How did Neanderthals deal with illness and injuries?

[MUSIC PLAYING] FLORA LICHTMAN: Hey, it’s Flora. And you’re listening to Science Friday. If you try to look up where medicine originated or the earliest medical interventions, you’ll probably find yourself reading about ancient Greece or Egypt or Mesopotamia. But what about before that, like, way before that? How did early humans treat disease or cope with injuries? What did a Neanderthal do if she broke a rib or needed a root canal? Was there prehistoric health care?

Today we’re digging into those questions, and what these medical interventions tell us about our ancient relatives, and how the practice of medicine evolved. Here to field all things medical is Dr. Penny Spikins. She studies the origins of medicine and health care at York University in England. And if you’re going to talk about ailments, you cannot sleep on teeth. So for our dental needs, we have Dr. Laura Weyrich, who studies ancient oral microbiomes at Penn State University. Welcome to Science Friday.

LAURA WEYRICH: Thanks so much for having us.

PENNY SPIKINS: Yeah, thank you. It’s brilliant to be here.

FLORA LICHTMAN: Penny, what’s the oldest evidence of medical care?

PENNY SPIKINS: Oh, that’s a fantastic question. Well, I think it depends how you define medical care because, actually, we might not be the only species that have medical care if you’re quite broad about your definition because, when we look at our cousins, chimpanzees, our nearest living cousins, chimpanzees, with whom we share a common ancestor 7 to 8 million years ago, they have some practices that we might begin to call medical care.

That is, if they’ve got internal parasites, they can pick some really, really spiky leaves to eat deliberately to flush out those internal parasites. And they can also use leaves as wound dressings, not just on themselves but on other chimps. So it may be that, actually, when you say, how far back does it go, it’s like, ooh. Could be more than 7 to 7 million years, really.

FLORA LICHTMAN: Well, as always, the question is more complicated than it seems, it sounds like. Well, let’s talk about our human ancestors. What kind of practices do we see? And when do they appear?

PENNY SPIKINS: Well, some of our best early evidence comes from about 1.7, 1.8 million years ago. And that’s when we see Homo ergaster in Kenya. KNM-ER 1813, she’d had hypervitaminosis. And we don’t quite how she got that. But she was in a lot of pain, probably unconscious for various periods for several weeks, perhaps even months. And she couldn’t possibly have survived that long without others helping her.

So I think we can really take back some of those examples to at least 1-and-1/2 million years ago, perhaps 2 million years ago, which, actually, is really early when we think about our evolutionary past. That’s when we first start to say this is what we call human, members of the genus Homo. And it begins to make us think, doesn’t it, that perhaps it’s actually quite critical to how we evolved. Perhaps caring for others wasn’t just a side thing. It might’ve been really important to perhaps even what made us successful, if it goes back that early.

FLORA LICHTMAN: Wow. Laura, what about dental care?

LAURA WEYRICH: I think the teeth tell a very similar story as well. I think a lot of our visions of ancient teeth are of everybody having cavities in every tooth and having gangly, horrible teeth. And Neanderthals actually have beautiful teeth. I wish I had teeth as good as a Neanderthal, for the most part. They have amazing oral health. And it tells you something about the health of their diet, and their foraging, and what they’re going through, and what they’re eating.

FLORA LICHTMAN: That’s amazing.

LAURA WEYRICH: Yeah.

FLORA LICHTMAN: Their teeth were great? Because I think of teeth as such a liability.

[LAUGHTER]

LAURA WEYRICH: Yeah, exactly. They can be, totally. But when you have great oral health, they’re something that really help you and benefit you. They’re tools you carry around with your body. Our work really shows that Neanderthals had very different types of microorganisms in their mouths. And so they weren’t probably able to get tooth decay and able to get gum disease in the same way that modern humans are. And they also have really great healthy diets, probably lots more leafy greens and protein than what the average person’s eating today. [LAUGHS]

FLORA LICHTMAN: I just saw this new study about the oldest root canal in a Neanderthal. Did you see this?

LAURA WEYRICH: Yeah, there was a really exciting new paper that showed that maybe Neanderthals were actually taking care of their teeth in ways dentists still do today, so actually creating small tools enough to drill down into the top of a tooth where you have tooth decay, and you have a lot of pain. It probably would’ve been an enormously painful process to give yourself, effectively, a root canal at that stage.

FLORA LICHTMAN: With a tree branch? What was the tool like?

LAURA WEYRICH: They think it was probably made out of jasper, so like a hard, rock-like substance that you could sharpen and whittle down to be a little bit of a drill that you would’ve massaged between your fingers, and rotate it back and forth to get it to drill down through that sort of enamel and release that pain. The researchers also estimate it would’ve taken somewhere between 30 and 40 minutes to drill these holes. And so it’s not just a quick mechanical drill that’s [BUZZING SOUND] in your mouth.

This is something where someone’s probably holding you down. And the other person is probably needling back and forth with this rock tool in your tooth to release that pain and pressure. So who knows if they were able to find some plants that helped with that pain resolution after it? I sure hope so.

FLORA LICHTMAN: I mean, I feel like we’re giving people nightmares already in this segment when we talk about DIY medical–

[LAUGHTER]

–DIY dental drills.

LAURA WEYRICH: Yeah. [LAUGHS]

FLORA LICHTMAN: I mean, Penny, what about– Laura brought up Neanderthals. What do we see in Neanderthal medical care? What’s in their doctor bag?

PENNY SPIKINS: It’s actually surprised– I mean, I’m surprised by how much we see. I probably shouldn’t be, should I? But I am quite surprised by what keeps coming up. We know that there’s basis of desire to care for each other. I mean, if we look at the whole spread of Neanderthals, 70%, 80% at least of them have had an injury that’s healed. And so a lot of those have probably only healed because other people have looked after them. I mean, our best example of that is Shanidar 1. But there are quite a lot of other examples, actually.

Shanidar 1, it’s this man who, when he was a late teenager, suffered a whole series of debilitating injuries. So he ended up blind in his left eye, probably deaf with one arm that was either completely lost part of it or was amputated, and one withered leg. So when we put that together, that’s someone with quite high needs, even in our society, and lived for at least a decade and probably, maybe 15 years.

And a lot of Neanderthals seem to have these patterns. La Chapelle-aux-Saints had osteoarthritis in their lower spine really quite severely, probably looked after for several months. So there’s this big pattern of provisioning, and care, and looking after individuals that end up ill or injured. But then we ask. OK, so, as you’re saying, well, what was their medical abilities?

So if we look at the El Sidrón Neanderthals and we look at the dental calculus, you can see remains of things like yarrow and chamomile. And they’re calming agents. There’s even painkillers and antibiotics in one of the individuals. So they’re really, very fine tuned to how they can use herbs and plants in ways that we would see as quite medicinal.

We know, for one thing, they must’ve had assisted childbirths because we know from the shape of the Neanderthal pelvic canal that babies were born having to twist as they come out the pelvic canal like with us. So they’re very likely to have had assisted childbirth. How they managed that, we don’t know. But it seems quite likely.

FLORA LICHTMAN: Should we be thinking like an OB, Penny, like an OB or a midwife?

PENNY SPIKINS: Well, that’s interesting, isn’t it? Because, when we started to talk about medicine, we’ve got this evidence for medical things. But what we don’t know is was there a specialist. Was there a medical specialist? But these are really small groups. So we don’t know for certain. But maybe there’s 12 to 15 in a group. It just doesn’t seem possible that they would’ve had a specialist medical person. It may have been some people who are a bit more specialized than others. But it’s probably a knowledge that’s just passed on culturally.

This particular flower or bark can heal pain. This particular thing has antimicrobial properties. And they probably just experimented and learned over thousands of years. But I’m surprised by the range of medical abilities they seem to have picked up, developed, and passed on.

FLORA LICHTMAN: Laura, I know teeth are your jam. I mean, tell us more about what ancient teeth tell us, reveal about what medicines were used or what medical care was available.

LAURA WEYRICH: Yeah, absolutely. From our perspective, teeth are not just teeth. They’re also all of the bacteria and viruses and fungi that are living on the outside of them. And those microorganisms bind together and form a film that grows on your teeth. And you’ll feel it yourself. If you ever drink a sugary drink, you feel that grossness. Dental plaque, that is a film. That is a microbial biofilm. The really awesome thing about that, though, is it calcifies at night when you sleep.

And it turns into this rock-hard matrix, locking all those bacteria, as well as anything else that might be in the local environment, in it in place. So if you don’t have modern dentistry, it never gets removed. So Neanderthals and very ancient humans would’ve had this dental plaque, which, when it’s calcified, we call it dental calculus. And it would’ve built up over their entire lifetime. We also study all these really healthy microbes in your body called the microbiome. And many of those live on your teeth. And those are directly linked to chronic disease development.

So now for the first time, we can look at Neanderthals’ teeth, and not just know about whether or not they had cavities or tooth decay. But we might know something about whether or not they suffered from a chronic disease. Or someday we might be able to tell whether or not they had mental health disorders, or whether or not they had aches in their bones. That would be directly attributable to these microbes that live in their mouths. So we’re really excited about looking at what all of these little bits and pieces stuck between your teeth can tell you about somebody, and what ancestors can tell us from long ago based on what was stuck between their teeth.

FLORA LICHTMAN: Oh my gosh. I want to hear more about what ancient plaque can tell us. I can’t believe fossil plaque is revealing all the secrets. Amazing. But I have to take a quick break. When we come back, we’re going to ask more about that. Stick around.

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FLORA LICHTMAN: OK, Laura, what can the little bits stuck in our teeth tell us about medicine? Do we find evidence of actual medicines in ancient teeth?

LAURA WEYRICH: Absolutely. So one of the amazing things about the El Sidrón Neanderthals that Penny mentioned earlier was that we had the ability to study the dental calculus that was on some of their teeth. And one of those individuals had quite a big abscess. They would’ve been in a lot of pain. If you’ve ever had tooth pain, you know exactly what that Neanderthal was feeling. And in that particular individual, we were able to find DNA that wasn’t just from the microbes or bacteria in his mouth, but also, from probably what we think, was medicine that was being used to treat that abscess.

And so we found things that associated with tree bark that would’ve had these properties of painkilling. We also found molds, things like penicillium, which have antibacterial properties, which probably we’re trying to kill that infection. Now, it’s unlikely for things that quickly pass through your mouth to get stopped and incorporated in dental calculus. So we actually think it’s much more likely that there was maybe a pulp or some sort of bolus that might’ve been put in the mouth near that tooth, really sat there to hopefully reduce the pain and treat that abscess.

And so it just speaks to their incredible intelligence, I think, and their ability to read the world around them, and bring in plants and care for someone who’s suffering and struggling in a medical context.

FLORA LICHTMAN: As always, we got a PSA. Stop underestimating Neanderthals.

LAURA WEYRICH: Yes, absolutely.

PENNY SPIKINS: So true.

LAURA WEYRICH: Yeah, if there’s one thing people take away from today, it’s that Neanderthals are not that club-toting, grunting, caveman-type mentality that was the picture of them that was drawn using, really, the first Neanderthal who was arthritic and probably was hunched over. But it’s not because that was a representation of the species. It’s because that person was in a lot of pain and very elderly. And so our narrative today is really being reshaped as we speak, as new science comes out, to speak to Neanderthals’ intelligence, to speak to their ability to care and to interact with their environments, and to learn and to, really, from my perspective, integrate within human society when anatomically modern humans showed up.

FLORA LICHTMAN: Yeah, Penny, let’s take a step back and talk about the big picture. I mean, we’ve been talking about the details of early root canals, early medical interventions. But what does it mean for a species to be taking care of their own like this?

PENNY SPIKINS: I think it’s fascinating the way in which we can look at this dental procedure. And what goes into it takes a huge amount around it, which is all part of evolution and cultural evolution and social evolution because, just for that one practice to happen, we need to have evolved the motivation to care for someone else. We need to have the courage to take on all of that pain.

I mean, whoever’s having that done and whoever’s going to do that, that’s quite– I mean, it’s brutal. It’s quite courageous what’s happening there. We need to have the social support around. Somebody was probably holding them. Somebody else was encouraging that this would happen. There’s all sorts of social support afterwards for looking after them until they felt a little bit better. I mean, to be able to stand back and think, this is going to hurt more in order to make it hurt less in the future, and that’s quite of itself shows a lot of intelligence.

And it fits into a much bigger picture of a people that were genuinely caring for each other and integrating that capacity to care with intellect in ways that’s probably quite unique to us, isn’t it? It’s quite unique to humanity to be able to integrate our emotional capacity to care with the intellect to bring it out, bring it forward, and be able to help people in a really thoughtful way. So it’s fascinating, I think.

FLORA LICHTMAN: Does tracking these injuries also tell us what life was like for Neanderthals or early humans? The fact that our ancestors are getting injured so much, what does that tell us about what their day to day was like?

PENNY SPIKINS: Well, it’s not necessarily an easy life, is it? I mean, they are at risk of being injured. And we know there are all sorts of predators around as well. And there are various Neanderthals that have actually been quite possibly killed or certainly hurt by predators. And they’re taking on quite risky hunting behaviors. So life isn’t necessarily easy in those terms. But we really do get that sense that they’ve got each other’s backs as well. And that’s really interesting to see that this is not–

We imagine both ourselves and our evolutionary past as a time of like invulnerability, independence. And we have this– I don’t know. Particularly today, we have this idea of this paleo fantasy, that, back in our past, we were really strong, really independent, really invulnerable, and really competitive. And actually, when we look at–

FLORA LICHTMAN: Eating a high-protein diet, yeah.

PENNY SPIKINS: Yeah, eating a high-protein diet, obviously big and muscly. And when we look at the archeological record, what we see is a set of people who were vulnerable individually. They needed other people to help them. They needed social support. But together as a group, they were really strong. And that’s so different from our image, isn’t it? So different from each individual person’s going to be completely competitive and fine. It’s really not true. And there’s a real message there, I think, about you know what? We’re quite vulnerable. We need other people.

We’re not naturally competitive. We’re not naturally hard and tough. But together we can make things work. And you really see that with Neanderthals.

FLORA LICHTMAN: This was so fascinating. Professor Penny Spikins is an archeologist at the University of York. And Professor Laura Weyrich is a microbiologist at Penn State. Thank you both for joining me.

PENNY SPIKINS: Thank you so much, Flora. That was fascinating.

LAURA WEYRICH: Thanks so much for having us. I really appreciate it.

FLORA LICHTMAN: This episode was produced by Rasha Aridi. And if we can help you excavate an answer to a science question in your life, please leave us a voicemail, 8774-SciFri is our number, 8774-SciFri. Look, we answer a lot of questions on the show. So please call us. We’ll catch you next time. I’m Flora Lichtman.

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