequent multilocular inflation of the tissue. If
his observation be confirmed, it constitutes a strong objection to the
hyperæmia theory of the caisson disease. There is neither
permanent hyperæmia nor congestive or hemorrhagic myelitis
developed, as far as the limited material thus far studied permits a
conclusion.
70 Clark, St. Louis Med. and Surg. Journ., cited from Hammond, loc. cit.
71 E. Leyden, Archiv für Psychiatrie, ix. p. 316.
Pure spinal hyperæmia rarely presents itself for treatment. The form
due to over-exertion is recovered from by rest in a very short time;
that due to suppressed discharges, by the re-establishment of the
latter or by the application of leeches to the lumbo-sacral and iliac
region. Ergotin is recommended by Hammond in very large doses. It
is a question whether this drug may not exert a bad effect in
protracted cases where its use has to be continued for a long time.72
In using it, it is well to bear in mind that imperfect nutrition of nerve-
elements is perfectly compatible with an increased blood-amount.
72 A young physician, who for a long period took ergotin in twelve-grain doses for the
relief of symptoms regarded as congestive, acquired a tolerance of the drug such as I
have not seen recorded anywhere, and in addition presents some obscure signs of
cerebellar disease and initial optic-nerve atrophy.
Strychnia has been given with benefit in the caisson disease—

another evidence, as this drug is theoretically contraindicated in true
hyperæmia, that this disease is not, as Hammond and the majority of
authors with him regard it, essentially a congestive affection. The
treatment of those numerous cases in which signs of venous fulness
accompany spinal exhaustion and irritation is detailed in the articles
dealing with those affections.
Spinal Anæmia.
Anæmia of the cord-substance proper, like hyperæmia, is practically
inseparable from the corresponding condition of the membranes.
The influence of a reduced blood-amount on the functional activity of
the spinal cord is more susceptible of exact demonstration than the
corresponding nutritive disturbance of the brain. As the functions of
this segment of the nervous axis are far simpler than those of the
higher organ, there is more unanimity among observers as to the
interpretation of their disordered states. In Stenon's experiment, and
the more elaborate modifications made by those who have followed
his method, it is found that interference with the supply of arterial
blood to the spinal cord is followed by abolition of the function of the
gray matter; if the supply be still further diminished, the functions of
the white tracts become eliminated; next the peripheral nerves, and
ultimately the muscles themselves, lose their normal excitability. On
the re-establishment of the circulation these various parts regain
their functional capacity in the inverse order of its suspension—the
muscles first, next the nerves, then the white substance, and last the
gray substance of the cord. The initial symptoms of some cases of
myelitis from refrigeration correspond more nearly to such a result of
artificial anæmia of the cord than they do to anything that is
customarily regarded as hyperæmia.73
73 I have seen distinct pallor of the spinal meninges on dipping the posterior
extremities of a dog, whose cord had been exposed, into water. It is to be remarked,
however, that other observers, notably Hammond, have either obtained different
results or interpreted the consequences of refrigeration differently.
No one has gone farther than Hammond in erecting a theoretical

anatomical framework which elaborately provides for the
accommodation of various symptoms of spinal anæmia. He
describes anæmia of the posterior columns, and sharply
discriminates between it and anæmia of the antero-lateral columns.
It is a question whether the conducting tracts of these columns are
seriously affected in their functions by anæmia as long as the
centres of innervation are well nourished. Undoubtedly, it is the gray
substance of the cord which is most vulnerable to the influence of
disturbed circulation and nutrition, as Stenon's experiment has
shown; and a glance at the distribution of the blood-vessels will show
that a partial anæmia or hyperæmia, limited to special cornua in any
considerable length of the cord, is an exceedingly improbable
occurrence. With regard to isolated anæmia of the white columns, it
is to be admitted that the posterior are most vulnerable to
malnutrition. But it is doubtful whether this vulnerability is so great as
to allow of an exclusively posterior anæmia, or whether a protracted
anæmia of this kind could exist for years as a purely symptomatic—
or, as some designate it, functional—disorder.
Hammond candidly states that in specifically locating the lesions in

these affections he is aware that post-mortem examinations are
wanting to support them, and admits that what he calls anæmia of
special parts of the cord is the spinal irritation of most authors, and in
part the reflex paraplegia of others.
The most clearly-established form of cerebral anæmia is the one

which is indicated by the ischæmic paraplegia of Jaccoud and the
paraplegia following profuse hemorrhages. The former is produced
by all causes which, by obstructing the flow of arterial blood in the
abdominal or thoracic aorta, cut off the proper blood-supply to the
cord, which the latter receives through the intercostal and upper
lumbar arteries. Aneurism, compression by tumors, and embolism of
the aorta produce this result. The consequence is paraplegia
corresponding in all features of its development to the phenomena
observed in Stenon's experiment. These features, already detailed,
suffice to show that it is not the anæmia of the peripheral nerves and
muscles that is chiefly responsible for the paraplegia, but the
insufficient irrigation of the gray and white substance of the cord
itself. The same is true of the paraplegia following hemorrhage which
has been noted after uterine, renal, and enteric hemorrhages. Both
affections are exceedingly rare.
The influence of general anæmia on the functions of the spinal cord

is not susceptible of accurate study. The cerebral enlargement of the
nervous axis is so much more unfavorably situated than the cord that
it suffers first and most when general anæmia is present. The
consequence is that the signs of cerebral anæmia mask those of
spinal anæmia. It is supposed, however, by many authorities that the
effect of anæmia on the cord may be regarded as an auxiliary factor
in the production of hysterical and neurasthenic symptoms.
How far the spinal cord is liable to suffer from arterial spasm is as yet
a matter of conjecture. It is supposable that just as a powerful
psychical impression provokes a sudden spasm of the cerebral
arteries, so a peripheral irritation may provoke a spasm of the spinal
arteries. In this way the reflex paralyses, motor and vaso-motor, are
explained by many writers.
The subject of reflex palsy has been so much confused by improper

cataloguing—if it can be so called—that some of the best authorities
have become sceptical as to its occurrence. Among the chief
sources of error has been the attributing to irritation of the genital
organs various convulsive, psychical, and paralytic disorders.
Adherence of the prepuce and its excessive length were charged
with being responsible for idiocy, imbecility, epilepsy, and every form
of paraplegia and panplegia. It was further claimed that instances of
complete cure of each of these affections had followed the removal
of the exuberant or adherent prepuce. I cannot find a single instance
recorded where such a cure was effected in any of our large medical
centres, so as to prove convincing to critical colleagues. On the
contrary, L. C. Gray74 has shown that various surgical procedures
have been needlessly resorted to on this erroneous theory in cases
of organic diseases of the spinal cord. I have seen two unfortunate
children suffering from the worst forms of anterior poliomyelitis, one
afflicted with pseudo-hypertrophic paralysis, and several
hydrocephalous and microcephalous idiots, whose prepuces had
been sacrificed to the theory alluded to—it is needless to add without
any result, good or bad.
74 Reflex Irritation from Genital Irritation. In this paper written communications from all
or nearly all neurologists in the United States—certainly including all those of national
fame and large experience—are cited, in which they testify to never having seen a
case of this character cured by operations on the penis (Annals of Anatomy and
Surgery, Jan. and Feb., 1882.)
The possibility of a reflex paralysis occurring from genital irritation in

the male cannot be denied; among the lower animals a ligature
around the spermatic cords sometimes produces paraparesis, and
paraplegia is a common complication of renal and vesical troubles in
others. But analogous observations in man are rare, and becoming
rarer with our increasing acumen in diagnosis. In females peculiar
reflex disturbances are found associated with uterine and ovarian
derangements. In one case of retroflexion, with possible dislocation
of the ovary, referred to me by H. J. Boldt, there is a remarkable
vaso-motor paralysis of the right arm during each menstrual period:
this member becomes greatly enlarged, of a purplish-blue color, and
cold. Equally remarkable are the reflex disturbances resulting from
the presence of worms in the intestinal canal. Every form of spinal
and cerebral paralysis, even aphasia, has been observed in
connection with helminthiasis. Such disorders yield as rapidly as
they are developed to the exhibition of vermifuges.
Special interest has been aroused by the discovery laid down in the
joint treatise of J. W. Mitchell, Morehouse, and Keen of reflex
paralysis following injuries, observed in the War of the Rebellion. The
cases cited by them appear singular on first sight. The paralysis is
often observed in parts of the body which are not only remote from
the seat of injury, but have no direct connection, physiologically or
otherwise, with it. The hand may be injured and the opposite leg
paralyzed.
Since Mitchell, Morehouse, and Keen first announced the existence

of this peculiar form of reflex paralysis a careful search has been
made by military surgeons engaged in other campaigns for like
results. Notably was this done in the Franco-Prussian War. A number
of confirmatory instances have been collected, some of which rival in
singularity those related by the discoverers of the affection. In one
case a unilateral paralysis agitans followed a punctured wound of the
opposite shoulder, and in another reflex aphasia followed a gunshot
wound of the lumbar region.75 A discrimination is to be made
between such cases where the paralysis, anæsthesia, or neuralgia is
an immediate result of the injury, and those where they follow after
weeks or months. In the latter instance we have not true reflex
disorders to deal with, an ascending neuritis having been found in
the few cases which could be carefully followed up.76
75 Sanitäts Bericht über die deutschen Heere im Krieg gegen Frankreich, 1870-71,
vol. vii.—abstracted in Neurologisches Centralblatt, 1886, p. 207.
76 In a case of Mollenhauer's, vesical paralysis and paresis of the right leg occurred
six years ago (1880) in a veteran of our civil war who had a gunshot wound of the
right hand, with signs, which are still present, of occasional exacerbation of brachial
neuritis. Prodromal signs of paresis were noticed at intervals since his return from the
campaign. The bladder trouble and paresis are now apparently stationary. Such a
case can be accounted for only on the assumption of an organic cord-change
secondary to a neuritis.
The theory that the reflex paralysis from utero-ovarian, intestinal, and
surgical affections, when acutely produced, is due to central
anæmia, is as acceptable as any other would be in the absence of
decisive observations.
Spinal anæmia will but rarely present itself as a subject for special
and separate treatment. When not associated with an intrinsically
grave condition, such as aortic obstruction, dysentery, fatal
hemorrhage, or typhoid fever, it is an exceedingly benign affection,
rapidly yielding to tonic and restorative measures combined with
rest.
Embolism, Thrombosis, Hemorrhage, and Abscess of the Spinal

Cord.
Although the spinal cord is a segment of the same central organ as

the brain, nourished in a similar way, and subject to the same
physiological and pathological laws, lesions of the vascular
apparatus, which play so important a part in brain pathology, play a
comparatively insignificant one in that of the spinal cord. Embolic,
thrombic, and primary hemorrhagic lesions of the cord are so rare
that their possible existence has even been denied. A primary
thrombosis of the cord has not yet been satisfactorily demonstrated
to occur independently of syphilitic lesions; and when it occurs the
ensuing tissue-changes, as described by Heubner, Julliard, and
Greiff, are usually in the background as compared to the
gummatous, sclerotic, or meningitic changes which coexist. The
clinical as well as the anatomical picture is accordingly either one of
a myelitis or meningitis, as the cases of Charcot-Gombault, Heubner,
McDowell, Wilks, Wagner, Zambaco, Homolle, Winge, Moxon,
Schultze, Westphal, Julliard, and Greiff show. (See Myelitis and
Spinal Meningitis.)
With regard to the occurrence of hemorrhage into the substance of

the spinal cord (hæmato-myelia), it is so rare an occurrence that I
can recall but a single case in which I entertained the diagnosis of
this lesion; and in that very case I am unable to declare that it was
not a hemorrhagic myelitis. Aneurismal changes of the spinal
arteries are comparatively of rare occurrence, and as other
predisposing causes to primary vascular rupture are rare in the cord,
the probability of its occurrence is very much diminished. Hebold,77
in a young girl who had developed severe cerebro-spinal symptoms
during a period of nine months following an erysipelatous disorder,
found the upper dorsal cord, on section, dotted with numerous
reddish and round points. These points corresponded to aneurismal
dilatations of the vessels. As there were other inflammatory and
vascular lesions in the same subject, the author referred their
causation to a general constitutional vice, the result either of the
phlegmonous or of a tuberculous disorder.
77 Archiv für Psychiatrie, xvi. 3. Rupture of miliary and other aneurisms in the
meninges has been reported by Astley Cooper, Traube, and others. It is remarkable
that such cases are more and more rarely recorded from year to year in inverse ratio
to the accuracy of our spinal autopsies. I have never found a miliary aneurism below
the uppermost cervical level of the cord. On the other hand, I have found extensive
spinal hemorrhage in cases where the vessels of the cord proper were fairly healthy.
It is claimed that suppression of the menses, over-exertion, lifting

heavy weights, and concussion are causes of spinal hemorrhage.
The same causes are also mentioned for acute hemorrhagic
myelitis; and it is a question whether the supposed hemorrhage is an
initial lesion or secondary to congestive or anæmic softening.78
78 I have never found vascular ruptures, although carefully searching for them, in the
spinal cord of persons dying instantly after falls from a great height, or, as in one case
which I was fortunately able to secure the cord of, where the subject had been
violently thrown down. Where hemorrhages have been found under these
circumstances they were, as far as I am able to learn from the cases recorded,
meningeal.
The symptoms attributed to spinal hemorrhage are the same, taking

the same locality of the cord, as those of a very rapidly-developed
transverse myelitis. It is unnecessary to enumerate these here in
anticipation of the next section. They are described as being much
more sudden. This suddenness is the only diagnostic aid on which
we can rely.79 The fate of the patient is said by Erb to be decided
within a few days. If he survive the immediate consequences of the
hemorrhage, he is apt to recover, as to life, altogether, with such
permanent atrophies, paralyses, and anæsthesias as are entailed by
the destruction of the tracts and gray substance involved in the
hemorrhage. The treatment recommended for this condition consists
of rest, either in the lateral or prone position, local depletion and
derivation to the intestinal canal, as well as the internal use of
ergotin. The local application of ice, which is also advised, is
probably based on illusory views.80 After the immediate danger is
past the case is to be treated as one of myelitis—a very safe
recommendation in view of the probability that it was a case of
myelitis from the beginning.
79 And even this sign is unavailable as a distinguishing feature in supposed
hemorrhage from concussion, as sudden paraplegias of motion and sensation are
found in some cases of railway spine, and, although a number of cases terminating
fatally have been examined, there was not always hemorrhage even in the meninges.
80 Until authorities shall have agreed as to what effect the exposure of the bodily
periphery to certain temperatures has on the circulation of the cord, it would be
premature to make any special recommendations as to the temperature at which they
should be kept. I am inclined to believe that while, as is universally accepted, a
general cooling of the bodily surface tends to increase vascular fulness in the cord, as
in all other internal organs, a partial cooling, as of the feet, produces local anæmia at
the level of origin of the nerves supplying the cooled part. Certainly, the bilateral
neural effects of unilateral cooling are in favor of this view.
The descriptions given of the hemorrhagic foci as observed after

death strengthen the view that they were in the majority of cases of
myelitic origin. Usually, they are stated to extend up and down the
cord in the direction of least resistance—that is, in the gray
substance—resembling an ordinary apoplectic clot. But in their
neighborhood there was usually considerable softening, and, to
judge by the descriptions given, this softening differed in no wise
from that which is the characteristic feature of acute myelitis;81 and
often the transition from a peripheral zone of white softening, through
an intermediate zone of red softening, to a central compact clot, is so
gradual as to leave it unquestionable that the softening pre-existed,
and that a vessel had broken down in the midst of the myelitic
detritus. Many ancient foci of myelitis betray the hemorrhagic
complication of their initial period by the presence of pigmented
residue of the absorbed clot.
81 In the latest treatise on nervous diseases published in our language (Ross, loc. cit.,
vol. ii. p. 325) the insufficient foundation on which a whole chapter has been built up is
illustrated by the admission that the usual evidence of acute central myelitis may be
observed far beyond the limits of the hemorrhagic infiltration. If a large area of
softening in the brain were found to contain a central or peripheral clot of blood, and
histologically resembling a typical embolic or thrombic softening, no one would be in
doubt as to which of the two was the primary lesion.
Embolisms and embolic softenings of that part of the spinal cord

which is supplied by the small spinal vessels are so rarely observed
in the dead-house that our knowledge of their possible occurrence
and character is almost entirely the result of experimental
observations or based on analogy. The situation of these vessels,
the angle at which their supply-tubes are given off from the aorta, all
act as protectors of the cord against what is one of the chief dangers
to which the brain is exposed. No definite symptoms have been
attributed to the few doubtful cases of simple embolic occlusion of
the spinal arteries found accidentally in human subjects. Even those
emboli which, when once let loose in the circulation, are found
distributed in nearly every organ of the body, those derived from
ulcerative endocarditis and those due to the invasion of micrococci,
are comparatively rare in the cord. Leyden found multiple capillary
emboli in the spinal cord from the former cause. Small grayish white
foci in a similar distribution were found to be due to an invasion of
cocco-bacteria from a decubitus by Rovigli.82 In this latter case an
increase of pain and muscular spasm in the history of the case of
sclerosis which was thus complicated was attributed to the parasitic
affection.
82 Rivista sperimentale di Freniatria, 1884, x. p. 227.
Just as simple and infectious embolic lesions are frequent in the

brain and rare in the cord, so purulent inflammation or abscess is an
exceptional occurrence in spinal as compared with cerebral
pathology, and probably for the same reasons.
Simple Acute Myelitis.
SYNONYMS.—Spontane (primäre) acute Rückenmarkserweichung,

Softening of the spinal cord, Ramollissement blanc de la moelle,
Myélite aiguë.
As Leyden, whose treatise83 may be regarded as the foundation of

our knowledge on this subject, correctly avers, it is to Abercrombie
and Ollivier that we owe the determination of the existence of that
acute structural disease of the spinal cord, now termed myelitis, as
an affection independent of meningeal changes. The anatomical
descriptions given by these older writers may be accepted at the
present day as models of accurate observation by the naked eye.
Their statement that in acute myelitis the substance of the spinal
cord is softened and changed into a puriform, yellowish, diffluent
mass; that while the disorganization is sometimes more marked in
the posterior, at others in the anterior, and occasionally in the lateral
half, it is most pronounced in the axis of the cord, because the
central gray substance is the favorite starting-point of the morbid
process,—requires no modification to-day. Considerable doubt
existed in the minds of the contemporaries of Ollivier and
Abercrombie as to whether this change was the result of a true
inflammation; and one of the clearest thinkers of the day, Recamier,84
regarded myelitic softening as a lesion peculiar to the nervous
apparatus, and different from ordinary inflammation. I believe that
the most profound investigators of the present day have not been
able to rid themselves of a similar doubt. The discovery of Gluge's
so-called inflammatory corpuscles, which was regarded as settling
the question, only served to confuse the student by the confidence
with which it was urged that they were infallible criteria of the
inflammatory process. Under the non-committal designation of
granule-cells these bodies still flourish in the annals of cerebro-spinal
pathology. As we shall see, a number of products of real disease, of
artifice, and of cadaverous change have passed and do pass muster
under this name. The first substantial progress in our knowledge of
the minute processes underlying inflammation of the spinal cord was
made by Frommann and Mannkopf, but it applied altogether to the
chronic inflammatory or cirrhotic affections of the cord. The
difference between acute and chronic myelitis is greater than is the
difference between acute and chronic inflammation in any other
organ; and it must be admitted that if Recamier is to be regarded as
having erred in asserting that acute myelitis is not a true
inflammation, he is justified in so far as he asserted many features of
the process to be altogether peculiar to the organ affected. Leyden
himself attempted to throw light on the subject by provoking myelitis
experimentally in dogs. He injected Fowler's solution into the spinal

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Business Process Management: 16th International

Business Process Management Forum: BPM Forum 2018,

Business Process Management Workshops: BPM 2018

Service Research and Innovation 7th Australian

Business Process Management: 17th International

Business Process Management: 18th International

Data Mining 16th Australasian Conference AusDM 2018

Business Process Management 12th International

Ingo Weber Jan vom Brocke (Eds.)

ISSN 0302-9743 ISSN 1611-3349 (electronic)

Library of Congress Control Number: 2018950653

© Springer Nature Switzerland AG 2018

The 16th International Conference on Business Process Management provided a forum

Internet-of-Things scenarios. Brian Pentland took a management perspective on busi-

September 2018 Mathias Weske

Sponsorship and Community Liaison Chairs

Doctoral Consortium Chairs

Mini-Sabbatical Program Chairs

Local Organization Liaison and Networking Chair

Local Arrangements Committee

Web and Social Media Chair

Fabrizio Maria Maggi University of Tartu, Estonia

Luciano García-Bañuelos University of Tartu, Estonia

Track III (Management)

Peter Fettke German Research Center for Artiﬁcial Intelligence

Alessio Cecconi Bian Yiyang

Florian Bär Nils Urbach

Institute of Databases and Information Systems, Ulm University, Germany

Abstract. The Internet of Things (IoT) has become increasingly pervasive in

Department of Accounting and Information Systems,

Founder, Chairman and Chief Architect of WSO2, Sri Lanka

Abstract. Middleware plays an important role in making applications secure,

BPM: Foundations, Engineering, Management . . . . . . . . . . . . . . . . . . . . . . 3

Bringing Middleware to Everyday Programmers with Ballerina. . . . . . . . . . . 12

Track I: Concepts and Methods in Business Process Modeling and Analysis

Open to Change: A Theory for Iterative Test-Driven Modelling . . . . . . . . . . 31

Construction Process Modeling: Representing Activities,

Feature-Oriented Composition of Declarative Artifact-Centric

Animating Multiple Instances in BPMN Collaborations: From Formal

Managing Decision Tasks and Events in Time-Aware Business

Track I: Foundations of Process Discovery

Interestingness of Traces in Declarative Process Mining: The Janus

Unbiased, Fine-Grained Description of Processes Performance

Abstract-and-Compare: A Family of Scalable Precision Measures

Correlating Activation and Target Conditions in Data-Aware Declarative

Track II: Alignments and Conformance Checking

Efficiently Computing Alignments: Using the Extended Marking Equation. . . 197

An Evolutionary Technique to Approximate Multiple Optimal Alignments . . . 215

Maximizing Synchronization for Aligning Observed

Online Conformance Checking Using Behavioural Patterns . . . . . . . . . . . . . 250

Track II: Process Model Analysis and Machine Learning

BINet: Multivariate Business Process Anomaly Detection Using

Finding Structure in the Unstructured: Hybrid Feature Set Clustering

act2vec, trace2vec, log2vec, and model2vec: Representation Learning

Who Is Behind the Model? Classifying Modelers Based on Pragmatic

Finding the “Liberos”: Discover Organizational Models with Overlaps . . . . . 339

Track III: Digital Process Innovation

On the Synergies Between Business Process Management

Effective Leadership in BPM Implementations: A Case Study

Conceptualizing a Framework to Manage the Short Head and Long Tail

Using Business Process Compliance Approaches for Compliance