Evidence of the earliest known limb amputation has been uncovered in Borneo.
A human skeleton thought to be from around 31,000 years ago shows the left foot surgically amputated, but also reveals that the patient recovered.
Researchers said the discovery in Borneo shows human foraging groups in tropical Asia had sophisticated medical knowledge and skills, including on how to prevent infection.
Until now, the oldest known complex operation happened to a Neolithic farmer from France about 7,000 years ago. His left forearm was surgically removed and then partially healed.
Writing in the journal Nature, Tim Maloney, from Griffith University in Australia, and colleagues said the discovery suggests the young person had their foot amputated when they were a child.
They survived the procedure and lived for another six to nine years before being buried in Liang Tebo cave, which is located in East Kalimantan, an area that contains some of the world’s earliest dated rock art.
Until now, treatment of people with illness or injury was thought to have been poorly developed among small-scale foraging communities. It was believed they could manage smaller procedures such as suturing and dentistry.
“The prevailing assumption has been that more complex surgeries were beyond the abilities of foraging societies past and present,” the authors said.
They added: “Before modern clinical developments, including antibiotics, it was widely thought that most people undergoing amputation surgery would have died, either at the time of amputation from blood loss and shock or from subsequent infection—scenarios that leave no skeletal markers of advanced healing.”
The experts said the surgeon who carried out the amputation on the child “must have possessed detailed knowledge of limb anatomy and muscular and vascular systems to prevent fatal blood loss and infection…”
They added that “intensive post-operative nursing and care would have been vital”, including regularly cleaning the wound and dressing it “perhaps using locally available botanical resources with medicinal properties to prevent infection and provide anaesthetics for pain relief”.
The experts continued: “Although it is not possible to determine whether infection occurred after the surgery, this individual evidently did not suffer from an infection severe enough to leave permanent skeletal markers and/or cause death.”
The skeleton had “remodelled bone” covering the “amputation surfaces”, which shows there was healing after the operation.
The authors also suggested the amputation was unlikely to have been caused by an animal attack or other accident, as these typically cause crushing fractures.
The amputation was also unlikely to have been carried out as a punishment, as the person seems to have received careful treatment after surgery and in burial.