 This is a case study from a site here in Switzerland, Aventicum, or Avanche, as the town is known today. You can see it's situated in close proximity to Berlin between an area of three lakes, the Lake Morale, the IPA, and Lake Nechatelle. Basically, Aventicum is known because it was the capital city of the region of the Elveti during the Roman periods. But we also have some small evidence regarding the medieval past of this city. Basically, we know more about the later medieval times than the time I'm going to discuss, because it has been uncovered to many sites during this time period, like the 10th and 11th century AD. However, we have some evidence starting from the population itself, when in 2019 a cemetery site was excavated, as you can see there at the periphery of the Roman city, and it's called the Sulfur S. Here, you have a general view of the cemetery. It was a small section of it, most probably, that was excavated. And our skeleton of interest is the one found in grade 17. And we are talking about a male individual, and the estimation of sex was based on chronic pelvic skeletal tissue. It was basically a fairly good preservative, so we had all the relevant skeletal features to do both the sex and the aging. And regarding aging, it was estimated to be 40 to 45 years old, based on dental adhesion, pubic synthesis, and the regular sex. What was striking, and you can see here with this all color, the sex, the amount of pathologies that we could detect on this particular skeleton. So starting from the more common one, he had a wide range of dental pathologies, and then moving to the most severe one, he suffered from osacromiale, trauma in several parts of the axial skeleton, and as well as several joints were also affected by the degenerative joint diseases. And if we see them step by step here, we have a case of osacromiale, which basically is the failure of fusing this tiny part on the top of the shoulder, which is known as acromion. It's usually a genetic or developmental defect, and sometimes it is thought to be, as a result, from mechanical stress on the developing acromion. The area affected, as you can see here, is between the mesoacromion and the preacromion, which has, like, at the end of the acromion process. Athletic changes were multiple on the skeleton, so we start from the sternocleavicular joint, where both sides, the left and the right, were equally affected, starting from the manubrium, the head of the sternum, and equally the sides of the left and the right clavicles at the proximal ends. There we could detect extensive osteophytic formation, this new bony outgrowth around the joint, as well as porosity. We also had similar relations on the vertebral column, spread from the cervical vertebrae to the lumbar vertebrae, and then, again, you have the most pathopneumonic features for this type of degenerative lesions that you can note on the vertebral column. And you have examples here of this type of degenerations affecting both cervical and lumbar vertebrae. Upper arm, as well, was affected by degenerative joint disease, and especially the joint between the humerus and the radius, that you can see to your left. And these specific features were located in the right part of the distal humerus and the right proximal part of the radius, when you have one of the most secure signs of osteoarthritic lesions, because you have this nicely polished area on the humerus and the radius, which we call aburnation. And then you have similar lesions at the joint of the humerus and the ulna, the humera ulna joint, where typical signs of osteoarthritis were also observed. But the most impressive pathology that we saw in this individual was that besides some more arthritic changes in the wrist joint, and in particular at the left distal radius and ulna, what was striking was the fusion, the ankylosis of all the carbones and the metacarpals of the left hand. As you can see in the picture here and in the micro CT scan that we did. It didn't end here. He had also some trauma on the skeleton, one of the most common traumatic incidents we come across in the bioarchaeological record, the so-called perifracture, when the distal part of the ulna is fractured and sometimes it is associated with cases of interpersonal violence when you are supposed to defend from a blow to the head, although this is a controversial issue and still open to discussion. And another fracture at the left ulna which is located to the mid to the distal one third of the shaft. And one of the tiny fragment of rib also presented a type of fracture, most probably it was right rib, it was really fragmentary, so siding, even if they are completed, sometimes it's a little bit tricky. But the fracture again, most probably an oblique one or transverse one was located towards the head of the rib. So basically let's see what caused these severe ankylosis, ankylosis in the wrist of this individual in the hand of the individual that we saw. There is a wide range of pathologies that can contribute to this type of ankylosis, the carbons and metacarpons all together in this amorphous mass that we have seen. I think the most, let's say, favorable candidate is rheumatoid arthritis. And here you can see what we used to do when it comes to differential diagnosis to check for pathologies, how they affect the entire skeleton. And in this case we were lucky because it was fairly complete so we can see exactly what happens in conditions like rheumatoid arthritis, diffuse adiopathic skeletal hyperostosis or other types of arthropathies like psoriatic arthropathy. There is also a possibility that a trauma was present but for example the city didn't show any evidence of trauma. I'm now working on this case with a colleague in the Lausanne hospital who is a very good radiologist and he has seen millions of cases and living passions so maybe we can together see better or for sure he's going to see things better than I do. There is also the case of infection or even in some cases you have some congenital cases where an individual can be born with this type of fusion in the hand. For the moment I would suggest rheumatoid arthritis arthritis as the most possible candidate. And focusing on this I would discuss a little bit what we know from modern clinical data regarding arthritis because it is really affecting a large let's say a percentage of modern population and it is actually laid as a chronic disabling condition often causing pain and deformity especially dangerous because it is known to be associated with various other systematic effects for example it can affect the visibility, the respiratory system, the lungs as well introduce cardiac problems. So it's not only the disease itself and let's say a last stage when you have an enclosed joint you can also suffer from a different systematic effects that can be caused by rheumatoid arthritis. It is known to strike the most productive years of adulthood so you can have an onset between 20 to 40 years. Although sometimes it differs in between patients and sometimes the progress of the disease is different. In some individuals can progress very rapidly while in other individuals these very painful symptoms appear in later and more advanced stages. However what it is known it is that within 10 years of their onset we know that at least 50% of patients at least from surveys in developing countries they are unable to hold down a full-time job. So basically this individual was not able to work in and function in full. And when it comes to medieval texts we don't have the time to go through all these medical pieces that refer to arthritic changes but it was fairly common. So you do have a lot of inferences from a medical treatise of the medieval era discussing how painful arthritis could have been for the population of the time. And I only give you this by Bartholomeus Anglicus in the 13th century saying that arthritis is a neck and evil in the fingers and toes with swelling and sore A. So this condition and effects and the symptoms sometimes were more or less diagnosed. However as we heard today earlier about the daily idea how many years you live in a good life until you die we could estimate that this individual most probably really lived for a good amount of his life in this type of pain and disability. Although it's not possible of course to understand when exactly the disease started we take the standards of modern clinical databases in order to have such a rough estimation. And then here comes the questions regarding a specific society specific debilitating condition or conditions because equally fractures affect a life on the individual. And if we need like three months for an individual to heal properly, not taking an account that other factors played an important role like age, sex, nutrition, status, et cetera. Then again we know that having two hands fractures two arms fractures plus an ankylois wrist this makes your life or your everyday life quite difficult. When it comes to viral context you could see from the topography of the century that this individual was not excluded it was buried among all their counterparts. So somehow his social identity for having this debilitating condition was not affected. However we always have to have in mind the idea of how the medivial male was preserved and he had to fulfill very specific societal expectations about work, about marriage, about his full performance in several aspects of everyday life. So for sure this individual suffered from limited activity, he had a painful everyday life and this resulted in somehow losing the productivity and the participation needed in daily communal activities maybe basic tasks necessary for day to day independent living was also in a way limited. And of course then comes the mind that in this state in this health status he needed some type of care which starts from the family and then to society but we don't have a very extended idea of how society, how he was in a state to have access to specified or specialized medical treatment. We don't know if professional medical were living at the time in medivial Aventico. And of course we don't know that anyone can look for first aid in herbal remedies and for example the plant Ruta Dravioleus, the common rule, was very well known at least for arthritic pains and for individual suffering from this type of pains. So this is a glimpse of life in an individual living in a medivial city around the 11th century AD and give us an idea more or less of his condition. However to me that was really striking and I think it's worth mentioning and what looking in our sample is that fractures and arthritic changes can contribute a lot to having a life of pain and disability. We are usually looking for the spectacular cases and perhaps rheumatical arthritis is one of them. Few cases are recorded in the biological record for the medivial period but even if someone suffers from only the generative lesions on the spine or any other joint of his body, this really affects his life. So we can also think about this aspect of everyday life in the past and how it really affected everyday level and everyday activities. Thank you.