Child amputation 30,000 years ago is the oldest on record

About 30,000 years ago, when the Ice Age was still far from over, a child living in present-day Indonesia underwent the oldest recorded surgical operation so far. The lower part of her left leg was amputated with precision and apparent hygiene, allowing her to reach adulthood without bone infections or other obvious health problems.

The clues that helped archaeologists reconstruct prehistoric surgery are described in an article in this week’s issue of the specialized journal Nature. The analysis still leaves a number of questions open, but it brings one more important indication about the behavioral and cultural complexity of the first Homo sapiens who colonized Southeast Asia, already famous for their pioneering work in cave paintings, for example.

The team responsible for finding the skeleton of the operated person is coordinated by Australian specialist Tim Ryan Maloney, from Griffith University. Along with Indonesian and South African colleagues, Maloney has been analyzing materials found in Liang Tebo Cave, a large limestone rock shelter on the island of Borneo.

In one of the site’s three rock chambers, archaeologists found a carefully arranged tomb. Some stones were placed on top of the grave, in the region of the head and the two arms, as if to indicate that there was a grave there. The corpse was accompanied by stone tools and a nodule of ocher, a pigment widely used for body painting among different peoples of the Pleistocene (the Ice Age).

Much of the skeleton was preserved, but it was not possible to accurately determine the sex of the individual. What is certain is that the person died at about 20 years of age and was relatively tall, with a body size close to the average for men and well above the average for women at the time.

Although he died in his youth of unknown causes, it is clear that the leg injury was not responsible for his death. Skeletal analysis shows that the cut in the bones, made from halfway down the shin, was most likely not accidental. Animal bites or very heavy objects falling on the leg (a tree trunk, for example) would leave very different marks and would not be as regular. In the case of a bite, there would be a high risk of an infection, but there is no evidence that such a thing has occurred.

In addition, enough time had passed for the bone to fully remodel in the place of the cut, and for the amputated leg to be atrophied from lack of use. Taking all this into account, the researchers estimate that the amputation would have taken place up to nine years before the individual’s death.

The implications, however, go far beyond the fact that the person survived several years after the operation. The precision of the cut suggests considerable knowledge of anatomy, perhaps linked to the fact that the peoples of the place had extensive experience of dismembering the corpses of the mammals they hunted using stone tools.

It is also possible that they mastered rudimentary techniques to staunch the copious bleeding that such a cut would cause. “Perhaps materials of plant origin, such as mosses, could have been used for this”, speculates Charlotte Ann Roberts, from the Department of Archeology at the University of Durham (United Kingdom), who commented on the study at the request of Nature.

Another challenge would be to face the risks of infection, even more so in a tropical and humid environment like Borneo, very similar to the Amazon. Once again, the biodiversity of the place may have helped prehistoric surgeons and their young patient, who would have used plants from the region with medicinal properties.

What is certain is that, with reduced mobility, the person needed the help of their community to feed themselves and carry out day-to-day tasks over the years. As for the reason for the amputation, there is still not enough data to know what led the inhabitants of the cave to opt for the surgical procedure.