BRISBANE, Australia — A child that lived in Borneo 31,000 years ago had their left foot amputated and apparently survived for up to nearly a decade, a new study reveals. Researchers say it’s the oldest evidence of surgical limb amputation, pre-dating the previous record by an astonishing 24,000 years!
The adolescent, between 11 and 14 years-old, appears to have used a crutch to negotiate a its difficult environment, or even a primitive prosthetic. The child’s gender is unknown, but researchers say they were most likely male.
Those who removed the lower third of the young patient’s leg must have had detailed knowledge of anatomy and muscular and vascular systems to prevent fatal blood loss and infection, according to the study. They may have had access to a natural antiseptic, from the rainforest’s rich variety of plants. The leg bone shows a clean sloping cut made with a “sharp tool.”
Named TB1, their remains were buried in Liang Tebo cave in East Kalimantan on the Indonesian island. It contains some of the world’s earliest dated rock art.
“A human skeleton found in Borneo, dated to about 31,000 years ago, shows the left foot had been surgically amputated – and that the patient recovered,” Dr. Maloney tells SWNS. “The findings suggest that advanced surgical procedures were happening in tropical Asia thousands of years earlier than previously recorded.”
The amputation was unlikely to be the result of an animal attack or other accident, as these typically cause crushing fractures. Study authors also ruled out punishment as the individual seems to have received careful treatment after surgery and in burial.
Did ancient cultures have ‘sophisticated medical knowledge’?
“This unexpectedly early evidence of a successful limb amputation suggests at least some modern human foraging groups in tropical Asia had developed sophisticated medical knowledge and skills long before the Neolithic farming transition,” Dr. Maloney writes.
The hunter-gatherers must also have understood the necessity to remove the limb for survival.
“Furthermore, during surgery, the surrounding tissue including veins, vessels and nerves, were exposed and negotiated in such a way that allowed this individual to not only survive but also continue living with altered mobility,” the researcher continues.
Intensive post-operative nursing and care would have been vital, such as temperature regulation, regular feeding, bathing, and movement to prevent bed sores while the individual was immobile.
“The wound would have regularly been cleaned, dressed and disinfected, perhaps using locally available botanical resources with medicinal properties to prevent infection and provide anesthetics for pain relief,” Dr. Maloney continues. “Although it is not possible to determine whether infection occurred after the surgery, this individual evidently did not suffer from an infection severe enough to leave permanent skeletal markers or cause death.”
“Furthermore, it is inferred life without a lower limb in a rugged and mountainous karst terrain presented a series of practical challenges several of which can be assumed to have been overcome by a high degree of community care.”
The patient likely reached young adulthood
At the time of death, the study reveals that the individual was a young adult about 19 or 20 years-old. The reassembled skeleton is 75 percent complete, with all teeth present and intact.
The skull and pelvis show intermediate traits, so their sex is unclear. However, their stature was more typical of a male, when compared to other prehistoric remains from Asia. The individual was also significantly taller than the average for a female from the same time period.
The stunning discovery demonstrates advanced medical expertise developed in a prehistoric tropical rainforest on the eastern margins of the Greater Sunda Islands in the Pacific Ocean.
Why is this procedure so shocking?
Amputations require a comprehensive knowledge of human anatomy and surgical hygiene and considerable technical skill. Before modern clinical developments such as antiseptics, most people undergoing them died from blood loss and shock or subsequent infection.
Previously, the oldest known complex operation happened in France about 7,000 years ago. A Stone Age farmer’s left forearm was surgically removed and then partly healed.
“We infer the comprehensive knowledge of human anatomy, physiology and surgical procedures evident in TB1’s community is likely to have been developed by trial and error over a long period of time and transmitted inter-generationally through oral traditions of learning,” Dr. Maloney writes.
“Notably, it remains unknown whether this ‘operation’ was a rare and isolated event in the Pleistocene history of this region, or if this particular foraging society had achieved an unusually high degree of proficiency in this area,” the researcher continues.
“Risk of death from trauma and disease has always been with us, and complex medical acts, such as limb amputation, could well have been more commonplace in the pre-agricultural past of our species than is broadly assumed at present.”
Fully understanding how this surgery took place may be impossible due to poor preservation of diseased bone as well as by preconceptions about the “primitive” nature of early medical cultural practices, especially among non-sedentary foraging populations in tropical Asia.
On the other hand, human colonization of the ancient rainforests of Borneo may have both prompted and facilitated advances in technology that were unique to this region.
“For example, rapid rates of wound infection in the tropics may have stimulated the development of new pharmaceuticals – for instance, antiseptics – that harnessed the medicinal properties of Borneo’s rich plant biodiversity and endemic flora,” Dr. Maloney explains.
Discovering the dawn of surgery
Professor Charlotte Roberts, an archaeologist at Durham University, who did not take part in the study, described the case as the “dawn” of surgery.
“Evidence that a child in a hunter-gatherer society survived amputation offers a remarkable insight into the origins of surgery,” Prof. Roberts says in a statement. “It challenges the current view that such procedures emerged alongside farming some 10,000 years ago. That this child survived the procedure and is estimated to have lived for many years afterwards is astounding.”
“Another interesting open question is whether the child received pain management during the operation, such as sedation through the use of a plant-based medicine,” Roberts continues.
“The hunter-gatherer community in which this person lived would have been relatively mobile while foraging and hunting for food, and this would have made the individual’s
recovery process very challenging, considering how people recover from amputations and the need for care, rest, healing and rehabilitation.”
It could have been harder to support this child than someone in settled farming communities of later periods, where it would have been easier for people to help them at the same time as working. The study provides new insights into the implementation of care and treatment in the distant past, challenging the perception it was not a consideration.
“That this person was given a deliberate burial in a cave when they died perhaps confirms the care provided in life by this community continued after a person’s death,” Dr. Roberts explains.
“Furthermore, there are signs of innovative behavior in societies in this region of Borneo, namely, the creation of rock art 40,000 years ago.”
“Finally, whether the child had the use of an ‘artificial limb’ or a support – such as a crutch – could be contemplated,” Roberts concludes. “This has been considered for a sixth-century Austrian male individual who was excavated, although, in that case, there was archaeological evidence of an artificial foot preserved in the grave.”
South West News Service writer Mark Waghorn contributed to this report.