An operation in the Stone Age
In 2020, a team of Indonesian and Australian archaeologists were excavating in Liang Tebo, a limestone cave in a remote part of East Kalimantan, Indonesian Borneo. Just days before the COVID-19 pandemic closed international borders, they uncovered the intentionally buried skeleton of a young adult. Analysis revealed something astonishing: the lower third of the individual's left leg was gone. The cut was clean and angled, showing none of the crushing fractures associated with an accident or an animal attack.
The remaining tibia and fibula bones showed clear signs of healing and regrowth, forming a stump. This indicates the person, who was likely a child at the time of the operation, survived the procedure. Palaeopathological analysis confirmed there were no signs of major infection, a remarkable outcome for any surgery before modern medicine. Radioisotope dating of a tooth and burial sediments placed the is approximately 31,000 years old. The individual lived for another six to nine years before dying in their early twenties.
Before this find, the oldest known surgical amputation belonged to a 7,000-year-old Neolithic farmer in France. The Liang Tebo discovery pushed back the timeline for complex medical procedures by 24,000 years, showing that hunter-gatherer societies possessed advanced medical skills long before the rise of agriculture.
Prehistoric medical knowledge
The success of the 31,000-year-old amputation implies a sophisticated understanding of human anatomy and medical care. The surgeon would have needed knowledge of the leg's circulatory system—veins, arteries, and nerves—to manage bleeding and perform the operation without causing fatal blood loss or shock. The tools used were likely sharpened stone implements.
Post-operative care was essential for the patient's survival. The individual would have required intensive nursing, with the wound needing to be kept clean to prevent infection. The patient's limited mobility meant the community had to provide care and support for years. The challenging, mountainous terrain around the Liang Tebo cave would have been difficult to navigate for an amputee.
Borneo’s rainforests contain thousands of plant species, many with medicinal properties. It is possible that these early modern humans used specific plants with antiseptic or antimicrobial qualities to manage the wound and prevent infection, important for the individual's long-term survival. This find suggests that some foraging groups in tropical Asia had developed a complex medical culture thousands of years earlier than previously understood.