Burial in Borneo is earliest known amputation patient

At the beginning of the last ice age, 31,000 years ago, a community in what is now eastern Indonesia buried a youngster in the dry floor of a mountain cave painted with handprints. The people lived on the edge of what was then a low continent called Sunda, and they were probably part of the same group of early navigators who crossed into Australia. They were also refined in other ways: according to a description of the funeral published in the magazine today Naturethe young adult is the oldest human known to have survived a surgical amputation.

Caring for the sick and injured is an essential part of human evolution. To care for a critically injured person, communities must develop medical knowledge and have additional resources to spend on their recovery. Skeletons of humans and Neanderthals both show evidence of healed traumatic injuries dating back tens of thousands of years, and some anthropologists argue that the ability to provide medical care allowed hominids to spread across the planet.

A successful operation requires even more sophistication. “Surviving an amputation is a recent medical norm for most Western societies,” Tim Maloney, an archaeologist at Griffith University and the lead author of the paper, said at a news conference made possible by the development of effective antiseptics at the end. of the 19th century.

When Maloney and his team excavated the cemetery, hoping to learn more about the people who painted the cave at least 40,000 years ago, they noticed something odd: The skeleton was missing his left foot, while the delicate bones of the right foot were missing. well kept. When they looked more closely at the tip of the left leg, they saw that the tibia and fibula had been cut and the ends of the bone had healed.

A close examination of the tibia and fibula showed years of healed bone from amputation. From T. Maloney et al., Nature, 2022.

When the researchers examined the ends of the bones, they found no signs of an animal attack or crushed stone, which would have left fractures or crushes around the edges. The clean nature of the wound suggested it was made intentionally. Based on the age of the skeleton — about 19 at death — and the healed bone, the researchers believe the surgery took place when the individual was a preteen, six to nine years before their death. Not only did they survive, but they managed to continue living in their rugged mountain home.

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Even if this loss of a limb was accidental, “it’s still significant that they managed to keep the person alive,” said Rebecca Gowland, a human skeletal remains expert at Durham University who was not involved in the study. used to be. But she says she has no reason to doubt the interpretation of the amputation. “I’ve seen some amputated limbs and it looks like it could well be a healed amputation.” she says.

A surgical procedure like this, and the survival of the child, suggests experience, medical knowledge and confidence. “You can’t survive having your lower leg removed, especially as a child, without managing shock, blood loss, and infection,” says Maloney.

Gowland agrees. It also indicates “that there are people in that community who are saying, ‘This is what we need to do to take the really drastic action to cut someone’s leg,'” she says.

Why exactly the child had to be amputated is a mystery. Because it happened so long before the individual’s death, no evidence of the actual procedure remains. It’s possible they had an infection that had become dangerous, or suffered a catastrophic crushing injury to their foot and ankle.

But comparing the wound to successful amputations in more recent history allows archaeologists to guess the details of the surgery. The surgeons had to control the bleeding, either with compression bandages, tourniquets, or cauterization. The researchers believe the cut was made with stone tools, which, while fragile, can be incredibly sharp — obsidian scalpels are used even today in some specialized medical procedures.

Perhaps most surprisingly, the bone showed no signs of infection in an environment where it’s hard to avoid — even the excavation team regularly treated infected cuts. The answer may have to do with knowledge of medicinal plants. “It is an open question whether this was a unique development associated with communities living in [the biodiverse] tropics,” says Maloney, “or whether it’s a combination of trial and error within a community that took care of their children, as most of us do around the world.”

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Rowland says it’s important not to think about surgery through a modern medical lens. People may have understood how to control bleeding and care for the wound without detailed information about blood vessels, veins and anatomy of limbs. “People have had very different views about healing and the body in the past,” she says. But “they absolutely had to understand that they had to stop bleeding, and they had to stop infection, and that’s pretty impressive.”

The skeleton was discovered in the central chamber of a limestone cave on the eastern edge of Borneo Island, overlooking the headwaters of the nearby Amarang River, in a valley full of ancient rock art. “It’s very cathedral-like,” says Maloney. The grave itself was marked by carved stones and accompanied by stone tools and a bead of red pigment.

The unusual burial of the individual, marked by the bead of paint, is as interesting to Rowland as the actual amputation. “It may be that they had a special status before the amputation,” which made them eligible for the surgery, she says. “Or maybe the amputation made them special.”

Maxime Aubert, who specializes in dating rock art at Griffith University, and co-authored the study, notes that there is still very little information about the culture to which the individual belonged — the excavation was part of ongoing work to understand who made the rock art. What the researchers do know is that culture valued works of art. By the time the person was buried in the cave, some of the paint on the walls had been there for at least 10,000 years.

The amputation adds color to the technological and cultural sophistication of the artistic people, whoever they were. The second oldest known surgical amputation dates back to 7,000 years ago, in Neolithic France, after the arrival of established agriculture. A favored model among archaeologists assumes that advanced technology must be accompanied by sedentary living and agriculture. “This challenges, if not completely negates the idea,” says Maloney, “that advanced medicine was beyond the capacity of these early foraging and hunting communities.”