1
The oldest amputation on a Neolithic human skeleton in
France
Cécile Buquet-Marcon*, Philippe Charlier** & Anaïck Samzun***
While 'surgical ' practices such as trepanations are well attested since the first
stages of the European Neolithic, the amputation of limbs in Prehistoric periods
has not been well-documented until the case presented here. The particularly well-
preserved remains of an aged male were recently uncovered in the Neolithic site
(4900-4700 BC) of Buthiers-Boulancourt in the vicinity of Paris, France. It was
already noticed in situ that the distal part of the left humerus was abnormal and
this led us to the hypothesis of a partially healed 'surgical' amputation.
The further investigations reported here confirm a traumatic origin and a partial
cicatrisation after surgery, indicating that the patient survived. It also proves the
remarkable medical skills developed during Prehistorical times. In addition, the
associated grave goods are original, including the skeleton of an animal, a polished
schist axe and a massive 30 cm long flint pick. Despite the serious handicap from
which he suffered in this pastoral-agricultural community, the buried man
obviously enjoyed some particular social status, as suggested by the remarkable
and 'prestigious' accompanying grave-goods. If indeed this man benefited from
some form of community care, this would indicate the level of social solidarity in
Western Europe almost 7000 years ago.
This paper reports the exceptional discovery of an amputated Neolithic man, buried
some 7000 years ago with remarkable grave goods. Indeed, among the c. 2500 burials
known to us from the Linear BandKeramik (LBK) and post-LBK culture area, spanning
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through the loess and silt soils of Western, Central and parts of Eastern Europe
1
, such
surgical practices have never been really confirmed by archaeologists.
This discovery occured at the Neolithic site of Buthiers-Boulancourt (France), a
site identified in 2003 in the framework of preventive archaeology, when a trial-
trenching evaluation was carried out prior to the expansion of a sand quarry. Situated
some 70 km south of Paris, this site was occupied by agro-pastoral farmers widely
described elsewhere
2
. Two dwelling areas have been evidenced during the two seasons
of study in 2003 and 2005 (A.S. in preparation). The largest area (about 1 ha) includes
six « Danubian » dwelling houses on a pattern evidenced "from the Seine and to the
Dniestr"
3
, dated on ceramic grounds to the end of local Early Neolithic (Villeneuve-
Saint-Germain group, 4900-4600 BC i.e. Late and post-LBK Culture in the general
context of the Neolithic in Western and Central Europe's Neolithic)
4
. The second
dwelling area, smaller in size, has been identified as belonging to the beginning of the
Middle Neolithic, i.e. the Cerny culture (4600-4200 BC), which corresponds to the
"Stroke ornamented pots" culture of Central Europe
5
. The Early Neolithic dwelling area
also yielded two small sepulchral groups with individual pits characteristic of this
period
7
with respectively two and three burials, as well as an isolated incineration, a rare
occurrence in the Early Neolithic of France (A. S. in preparation).
The burial that concerns us is part of the second sepulchral group, and located at
only few metres from ovens and a lateral pit. The age of the tomb established by 14C
dating at 4900-4710 Cal. BC (GrA-30913: 5920+- 40 BP. Groningen, Centre for Isotope
Research, University Groningen, Netherlands) matches that of the other burials of
Buthiers et Boulancourt, particularly the neighbouring burial of an old woman dated to
4830-4610 cal B.C. (GrA-31022: 5860+-BP. Groningen, Centre for Isotope Research).
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The tomb consists of a particularly large and deep oval pit (dimensions: 2, 50 x 1,
60 x 1, 50 m), which has been directly dug out in the hardened calcareous ground. The
robust male skeleton is oriented East-West, head East and facing South, like most
contemporary burials in Western Europe
8
. Also the position is characteristic of the
period: the individual is lying on his left, in a crouched position, lower limbs flexed
leftwards, and knees over elevated. The feet are brought or possibly loosely held
together at the ankles. The right upper limb is also flexed with a hand nearby the left
shoulder. Ochre was spread only under the skull. The alignment of the right side of the
skeleton elbow, great trochanter and foot indicates a board-like surface. The linear
charcoal print observed at that place reinforces this impression. Some disarticulations
and moves unrelated to later burrowing confirm that the body's decomposition has
occurred in an unclogged space, as in a box or a coffin propped up by several stones and
a grinding-stone fragment. Thus the right femur and patella have disarticulated and
fallen into the pit bottom. The position of the right tibia and fibula, kept in balance by
the left femur, is anatomically impossible in regard to the left limb. There was no silt to
keep the knee in high position and bones have thus collapsed. As the right foot did not
follow the rest of the limb, and is still over elevated, something was present holding it.
The left foot confirms this observation with a position in balance, articulation preserved,
whereas the right foot slightly collapsed backward. A corpse deposited into a supple
material such as a sheet made of mat, skin, leather, or wooden bark could account for
the foot position.
Although most known examples of such funerary practices are dated to Middle
Neolithic, at least one case of this kind has already been observed at the nearby Early
Neolithic site of Vignely
9
.
The skeleton is affected by numerous osteoarthritis deteriorations, particularly
important on vertebras, from the cervical part especially the eburnation of the axis
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extremity - to the lumbar region. Main lesions are inter apophysis, with the yellow
ligament ossified. Lower limbs are also damaged, especially the knees and feet
articulations. One of the thoracical vertebra is cracked by a Schmorl's node, which is a
herniation of the cartilage of the intervertebral disc through the vertebral body endplate
and into the adjacent vertebra. If the vertebra is poorly preserved, the node bank is
clearly visible. Other pathologies affect the maxilla and mandible with the loss ante
mortem of all the teeth. The cavity resorption is sometime incomplete, and several parts
of the bone show infections.
The funerary assemblage
The exceptional funerary assemblage found with our amputated man is unique amongst
the numerous burials excavated throughout the LBK area. The sepulchral goods include
the deposit, at the feet of the skeleton, of a complete young animal (ovid or caprid,
according to the zooarchaeological analysis by C. Bemilli, Inrap-UMR 5197) and also,
adjacent to its skull, a 20 cm long polished axe in schist. In addition, a very large (30 cm
long) bifacial flint pick, polished on both ends and partially on its surface, was
perpendicularly placed on his left humerus.
During the Early Neolithic, tombs rarely if ever contain the deposit of a complete
animal, as distinct from its parts (leg, mandible or skull). The significance of this
domesticated animal raises questions: does it represent food provisions and/or an asset
for the beyond? The schist axe is a completely polished artefact made of a flat block. Its
shape is very narrow and elongated, with an oval section. It is significantly longer than
the small-size specimens well known for this period and the stage after. During the early
phase of Neolithic, tools such as axes are very rarely evidenced in the dwelling areas or
in a funerary context. This object was thus very rare in Parisian Basin and therefore
should be considered as a "prestige" object
10
. We cannot establish whether or not it was
manufactured especially as a funerary offering.
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The third item found in this burial is a flint pick which, just like the axe, was most
probably never used. These tools appear in Western Europe at the very end of the LBK
and become widespread by the post-LBK (round 4500 BC)
11
. Such an item must have
been still very rare at Early Neolithic sites. It is noteworthy that, following ethno-
archaeological observations
12
, both axes and picks present a high absolute value, which
would confer a peculiar status to this old man in his agro-pastoral community.
The amputation
The main particularity of this buried individual is the left humerus position, away from
the ribs, and a total lack of bones of the left forearm, wrist or hand. The lack of bones or
limbs is frequently observed on the archaeological skeletons, mostly due to
taphonomical factors. Here in Buthiers-Boulancourt, the absence cannot be explained by
poor conservation since the right limb is almost complete, including phalanges, as is the
whole skeleton. The abnormality of the distal part of the left humerus was already
recognised during excavation. The distal extremity had a very clear section localized on
both Epicondylus medialis and Epicondylus lateralis. The section is oblique down and
internally for the Epicondylus medialis, and down and externally for the Epicondylus
lateralis, which may indicate a traumatic origin rather than a malformative one. More,
the absence of progressive bone thinning at this extremity rule out any teratological
hypothesis such as amelia, hemimelia and any other partial or complete congenital
amputation. However, the smooth alteration of the surface should be relative to
taphonomy. At least, taphonomical traumas are present but are definitely not
responsible for the distal section: small protuberances on the bone part rather led us to
suggest a partially healed amputation.
The first radiological and microtomographical examination showed that, despite
diagenetic surface alterations that affected the cortical bone, signs of cicatrisation occur
on the distal extremity, i.e. a layer of newly-formed cortical bone overlying the
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primitive bone defect; the density of this new bone is superior to native bone. Dense
images inside bone diaphysis are artifacts (sediments inside the bone) and not
pathological.
The age of this cicatrisation before death is evaluated, due to the cortical
thickness, to some months or years, indicating a long survival after this "surgical"
performance. The macroscopic examination did not show any inflammation in contact
with this amputation, indicating a relative non septic intervention. A comparison of
diameters, thickness and bone densities of both humeral bones did not show any
significative difference, indicating a mobile left humerus without any atrophy or
decalcification.
The complete paleopathological examination of the whole skeleton did not show
any other lesion (particularly traumatic) that could explain such an intervention. It is the
first amputation evidenced in France and it is a complex and successful medical act.
Some surgical interventions on bones are well evidenced in prehistoric periods, such as
trepanations which entail removing a part of the cranial vault
13
. This undeniable surgical
act has already been demonstrated in Mesolithic
14
and Early Neolithic
15
and becomes
more widely developed during Late and Final Neolithic.
Discussion
The scanner imagery (4) and the 3D reconstruction (A. Mazurier and R. Macchiarelli)
confirm the amputation of the arm (3). We clearly identify a remodelling of the bone on
its anterior and distal end. It corresponds to the linear cortical bank and the section of
the amputation already recognized in the field. As no definitive signs of infection are
visible on the skeleton, we have been led to consider trauma as the most plausible
origin. Two points need to be discussed here; the technical procedure employed in this
`surgical' operation, and the kind of trauma that led the 'surgeon' to cut precisely above
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the trochlea. This part of the bone is actually extremely robust, especially if a flint tool
is used, and it would have been much easier to amputate few centimetres away from the
elbow articulation, on the diaphysis.
We thus assume that the trauma, whatever its cause, has partly torn away the limb
and broken the bones, at least the forearm. The operation took advantage of this, by
completing the amputation. But the medial pilaster with the remains of the very linear
cut attest that the bone was not completely broken. This is not therefore an accidental
amputation, but a real "medical" choice. A cortical fragment on the posterior side
indicate the process: a cut was made from the anterior side and the weight of the
forearm has caused the break of the last millimetres of the cortical, like a piece of wood.
The arm was probably held upward to benefit from the maximal aperture of the elbow.
Given that this elderly patient survived, his Neolithic caregivers must have had
good knowledge of the needs and means to prevent blood flow through staunching,
disinfection and cicatrisation. Thus, some remarkably sophisticated medical skills were
available 7000 years ago to keep societies in health.
Concerning the Middle Palaeolithic, hypothetic healed amputations have been
mentioned on two Neanderthal skeletons (Shanidar I, Irak
16
and Krapina in Croatia
17
).
However, we have not found any mention of proven amputations in Early
Neolithic times, but there are two presumed cases, attributed to the LBK Culture. The
first is from Sondershausen in eastern Germany: among the 45 burials excavated
between 1951 and 1955
18
, burial 18 shows a skeleton globally in the same position as
that of Buthiers-Boulancourt: on its back, lower limbs flexed on its left side, the right
upper limb flexed with the hand on the left shoulder. The left forearm is absent. No
perturbations were visible on the distinctive loess filling of the pit. While the graphic
documentation is of poor quality the humerus diaphysis appears to be complete,
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suggesting that the presumed cut might have been applied at the same emplacement as
our humerus.
Another burial from the same culture was found at Vedrovice, in Moravia (Czech
Republic). The site was excavated from 1975 to 1982 and revealed 110 tombs
19
. During
the last campaign, burial 82/79 was found to contain an old man lying on his belly, with
all the limbs flexed. The left forearm lies under the rib cage. The hand is absent as are
the distal extremities of the ulna and the radius. The authors suggested a healed
amputation, but in the publication no documentation or image illustrates precisely the
bone extremities.
Even if no further examinations can confirm these suggestions, these two
examples can suggest the existence of some elaborate medical practices over the whole
Linear pottery culture of the European Neolithic.
Conclusion
This amputation is the first case evidenced for Prehistorical times in France and it is a
successful surgical intervention that led to cicatrisation of the arm. Moreover, in spite of
a very invalidating amputation of arm and some handicapping osteoarthritic backaches,
this old man survived in this agro-pastoral community. This discovery confirms the
existence at the time of some form of mutual aid and solidarity towards disabled people.
To judge by the high value of the grave goods, this man seems to have benefited from
some special status in the social hierarchy of this Neolithic community. The quality of
rarely evidenced 'prestige' funeral goods, namely the pick and the axe, also confirm the
skills of contemporary craftsmen. Their technological competence is not always
perceptible when studying the flint assemblages attested in the dwelling refuse-pits. The
unexpected attentions and technical competences in surgery given by this Neolithic
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group towards one of their elderly and disabled member suggests a considerable level of
social, medical and even moral development in Western Europe, some 7000 years ago.
Methods
The neolithic humerus and the modern humerus microtomographic records were
performed at the University of Poitiers, France, with a X8050-16 Viscom model
(respectivly on the 2007/02/26 and the 2007/03/04).
Scanning procedure: Both bones have been scanned by A Mazurier according to the
following parameters:
Scanning
parameters
Neolithic
humerus
Modern
humerus
Energy 120kV
100kV
Intensity 150µA
130µA
gain of the camera
75%
54%
integration number
16
16
zoom of the camera
mode 1
mode 1
projections 1800/360°,
i.e.
1/0,2°
1500/360°, i.e.
1/0,24°
offset of the frame
grabber
175
140
gain of the frame grabber
662
700
Neolithic humerus:
Reconstructed volume has a 1004x1004x1004, 8bits format with a resolution of
63.0637µm
3
. A ring artefacts correction has been done and the original uCT slices
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reduced. The 845 final 8bits-tif format sections of 848x426 pixels have a resolution of
63.0637µm
3
.
Comparative modern humerus (coll. Univ. Poitiers) :
Reconstructed volume has a 1004x1004x1004, 8bits format with a resolution of
68.2275µm
3
. A ring artefacts correction has been done and the original uCT slices
reduced. The 976 final 8bits-tif format sections of 897x434 pixels have a resolution of
68.2275µm
3
.
*Inrap/UMR 5199 PACEA, 32 rue Delizy 93698 Pantin, France
** MD, PhD, Forensic Department Hopital Universitaire, 104 bd Raymond Poincaré
92380
Garches and EPHE La Sorbonne, Paris.
***MA, PhD, Inrap/UMR 7041 "Protohistoire européenne" 32 rue Delizy 93698
Pantin, France
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Acknowledgments
We thank R. Macchiarelli UMR 6046, University of Poitiers, for suggestions and help particularly for
scanner imagery. The microtomographic images were performed by A. Mazurier, ERM, Poitiers. N.
Schlanger, Inrap, UMR, contributed to elaboration of the article. J.-P. Farruggia UMR 7041 helped us to
find comparative amputated cases in the LBK area. A first CT scan and conventional radiography was
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performed in the University Hospital of Garches by R. Carlier, MD and reviewed by I. Huynh, MD from
the University Hospital of Pitié-Salpétrière. A first microtomographic record was performed by Prof. B.
Tavitian and his team (Orsay).Traceological examination has been performed by M. Christensen
(University of Paris-I-Sorbonne, France). We thank them for help.
Figures legends
Fig. 1- General view of the burial 416 (photography Inrap). Close to the skull,
we see the schist axe and above the left humerus, the long flint pick. The
domestic animal deposit, very poorly preserved is at the feet of the old man.
Fig. 2 Detail of the amputated humerus (photography LDA CG 94). The end of
the bone is clearly abnormal. The surface is rectilinear which indicate that the
trauma did not tear completely the bone out. He needed a surgical operation to
disarticulate the forearm, thus the Neolithics cut it, most probably with a flint tool
that cause the rectilinear aspect.
Fig. 3 3-dimensional computed-microtomography reconstruction of the
humerus (realisation A. Mazurier), distal view. Taphonomic factors have
damaged the skeleton and reactive bone developments are only partially
preserved. It is extended on the anterior part of the bone end, on the olecranian
part of the Epicondylus lateralis and on the Epicondylus medialis part (white
arrows). This development is the sign of the healing and proves that the old
man survives to the amputation. A cortical fragment on the posterior side
indicate the way the prehistoric surgeons have proceeded to cut: from anterior
side to posterior side (yellow arrow).
Fig.4 Comparison of 3 microtomography reconstructions of the Neolithic
humerus with a microtomography reconstruction of a modern humerus (coll.
University of Poitiers, realisation A. Mazurier). We obser
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ve on the upper slices the thin remodelling of the distal section (white arrow).
On the lower ones, the yellow line indicate on the comparison humerus (right
image) the amputation emplacement, the yellow arrows compares the
olecranian hole between the Epicondylus lateralis and on the Epicondylus
medialis part and shows its abnormal extension on the neolithic.
Fig. 5- Detail of the funerary deposit: a flint pick and a schist axe (Photography
Inrap). These tools are exceptional in a burial of the beginning of Vth Mil. BC.
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