Earliest evidence for surgical amputation

Abstract The prevailing view regarding the evolution of medicine is that the emergence of agricultural societies around 10,000 years ago (the ‘Neolithic Revolution’) gave rise to a host of health problems that were previously unknown among non-sedentary foraging populations, stimulating the first major innovations in prehistoric medico-socio-cultural practices1,2. Such changes included the development of more advanced surgical procedures, with the oldest known indication of an ‘operation’ formerly held to consist of a farmer with a surgically amputated arm from a Neolithic site in France, dating to around 7,000 years ago3. This accepted case of amputation would have required comprehensive knowledge of human anatomy and considerable technical skill and has thus been viewed as the earliest evidence in world history for a complex medical act3. Here, however, we report the discovery of skeletal remains from Borneo of a young individual who had their lower left leg surgically amputated, probably as a child, at least 31,000 years ago. The individual survived the surgical procedure, living for at least another six to nine years before intentional burial within Liang Tebo cave—located in East Kalimantan, in a limestone karst area that hosts some of the world’s earliest dated rock art4. This unexpectedly early evidence for successful limb amputation implies that modern human foraging groups had developed sophisticated medical knowledge and skills long before the Neolithic farming transition.