Early limb amputation in Borneo

The fossilised remains date to between 31,000 and 30,000 years ago. Previously, the earliest known evidence of surgical amputation came from a farmer in France c.7,000 years ago.

Archaeologists working in a remote part of Indonesian Borneo have discovered a human skeleton that appears to offer the earliest known evidence of a surgical limb amputation.

Image: Tim Maloney

The fossilised remains, which date to between 31,000 and 30,000 years ago, were found during excavations at Liang Tebo, a site in East Kalimantan, in 2020. The individual, who is of indeterminate sex and was aged 19-20 at the time of death, is missing the lower part of their left leg. Recent analysis indicates that it was surgically amputated during childhood. The clean cut, which severed both tibia and fibula, matches the pattern of a surgical amputation rather than an accidental injury, while the ends of the remaining leg bones display a bony growth of the type seen in modern amputation cases.

Although we do not know exactly how the amputation would have been carried out, it is clear that the ‘surgeon’ responsible must have had an advanced knowledge of human anatomy and complex medical techniques in order to remove the limb without fatal blood loss or infection. In fact, not only did the individual survive the amputation itself, they went on to live for another 6-9 years. This indicates that they must have received considerable care from their community, both to nurse them through the immediate aftermath of the surgery, and to help them survive with reduced mobility in the mountainous region in which they lived.

Image: Tim Maloney

Examples of early medical interventions are known from other prehistoric sites, but until now it was commonly believed that complex surgeries like this were beyond the abilities of hunter-gatherer communities. Previously, the earliest known evidence of surgical amputation came from a farmer in France c.7,000 years ago, supporting the assumption that advanced medical expertise developed around the time of the Neolithic Revolution, c.12,000 years ago. The new discovery from Liang Tebo suggests that this is not the case, and that the ability to perform complex medical procedures developed much earlier in Island Southeast Asia. The researchers highlight that these abilities may have been present in other areas of the world as well, although no evidence has yet been uncovered, but that it is also possible that Borneo’s rainforests were home to people with an exceptional level of medical expertise in the Late Pleistocene, perhaps due to both the increased risk of infections and the wealth of plants with medicinal properties found in this tropical climate. It is also unknown whether the surgical skills seen at Liang Tebo were standard across the region at this time, or if this case is a rare exception. Nevertheless, the discovery offers a unique insight into a community with advanced medical knowledge long before the advent of farming, which could have dramatic consequences for our understanding of the history of healthcare.

The research has now been published in Nature (https://doi.org/10.1038/s41586-022-05160-8).