Research highlight

Anthropology: Oldest evidence of surgical limb amputation found in Borneo

Nature

September 8, 2022

A human skeleton found in Borneo, dated to about 31,000 years ago, shows that the left foot had been surgically amputated and that the patient recovered, reports a Nature paper. The findings suggest that advanced surgical procedures were happening in tropical Asia thousands of years earlier than previously recorded.

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 amputation surgery died from blood loss and shock or subsequent infection. Previously, the oldest known complex operation happened to a Neolithic farmer from France about 7,000 years ago, whose left forearm had been surgically removed and then partially healed.

Tim Maloney and colleagues report the discovery of skeletal remains of a young individual from Borneo who had the lower third of their left lower leg surgically amputated, probably as a child, at least 31,000 years ago. They found that the individual survived the procedure and lived for another six to nine years, before being buried within the Liang Tebo limestone cave located in East Kalimantan. The authors suggest that the individual(s) who amputated the lower left leg must have possessed detailed knowledge of limb structure, muscles and blood vessels to prevent fatal blood loss and infection. They suggest that the amputation was unlikely to have been caused by an animal attack or other accident, as these typically cause crushing fractures. The amputation was also unlikely to have been carried out as a punishment, as the individual seems to have received careful treatment after surgery and in burial.

The findings suggest that some early modern human foraging groups in Asia developed advanced medical knowledge and skills in a Late Pleistocene tropical rainforest environment. Rapid rates of wound infection in the tropics may have stimulated the development of novel pharmaceuticals, such as antiseptics, that harnessed the medicinal properties of Borneo’s rich plant biodiversity, the authors suggest.

doi: 10.1038/s41586-022-05160-8

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