A study emerged last week about the oldest known healed surgical amputation, found on a young adult in an art-covered cave in Borneo. In this study, the authors claim that because it is so rare for people to survive amputations without additional treatment, the young adult must have received sophisticated medical care that allowed them to live years after the surgery.
“We infer that the Late Pleistocene ‘surgeon(s)’ who amputated the lower left leg of this individual must have possessed detailed knowledge of limb anatomy and the muscular and vascular systems to prevent fatal blood loss and infection,” the authors write. “They also must have understood the need to remove the limb in order to survive. Finally, during surgery, the surrounding tissue, including veins, vessels, and nerves, were exposed and contracted in such a way that allowed this individual not only to survive, but to continue living with altered mobility.
But people have experienced amputations more often than we think. Does this mean that trauma does not always require complex medical care? Or are the treatments we now think of as simple more effective than we give them credit for?
For Gillian Bentley, a biological anthropologist at Durham University in England, the example that comes to mind is a subsistence hunter she met decades ago in what is now the Democratic Republic of Congo. One morning she got up early for breakfast when an old pygmy came to the village. “He walked with a stick and his lower leg and foot were missing,” she says.
His story, relayed to her by a colleague who had conducted a demographic survey in the area, was that the man, a member of the semi-nomadic Efé ethnic group, had cut off his own leg after being bitten by a venomous snake while foraging. Apparently he had survived, although he had to walk through tropical jungles with a wound healing—with the risk of infection.
This man’s survival suggested to Bentley that amputation “does not require complicated surgery.” “He did what he had to do under the circumstances,” she adds. She wasn’t there while studying medicine, but says she’s never seen evidence of traditional use of antimicrobials in the community, where painful bacterial infections called tropical ulcers are common. More often, she says, people turned to the mission station in her village for care.
[Related: Indigenous languages hold the keys to medicinal forest libraries]
But was this senior Efé proof that people regularly survive amputations? And if so, does that mean the Bornean teenager didn’t need such specialized care? “I would be careful to extrapolate from hunter-gatherer work today, especially based on a single account,” says Karen Hardyan archaeologist at the Autonomous University of Barcelona who studies the history of herbal medicine.
She points out that modern humans who practice hunter-gatherer lifestyles live in different social and ecological contexts than those thousands of years ago. The worlds of the Efé people have been shaped by slave raiders, colonial plantations, and warfare over the past two centuries. More generally, the social transitions of the Paleolithic period undermined herbal knowledge, Hardy says. Her research shows that the transition to agriculture and a sedentary lifestyle during the Neolithic was associated with fewer medicinal plants.
So the Efé case may not be representative of how people have survived amputations historically. “[Paleolithic people] they would have known about the antibacterials and how to stop the blood flow,” says Hardy. “There are a lot of plants that do that, and a lot of evidence that they were able to use those plants. I have no problem at all accepting that experience is needed to do an amputation in terms of pain relief and antibacterials.
Part of how you understand the implications of these cases depends on how you define “advanced medical treatment.” While modern surgery, with its schematic understanding of arteries, nerves, antiseptics, and anesthesia, has brought obvious benefits, older treatments may still have been effective without fitting neatly into the framework of modern medicine.
In the records of 18th and 19th century amputations from the European and American armies, a significant number of patients survived in a context known for deaths from infectious diseases. A doctor on the warship HMS Victory recorded 102 injuries and 10 amputations after a battle in 1805. Only 6 of the wounded died. “They didn’t know about hygiene or hand washing, and antiseptics didn’t come until 1875,” says Mervyn Singer, an intensive care physician at University College London. According to other data collected by Singer, amputation survival during the American Civil War ranged from 50 to 90 percent—not good odds, but still admirable given the resources of the battlefields.
Recent analysis of buried skeletons in a hospital cemetery in England between the 18th and 19th centuries found that a surprising number of amputations were cured. And that’s just the dead. “Those who fully recovered would leave [the hospital]so it’s a biased sample,” says Rebecca Gowland, an anthropologist who studies skeletal trauma at Durham University.
Singer, who has collected military records of amputations as part of his research on how the body survives stress, says many of the advances in his field over the past few decades have involved the realization that sometimes a sick person needs fewer interventions. instead of more. This includes “giving them less fluids, ventilating them less, sedating them which is less difficult, and not aggressively feeding them,” he says. His theory is that the body has a wider capacity to deal with trauma than we give it credit for, including, perhaps, an amputated limb.
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But battlefield amputees received nonsurgical care, and some of it may be more effective than we give it credit for, Singer says. Going back to the 1500s, surgeons realized they could stop arterial bleeding with forceps. Amputation patients may have had a wound burned with hot oil, copper sulfates, or tarwhich can both stop the bleeding and sterilize the site.
For Hardy, the latter treatment is particularly telling because there is plenty of evidence that prehistoric people—even pre-human hominids—collected and worked with natural tar or bitumen. Neanderthals used it and resin to attach stone tool heads to wooden handles. It is not difficult to think that some of them may have incorporated the material into their medicinal regimens.
There is even evidence that caregivers administered treatments that are now widespread long before the modern medical system existed. The first defibrillators appeared in the late 1700salthough it took another 250 years for them to become popular with hospitals and emergency departments.
Hardy gives the example of North African shepherds who treated saddle wounds with a specific mold –that’s what it turned out to be Penicillin. “It’s just a world of things that nobody knows yet,” Hardy says. Humans may be better at surviving a lost limb than we would expect, but that may also be because we are better at self-healing than we realize.
