TIM MALONEY / AFP
The bones of this surgical operation were unearthed in March 2020 in the limestone cave of Liang Tebo, in Indonesia.
SCIENCE – Child passed over billiards and survived surgery more than 30,000 years ago: Oldest evidence of surgical amputation found on skeleton in cave in Indonesia, expert says study that revisits the history of medicine.
Until now, the oldest testimony of such a surgical intervention dates back 7,000 years, updated in 2010 on a Neolithic site in France (Seine-et-Marne): an amputation of the arm of an elderly man, obviously successful because imaging of the ancient bones revealed signs of healing.
Scientists generally agree to link the appearance of the first medical practices to the Neolithic revolution of about 10,000 years ago, where agriculture and sedentarization brought to the surface health issues previously unknown.
But the excavation of human remains at least 31,000 years old, in the Indonesian part of Borneo, upsets this vision by revealing that hunter-gatherers practiced surgery thousands of years earlier than estimated.
Discovery “rewrites our understanding of this medical know-how”explained paleontologist Tim Maloney, of Griffith University in Australia, who led the study published Wednesday in Nature.
The bones had been unearthed in 2020 in the imposing limestone cave of Liang Tebo, known for its cave paintings. Among the countless bats, terns, swifts and even a few scorpions inhabiting the place, the paleontologists delicately removed the sedimentary layers and found the burial of a remarkably preserved skeleton.
He was only missing his left ankle and foot. The end of the remaining leg bone showed a cutout “sharp and oblique, which can be seen by looking through the bone”, described Tim Maloney during a press conference. An appearance that would have been less regular if the amputation had been caused by a fall or an animal attack.
So many clues not of an accidental amputation, but of a real medical choice.
Anatomical knowledge
Even more surprising: the patient, who died around the age of twenty, seems to have survived between six and nine years after the intervention, according to the signs of bone repair, observable under a microscope. It is also unlikely that the amputation was performed as a punishment, as the child (or young adolescent) appears to have received careful treatment after the surgery, and at the burial.
“It assumes a thorough knowledge of human anatomy, the muscular and vascular system”, analyzes the study. The people who operated on the young teenager had to “regularly clean, disinfect and dress the wound” to prevent post-operative bleeding or infection that could lead to death.
The physical state of the young amputee, diminished and dependent, also probably forced those around him to take care of him for six to nine years, testifying to an altruistic behavior among this group of hunter-gatherers.
These jobs “shed new light on the care and treatment provided in the distant past, and upset our view that these questions were not taken into consideration in prehistoric times”reacted Charlotte Ann Roberts, an archaeologist at the British University of Durham, in a commentary accompanying the study.
In terms of surgery, there are many prehistoric traces of trepanation or pulling of teeth. But those of limb amputations are extremely rare, as they are difficult to identify on poorly preserved bones.
After the discovery of Borneo, many questions remain unanswered: how did they proceed? Was the practice common? How did they relieve the pain?
In the tropics, the rapidity of infections may have spurred the development of antiseptic products that exploit the medicinal properties of Borneo’s rich vegetation, the authors argue. They also suggest the use of a cut stone blade to operate.
New excavations are scheduled next year in the cave of Liang Tebo, with the hope of learning more about the humans who populated it. “The conditions are ripe for astonishing new discoveries in this ‘hot spot’ in human evolution”says Renaud Joannes-Boyau, associate professor at Southern Cross University (Australia), who helped date the skeleton.
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