The loss of a limb made global headlines last week after the newspaper Nature published evidence of a successful medical amputation that took place 31,000 years ago in what is now Borneo. The new discovery isn’t just the oldest known case of limb removal. It is the first documented surgical procedure of any kind in several thousand years. Consequently, it radically rewrites the timeline of the evolution of human medical knowledge and practice.
To put this date in context: 31,000 years ago, the human species had not yet reached North America. Written language had not yet appeared, and would not be for 25,000 years. The first metal tools would not appear for about 20,000 years; this amputation was performed with a chiseled stone blade (probably obsidian). And the prehistoric Asians who performed this procedure lived among the monstrous mammals of the Ice Age, the ancestors of modern rhinos, hippos and tigers. It was a very, very long time ago.
The Nature the article received tons of media coverage, but don’t overlook the five-minute video released earlier this week by Griffith University, university residence of the authors of the article. In addition to presenting the scientific findings in reasonably accessible terms, the video illustrates the rugged terrain this long-lost patient had to navigate after recovering from surgery. It is worth watching.
Almost nothing was known about the prehistoric origins of amputation until this century. But the past two decades have produced an impressive body of evidence across multiple continents regarding the removal of Stone Age limbs. All of these ancient cultures had the expertise not only to surgically amputate limbs, but also to control blood loss and prevent infection well enough for patients to survive. And all of them seem to have developed these abilities independently – they are too distant in time and space to have transmitted this knowledge to each other.
Here’s what the archaeological record shows about paleoamputation.
Europe, c. 4900 BCE
Until last week, the oldest known example of medical amputation occurred near present-day Paris around 6,900 years ago. Documented in the log Nature Previous in 2007, this case involved an amputation above the left elbow which was most likely performed with a flint blade or axe. Like the Borneo researchers, the French archaeologists used osteological evidence to establish that a) the bone was deliberately cut, not traumatically severed or bitten by a predator; and b) significant scarring has occurred indicating that the patient lived for many years after the amputation.
The authors speculate that the French patient had to be pulled from a limb as a lifesaving measure, after an injury left him with a gangrenous arm. “This is not an accidental amputation, but a genuine ‘medical’ choice,” they write. “Since this patient survived, his caregivers must have had a good knowledge of the needs and means of preventing blood flow through tin plating, disinfection and [wound care]. . . . The unexpected attentions and technical skills in surgery given by this Neolithic group to one of its aged and disabled members suggests a considerable level of social, medical and even moral development.
The article refers to two other amputee skeletons from prehistoric Europe, one in Germany and the other in Czechoslovakia. Six years later, Bulgarian archaeologists published evidence of an amputation below the elbow dating back around 6,400 years. This document appeared in the International Journal of Osteoarchaeology.
Egypt, c. 2500 BCE
It has long been known that the ancient Egyptians developed prosthetics; the earliest examples date from around 900 BCE. But only recently have we seen evidence that they practice medical amputation. It was discovered in 2010 by researchers from Al-Azhar University and the Giza National Research Center, and it suggests that surgical removal of limbs predated prosthetics by at least 1,000 years. Published in the Journal of Applied Sciences Research, the study describes two cases of amputation, one below the knee and the other below the elbow. The below-knee amputee was found in a cemetery for high-ranking members of society, while the upper-limb amputee was buried in a workers’ cemetery. “The healing pattern in the two individuals, from two different social classes, suggests that medical care was equally [available] for them,” the authors write.
In the same year, a joint American-Belgian investigation provided similar evidence in four skeletons discovered near Dayr-al-Barshā. However, a later article from 2014 in Acta Orthopaedica expressed skepticism about the Egyptian finds, suggesting that the skeletal evidence for limb removal is inconclusive at best. “There is no direct evidence that therapeutic amputations were part of surgery in ancient Egypt, especially for larger limbs,” this author argued. “Considering the level of Egyptian surgery in general. . . . the procedures described in the medical papyri are very simple in nature. Not a single surgical incision has been found in any of the tens of thousands of mummies studied during the pharaonic era.
India, c. 2000 BCE
Evidence that ancient Indians practiced amputation comes from the Rig Veda, a 3,500-year-old collection of hymns and verses. In a famous episode, warrior queen Viśpálā loses her right leg in battle, gets fitted with an iron prosthesis, and returns to the battlefield with more fury than ever. Unfortunately, there is no scientific evidence to support this story. The earlier documented amputation cases in India date back to around 600 BCE and mostly refer to punitive procedures: criminals and prisoners of war sometimes had their noses, ears or fingers cut off. The famous Indian doctor Sushrata, often called the father of plastic surgerymade a name for himself by reconstructing severed noses.
Peru, c. 200 AD
There is both physical and material evidence that ancient cultures in the Western Hemisphere practiced medical amputation. Hard evidence was first presented in 2000, when archaeologists unearthed three sets of Moche culture remains, each bearing telltale signs of deliberate cutting and subsequent healing of the lower tibia. Soft evidence appears in ceramic figures of the same period, which regularly represent individuals who are missing an arm or a leg.
A more recent paper, published last year, examines two similar Peruvian cases dating to somewhere between 1250 and 1500 AD (when the (Incas) ruled), suggesting a continuity of surgical knowledge and limb care that spanned perhaps 1000 years.