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Some 31,000 years ago in the misty rainforests of the island of Borneo, stone tool met bone and a limb was severed—but a young life was saved. Researchers have found evidence for the earliest known surgical amputation, tens of thousands of years before the advent of modern surgical tools, antibiotics, or painkillers.
The findings illuminate both the medical expertise and compassion of the pioneering hunter-gatherers who populated Southeast Asia at this time, says Charlotte Roberts, a bioarchaeologist at Durham University who was not involved with the work but—as a former nurse—is familiar with the procedure. “We cannot doubt they were very sophisticated.”
The find traces to early 2020, when a team of Australian and Indonesian scientists excavated the floor of a cave called Liang Tebo in a remote, densely forested region of eastern Borneo. “There are absolutely no settlements, no telephone signal, no electricity,” says team member Andika Arief Drajat Priyatno, an archaeologist at the East Kalimantan Cultural Heritage Preservation Center.
Other researchers had previously inspected the cave, noting red-outlined hand stencils and zig-zag decals lining its limestone walls and ceiling. Those paintings haven’t been dated yet, but rock art depicting figures such as wild cattle and other animals from other caves in the region are at least 40,000 years old. That makes the hunter-gatherers who lived here the world’s first known figurative artists.
As workers, including Andika and others, scraped away a section of cave floor inch by inch, they discovered a remarkably intact human skeleton reclined in a kneeling position, with stones positioned above its head and hands, as if they were grave markers. The individual, whose sex could not be determined from their bones, was in their early 20s when they died. A small chunk of ochre, a natural pigment, was buried near the person’s face. That hints that they may have created some of the markings on the cave walls, says the study’s senior author, Maxime Aubert, a geochemist and archaeologist at Griffith University, Gold Coast, in Australia.
When the skeleton was fully revealed, the researchers noticed it was missing the bottom of its left leg from about the middle of the shin downward. The shin bones had fused at the bottom—a clear sign of healing following a traumatic injury, explains co-author Melandri Vlok, a bioarchaeologist at the University of Sydney. But then the team’s work had to halt, as the COVID-19 pandemic descended and Indonesia closed its borders.
When the scientists returned the following year, Vlok noticed the end of the leg was cut cleanly in a straight line, with no sign of crushing or shattering, as expected if a rock had fallen on it or an animal had bitten it off. “It looks exactly like what you would expect if a sharp blade cut completely perpendicular to the bone,” she says. “It made us confident this was surgery.”
The ancient surgeon likely used a stone or bone tool to cut through the leg, Aubert says, although the team hasn’t yet found the Stone Age equivalent of a bone saw.
The researchers radiocarbon dated bits of charcoal in sediment layers immediately above and below the grave to about 31,000 years ago. They also applied another technique known as electron spin resonance dating to directly date one of the skeleton’s molars; the results matched the sediment’s radiocarbon dates.
Taken together, the evidence suggests people on the island are the first known to perform a successful amputation, the team reports today in Nature. Previously, the oldest confirmed amputation—of a man’s arm below the shoulder—dated to about 7000 years ago in what today is France.
The team can’t say why ancient surgeons amputated the Borneo limb—whether because of disease or traumatic injury. Based on the degree of fusing of the shin bones, the individual lived and grew for another 6 to 9 years, Vlok says. The cause of death is unclear.
The region’s tropical environment means it’s incredibly easy for wounds to become infected, Vlok says. “I once cut my finger during an excavation and quickly had to rush to the hospital to get antibiotics,” she says. Surviving surgery would have been virtually impossible without something to clean the wound, as well as to relieve pain, says India Dilkes-Hall, a co-author and archaeologist at the University of Western Australia, Perth.
Fortunately, Borneo’s rich biodiversity offers a vast pharmacopoeia. For example, when properly processed, the normally toxic fruit of the Pangium edule tree can be used as an antiseptic, Dilkes-Hall says. Humans had been in the region for thousands of years and may have learned the medicinal properties of local plants, she notes.
“The argument here is exceptionally well-constructed,” says Haagen Klaus, an anthropologist at George Mason University who was not involved with the work. “They make a very convincing case for a surgical amputation 31,000 years ago.”
Some anthropologists have tended to dismiss early hunter-gatherer societies as primitive, he says, but findings like this one suggest that wasn’t the case. “It’s become very clear they had lives and societies far more complex and sophisticated than we imagined, including knowledge of medicine and human anatomy.”