Scientists find evidence of oldest known surgery, from 31,000 years ago

Archaeologists have uncovered the remains of a young hunter-gatherer in Borneo who survived the amputation of the lower left leg around 31,000 years ago, in a discovery that could rewrite the history of surgery.

The findings, published in the journal Nature on Wednesday, are believed to be the earliest known example of a complex amputation, predating other Stone Age surgeries by tens of thousands of years.

“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,” the authors wrote.

Successful amputations require a comprehensive understanding of human anatomy and surgical hygiene, as well as considerable technical skill. Until now, the oldest evidence of amputation was found in the skeletal remains of an elderly farmer in France, whose forearm had been amputated above the elbow some 7,000 years ago.

The consensus among medical experts is that humans lacked the skills and technology to perform difficult surgical procedures such as amputation until people began farming and living in permanent settlements over the past 10,000 years. Even then, before advances such as antiseptics, most people undergoing amputation surgery died of blood loss and shock or subsequent infection.

The latest discovery – in a remote region of eastern Kalimantan, the Indonesian portion of the island of Borneo – challenges the view that “advanced medicine was beyond the capacity of these early foraging and hunting societies,” Tim Maloney, an archaeologist at Australia’s Griffith University and one of the project’s lead researchers, told reporters Wednesday. “It rewrites our understanding of the development of this medical knowledge.”

The young hunter-gatherer apparently not only survived the complicated operation, but also lived for six to nine more years in an inhospitable tropical rainforest region. Australian and Indonesian scientists found the remains in 2020 during an archaeological excavation at a limestone cave that is accessible only by boat at certain times of the year.

“It was a huge surprise that this ancient forager survived a very serious and life-threatening childhood operation, that the wound healed to form a stump, and that they then lived for years in mountainous terrain with altered mobility – suggesting a high degree of community care,” said Melandri Vlok, a paleopathologist at the University of Sydney.

She examined the remains and confirmed telltale bony growths related to healing, suggesting the limb was surgically amputated when the young hunter-gatherer was still a child, several years before their death in early adulthood.

The remains were found in a large cave that contains some of the world’s earliest rock art, dating back at least 40,000 years. During the excavation, Maloney said, the archaeologists grappled with scorpions, bats and proboscis monkeys that were less than impressed by their presence in the ancient cave system.

The skeleton was dated using sediment samples from around the burial area and tooth fragments.

Asked how the researchers were able to rule out causes other than amputation for the missing limb, such as a congenital condition, Maloney said the bones were consistent with clinical comparisons to individuals who have undergone a similar surgical procedure.

“All of them demonstrate the same kind of remodeled bone,” he said. The ossification of the bone fragments also indicates that pressure was occasionally applied to the stump as the young hunter-gatherer probably rested on it after the limb was removed, he added. The amputation was also unlikely to have been caused by an animal attack or other accident because these typically cause crushing fractures.

The paper’s authors said the discovery suggests that advanced surgical procedures were happening in tropical Asia thousands of years earlier than previously recorded, and that ancient foragers may have tapped into natural medicines found in the tropics to prevent the wound from becoming infected as it healed after surgery.

However, they said it remains unknown whether the amputation was a rare and isolated event or the foragers had “achieved an unusually high degree of proficiency in this area.”