A human skeleton provided evidence of the first known amputation of a limb after his foot was surgically removed.
Researchers in Borneo also determined that the patient, believed to have lived around 31,000 years ago, had his limb amputated as a child and had recovered from the procedure.
The researchers said the find on the island shows human foraging groups in tropical Asia had sophisticated medical knowledge and skills, including how to prevent infection.
Writing in the journal Nature, Tim Maloney of Griffith University in Australia and his colleagues said the human skeleton is that of a young person.
They survived the procedure and lived for another six to nine years before being buried in Liang Tebo Cave in East Kalimantan.
The area contains some of the earliest dated rock art in the world.
Until now, the treatment of sick or injured people was thought to be poorly developed in small-scale foraging communities.
They were believed to be able to handle smaller procedures such as suturing and dentistry.
“The prevailing assumption has been that more complex surgeries were beyond the capabilities of past and present foraging societies,” the authors said.
They added: “Before modern clinical developments, including antibiotics, it was widely believed that most people undergoing amputation surgery would have died, either at the time of amputation from blood loss and shock, or as a result of subsequent infection scenarios that leave no skeletal markers of late-stage healing.”
Experts said the surgeon who performed the amputation on the child “must have detailed knowledge of the anatomy of the limbs and the muscular and vascular systems to prevent fatal blood loss and infection”.
They added that “intensive nursing and postoperative care would have been vital”, including regular wound cleaning and dressing “perhaps using locally available botanical resources with medicinal properties to prevent infection and provide anesthetics to relieve pain.
The experts continued: “While it is not possible to determine whether an infection occurred post-surgery, this individual clearly did not suffer from an infection severe enough to leave permanent skeletal markers and/or cause death.”
The skeleton had “reshaped bone” covering the “amputation surfaces”, showing that there was healing after the operation.
The authors also suggested that the amputation was unlikely to have been caused by animal attack or other accident, as these usually cause crush fractures.
It is also unlikely that the amputation was performed as a punishment, as the person appears to have received careful treatment after the operation and at the burial.
So far, the oldest known complex operation was performed on a Neolithic farmer in France around 7,000 years ago. His left forearm was surgically removed and then partially healed.
