A skeleton discovered in a remote corner of Borneo is rewriting the history of ancient medicine, proving that amputation surgery was successfully performed about 31,000 years ago, scientists said Wednesday.
Previously, the earliest known amputation involved a 7,000-year-old skeleton found in France, and experts believed such surgeries only emerged in established agrarian societies.
The finding also suggests that Stone Age hunter-gatherers living in Indonesia’s present-day East Kalimantan province had advanced medical knowledge of anatomy and wound treatment.
“It rewrites our understanding of the development of this medical knowledge,” said Tim Maloney, a researcher at Griffith University in Australia who led the work.
The skeleton was discovered in 2020 in the imposing Liang Tebo Cave, known for its 40,000-year-old murals.
Surrounded by bats, terns and swallows, and punctuated by the occasional scorpion, scientists painstakingly removed sediment to reveal an amazingly well-preserved skeleton.
Only one notable feature was missing: the left ankle and foot.
The base of the remaining leg bone was of a surprising shape, with knobby regrowth over an apparently clean fracture, strongly indicating that the ankle and foot were intentionally removed.
“It’s very neat and angled, you can see the surface and the shape of the incision through the bone,” Maloney told a news conference.
Other explanations, such as an attack by an animal, a crushing injury, or a fall, would have caused bone fractures and healing different from those in the skeletal leg.
A tooth and surrounding sediment showed the skeleton to be at least 31,000 years old and belong to a person who died at about age 20.
Despite the incredible trauma of amputation, they appear to have survived six to nine years after surgery, based on the regrowth on the leg bone, and suffered no major postoperative infection.
That suggests “detailed knowledge of the anatomy of limbs and muscle and vascular systems,” the research team wrote in a paper published Wednesday in the journal Nature.
“Intensive post-operative nursing and care would have been vital … the wound would have been regularly cleaned, dressed and disinfected.”
‘A hotspot of human evolution’
Humans have been operating on each other for centuries, pulling teeth and drilling skull holes in a process called trepanation.
But amputation is so complex that in the West it only became a surgery about a century ago that people could reasonably hope to survive.
The oldest earlier example was a 7,000-year-old skeleton with a forearm found in France in 2010.
It seemed to confirm that humans only developed advanced surgery after they settled in agrarian societies, freed from the daily grind of hunting for food.
But the Borneo find shows that hunter-gatherers were also able to overcome the challenges of surgery, and they did so at least 24,000 years earlier than once thought.
Despite everything the skeleton reveals, many questions remain: how was the amputation performed and why? What was used for pain or to prevent infection? Was this surgery rare or more common?
The team speculates that a surgeon may have used a lithic knife carved from stone, and that the community gained access to rainforest plants with medicinal properties.
The study “provides our view of the implementation of care and treatment in the distant past,” wrote Charlotte Ann Roberts, an archaeologist at Durham University, who was not involved in the study.
It “challenges the perception that caregiving was not a consideration in prehistoric times,” she wrote in a review in Nature.
Excavations are expected again in Liang Tebo next year, in the hope of learning more about the people who lived there.
“This is really a hot spot of human evolution and archaeology,” said Renaud Joannes-Boyau, an associate professor at Southern Cross University who helped date the skeleton.
“It’s definitely getting warmer and warmer, and the conditions are really geared up to make more amazing discoveries in the future.”
Missing Stone Age foot may show oldest amputation
Tim Ryan Maloney et al, Surgical amputation of a limb 31,000 years ago in Borneo, Nature (2022). DOI: 10.1038/s41586-022-05160-8
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