Evidence of Stone Age amputation forces rethink over history of surgery

The surgeon was dressed in a goat or sheep skin and used a sharpened stone to amputate the arm of his patient.

The operating theatre was not exactly Harley Street — more probably a wooden shelter — but the intervention was a success, and it has shed light on the medical talents of our Stone Age ancestors.

Scientists unearthed evidence of the surgery during work on an Early Neolithic tomb discovered at Buthiers-Boulancourt, about 40 miles (65km) south of Paris. They found that a remarkable degree of medical knowledge had been used to remove the left forearm of an elderly man about 6,900 years ago — suggesting that the true Flintstones were more developed than previously thought.

The patient seems to have been anaesthetised, the conditions were aseptic, the cut was clean and the wound was treated, according to the French National Institute for Preventive Archaeological Research (Inrap).

The revelation could force a reassessment of the history of surgery, especially because researchers have recently reported signs of two other Neolithic amputations in Germany and the Czech Republic. It was known that Stone Age doctors performed trephinations, cutting through the skull, but not amputations. “The first European farmers were therefore capable of quite sophisticated surgical acts,” Inrap said. The discovery was made by Cécile Buquet-Marcon and Anaick Samzun, both archaeologists, and Philippe Charlier, a forensic scientist.

It followed research on the tomb of an elderly man who lived in the Linearbandkeramik period, when European hunter-gatherers settled down to agriculture, stock-breeding and pottery. The patient was important: his grave was 2m (6.5ft) long — bigger than most — and contained a schist axe, a flint pick and the remains of a young animal, which are evidence of high status.

The most intriguing aspect, however, was the absence of forearm and hand bones. A battery of biological, radiological and other tests showed that the humerus bone had been cut above the trochlea indent at the end “in an intentional and successful amputation”. Mrs Buquet-Marcon said that the patient, who is likely to have been a warrior, might have damaged his arm in a fall, animal attack or battle.

“I don’t think you could say that those who carried out the operation were doctors in the modern sense that they did only that, but they obviously had medical knowledge,” she said.

A flintstone almost certainly served as a scalpel. Mrs Buquet-Marcon said that pain-killing plants were likely to have been used, perhaps the hallucinogenic Datura. “We don’t know for sure, but they would have had to find some way of keeping him still during the operation,” she said.

Other plants, possibly sage, were probably used to clean the wound. “The macroscopic examination has not revealed any infection in contact with this amputation, suggesting that it was conducted in relatively aseptic conditions,” said the scientists in an article for the journal Antiquity.

The patient survived the operation and, although he suffered from osteoarthritis, he lived for months, perhaps years, afterwards, tests revealed. Despite the loss of his forearm, the contents of his grave showed that he remained part of the community. “His disability did not exclude him from the group,” the researchers said.

The discovery demonstrates that advanced medical knowledge and complex social rules were present in Europe in about 4900BC, and that major surgery was likely to have been more common than we realised, Mrs Buquet-Marcon said.

The Times (01/25/2010)