The thought of undergoing any surgical procedure before the invention of modern medicine is beyond terrifying. It is also murky and mysterious, as archaeologists are still struggling to determine when and where the first surgeries and amputations actually took place.

According to a paper published in Nature, researchers have discovered the body of an ancient adolescent without a lower leg on the island of Borneo. Buried approximately 31,000 years ago and bearing all the telltale signs of deliberate and successful amputation, the body provides the earliest evidence of such an operation. This suggests that ancient people were performing complex medical procedures many years before previous approximations.

A surgical surprise

The archaeological tradition tends to see the medical techniques and technologies of ancient foragers as simple. Complex procedures such as surgeries and amputations are thought to have appeared only after the first agricultural societies were settled 10,000 years ago.

But, predating the transition to agriculture by about 20,000 years, this 31,000-year-old body challenges tradition. This suggests that the ancient peoples of Borneo acquired advanced medical skills in the mid-Pleistocene, many years earlier.

“The discovery of this extremely old evidence of deliberate amputation demonstrates the advanced level of medical expertise developed by early modern foraging humans,” the authors said in their analysis. “This unexpected early evidence of successful limb amputation suggests that at least some modern human foraging groups in tropical Asia developed sophisticated medical knowledge and skills long before the Neolithic transition to agriculture.”

Signs of amputation

Archaeologists found almost the entire body in a cave on the Indonesian side of the island. Their analysis of the bones and surrounding sediment suggests that the individual, whose gender remains unknown, died thousands of years before the transition from foraging to farming at around age 19 or 20.

But what was most intriguing about the skeleton was not what was present, but what was absent. With the lower third of his left leg missing, the body’s tibia and fibula bones came to a sudden stop in a much cleaner cut than an accident or animal attack could have caused. They also showed no signs of infection, suggesting the incision remained clean after the procedure.

According to the researchers, these are all indications of a complex surgical amputation in which the surgeons demonstrated “advanced medical knowledge” and dedication to their patient’s recovery. “Intensive postoperative nursing and care would be vital,” the authors state in their study.

By all accounts, the surgeons continued with this treatment and care, as the remains show that the amputation occurred in the individual’s childhood, allowing them another six to nine years of life after the procedure.

In addition to revealing surprising surgical prowess among Pleistocene Borneans, the skeleton also opens up a world of new questions about the acquisition and application of ancient medical practices.

“The comprehensive knowledge of human anatomy, physiology and surgical procedures […] it is likely to have been developed through trial and error over a long period of time and passed down between generations through oral traditions of learning,” the researchers concluded in their study. “Notably, it remains unknown whether this ‘operation’ was a rare and isolated event in the Pleistocene history of this region, or whether this particular foraging society achieved an unusually high degree of skill in this area.”

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