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A Prehistoric Amputation in Borneo Occurred 31,000 Years Ago
Unmistakable proof of Stone Age surgery
Surprising discoveries1 have been from the newly discovered bones of a young adult who was interred 31,000 years ago in the Liang Tebo cave. Clean diagonal cuts severed the ends of the tibia and fibula on the left leg of this person a few inches above the ankle were observed. This is the earliest proof of a surgical amputation that has ever been discovered, and it indicates that the patient lived for many years later.
Bones from Neanderthals and early members of our own species show that accidents happened to individuals quite frequently throughout the Pleistocene. Injury must have been a frequent occurrence in primitive times. And a limb could be lost as a result of any number of injuries.
But, the limb bones of Tebo 1 have perfectly chopped ends and neatly angled edges, which come from no other origin. Those cuts appear to have been made with sharp tools by deft hands. Intentional.
Tebo 1 lived between 6 and 9 years after losing the leg, based on the healing and bone remodeling in the wounds. The authors speculate that Tebo 1 was 19 or 20 years old when it died based on additional skeletal hints. Consequently, the age at which the amputation took place was between 10 and 14.
Amputation is a difficult process. Because you can’t really just cut the limb and expect it to heal. Instead, a flap of skin and muscle must be left at the end of the operation to cover the wound. So whoever did this must have been familiar with the anatomy of bone, blood vessels, and muscle since there were no signs of infection and the bones healed well. Additionally, they must be able to manage bleeding, perhaps suture tissues and vessels, and relieve pain.
Just as interesting, there are no indications of inflammation in the severed leg bones, indicating that, even if Tebo 1 had an infection after the amputation, it was not severe enough to spread to the bone. Tebo 1's apparent lack of major infection indicates that whoever performed the amputation was aware of the need to keep the wound, the surgical instruments, and their hands clean. Furthermore, it also shows that Tebo 1 was well-cared for following the procedure.
The left tibia and fibula are thin in a way that signals atrophy from disuse and they are smaller than the ones on the right, which likely means the bones of the left leg didn't continue growing after the childhood injury. Tebo 1 was born with one leg and had limited movement. Due to the incapacitating nature of the lower left leg injury, it is possible that Tebo 1 was only occasionally ambulatory as even the right leg has some bone thinning. Tebo 1 did, however, mature, which challenges our preconceived notions about both what very old humans knew and how they interacted with one another.
The earliest known evidence of amputation before Tebo 1 was found in France, dating to 7,000 years ago. Those findings was consistent with the long-held belief among researchers that people did not first acquire surgery or more advanced medical knowledge until some time after the development of agriculture and settled village life.
But, the tale of Tebo 1 contradicts that notion. Our understanding of human civilization 31,000 years ago in Borneo is not equivalent to those in France from 7,000 years ago. That begs us to ask, in Tebo 1's universe, how frequent were amputations and how frequently did patients survive? Surely, at least one group had the knowledge, abilities, and resources necessary 31,000 years ago to carry out major surgery in the middle of a forest. They had to figure out how to get by without notes, textbooks, or any other written materials.
In addition to the skill of the one who performed the amputation, the nursing care that was necessary to keep Tebo 1 alive and to aid in the patient's recovery and adaptation following surgery is remarkable. More than just wound care and dressing would have been required. Tebo 1 would have required rest, assistance with movement, and frequent bathing to avoid bedsores. Tebo 1 would eventually have required assistance and accommodations to keep up with a highly mobile community in a very challenging environment. Tebo 1 would have need extensive rehabilitation.
However, there is no reason to believe that Tebo 1 was a burden on the community based on the evidence in Liang Tebo. The deceased was carefully buried with a few stone tools and a chunk of ocher. He was interred in the cave's largest chamber, which was painted with stencils by hand. The entrance to his gravesite was ornamented with three stones.
Tebo 1 possibly also made a contribution to his group. The skeleton of Tebo 1 may provide a hazy hint; the right collarbone's form reflects a lifetime of constant, circular movements with the right shoulder… And grave goods typically have a connection to occupation, such as the chert tools and ocher in Tebo 1's grave. Borneo's caverns are densely painted with ancient art that dates back more than 43,000 years, and ocher is a prevalent colour. Tebo 1 might have contributed to some of that artwork or assisted in turning ocher into pigment.
All of this might not be as shocking as it seems.
Since the Neanderthals, many of whose remains display signs of healed wounds that they couldn't have recovered from without some kind of care, there has been evidence of humans taking care of sick, injured, or crippled group members.
We've taken care of one another for a very, very long time.
Maloney, T.R., Dilkes-Hall, I.E., Vlok, M. et al. Surgical amputation of a limb 31,000 years ago in Borneo. Nature (2022). https://doi.org/10.1038/s41586-022-05160-8