A handsome amputation of a lower leg, 31,000 years ago in Borneo

As early as 31,000 years ago, humans were able to successfully perform a leg amputation. This is apparent from the discovery of a well-preserved skeleton of a twenty-year-old man or woman in a cave on East Borneo, from whom a large part of the left lower leg had been deposited around the age of ten. Dating to C-14 and uranium shows that this person was carefully buried there 31,000 years ago. Elsewhere in the cave, the Liang Tebo near the Marang River, petroglyphs, including hand stencils, have also been found. The area around the cave has been known for its ancient rock paintings for several years. Lubang Jeriji Saléh cave with the oldest drawings in the world (40,000 years old) is a few kilometers away.

The Australian-Indonesian research team, led by Tim Maloney (Griffith University, Queensland) sees the find as an important indication that hunter-gatherers are also capable of complicated surgical procedures, this is how they write this week in Nature.

Hole in the skull

So far, the oldest known prehistoric amputation dates from agricultural times, a 7,000-year-old French case in which a left forearm was successfully amputated. Anthropologists have always praised hunter-gatherers for their knowledge of plants and herbal medicine, but as far as we know, surgical interventions did not go further than the drilling of a hole in the skull (often for ritualistic reasons) or the removal of one or more phalanges.

New bone formation on the stump of the person from the Liang Tebo grave indicates that he or she survived at least six to nine years after the amputation. The fact that the amputation must have taken place in childhood can also be deduced from the small size of the remaining part of the tibia, which has not grown any further after the amputation. The fact that it concerns an amputation and not an injury from, for example, a crocodile bite, is inferred, among other things, from the lack of crushing. It is also unlikely that the tibia and fibula would be cut off in the same place.

Careful Burial

The remaining bones in the left leg are particularly thin, because very little has been written on them, the researchers write Nature. But the bones in the right leg are also relatively thin: it must not have been easy in the mountainous area to walk around limping or with a stick on one leg. The person concerned must have been well cared for by his family and other group members, as evidenced by his careful burial. Three stones were placed on the tomb, above the head and also by the arms – apparently to indicate the tomb. A piece of red ocher was also found in the grave. It is often believed that red ocher is used to give color to a dead person.

In Western medicine, successful amputation has only been normal practice for a hundred years, mainly due to better infection control (partly thanks to antibiotics). Blood loss was also usually fatal. All the more credit to the people 31,000 years ago in Borneo. According to the researchers, those ‘surgeons’ must have detailed knowledge of the leg anatomy and all vascular systems to successfully perform the amputation.

The wound care afterwards (with long-term cleaning and disinfection) must also have been almost perfect, possibly thanks to knowledge of local medicinal plants that disinfect and (hopefully) also relieve pain. Such knowledge must have been developed over a long period of time – through trial and error – and passed on from generation to generation, the researchers say. It is plausible that such knowledge was also developed early elsewhere, but has not yet been noticed in excavations.

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