A burial in Borneo is the earliest known amputee

At the beginning of the last ice age, 31,000 years ago, a community in what is now eastern Indonesia buried a young man in the dry floor of a cave on a mountainside, painted with handprints. The people lived on the edge of what was then a low-lying continent called Zonda, and they were probably part of the same group of early navigators who crossed to Australia. They were complex in other ways as well: according to the published description of the burial in the magazine today Natureyoung adult is the oldest person to survive a surgical amputation.

Caring for the sick and injured is an important part of human evolution. In order to care for severe injuries, communities must develop medical knowledge and spare resources to devote to recovery. Human and Neanderthal skeletons both show evidence of healed traumatic injuries tens of thousands of years ago, and some anthropologists claim that the ability to provide medical care allowed hominids to spread across the planet.

A successful operation requires even more complexity. “Survival of amputation is a recent medical norm for most Western societies,” Tim Maloney, an archaeologist at Griffith University and lead author of the paper, said at a press briefing, made possible by the development of effective antiseptics in the late 1800s.

When Maloney and his team excavated the burial site, hoping to learn more about the people who painted the cave at least 40,000 years ago, they noticed something strange: The skeleton was missing its left foot, while the delicate bones of the right foot were well preserved. When they looked closely at the tip of the left leg, they saw that the tibia and fibula had been cut off and the ends of the bone had grown over.

Close examination of the tibia and fibula revealed many years of healed bone after amputation. From T. Maloney et al., Nature, 2022.

When the researchers examined the tips of the bones, they found no signs of animal attack or rockfall that would have left fracture or crushing marks around the edges. A clean wound indicates that it was done on purpose. Based on the age of the skeleton — about 19 years old at the time of death — and the healed bone, researchers believe the surgery took place when the man was a teenager, six to nine years before death. Not only did they survive, but they managed to continue living in their rugged mountain home.

[Related: Skull research sheds light on human-Neanderthal interbreeding]

Even if this limb loss was accidental, “it’s still significant that they managed to keep the person alive,” says Rebecca Howland, an expert on human skeletal remains at Durham University who was not involved in the study. But she says she has no reason to doubt the interpretation of the amputation. “I saw several amputated limbs, and it looks like it could very well be a healed amputation.” she says.

Such a surgical procedure and the child’s survival require experience, medical knowledge and confidence. “You can’t survive a leg removal, especially in childhood, without dealing with shock, blood loss, and infection,” Maloney says.

Howland agrees. It also shows that “there are people in this community who are saying, ‘This is what we need to do to take really drastic measures — cut someone’s leg off,'” she says.

Why exactly the child needed amputation remains a mystery. Since this happened long before the person died, no evidence of this procedure survives. They may have had an infection that became dangerous, or they may have suffered a catastrophic crushing injury to their foot and ankle.

But by comparing the wound to successful amputations in later history, archaeologists can make some assumptions about the details of the operation. The surgeons had to stop the bleeding either with the help of compression bandages, tourniquets, or cauterization. Researchers believe that the incision was made with stone tools that, although fragile, can be incredibly sharp – obsidian scalpels are used in some specialized medical procedures even today.

Perhaps most surprisingly, the bone showed no signs of infection in an environment where it is difficult to avoid – even the excavation team regularly dealt with infected cuts. The answer may be related to the knowledge of medicinal plants. “The question remains open whether this was a unique event associated with the communities living in [the biodiverse] the tropics,” Maloney says, “or is it a combination of trial and error in a community that took care of its children, as most of us do around the world.”

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Rowland says it’s important not to view surgery through the lens of modern medicine. Humans could understand how to control blood flow and care for a wound without detailed information about blood vessels, veins, and limb anatomy. “In the past, people had very different ideas about health and the body,” she says. But “they definitely had to realize that they had to stop the blood loss and they had to stop the infection, and that’s pretty impressive.”

The skeleton was found in the central chamber of a limestone cave on the eastern edge of the island of Borneo, overlooking the headwaters of the nearby Amarang River, in a valley full of ancient rock art. “It’s a lot like a cathedral,” Maloney says. The grave itself was marked with carved stones and accompanied by stone implements and a bead of red pigment.

The unusual burial of a person, marked with a ball of paint, is as interesting to Rowland as the actual amputation. “Maybe they had some kind of special status before the amputation” that made them eligible for the surgery, she says. “Or maybe the amputation made them special.”

Maxim Ober, who specializes in the study of petroglyphs at Griffith University and one of the authors of the study, notes that until now very little is known about the culture to which the man belonged – the excavation was part of an ongoing effort to understand who made the petroglyphs. Researchers know that the culture valued works of art. By the time a man was buried in the cave, some of the paint on its walls had been there for at least 10,000 years.

Amputation adds color to the technological and cultural sophistication of art people, whoever they are. The the second oldest known surgical amputation – 7000 years ago, in Neolithic France, after the advent of sedentary agriculture. A favorite model among archaeologists suggests that a sedentary lifestyle and agriculture must have been accompanied by sophisticated technology. “It very much challenges, if not completely overturns, the idea,” says Maloney, “that advanced medicine was beyond the reach of these early foraging and hunting societies.”

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