NATURE PODCAST

07 September 2022
Missing foot reveals world’s oldest amputation

Welcome to the Nature Podcast. This week: evidence of amputation surgery dating
back 31,000 years.

Host: Nick Petrić Howe

And the latest from the Nature Briefing. I’m Nick Petrić Howe.

Host: Benjamin Thompson

And I’m Benjamin Thompson.

[Jingle]

Interviewer: Benjamin Thompson

Think about surgery today and you might picture a shiny operating theatre full of
advanced technology and specialist medical staff. But the story of surgery goes
back a long way, before germ theory, before Hippocrates, even before the invention
of metal tools. Until now, one of the earliest examples of a complex medical
procedure was seen in the skeleton of a Neolithic farmer in France who had had part
of their left arm amputated about 7,000 years ago. But this week, a paper in Nature
suggests that surgery may be far older than we thought, after researchers found
evidence of an amputation that occurred around 31,000 years ago. The story begins
in a cave in the rainforest in the east of Indonesian Borneo. It’s in a pretty
remote location and getting there is a bit of a trek, as Adhi Agus Oktaviana, a PhD
student from Griffith University in Australia, one of the authors of the new paper,
explains.

Interviewee: Adhi Agus Oktaviana

If we go there from the airport, we need around six hours with a car and then three
hours with a small boat to the base camp. And the next three hours, small boat
again, and then walking. Yeah, it’s like a fairly remote area. There’s a lot of
caves there, around 100 to 300 metres from the valley surface.

Interviewer: Benjamin Thompson

These caves, high up in the valley, are made of limestone, and they’re famous for
their examples of early human art, such as stencils of hands. In some of the caves,
this art has been dated as being potentially 40,000 years old. The cave Adhi and
his colleagues were working in is called Liang Tebo.

Interviewee: Adhi Agus Oktaviana

So, in this cave, we have a lot of hand stencils there on the cave wall or on the
ceiling.

Interviewer: Benjamin Thompson

To learn more about the people who might have lived in this area around the time
these artworks were made, the team set about excavating the Liang Tebo cave,
looking for archaeological evidence of human habitation – things like stone
artefacts and so on. And they found them, says Tim Maloney, another member of the
team, also from Griffith University. But they also found something more.

Interviewee: Tim Maloney

At close to a metre down, we uncovered a very well-defined deliberate burial with

stone burial markers and with brightly coloured red ochre or earth pigment grave
goods. Within that grave, the individual, they were likely in their early 20s when
they died. The skeletal signatures of sex aren't quite distinct so we can't say
whether they were male or female. We can say they likely died around 31,000 years
before present.

Interviewer: Benjamin Thompson

Finds like this are exceptionally rare, but something else caught their attention
as they uncovered the skeleton.

Interviewee: Tim Maloney

During that process, it was quite clear that the lower left leg was completely
absent, and then the tibia and fibula had some really unusual bony growth. The
opposite right leg, all 26 foot bones were perfectly articulate. And at the time,
having answered through the excavation process, where is the left foot – not here
being the answer – the next question is what happened? And that's a question that
needs to be answered by a paleopathologist.

Interviewer: Benjamin Thompson

Paleopathologists study diseases and injuries in long-dead human and animal

remains.

Interviewee: Tim Maloney

We were able to get a colleague to inspect and confirm our suspicions that that
unusual bony growth is a very compelling match for clinical examples of amputation
surgery.

Interviewer: Benjamin Thompson

Tim says that this pattern of this unusual bony growth is different from what might
be seen if the foot had been lost as a result of something like an animal bite,
say, suggesting that precise cutting – deliberate amputation – is the most likely
explanation. And what’s more, the fact that any extra growth was seen on the leg
bones at all shows that the person must have survived having their foot removed.

Interviewee: Tim Maloney

Based on clinical comparison, a minimum of 6-9 years of healing has occurred, which
means that between 6-9 years prior to their death in their early 20s is when this
occurred. So, somewhere potentially in the order of 10-14, perhaps that age bracket
is when they had the amputation surgery. We cannot say what caused an injury to
encourage or require that procedure. However, it does imply that the people that
conducted it clearly had mastered a range of complexities associated with it, but
they were also aware of the importance of conducting it.

Interviewer: Benjamin Thompson

Amputation is complex and, in addition to a detailed knowledge of anatomy, its

success in modern times is largely thanks to antiseptics and antimicrobials that
prevent deadly infection. But even though this surgery was performed thousands of
years ago, the team found no evidence of infection at the amputation site. It’s
difficult to know why, but Tim thinks where the person lived may have played a key
role.

Interviewee: Tim Maloney

This is occurring not only in an area of this amazing rock art, but it's part of
the Earth's tropics, which is also home to, today and very likely when this
individual lived, some of the highest biological diversity on planet Earth. The
plant diversity harbours a great many botanical resources with antiseptic and
antimicrobial properties, supports the case that the surgeons probably had a good
grasp of botanical resources to support this successful surgery.

Interviewer: Benjamin Thompson

Tim says his colleagues are looking at things like seeds and charcoal samples
uncovered at the site to see what they might reveal about any plants used to
prevent infection. They’re also looking for evidence of what sort of tool might
have been used to remove the foot. Charlotte Roberts, an archaeologist from Durham
University in the UK, has written a News and Views article about the work. She
suggests that the find might mean our presumptions about the origins of surgery
might need a bit of a rethink.

Interviewee: Charlotte Roberts

The thing that struck me most was evidence for surgery 31,000 years ago,
astounding, really, and to see it in a skeleton, an intentional burial in a cave. I
mean, it's really quite rare in my field to see direct evidence for treatment of
disease or injury. It’s so long ago that it challenges the view that medicine was
really late in coming to societies. Everyone thinks it really developed when people
started to farm and live in settled communities, but this just challenges that idea
we have this assumption.

Interviewer: Benjamin Thompson

Charlotte suggests that the fact that this surgery happened, and that the person
receiving it lived for several years afterwards, provides some insights into the
communities living in this area at the time.

Interviewee: Charlotte Roberts

Whatever they were treating this person for with that amputation, they felt they
needed to intervene. And it just really indicates that they were a caring society
because they cared for that person during their life, and they cared for them when
they died and carefully buried this individual in a cave. And that, for me, just
shows that care has been with us in our societies way back 31,000 years ago up to
the present day.

Interviewer: Benjamin Thompson

Quite what form this post-surgery care looked like is something that Charlotte is
interested to know. There's another question too. Was this a one-off event or were
practices like this common in this area? The absence of written records and
scarcity of well-preserved skeletal remains makes this difficult to answer right
now. Although lots of questions do remain, Adhi, who you heard from at the start,
says this find is important, as it sheds new light on what life was like in ancient
Borneo and who the people who made the paintings in the cave thousands of years ago
may have been.
Interviewee: Adhi Agus Oktaviana

The finding of a skeleton of 31,000 years, it's always amazing because we can
understand how a historic people are living, how they survived in the jungle of
east Borneo. I think it’s incredible for Indonesian archaeologists. We have the
proof of the people who were living with the early art itself.

Interviewer: Benjamin Thompson

That was Adhi Agus Oktaviana there from Griffith University in Australia. You also
heard from Tim Maloney also from Griffith University, and Charlotte Roberts from
Durham University in the UK. To read the paper and the News and Views article, look
out for a link in this week’s show notes.

Host: Nick Petrić Howe

Later in the podcast, we’ll be hearing how the James Webb Space Telescope is
improving our understanding of exoplanets. That’s in the Briefing chat. Right now,
though, it’s time for the Research Highlights with Shamini Bundell.

[Jingle]

Shamini Bundell

The discovery of mummified skin from young Triassic reptiles may provide hints at
the climate that killed them. Around 252 million years ago, at the end of the
Permian period, climate change thought to be caused by volcanic eruptions led to
the largest mass-extinction event in the Earth's history. While looking for clues
as to what the climate was like in the early Triassic just after the mass
extinction, researchers uncovered the remains of 170 four-limbed animals in South
Africa's Karoo Basin. These were mammal-like reptiles from two species in the genus
Lystrosaurus, among the few creatures to survive the cataclysm. Among the tangled
remains, the researchers found young Lystrosaurus that had died in clusters around
what was once a dry riverbed. Several were found in a spreadeagled position,
similar to what's seen in some animals when they collapse from heat exhaustion. Two
of the fossils also had what appeared to be mummified skin, which probably formed
through rapid drying after death. Together, this evidence points to a mass die-off
of young Lystrosaurus owing to heat and water shortages, suggesting that in the
aftermath of the Permian extinction, the Triassic climate underwent periods of
drought. Read that research in full in Palaeogeography, Palaeoclimatology,
Palaeoecology.

[Jingle]

Shamini Bundell

Mapping avalanche risk in remote mountain regions has just become a little easier
thanks to old satellite data. Snow avalanches kill dozens of people each year. They
can also block mountain roads, cutting off key routes for transporting food, energy
and medicine. Many studies of avalanche risk have been done in wealthy countries or
using resource-intensive techniques. But this team of researchers wanted to build a
simple way to forecast avalanche risk in remote areas with limited internet
connections. To do this, they compiled a collection of satellite images of
northeastern Afghanistan taken between 1990 and 2021. By mapping snow patches which
remained on the ground late into melt season, the scientists could identify places
where avalanches had occurred, even if nobody had noticed them at the time. This
allowed them to identify areas at risk, as well as a changing trend in the location
of avalanches in the area they studied. The authors say they designed their Snow
Avalanche Frequency Estimation or SAFE to help local planners to prioritise their
efforts to mitigate avalanches. Read that research in full in The Cryosphere.

[Jingle]

Host: Nick Petrić Howe

Finally on the show, it’s time for the Briefing chat, where we discuss a couple of
articles that have been featured in the Nature Briefing. Ben, what have you got for
us to discuss this time?

Host: Benjamin Thompson

Well, I’ve been reading an article in Nature that’s looking at the ongoing flooding
in Pakistan, and why these floods have been so extreme this year – the worst this
century, in fact.

Host: Nick Petrić Howe

Yeah, I've certainly heard about these. They've made headlines across the world.
So, I guess, take me from the start. What's going on here? What's happened with
these floods?

Host: Benjamin Thompson

Well, let's give some context here then, Nick. So, currently, at least a third of
the country is underwater. Thirty-three million people have been displaced, and
more than 1,200 people have been killed and, of course, our thoughts go out to
everyone who has been affected by these events. And researchers have been looking
at what factors have been contributing to these floods being quite so devastating.
And it seems like one of the main factors is likely the extreme heatwaves the
country has been experiencing this year, and extreme heat is something we talked
about on the podcast a few weeks ago. And in Pakistan, between April and May,
temperatures were over 40 °C for prolonged periods in many places. And on one day,
one city recorded temperatures over 50 °C.

Host: Nick Petrić Howe

Now, obviously, when I think of heatwaves, they are huge issues, but I don't
immediately understand like how that leads to flooding. So, why do the hotter
temperatures lead to this sort of flooding?

Host: Benjamin Thompson

Well, warmer air can actually hold more moisture, and meteorologists warned that
the extreme temperatures would probably result in ‘above normal’ levels of rain
during the monsoon season, which runs from July to September. But there are other
things at play here as well, Nick. So, researchers are saying that the intense heat
also looks to have melted glaciers in northern mountainous regions, increasing
water flowing into the Indus river, which runs the length of the country. It's not
necessarily clear yet how much water, but certainly another factor at play. And
also, the heatwaves have actually coincided with an area of intense low pressure,
which has brought intense rain to coastal provinces. So, there's a lot of unusual
factors here, and this all has been exacerbated by the early arrival of the monsoon
period. So, the effects of it all is that Pakistan has received three times its
average annual rainfall for the monsoon period so far, and some provinces have had
five times that average.

Host: Nick Petrić Howe

So, obviously, there are these huge floods. What sort of effects are these floods
and this huge amount of rainfall having on the country?

Host: Benjamin Thompson

Yeah, I mean, I think ‘catastrophic’, Nick, is the right word to use. So, 1.2
million houses, 5,000 kilometres of road, 240 bridges destroyed, and some
researchers are saying that the worst might not be over. For example, some weather
agencies have also predicted that the ongoing La Niña climate event, which is often
associated with stronger monsoon conditions, may continue until the end of the
year, bringing further strong rainfall.

Host: Nick Petrić Howe

And whenever I hear about extreme weather these days, my first thought is climate
change.

Host: Benjamin Thompson

Yeah, the intensity and frequency of extreme events is very much associated with
climate change, and climate models suggest that more intense rainfall will happen
in a warmer world. And research has shown that between 1986 and 2015, temperatures
in Pakistan rose by 0.3 °C per decade – higher than the global average. But
researchers and public officials are also saying that other factors are probably at
play here as well, such as an ineffective early-warning system for floods, poor
disaster management, and a lack of drainage and storage infrastructure. So, there's
an awful lot going on here and, as I said, our thoughts go out to everyone affected
by the ongoing floods. But let's move on with the show this week, Nick, and what
have you brought for this week's Briefing chat?

Host: Nick Petrić Howe

Well, this week, I've been reading a couple of articles in Nature, that are about
the James Webb Space Telescope’s efforts over the past couple of weeks to look at
exoplanets and figure out what's going on with them.

Host: Benjamin Thompson

Yeah, so exoplanets then – these planets orbiting distant stars – are something
we've covered on the podcast a few times, and it’s something that I'm very excited
about in general. But what's the James Webb Telescope telling us about them in this
instance?

Host: Nick Petrić Howe

Yeah, so one of the aims of the James Webb Space Telescope was to look at
exoplanets, and it is now kind of exciting to see what it's able to do. So, in the
first of these studies that I wanted to discuss, it was actually taking an image of
an exoplanet, and that's pretty interesting because it's able to do it in a way
that other telescopes haven't been able to do before. So, normally, when you're
looking at exoplanets, the star’s light can sort of blow out the planet and you're
not able to see it in much detail. But the James Webb has got infrared sensors, so
it’s able to take these pictures in infrared, and that basically ramps up the
contrast between the star and the planet, so you're able to get a better image of
the planet. So, yeah, the James Webb has taken a picture, which to me looks like a
couple of pixels but scientists were very excited about, of this exoplanet with the
fun name HIP 65426 b, that they say is similar to Jupiter but hotter and younger.
Host: Benjamin Thompson

Right, okay, and why is taking a picture of a hot young Jupiter in infrared quite
so exciting then?

Host: Nick Petrić Howe

Well, it’s exciting because it shows what the James Webb Space Telescope can do.
And by using this sort of deep infrared, you can actually get an understanding of
what the planet is made of and really get to some of the answers that scientists
have been trying to figure out about exoplanets for a long time. Which brings me on
to the second story that was in Nature, and this was about an exoplanet that was
spotted that had carbon dioxide on it, which is the first time that's been seen on
an exoplanet.

Host: Benjamin Thompson

Right, so, I know that looking at the atmospheres of exoplanets is something that
researchers are super interested in and are very keen to do in high detail, and is
finding CO2 then quite an exciting thing?

Host: Nick Petrić Howe

It is exciting because this exoplanet, which also has a fun name, WASP-39b, it's
been looked at in the past using different telescopes, and there have been hints of
carbon dioxide but it's never been conclusive. But now, with this new data coming
from James Webb, it seems like there's a really nice peak on the graph that they
have that shows that there's CO2 present there.

Host: Benjamin Thompson

And what's kind of the broader context of this then, Nick?

Host: Nick Petrić Howe

Well, it’s boosted confidence that James Webb will be really useful for exoplanet
studies. And also, carbon dioxide is one of the components could be a sign of life.
It will actually be a mix of carbon dioxide and methane that would be quite a good
sign of life, and this is just one part of that, so it's just the carbon dioxide
part of that. And now scientists have seen that there is this carbon dioxide here,
they can start to come up with ideas and theories as to why it’s there because you
would think that a planet like this – a planet similar to Jupiter – would have a
similar composition to the star it is orbiting, but that's not the case for this
planet and it's also not the case in our own Solar System. So, now, scientists can
start to figure out why, and they’ve got a couple of ideas.

Host: Benjamin Thompson

Well, you've teased us there, Nick. Pray tell, what are these two ideas?

Host: Nick Petrić Howe

Well, one is that during the early formation of this planet, it was hit by a lot of
comets and asteroids that had certain elements in them that then led to sort of CO2
in the atmosphere. And that would be interesting because it would be similar to
what scientists think when Saturn was in its early formation. The other one is that
maybe it formed from materials in the colder outer reaches of that particular
system and then migrated closer to the star. And then when it got close to the
stars, some of the different elements were blasted off, which would have
concentrated heavier elements and then led to more CO2 in the atmosphere.

Host: Benjamin Thompson

So, it seems like there's questions then about the origin story of this CO2, but
the fact that researchers can now think about answering these questions with the
telescope must be quite exciting for them.

Host: Nick Petrić Howe

Yeah, the researchers interviewed for the articles were really excited about these
findings because it really shows what James Webb can do.

Host: Benjamin Thompson

Well, Nick, I'm sure we'll be talking about a lot of science that comes from the
James Webb Space Telescope in the forthcoming months and years. But for the time
being, let's leave it there for this week's Briefing chat. And listeners, for more
on those stories, and where you can sign up for the Nature Briefing, look out for
links in this week's show notes.

Host: Nick Petrić Howe

And that's all for this week's podcast. But as always, you can reach out to us on
Twitter – we’re @NaturePodcast. Or you can send us an email to podcast@nature.com.
I’m Nick Petrić Howe.