 Thank you so much for the introduction and also for this great session. And I feel a bit disabled right now. Can anybody hear me? So, okay, that's good. I feel a bit disabled right now because I miss my ponder. But luckily we have this wooden prosthesis. So, and this means that I'm able to adapt to my physical needs. So, and this will also be done by people with disabilities in the past. So, thank you. So, I'm very happy to use this particular case study of this femoral amputation that was observed in a medieval young adult female from the community of Morsel, which was situated in Belgium. And this particular case study hopefully will help us to assist in interpretation of disability in the past. And we can use a few, we can ask ourselves a few questions about health care by the combination of a theological evidence, for instance, also by using funerary data as well as knowledge about surgical interventions and medical treatments. And we can also ask ourselves or we can ask questions like how will they adapt to their physical needs, for example, by the aid of crutches or other instruments. And I will also use evidence of other healed female amputations mainly seen in the late medieval archeological records. And this tool hopefully described the reasons for an amputation because of course many people did not survive such a traumatic experience especially before the introduction of modern techniques such as flap techniques or before the introduction of anesthesia. So this is a particular case study and Morsel is here, I can use this, is situated in the province of East Flanders and it was actually a part of the cultivation of rye and oats. It was mainly an important center for the cultivation of flax and the production of linen which was also specifically in the provinces of West Flanders and East Flanders one of the main important economic activities for Flanders during the late Middle Ages and beyond. Probate inventories, they demonstrated that many families in Morsel owned a spinning wheel as a kind of additional income. And here this is our case study. Morphological traits of the pelvic bone indicated a most likely female individual and aging was done also by morphological characteristics used for aging techniques such as the ointure surface and indicated an age between 19 and 25 years old. Apart from the amputated rye femur I didn't find any other evidence of trauma or degenerative joint disease or infections. Here I do have a map of the churchyard. The skeletons are very little, I know they're not very big but luckily the arrow is a bit bigger so I don't have to use my wooden eggs right now. So she was buried at the edge of a rope. Does this demonstrate or indicate differential burial treatments? Probably not because I looked at other individuals who were buried at the margin of the churchyard or at the edge of a row and they were mainly old adults with no signs of infections or with no signs of trauma apart from degenerative joint diseases. This is the St Martin Church and the excavations revealed more than hundreds burials mainly from the medieval and post-medieval era and the medieval burials they were also clustered around the chapel which is not pictures but it was here has luckily long enough normally it was over here which was the chapel the St. Kudala Chapel. So I also want to take a closer look at the astrological evidence and this is the amputated rye femur. We don't know how long she survived after the amputation to place because we can see osteothelitic formation or bone exostosis that obscures the cut marks but what is clear is that the stone got infected and this was often the case after an amputation even after the introduction of antibiotics in the 19th century so many people died because of this infection and it's demonstrated by the formation of the large cloaca that is caused by osteomyelitis or a nonspecific infection running through the bloodstream so it is quite likely that first must have drained out from the end of the stump for a certain amount of time and I also wanted to take a look I took some CT scans as well and before that I found another case study of a young adult individual who got an amputation at the age of 9 and 14 years later at the age of 23 her stump got infected and she was in need of a second amputation and because of this pus that has drained out from the end of the stump this might imply a chronic stable osteomyelitis. I derived some osteometric data for example from the sub-trochanteric area so I took measurements of the meteorolateral diameter and posterior diameter of both this is the amputated trachymer this is the healthy left and all measurements were smaller compared to the healthy left one and this is possibly due to reduction in locomotion in the affected limb as well as a decrease in mechanical loading and it's called disuse osteopenia so it's a loss of bone density and this also implies a long-term immobilization of the affected limb these are CT scans and here we can see a dense substance located in the medulla it's not confirmed whether this is pathological or not because the cortex seems quite normal as well as the delineation but it's more evident here in the distal end so we can see involugrum which is actually new peristil bone growth and this is caused by tearing of the peristil by the intensification of pus. So I collected evidence I mean Mace has collected some evidence of yield limb amputations in his paper published in 1996 and he used evidence from a wide range of geographical locations as well as time periods so and I collected specifically evidence from the late Middle Ages and also added a few new case studies for example there is a battle field in Portugal and they revealed two adults with amputated limbs and this demonstrates that even soldiers with an amputation they were even forced or able to participate in one pair. Another case study here is located in Switzerland and shows two monks with an amputated left foot and this might be caused by diabetes so as you can see there are more meals actually affected or observed with amputations and this might be due to the reasons for an amputation and those reasons actually are usually categorized into three broad groups and the first one is traditional punishment which was often observed by the amputation of the foot or the hands and when women were punished it was either done by drowning or burning so that might be a reason because more meals are observed with amputations. Another category is surgical intervention because of a congenital disorder or because of a trauma or because of an infection disease and the third group is a blade injury or a violent injury and it's mostly water-related so what might be the reason for the amputation in our case study probably surgical intervention because of a trauma it is demonstrated that usually farmers are more prone to traumatic injuries it might have been because of a trauma of the poplittle artery which is located here on the posterior side of the tibia. Another reason might be leprosy but I couldn't find any evidence in the hand bones or in any other individual from the morsel community that might be related to leprosy but another third reason and that was also suggested to be the coast in the swiss months might be ergotism I'm not sure if anyone here has word of ergotism no one yes okay well ergotism was widely common and endemic in Flanders and it was even historically reported in the area of morsel and also in the Netherlands and in France and this is caused by the consumption of contaminated rye so it shows here this body the left picture and it is caused by fungus it's called clavichips corporea it's over here and what happens after the consumption of contaminated rye is that it's mostly affected the nervous system so people started to behave um emotionally or they started to hallucinate but these are lesions we can't identify these skeletal remains but sometimes it affected the lower limbs by cutting off the blood supply so this means that it often resulted in gangrene so an amputation was necessary this picture here shows a picture actually from a Flemish painter it's painted by Peter Bruegel the elder it's called crippled and beggars and it made depict victims of this ergotism this infectious disease it's also called st. Anthony's fire and this relates to a group of monks from the st. Anthony order and they often took care of those patients and the fire relates to this burning sensation that was felt in the lower limbs of the patients so here of course they have wooden tools as well so okay and also these are prosthetics and crutches so unfortunately wood doesn't preserve pretty well in the archaeological records unless it's mummified or unless it's underwater so how can we demonstrate the likelihood of an underarm crutch is by looking at antisocial changes for example or musculoskeletal stress markers and this was observed in the right humerus and it shows more elasticity compared to the left one and it's also indicated in a study by Knussel who was here this morning Christopher but yes a double booking unfortunately so and Gurgel and they found similar osceous alterations seen in the right arm they was observed in a devoliparous adult male from Jesus there and he was also observed with a traumatic injury in the right limb no amputation so and it's also actually specifically in the deltoid muscle and they did some EMG scans and it seems that those muscles are pretty active when you use a crutch to move the crutch forwards what about lower limb prosthesis there was no evidence for the use of a lower limb prosthesis in this case study but it doesn't mean it wasn't used because we do have evidence dating to the classical room and dating to classical grease as well and the oldest known evidence for a lower limb was found in the grave in Italy and this one at the right here it was actually wood with a bronze cover and was found in the grave yes dating to 300 BC but the oldest prosthetic device that was ever found was a wooden toe and it was found in the burial from ancient Egypt it was the priest's daughter burial dating to 1000 BC found in Luxor so it was pretty well preserved but also the early medieval records show some evidence for prosthesis for example the iron ring over there was found in high status burial in Austria and it was found in situ on the place where the footballs should have been it is suggested for stabilizing the wooden foot prosthesis so as I said before amputations were very traumatic was a very traumatic experience for patients a very horrific experience as well especially before the introduction of anesthetics in the 19th century so what they do to alleviate the pain was usually a mixture of plants with sedative properties opium and alcohol and by the 15th century they usually a common procedure they use during amputations was a mixture of mandrakeura or mandrake black henbing that's in the middle and this was also widely used in islamic countries in europe and in asia and opium so it's needless to say that many patients they had a good sleep but unfortunately many failed to wake up as well so I don't have any evidence for a doctor and the late medieval period in Warsaw the earliest evidence I could find for a medical practitioner dates to the beginning of the 18th century and it was likely a non-academic surgeon so if patients needed to go to a doctor they had to go to the nearby town of Alst which was about three miles away so about one hour walking distance if you were able to walk so I would like to finish or conclude with some final remarks of course we need to be careful when we use little data to interpret healthcare because of course each person reacts individually during the healing process or shows a variation during the healing process and we don't know actually how people or impaired people dealt with their ailments or with his or her impairment so also it's what I wanted to say as well I wanted to relate to this paper by Irina Metzler who is an historian and not an archaeologist and she demonstrated that even disabled women were able to participate in social economic activities for example in textile workshops and if we consider the nature of our community of the Morsel community it's maybe possible that she was still able to participate in preparations of the spinning process and also Morsel was a very Catholic and Christian community and enrouted in this deep Christian tradition and if we can consider for instance altruism or showing care so it possibly it might be possible that she of course was taken care of by the family because she survived this amputation so in people who just have fitter people must have of course taken care of her so if we can all consider this broader framework or all these different agencies for example the historical texts as well as the osteological evidence and the funerary data so of course we may be able to interpret this data and seeing this as a kind of assistance in interpreting data for people with disabilities in the past and I would like to thank of course the session organizers and some other people from Belgium who helped me with pictures and the museums in London for the additional information and these are the references