Neanderthals Suffered a Lot of Traumatic Injuries. So How Did They Live So Long?

Our ancient-hominid relatives seem to have had surprisingly sophisticated health care.

A chamomile plantation
A chamomile plantation (Vasily Fedosenko / Reuters)

Neanderthals suffered many gruesome injuries in their day. The precious remains of our ancient-human relatives reveal crushed limbs, fractured skulls, and broken ribs—relics from hunting accidents and warfare. That’s not to mention severe tooth abscesses and broken teeth that would have contributed to severe chronic pain.

Behind these gory details, however, lies the fact that many of these individuals appear to have survived for months or even years after their injuries. They lived to fight another day. This is at odds with some common assumptions about Neanderthals: Compared to modern humans, they are often thought to have lacked the necessary compassion or cognitive abilities to look after the sick. “We can infer from the fact that they survived that they must have been helped by others—and in some cases that help must have been knowledgeable and quite well planned,” says Penny Spikins, an archaeologist at the University of York in the United Kingdom. Their survival would have only been possible, in other words, if they had sophisticated health care.

In a recent paper in Quaternary Science Reviews, Spikins concludes that Neanderthals’ medical skills were remarkably similar to our own ancestors’ methods, and included wound dressing, fever management, midwifery, and a budding pharmacopeia of herbal remedies. Developing these abilities, she hypothesizes, might have even changed the course of their evolution.

Spikins has previously researched the motives of Neanderthal health care. In an attempt to debunk the myth that Neanderthals lacked the compassion of modern Homo sapiens, for instance, she describes one individual found in Shanidar Cave in Iraq who survived for a decade or more despite a withered arm and head injuries that would have probably resulted in sight and hearing loss. His survival would almost certainly have been impossible unless other group members had provided him with food, water, and shelter—a level of altruism not typically associated with the Neanderthal mind, Spikins says. She has now charted many other examples of individuals who could not have lived through their illnesses without the help of others.

Her latest paper builds on this analysis by examining some of the specific medical skills involved in such a level of care. In the vast array of bones that archaeologists have uncovered, the fractures had often healed without significant deformities, suggesting that they had been set with a primitive splint. Many of these wounds, such as the severe head traumas and broken ribs, probably would have resulted in significant blood loss and increased risk of infection, yet the injured individuals survived long enough for the bones to heal, and their remains lack signs of severe infection—which, Spikins says, would be apparent in lumps and bumps on the bone edges.

All of this suggests that Neanderthals had some means of dressing wounds. Spikins doesn’t know exactly what those methods were, but she points out that bandages can be made from animal parts. Some Inuit groups today, for instance, use lemming skin to dress wounds and boils, since it is said to be particularly good at adhering to human flesh. It’s feasible that Neanderthals would have also come across similar methods to stem the blood flow and to keep the wound (relatively) hygienic, Spikins says.

Neanderthals may have even been in command of some natural drugs to speed their recovery. One of the other individuals in the Shanidar Cave was found to be buried with numerous plants that are believed to have medicinal properties, including yarrow, a natural antibacterial and anti-inflammatory agent that appears to accelerate wound healing. As a common folk cure, it is also said to reduce fevers and alleviate the symptoms of viral infections such as influenza, and to reduce flatulence and stomach cramps. Perhaps this was a sign of the health care he had received during his lifetime.

Supporting this hypothesis, Karen Hardy, of the Catalan Institution for Research and Advanced Studies and the Autonomous University of Barcelona, has spent the past six years analyzing the calcified plaque left on Neanderthal teeth, which can carry tiny traces of the foods they ate. In the first of these experiments, Hardy found the chemical signatures of yarrow and chamomile, which is also thought to be an anti-inflammatory agent. Since these plants taste extremely bitter, and have little nutritional value by themselves, she hypothesizes that they were instead used for self-medication.

One of Hardy’s later plaque analyses of another Neanderthal individual revealed traces of poplar, which contains the natural painkiller salicylic acid, and the mold penicillium, the source of one of our most successful antibiotics. While we can’t be sure that Neanderthals deliberately ingested these substances for medicinal purposes, it’s telling that this individual suffered from a severe tooth abscess. Within the plaque, Hardy also found traces of microsporidia parasites, which cause acute diarrhea in humans. “The best guess is that it had to do with one or both of these infections,” she told me.

At least one form of Neanderthal health care seems more certain: midwifery. Skeletal remains demonstrate that, like anatomically modern humans, the size and shape of a Neanderthal baby’s head and the mother’s pelvis would have made unassisted childbirth dangerous. “The only way those heads could have got out of the birth canal is with that characteristic ‘twist’ which happens with modern humans at birth,” says Spikins—a maneuver that presents a high risk without assistance. From this, we can be fairly certain that they had developed some kind of midwifery to reduce the mortality rates, she says.

These findings don’t just sketch out a new branch to the history of medicine, showing that Neanderthal health care was remarkably similar to our own ancestors’ strategies; the research might also help us to better understand Neanderthals’ long-term adaptations to their environment. Many Neanderthals lived in colder and more arid regions across Western and Central Europe and some parts of Asia, where they ventured as far north as the Altai Mountains in Siberia. In the more northern areas, the main food source would have been hulking great creatures such as mammoths and woolly rhinos, the hides of which were so thick that they could only be hunted with spears at a dangerously close range. In southern regions such as modern-day Spain, meanwhile, Neanderthals appear to have chased ibex over mountainous terrains, which came with a serious risk of falls. That’s not to mention the many predators—including hyenas and saber-toothed cats—in these regions that posed their own dangers.

As a result of these challenges, injury rates were extraordinarily high, with one estimate suggesting that between 79 and 94 percent of Neanderthals sustained at least one traumatic injury in their lifetime. Spikins believes it simply would not have been possible for them to have adapted and spread so widely in these areas if they had not found the means to treat serious injuries. “As primates, we’re not naturally adapted to hunting large animals,” she explains of Neanderthals and Homo sapiens alike. “But health care allowed groups to sustain much higher rates of injury than they would otherwise be able to sustain, so they move into an ecological niche that they weren’t really well-suited for.”

Spikins hypothesizes that—as with modern humans—Neanderthal health care could have also allowed greater cultural complexity to flourish, by enabling the older generation to share their knowledge with younger members of the group. “The whole population structure changes with health care, so you have more members who are older,” she says; that cumulative knowledge might have allowed them to develop more sophisticated ways of hunting, for instance. She would also be interested to investigate whether midwifery allowed for the continued evolution of the brain. “We’d really hope that this study could prompt further thoughts about the ways these cultural practices can impact on our biological evolution,” she says.

Other archaeologists I spoke with were intrigued by Spikins’s paper, although they caution that we shouldn’t yet draw firm conclusions from the available evidence, which is still somewhat circumstantial. We can only infer so much from the way their bones healed, rather than material artifacts demonstrating the specific practices involved, and it is impossible to know for certain why those Neanderthals were ingesting those bitter-tasting plants.

“There is little hard evidence—most of it is presumed,” says April Nowell of the University of Victoria in Canada. She points out that many other animals have been known to self-medicate to a limited degree—and so it makes perfect sense that Neanderthals would be “equally if not more knowledgeable” of the medicinal benefits of plants. But she would have preferred more direct comparisons with anatomically modern humans and other primates to see whether the health-care adaptations differed between groups. It would have also been interesting to see whether the specific injuries, and the potential treatments, depended on the location and the particular challenges that it presented, and whether they changed over time. Did the Neanderthals in the north suffer from different maladies compared to those in Southern Europe?

In principle, however, the existence of more sophisticated health care chimes with the burgeoning recognition of Neanderthal intelligence. “It is totally in line with Neanderthal cognitive abilities, which there is no reason to suspect were very different from our own, and which would have allowed them to survive in their challenging environment,” says Francis Wenban-Smith of the University of Southampton. It is one more reason, he says, to recognize our cousins’ “capabilities as members of the human family, rather than presuming them to be the simple-minded brutes of popular folklore.”