Over 31,000 years ago, a skilled Late Pleistocene surgeon performed a risky but successful amputation that allowed a young man to survive: an amazing feat in a time that greatly pre-dates painkillers, antibiotics or modern medical knowledge.

The case of the Pleistocene amputee called TB1 quickly became not only the oldest amputation ever, but also the oldest example of a successful amputation that was ever registered. 

Before this discovery, the latest trace of amputation was thought to be the skeletal remains of a European Neolithic farmer from 7,000 years ago. The farmer - found in Buthiers-Boulancourt (France) - had a left forearm surgically removed. 

TB1’s operation greatly pre-dates that amputation, redefining what we thought we knew about medical history.

Now affectionally named "Skully", TB1 was a young man who lived around 31,100 years ago in a mountain area of Kalimantan, in the Indonesian portion of Borneo.

His skeletal remains showed a clean surgical cut on the lower left leg and foot, through the tibia and fibula, indicating an amputation that likely happened when he was a child.

The case of Skully was published in Nature on 7 September 2022 with the title “Surgical amputation of a limb 31,000 years ago in Borneo.”

Professor Maxime Aubert from the Griffith Centre for Social and Cultural Research, reported that Skully's remains were discovered first in 2020 in a limestone cave called Liang Tebo. 

The cave is situated in the Sangkulirang-Mangkalihat region of eastern Kalimantan, and remarkably contains some of the world’s earliest traces of rock art: nestled in a flourishing landscape of verdant mountains and valleys, this remote area is accessible only by boat at certain times of the year.

The archeological excavation lasted 11 days and was overseen by a team of Indonesian and Australian archaeologists led by Griffith researcher Dr Tim Maloney, along with Dr India Ella Dilkes-Hall (from University of Western Australia) and Mr Andika Priyatno (Balai Pelestarian Cagar Budaya).

Paleopathologist Dr Melandri Vlok (University of Sydney) was invited to study the skeleton, and confirmed the hypothesis of the amputation.

“No one told me they had not found the left foot in the grave,” Dr Vlok said, explaining that the team wanted to hear what she would find. 

Her discoveries backed up what was already a strong suspect: the excavation team was facing the oldest case of amputation ever registered in human history.

“It was a huge surprise that this ancient forager survived a very serious and life-threatening childhood operation, that the wound healed to form a stump, and that they then lived for years in mountainous terrain with altered mobility – suggesting a high degree of community care,” Dr Vlok explained in the official press release after the discovery.

Working on the excavation

Although it is impossible to determine Skully's identity and what caused his injury, the bones allowed the experts to determine some interesting facts about his life.

The hypothesis that the amputation might have been a punishment seems unlikely, considering the care that was demonstrated in the surgery, the community-effort put into Skully's recovery and his careful burial.

Researches on the skeleton also confirmed the presence of more injuries, such as a well-healed neck fracture and trauma in the area of the collar bone.

Cave and excavation site

Dr Vlok suggested that all the wounds might have been caused by the same accident, for example, caused by a rock falling.

Either way, it was clearly understood that the removal of the limb was necessary to save TB1's life.

Amputations that result from trauma do not cause the clean sectioning witnessed in Skully. Outside of modern-day incidents caused by machines, there is no chronical evidence of an accidental amputation severing the lower limb of both the tibia and fibula: in other words, such a clean cut could only be man-made.

“Blunt-force trauma from an accident or an animal attack typically causes comminuted and crushing fractures features that are absent from the simple and oblique amputation margin of TB1," is reported in the research.

Skeleton in the excavation site

The post-operatory steps were just as important, as the wound must have been cleaned and dressed. 

Despite the limited Stone Age medical knowledge, some precautions were taken to ensure Skully's well-being and the success of the operation: he was moved regularly to prevent bed sores, and the skeleton didn’t display signs that could point to a post-operative infection serious enough to leave bone marks. 

Today, we would say that the wound likely ‘healed properly’.

Thanks to it, TB1 lived several years after the operation. 

It is undoubtful that surviving such complex surgery at the time, without modern painkillers or any knowledge of infection risks, must have been hard work – and, most of all, a community effort. 

Although botanical remedies against pain and infection might have been used to relieve TB1's suffering, there is no evidence of it.

Amazingly, Skully survived the injury and likely become part of his community despite the everyday mobility challenges posed by the amputation. 

Cave man art

As they saved TB1's life, the Late Pleistocene surgeon(s) who performed the oldest amputation demonstrated an awareness that is nothing short of amazing for the time. 

They proved that Stone Age communities could possess several amazing skills:

  • detailed knowledge of limb anatomy
  • knowledge of the muscular and vascular systems to prevent fatal blood loss and infection
  • understood the necessity to remove the limb to save the life
  • they negotiated the tissue (veins, vessels and nerves, were exposed) in a way that allowed the success of the operation

This incredible discovery rewrote a lot of what we knew about Stone Age medicine, communities and human beings.

"It shows us that caring is an innate part of being human," Dr Vlok told the BBC shortly after the discovery. "We can't underestimate our ancestors."

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