The dawn of surgery began at least 31,000-years-ago, archaeologists have concluded, after finding the skeleton of a stone-age amputee in Borneo.
Experts had always believed that complicated medical procedures, requiring knowledge of infection control and anatomy, could not have taken place before settled farming cultures emerged in the Neolithic period.
But Australian archaeologists have uncovered the grave of a child who had a foot amputated, and who then lived with a stump for a further six to nine years after the operation - a find that rewrites medical history.
The surgery happened 24,000 years before the previous earliest amputation patient, a farmer who lived 7,000 years ago in France and had his forearm removed.
Dr Tim Maloney, from Griffith University in Queensland, said: "One of the huge implications of this find is that it presents a really strong case that communities had advanced medical understanding to be able to successfully amputate the lower left leg of a child enabling them to not only survive the procedure but live a thriving life.
"It suggests a mastery of not only the operation itself and negotiating the complexities of removing the lower left leg, but also the understanding of the needs of antiseptic and antimicrobial management to enable the patient to survive.
"This community had a thorough understanding of veins, vessels, muscles and tissues." He added: "It overturns or rewrites the history of human medical knowledge. Surviving an amputation is a recent medical norm for most western societies."
The amputee had the operation as a child and died in their early twenties before being buried at Liang Tebo cave, which is located in the Indonesian province of East Kalimantan on the island of Borneo, an area that contains some of the world's earliest dated rock art.
The experts said it was clear that the injury had not been caused by an accident, or animal attack as there was no evidence of crushing, bone marks or infection.
They determined that the patient must have been an important member of the group as they would have needed intensive post-operative care and help walking. The amputee was also buried in a "cathedral-sized" cave with stone grave markers and ochre paints as grave goods.
Researchers said it was probably not a coincidence that the find had happened in the tropical rainforest, where although bugs were rife, botanicals to fight infections were also on hand.
The area could have also brought the birth of pharmaceuticals. It is believed the community discovered plants with antiseptic and pain relieving effects that made surgery possible.
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