Perhaps it took place in the shelter of a cave, or maybe outside where the tropical sun made it easier for the surgeon to see. The nervous young patient could have been fully alert, or sedated somehow with a concoction of medicinal plants from the surrounding forest, before the sharp stone did its grim work. Such fascinating details will likely always be speculation but an amazing fossil find makes one fact clear; 31,000 years ago, a young hunter-gatherer in Borneo had their lower left leg surgically amputated—and they survived.
Archaeologists working in a remote part of Indonesian Borneo have discovered what may be the earliest known example of a successful amputation—predating the next oldest such surgery by an amazing 24,000 years. A team of Indonesian and Australian researchers described the find this week in Nature.
The skeleton shows that a youngster’s lower left leg was skillfully severed and, despite the deadly risks of blood loss and infection, healed successfully. The leg bones show growth proving that the patient, though not very mobile, lived for years after the amputation, likely thanks to extensive community care during their convalescence and beyond. Scientists aren't sure whether the patient was male or female, but the stature makes male more likely. The amputation suggests that at least some foragers of Southeast Asia had developed significant medical knowledge and techniques long before the Neolithic Revolution some 12,000 years ago, after which other examples begin to appear in the archaeological record.
“It’s a remarkable find, and I do think it’s consistent with an amputation that’s been done surgically,” says Charlotte Roberts, a bioarchaeologist at Durham University who specializes in paleopathology and wasn’t involved in the research. “I can’t imagine what that child went through.”
The largely complete skeleton of a 19- or 20-year-old Homo sapiens was found during 2020 excavations at a site called Liang Tebo. The cave is in the remote Sangkulirang-Mangkalihat region of eastern Kalimantan, a rugged, rarely-visited landscape of limestone cliffs and forest accessible only by boat.
Early human remains are scarce in the region, and the authors suggest this may be the oldest known burial of a modern human that has ever been found in the region’s islands. During the dig, the find took on a whole new level of intrigue as the team discovered that the skeleton’s lower leg was entirely missing. The limb had been not broken or smashed, but cleanly removed, and the archaeologists found unusual boney overgrowth on the remaining fragments of the tibia and fibula. That overgrowth matched overgrowth seen in modern clinical cases of amputations.
Further investigations showed that the bone developed atrophy, indicating the part of the limb that remained was a stump with limited use. Investigations into this remodeling of bone structure showed some six to nine years of such changes. “This confirms that the surgery was not fatal, not infected and likely occurred during late childhood,” says Tim Maloney, who specializes in the archaeology of Borneo at Griffith University, in Australia, and co-authored the study.
To perform a successful operation, prehistoric surgeons must have had knowledge of anatomy. They sliced through not only bone but muscles, veins and nerves in such a way that the patient didn’t bleed to death or go into a fatal state of shock. Their scalpels were likely the flaked lithic edges common to the era; the skeleton’s grave was associated with fine flakes of a stone called chert, which can produce extremely sharp edges. Afterwards the surgeons may have employed a tourniquet or cauterizing, though neither would leave clear evidence on the skeleton and so remain unknown possibilities.
What seems certain, however, is that the patient enjoyed a considerable level of post-op care.
“It is highly unlikely that this individual could have survived the procedure without intensive nursing care, including blood loss and shock management, and regular wound cleaning,” Maloney notes. He believes the successful operation implies that the community also had some understanding of antiseptic and antimicrobial management to prevent fatal infection. In this, their foraging lifestyle and forest environment might have proved to be advantages.
“Given these people lived in an area of the Earth's tropics, home to some of the highest plant biodiversity, many with known medicinal properties, there is a strong case that adapting to this rainforest environment may have stimulated the development of advanced medical knowledge including plant processing for treatments.”
Whatever methods were employed they clearly worked, producing a well-healed amputation with no lasting skeletal evidence of complications or infections. During the years the patient lived and grew as an amputee, he very likely received ongoing assistance from the community while living a mobile lifestyle in this mountainous rainforest terrain.
“They actually made a conscious decision to look after this person,” says Roberts. “It seems to me that during this person’s life, and even at their death, as we can see from the funerary context, they were cared for very well.”
The evidence for prehistoric amputations, or surgeries of any kind, is relatively scarce. But some intriguing examples of serious medical procedures have been found. Some Egyptian mummies are amputees, including one fitted with an amazing 3,000-year-old prosthetic toe. Skulls from a Ukrainian cemetery show that trepanation, drilling a hole in the human skull, was practiced more than 9,000 years ago. The practice also occurred across the world from Ancient Greece to the Incan Empire. By 5,300 years ago, humans in northern Spain were performing ear surgery, cutting into a patient’s skull to relieve pain.
Previously, the oldest example of successful amputation surgery was found in France, where some prehistoric surgeon had deliberately, carefully severed the left forearm of an elderly male farmer about 7,000 years ago. The use of advanced surgical and medical techniques like the examples above is often linked to the dawn of agriculture, some 12,000 years ago, when settled communities and cultures began to develop. But life in Borneo was entirely different. The employment of such medical skill there, among hunter gatherers who were frequently on the move, is another piece of evidence suggesting that their cultures may have been quite sophisticated. Some of the world’s oldest known figurative paintings, cattle-like animals painted on cave walls at least 40,000 years ago, have also been found in this same region of Borneo.
The incredibly rare nature of the amputee skeleton find, however, makes it difficult to say if the amputation was itself an isolated act by an extraordinary human or group, or whether it is indicative of medical practices more common in prehistoric Borneo.
”There is little doubt advanced medical knowledge was well versed here 31,000 years ago,” Maloney says, "although just how widespread that was is unknown.”