Where and when was surgery born? The prevailing view regarding the evolution of medicine is that the emergence of agricultural societies established about 10,000 years ago gave rise to a series of health problems that had previously been unknown, stimulate the first major innovations in prehistoric medical practices.
Recent excavations have discovered a burial, at the site of a cave of Liang Tebo, located in eastern Kalimantan, Indonesian Borneo, in a limestone karst area that contains some of the earliest dated rock arts in the world. It's a Bornean Homo sapiens 20 years old individual,with intermediate sex traits and therefore the sex is indeterminate, who had the distal third of his left leg surgically amputated, probably as a child, at least 31,000 years ago.
The individual survived the procedure and lived for another 6-9 years. Completely remodelled lamellar bone has enclosed the inferior margin of the fibula, confirming that this was not a fatal pathology. There is no evidence of infection in the left limb, the most common complication of an open wound without antimicrobial treatment.
In this case anatomical knowledge had to be discreet, otherwise it would have been impossible to prevent the fatal loss of blood and infections. Certainly, post-operative care was indispensable, such as temperature regulation, regular feeding, bathing, and movement to prevent bed sores while the individual was immobile. The wound would have been regularly cleaned, dressed, and disinfected, perhaps using locally available botanical resources with medicinal properties to prevent infection and provide anaesthetics for pain relief.
This knowledge, in TB1’s community, is likely tohave been developed by trial and error over a long period of time and transmitted inter generationally through oral traditions of learning.
Notably, it remains unknown whether this ‘operation’ was a rare and isolated event in the Pleistocene history of this region, or if this particular foraging society had achieved an unusually high degree of proficiency in this area. It is not easy to understand these aspects of prehistoric society, but with certainty Borneo’s rich plant biodiversity and endemic flora has stimulated and facilitated early advances in medical technology that were unique to this region.
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