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Researchers discover earliest known stone-age surgery


Sharlene King
8 September 2022
Scientist inspecting laser equipment doing fossil analysis
Associate Professor Renaud Joannes-Boyau in the Biomics Facility with the specialist equipment used to date the fossil.

Southern Cross University has dated the skeletal remains of a young hunter-gatherer whose lower left leg was amputated by a skilled prehistoric surgeon 31,000 years ago.

The fossil discovery in a limestone cave on the island of Borneo, published in the journal Nature, is thought to be the earliest known evidence for a complex medical act, pre-dating other instances of stone age ‘operations’ found at sites across Eurasia by tens of thousands of years.

In a remote part of East Kalimantan on the island of Borneo, an area home to some of the earliest known figurative rock art, archaeologists have discovered the world’s oldest surgery.

Buried in the Liang Tebo limestone cave, the skeletal remains of a young hunter-gatherer whose lower left leg was amputated by a skilled prehistoric surgeon 31,000 years ago.

ASSOCIATE PROFESSOR RENAUD JOANNES-BOYAU: It was very exciting. Tim and Max found these amazing remains, this individual buried in the cave and they were excited. And I remember Max saying, you know 'We found the artist of the rock art' so he said we absolutely need to to date the remains. As with all the modern sites today we have to do a comprehensive approach when we do the dating and so we date the sediments and then we also date the remains.

The age of the fossil was calculated with specialist equipment in the University’s Biomics Facility located at the Lismore campus.

ASSOCIATE PROFESSOR RENAUD JOANNES-BOYAU: So I dated the teeth. Because the uranium in the sediment was so low we didn't believe that the bone will actually give a good age, so we went for the teeth which are more reliable. As you know they resist much more in the burial site. So we had to do another technique called electron spin resonance to actually get the age of the fossil and it turned out to be quite old.

PROFESSOR MAXIME AUBERT: So in 2018 we published a paper where we show that some of the rock art in those caves they are at least 40,000 years old so essentially we set up a project to find out who made that rock art because we had no idea.

DR TIM MALONEY: This person was a valued member of their community. As a child they successfully had their lower left leg surgically removed. That only became a medical norm in modern society in most parts of the world after the invention of antiseptics, within the last century or so.

A team of Indonesian and Australian archaeologists co-led by Griffith University academics unearthed the complete human skeletal remains.

Up until this discovery, the oldest evidence yet revealed for amputation surgery had comprised the 7,000-year-old skeleton of an elderly male Stone Age farmer from France, whose left forearm had been carefully amputated just above the elbow.

“Dating the remains directly turned out to be a challenging task,” said Associate Professor Renaud Joannes-Boyau, Head of the Geoarchaeology and Archaeometry Research Group at Southern Cross University.

He calculated the age of the fossil with specialist equipment in the University’s Biomics Facility located at the Lismore campus.

The skeleton was well preserved, likely because it was intentionally deposited into a burial. Yet neither direct radiocarbon dating of the remains, nor direct uranium series dating of the bones, provided exploitable results.

“We had to measure the amount of radiation received by the tooth enamel during burial using the electron spin resonance (ESR) dating technique to confirm the individual died some 31,000 years ago,” Associate Professor Joannes-Boyau said.

The direct ESR dates of the dental remains are in agreement with the radiocarbon ages obtained on the surrounding sediments.

Fossil skeleton showing amputated lower leg

Pelvis, legs and remaining foot from the earliest-known amputation patient (credit: Tim Maloney).

Professor Maxime Aubert from the Griffith Centre for Social and Cultural Research, co-leader of the research project undertaken with Indonesia’s Centre for Archaeology, Language and History, said the new finding was brought to light in 2020 during an archaeological excavation at Liang Tebo.

Liang Tebo is a limestone cave in the remote Sangkulirang-Mangkalihat region of eastern Kalimantan, the Indonesian portion of Borneo, which is accessible only by boat at certain times of the year.

“What the new finding in Borneo demonstrates is that humans already had the ability to successfully amputate diseased or damaged limbs long before we began farming and living in permanent settlements,” Professor Aubert said.

The archaeological excavation was overseen by Griffith researcher Dr Tim Maloney, along with Dr India Ella Dilkes-Hall (University of Western Australia) and Mr Andika Priyatno (Balai Pelestarian Cagar Budaya), with the field team surprised to observe that the human skeleton was missing its left foot and lower leg.

Previously, archaeological research across Eurasia and the Americas had uncovered human bones that bore signs of prehistoric surgeries, including holes drilled in skulls (trepanation).

“In light of the much younger age of these prior findings, the discovery of a 31,000-year-old amputee in Borneo clearly has major implications for our understanding of the history of medicine,” Dr Maloney said.

“It was thought the shift from foraging to farming at the end of the ice age gave rise to previously unknown health problems that stimulated the first incremental advances in medical technology, including the earliest attempts at stone age ‘surgery’”.

The team said the surgeon(s) who performed the operation 31,000 years ago must have had detailed knowledge of limb anatomy and muscular and vascular systems to expose and negotiate the veins, vessels, and nerves and prevent fatal blood loss and infection.

Intensive post-operative nursing and care would also have been vital, and the wound would have had to have been regularly cleaned and disinfected to prevent infection.

The medical skill and proficiency demonstrated by this amputation contrasts with the litany of horrors that awaited patients of medieval surgeons in Europe, while modern medicine only reached regular amputation success following the discovery of antiseptics at the turn of the previous century.

Coloured illustration of prehistoric person with amputated left foot

Artist impression of Tebo1 with amputated lower left leg (credit Jose Garcia (Garciartist)).

Study details

Surgical amputation of a limb 31,000 years ago in Borneo

Published in Nature



Learn more: read The Conversation article.


Media contact: Sharlene King, media office at Southern Cross University, 0429 661 349 or [email protected]