Archaeologists excavating Liang Tebo Cave on the Indonesian island of Borneo have discovered the skeletal remains of a young individual who had the distal third of their left lower leg surgically amputated, probably as a child, at least 31,000 years ago; the individual survived the procedure and lived for another 6-9 years, before their remains were intentionally buried in the cave. The discovery pre-dates the previous oldest known evidence for amputation surgery by 24,000 years.
The Sangkulirang-Mangkalihat Peninsula in East Kalimantan province on Borneo hosts an extensive limestone karst landscape that, during the Late Pleistocene, was located close to the extreme easternmost edge of the Eurasian continental landmass, Sunda.
This rugged karst terrain harbors numerous caves and rock shelters that abound with archaeological evidence of prehistoric human occupation, including figurative rock art dating to at least 40,000 years ago.
Liang Tebo — a large three-chambered limestone cave with preserved rock art — is situated approximately 2.5 km from, and 165 m above, the Marang River.
In 2020, archaeologists found the skeleton of the young adult without the left foot in the central floor area of the largest chamber of the cave.
“The cut was clean, well healed and had no evidence of any infection,” said Dr. Melandri Vlok, a researcher in the Sydney South East Asian Centre at the University of Sydney.
“The chances the amputation was an accident was so infinitely small. The only conclusion was this was Stone Age surgery.”
“The find is incredibly exciting and unexpected. The discovery implies that at least some modern human foraging groups in tropical Asia had developed sophisticated medical knowledge and skills long before the Neolithic farming transition.”
While it is not entirely clear what led to the amputation, the individual also had a very well healed neck fracture and trauma to their collar bone that may have occurred during the same event.
“An accident, such as a rock fall may have caused the injuries, and it was clearly recognized by the community that the foot had to be taken off for the child to survive,” Dr. Vlok said.
“It is an extremely rugged environment with steep mountains dotted with caves containing some of the oldest paintings created by our species,” said Professor Maxime Aubert, a researcher in the Griffith Centre for Social and Cultural Research and the Australian Research Centre for Human Evolution at Griffith University, and the Geoarchaeology and Archaeometry Research Group at Southern Cross University.
The archaeologists had to kayak into the valley and scale the enormous cliff to get into the cave, proving just how remarkable it was for someone with only one leg to have survived in such challenging terrain.
“This unique find challenges assumptions of humanity’s capabilities in the past and is set to significantly advance our understanding of human lifeways in tropical rainforests,” said Dr. India Ella Dilkes-Hall, a researcher in the School of Social Sciences at the University of Western Australia.
The team’s paper was published in the journal Nature.
T.R. Maloney et al. Surgical amputation of a limb 31,000 years ago in Borneo. Nature, published online September 7, 2022; doi: 10.1038/s41586-022-05160-8