These 31,000-Year-Old Human Bones Are Rewriting Medical History

Scientists have discovered astonishing evidence of a surgical amputation that was performed on a person about 31,000 years ago in Borneo, making it by far the oldest known example of such a complex medical procedure, according to a new study. 

Archaeologists led by Tim Maloney, a research fellow at Griffith University in Australia, found the remains in 2020 during an excavation inside a limestone cave called Liang Tebo. The Bornean individual, known as TB1, appears to have had their lower left leg amputated, perhaps while they were a child, after which they lived for another six to nine years, suggesting that the procedure was a success. 

Prior to this discovery, the record for the earliest known amputation belonged to a French farmer who lived 7,000 years ago, and who had his forearm removed, which means TB1 pushes the timeline of the procedure back a whopping 24,000 years. Whereas previous research has suggested that complex surgical procedures emerged within the past 10,000 years, a time known that includes the Neolithic period, the discovery of TB1 shows that some communities developed these techniques during the previous period, known as the Late Pleistocene.

Maloney and his colleagues concluded that this “unexpectedly early evidence of a successful limb amputation suggests that at least some modern human foraging groups in tropical Asia had developed sophisticated medical knowledge and skills long before the Neolithic farming transition,” according to a study published in Nature on Wednesday.

“The discovery of this exceptionally old evidence of deliberate amputation demonstrates the advanced level of medical expertise developed by early modern human foragers in a Late Pleistocene tropical rainforest environment,” the researchers said. “We infer that the comprehensive knowledge of human anatomy, physiology and surgical procedures evident in TB1’s community is likely to have been developed by trial and error over a long period of time and transmitted intergenerationally through oral traditions of learning.” 

“Notably, it remains unknown whether this ‘operation’ was a rare and isolated event in the Pleistocene history of this region, or if this particular foraging society had achieved an unusually high degree of proficiency in this area,” they added. “Risk of death from trauma and disease has always been with us, and complex medical acts, such as limb amputation, could well have been more commonplace in the pre-agricultural past of our species than is broadly assumed at present.”

There are many mysteries about the peoples who lived in Borneo, and other parts of Southeast Asia, tens of thousands of years ago, because it is rare to find human remains from this time. However, TB1 was found in a deliberately buried grave in a region that contains some of the oldest known rock art in the world, so these prehistoric peoples were artistically prolific and may have observed funeral rites, which are both indications of a complex culture.

The evidence of surgical amputation in TB1 now indicates that this community also possessed exceptional medical expertise and, perhaps, novel treatments derived from the tropical landscape. 

“We cannot exclude the possibility that human colonization of the ancient rainforests of Borneo both prompted and facilitated early advances in medical technology that were unique to this region,” the team said in the study. “For example, rapid rates of wound infection in the tropics may have stimulated the development of new pharmaceuticals (for instance, antiseptics) that harnessed the medicinal properties of Borneo’s rich plant biodiversity and endemic flora.”

The researchers considered the possibility that the amputation was the result of an unintentional injury or an animal mauling, but concluded that the clean removal of the limb, along with signs of healing, don’t match the messy profile of accidents and attacks. Likewise, the team doubted the amputation was performed as a punishment, because TB1 was clearly cared for by their community, including after their death, as evidenced by their marked gravesite. 

“With regard to TB1, we infer that the Late Pleistocene ‘surgeon(s)’ who amputated this individual’s lower left leg must have possessed detailed knowledge of limb anatomy and muscular and vascular systems to prevent fatal blood loss and infection,” the team said. “They must also have understood the necessity to remove the limb for survival. Furthermore, during surgery, the surrounding tissue including veins, vessels and nerves, were exposed and negotiated in such a way that allowed this individual to not only survive but also continue living with altered mobility.” 

“The wound would have regularly been cleaned, dressed and disinfected, perhaps using locally available botanical resources with medicinal properties to prevent infection and provide anaesthetics for pain relief,” the researchers added. “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.”

In other words, the evidence strongly points to a prehistoric community that had pioneered a system of care that allowed TB1 to live, with help, for many years after losing part of a limb. Life in this era was not easy for humans in any part of the world, but the tale told by these newly discovered bones seems to hint at societies that worked to heal and support their members. 

“It is inferred that life without a lower limb (combined with other traumas) in a rugged and mountainous karst terrain presented a series of practical challenges—several of which can be assumed to have been overcome by a high degree of community care,” the researchers said.  

“Our understanding of this aspect of H. sapiens prehistory, however, may be affected by poor preservation of pathological bone, as well as by preconceptions about the ‘primitive’ nature of earlier medico-socio-cultural practices, especially among non-sedentary foraging populations in tropical Asia,” they concluded.