University of Western Australia: Earliest known evidence of surgical amputation uncovered in Borneo

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A team of Indonesian and Australian archaeologists, including academics from Griffith University and The University of Western Australia, have unearthed the earliest known evidence of a surgical amputation, dating back at least 31,000 years, in a limestone cave on the island of Borneo.

They discovered human skeletal remains of a young adult who had their lower left limb surgically removed, probably as a child, with evidence showing the patient survived the procedure, living at least another six to nine years before intentional burial within Liang Tebo cave in East Kalimantan.

The findings, published in Nature, predates by 24,000 years the previously oldest known evidence of an ‘operation’ of a farmer with a surgically amputated arm from a Neolithic site in France, dated to 7,000 years ago.

Forrest Foundation Prospect Fellow Dr India Ella Dilkes-Hall, from UWA’s School of Social Sciences, co-led the 2020 excavations at Liang Tebo and said the “extraordinary discovery” is evidence that early modern humans had far more advanced medical knowledge and skills than originally supposed.

“The prevailing view around the evolution of surgical practice has been that it is intimately linked to the emergence of agricultural societies around 10,000 years ago during what is known as the Neolithic Revolution, which gave rise to a host of health problems previously unknown in non-sedentary foraging populations,” Dr Dilkes-Hall said.

“Our find, illustrating a deliberate amputation, demonstrates that an advanced level of medical expertise and skills was possessed by early modern human foraging societies.”

Dr Dilkes-Hall said the small team of archaeologists, supported by experienced local guides, were searching for evidence of human groups in the rugged karst terrain that hosts some of world’s earliest dated rock art when they discovered the human burial.

“Three deliberately placed limestone rocks were positioned as burial markers above the head and each arm of the individual who was uncovered lying on their back in an intentionally flexed position,” she said.

“It was incredibly exciting noticing that as careful excavation proceeded the foot and lower left leg were missing entirely, we couldn’t quite believe what we were seeing.”

The human remains and other artefacts were excavated and, with the agreement of the Indonesian Government, flown to Griffith University in Queensland where more detailed analysis by Dr Melandri Vlok confirmed an amputation had taken place.

“The evidence indicates that the person, whose sex we aren’t able to determine, had their lower left leg removed through deliberate surgical amputation of the distal tibia and fibula,” Dr Dilkes-Hall said.

“There was no evidence for infection of the limb, the most common complication of an open wound without antiseptic treatment, which indicates traditional ecological knowledge of plant-based medicinal remedies.”

Griffith University’s Dr Tim Maloney said if blunt force trauma from an accident or animal attack was the cause crushing features in the bones would be visible.

“Instead remodelled (healed) bone covers the amputation surfaces,” Dr Maloney said. “The cutting margins indicate the use of a sharp instrument, with lithic and shell edges found in association providing a possible source, although the exact nature of the surgical implements remains unknown.”

Dr Dilkes-Hall said the archaeologists think that, contrary to popular opinion about early modern humans and non-sedentary foraging societies, comprehensive knowledge of human anatomy, physiology and surgical procedures coupled with a mastery of medicinal plant use developed over a far longer period of time, perhaps even prior to this example, and was transmitted intergenerationally through oral tradition.

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