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Oldest evidence of ancient amputations discovered in Borneo

Borneo's unique climate may have contributed to the development of complex medical techniques.

(CN) — Amputation, even in somewhat near history, often resulted in death. But without modern tools and anesthetics, prehistoric humans were still able to achieve some rate of success in the procedure. In a study published Wednesday in the journal Nature, researchers describe the oldest known instance of a successful surgical amputation.

A Stone Age skeleton, discovered on the island of Borneo, shows evidence of an amputation to the lower left leg, with the foot missing entirely. The remains date to around 31,000 years ago, towards the end of the Paleolithic era. Researchers determined that the individual not only recovered from the risky amputation but survived for years afterward.

Carbon dating of the nearly complete skeleton indicated that the individual likely died as a young adult, but the remodeled tibia and fibula showed that the individual died roughly six to nine years after the surgical procedure, leading researchers to conclude that the amputation was performed when the individual was a child.

Researchers speculate that the person who performed the surgery would have had a fairly advanced knowledge of human anatomy as well as an awareness of the necessity of post-operation care to prevent fatal blood loss and infection. The ancient surgeon would have understood limb and musculature anatomy, as well as the circulatory system, even in children, the study stated.

“There’s a range of implications for what that means for these early societies, including a mastery of not only the operation itself and negotiating the complexities of removing the lower left foot of a child but there’s also a strong case to be made for understanding of the needs for antiseptic and antimicrobial management to enable the individual to survive,” said Tim Maloney, co-author of the study and research fellow at Australia’s Griffith University Center for Social and Cultural Research, in a press briefing Tuesday.

Amputations in prehistory were typically seen as a last resort and successful procedures were rare, as post-amputation survival rates only began to increase in the last several centuries.

Researchers also eliminated the possibility that the missing limb was the result of an accident or animal attack, as the bones showed no evidence of fracturing at the site of disarticulation. The remains were found in what Maloney and his team posit was a deliberate gravesite, as excavation efforts indicated that the individual had been carefully buried.

Prior to this discovery, 7000-year-old remains from Neolithic France were considered the oldest example of prehistoric amputation. The Borneo findings not only predate those remains but indicate that the development of surgical medicine was already beginning to develop tens of thousands of years earlier, and in an entirely different area of the world, than previously thought.  

“Notably, we do not think it is the case that this ‘operation’ was a rare and isolated event in the Pleistocene history of this region, or that this particular foraging society had achieved an unusually high degree of prociency in this area,” the study said.

The European amputation fell in line with the previously held idea that medical techniques began to develop in earnest once ancient humans began experiencing new health problems as agricultural societies evolved, but the Borneo remains challenge that theory, suggesting that relatively advanced medical care may have evolved during the hunter-gatherer days of human evolution.

Researchers also speculated that environment may have played a part in the evolution of medicine for Borneo’s ancient humans.

“This community was living in the Earth’s tropics, home to some of the highest plant biodiversity on planet Earth now and likely into the late Pleistocene,” Maloney said. “Perhaps this unique environment in which people clearly adapted and thrived in, producing rock art as well, perhaps it was that environment which helped stimulate that earliest known development of surgical procedure, at least 24,000 years earlier than the next archeological case.”

According to the study, the tropical climate may have exacerbated health issues, prompting the communities that lived there to develop, by necessity, botanical remedies and more complex medical techniques.  

The remains are not only the oldest evidence of surgical amputation in the world but is also the oldest overall burial discovered on an island Southeast Asia. The remains were discovered within Borneo’s extensive limestone case system, known for its rich archaeological evidence of prehistory. Borneo, which in ancient times was connected by land to Southeast Asia by lower sea levels, is also the home of the oldest known figurative art painting.

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