麻豆传媒

The earliest known evidence of a successful surgery was discovered in skeletal remains of a young adult who lived at least 31,000 years ago, according to a new report.

This individual, whose remains were discovered in the Liang Tebo cave, located in East Kalimantan, Indonesian Borneo, survived the amputation of their lower left leg just above the ankle most likely when they were a child, an estimated 6 to 9 years prior to their death. Evidence of the successful amputation was determined by the remodeled bone at the site of the amputation and the lack of evidence of infection, which suggests the use of unexpectedly advanced medical practices, reported Tim Ryan Maloney, PhD, of Griffith University in Queensland, Australia, and co-authors.

The discovery predates what was considered to be the earliest evidence of surgery by tens of thousands of years, the team wrote in .

After careful excavation of the burial site where the individual was discovered, researchers noted the absence of the bones in the left foot and lower fibula and tibia. Those fragmented leg bones had unusual signs of "bony growth," the authors reported. Furthermore, lamellar bone was completely remodeled in the lower area of the fibula, which suggests the individual survived for at least 6 years after the initial trauma. The remodeled bone was "consistent with late-stage amputation changes," the researchers said.

They also matched the discovery to other clinical examples of amputated bones to confirm the findings.

"In all of those cases, shock, blood loss, and infection were all controlled, so the match between those records is implying that those processes were part of the surgical procedure which allowed this individual to survive, which we know that they did," Maloney told 麻豆传媒.

He also highlighted that the individual's survival after the procedure was also confirmed by the nature of the remodeled bone, which showed signs of the person continuing to use the lower left leg as the bone reshaped.

"As the individual lived into their adulthood, they occasionally put pressure on the remaining stump of their lower left leg as the bone continued to heal into the later stages of amputation, preserving a unique signal of pressure being put on that stump," Maloney said.

He noted that while the team doesn't have evidence confirming the use of antiseptic or antimicrobial practices, it was possible to infer that the people who conducted this procedure used medical practices that would allow the individual to survive such a procedure.

"Obviously, we don't have a preserved record of that, [but] we have a comparative empirical record for most clinical cases, which makes it clear that you cannot survive the removal of your lower left leg -- particularly as a child more susceptible to the severity of such an operation -- without managing shock, blood loss, and infection," the researchers wrote.

They said that such medical practices may have been possible due to "the development of novel pharmaceuticals, such as antiseptics, that harnessed the medicinal properties of Borneo's rich plant biodiversity."

The discovery has shifted the understanding of how medical advances were introduced into human societies thousands of years earlier than previous believed, noted the author of an , Charlotte Ann Roberts, PhD, of Durham University in England.

Roberts wrote that it is "astounding" that the child survived for years after the amputation, and that the discovery is important "because it provides us with a view of the implementation of care and treatment in the distant past."

Roberts also noted that the previously oldest known surgery was thought to be in a Neolithic farmer from France, whose left forearm was surgically removed, and then partially healed roughly 7,000 years ago.

The new study, she said, "challenges the perception that provision of care was not a consideration in prehistoric times." This fact is made evident by the fact that this individual received a deliberate burial in a cave after their death, which Roberts noted might confirm that "the care provided in life by this community continued after a person's death."

The researchers said they have no way of extrapolating from the discovery how frequent the procedure might have been conducted at the time. However, Maloney noted that there are several contextual clues that suggest that the child lived in a society with several other known advantages, including evidence of artistic expression and advanced seafaring practices.

"We can't say how frequent it was, but we can say it was present here 31,000 years ago, coincidentally associated with these artistic people closely related to advance maritime migrations," Maloney said. "Every measure of social and technological complexity is essentially associated with this individual's community and life."

Comment