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Similar cranial trauma prevalence among Neanderthals and Upper Palaeolithic modern humans


Neanderthals are commonly depicted as leading dangerous lives and permanently struggling for survival. This view largely relies on the high incidences of trauma that have been reported1,2 and have variously been attributed to violent social behaviour3,4, highly mobile hunter-gatherer lifestyles2 or attacks by carnivores5. The described Neanderthal pattern of predominantly cranial injuries is further thought to reflect violent encounters with large prey mammals, resulting from the use of close-range hunting weapons1. These interpretations directly shape our understanding of Neanderthal lifestyles, health and hunting abilities, yet mainly rest on descriptive, case-based evidence. Quantitative, population-level studies of traumatic injuries are rare. Here we reassess the hypothesis of higher cranial trauma prevalence among Neanderthals using a population-level approach—accounting for preservation bias and other contextual data—and an exhaustive fossil database. We show that Neanderthals and early Upper Palaeolithic anatomically modern humans exhibit similar overall incidences of cranial trauma, which are higher for males in both taxa, consistent with patterns shown by later populations of modern humans. Beyond these similarities, we observed species-specific, age-related variation in trauma prevalence, suggesting that there were differences in the timing of injuries during life or that there was a differential mortality risk of trauma survivors in the two groups. Finally, our results highlight the importance of preservation bias in studies of trauma prevalence.

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Fig. 1: Neanderthal and Upper Palaeolithic modern human sites.
Fig. 2: Predicted cranial trauma prevalence in skeletal elements from Neanderthals and Upper Palaeolithic modern humans.
Fig. 3: Predicted cranial trauma prevalence in individual cranial specimens from Neanderthal and Upper Palaeolithic modern humans.

Data availability

Specimen-level data that support the findings of this study are provided in Supplementary Tables 1, 2. Quantification data for skeletal elements are available from the corresponding author upon reasonable request. Source Data for Figs. 2, 3 and Extended Data Figs. 1, 2 are provided in the online version of the paper.


  1. Berger, T. D. & Trinkaus, E. Patterns of trauma among the Neandertals. J. Archaeol. Sci. 22, 841–852 (1995).

    Article  Google Scholar 

  2. Underdown, S. A comparative approach to understanding Neanderthal trauma. Period. Biol. 108, 485–493 (2006).

    Google Scholar 

  3. Courville, C. B. in Diseases in Antiquity (eds Brothwell, D. R. & Sandison, A. T.) 606–622 (C. C. Thomas, Springfield, 1967).

  4. Hutton Estabrook, V. & Frayer, D. W. in The Routledge Handbook of the Bioarchaeology of Human Conflict (eds Knüsel, C. J. & Smith, M. J.) 67–89 (Routledge, London, 2014).

  5. Camarós, E., Cueto, M., Lorenzo, C., Villaverde, V. & Rivals, F. Large carnivore attacks on hominins during the Pleistocene: a forensic approach with a Neanderthal example. Archaeol. Anthropol. Sci. 8, 635–646 (2016).

    Article  Google Scholar 

  6. Trinkaus, E. Hard times among the Neanderthals. Nat. Hist. 87, 58–63 (1978).

    Google Scholar 

  7. Trinkaus, E. Neanderthal mortality patterns. J. Archaeol. Sci. 22, 121–142 (1995).

    Article  Google Scholar 

  8. Pettitt, P. B. Neanderthal lifecycles: developmental and social phases in the lives of the last archaics. World Archaeol. 31, 351–366 (2000).

    Article  CAS  PubMed  Google Scholar 

  9. Klein, R. G. The Human Career. Human Biological and Cultural Origins 3rd edn (Univ. Chicago Press, Chicago, 2009).

    Book  Google Scholar 

  10. Kunter, M. Gewalt- und Arbeitsverletzungen in alter Zeit. Knochenfunde als Geschichtsquelle. Spiegel der Forschung 3, 70–72 (1986).

    Google Scholar 

  11. Nakahashi, W. The effect of trauma on Neanderthal culture: a mathematical analysis. Homo 68, 83–100 (2017).

    Article  CAS  PubMed  Google Scholar 

  12. Mcbrearty, S. & Brooks, A. S. The revolution that wasn’t: a new interpretation of the origin of modern human behavior. J. Hum. Evol. 39, 453–563 (2000).

    Article  CAS  PubMed  Google Scholar 

  13. Trinkaus, E., Buzhilova, A. P., Mednikova, M. B. & Dobrovolskaya, M. V. (eds) in The People of Sunghir 269–294 (Oxford Univ. Press, Oxford, 2014).

  14. Brennan, M. U. Health and Disease in the Middle and Upper Paleolithic of southwestern France: a Bioarcheological Study. PhD thesis, New York Univ. (1991).

  15. Hutton Estabrook, V. Sampling Biases and New Ways of Addressing the Significance of Trauma in Neandertals. PhD thesis, Michigan Univ. (2009).

  16. Hutton Estabrook, V. Is trauma at Krapina like all other Neandertal trauma? A statistical comparison of trauma patterns in Neandertal skeletal remains. Period. Biol. 109, 393–400 (2007).

    Google Scholar 

  17. Trinkaus, E. Neandertals, early modern humans, and rodeo riders. J. Archaeol. Sci. 39, 3691–3693 (2012).

    Article  Google Scholar 

  18. Larsen, C. S. Bioarcheology. Interpreting Behavior from the Human Skeleton (Cambridge Univ. Press, Cambridge, 1997).

    Book  Google Scholar 

  19. Jurmain, R. Stories from the Skeleton. Behavioural Reconstruction in Human Osteology (Gordon & Breach, Amsterdam, 1999).

    Google Scholar 

  20. Martin, D. L. & Harrod, R. P. Bioarchaeological contributions to the study of violence. Am. J. Phys. Anthropol. 156, 116–145 (2015).

    Article  PubMed  Google Scholar 

  21. Redfern, R. C. Injury and Trauma in Bioarchaeology. Interpreting Violence in Past Lives (Cambridge Univ. Press, Cambridge, 2016).

    Google Scholar 

  22. Campillo, D. Healing of the skull bone after injury. J. Paleopathol. 3, 137–149 (1991).

    Google Scholar 

  23. Terberger, T. in Frühe Spuren der Gewalt (eds Pieck, J. & Terberger, T.) 129–154 (Landesamt für Kultur und Denkmalpflege, Schwerin, 2006).

  24. Fibiger, L., Ahlström, T., Bennike, P. & Schulting, R. J. Patterns of violence-related skull trauma in Neolithic Southern Scandinavia. Am. J. Phys. Anthropol. 150, 190–202 (2013).

    Article  PubMed  Google Scholar 

  25. Jiménez-Brobeil, S. A., du Souich, P. & Al Oumaoui, I. Possible relationship of cranial traumatic injuries with violence in the south-east Iberian Peninsula from the Neolithic to the Bronze Age. Am. J. Phys. Anthropol. 140, 465–475 (2009).

    Article  PubMed  Google Scholar 

  26. Schwitalla, A. W., Jones, T. L., Pilloud, M. A., Codding, B. F. & Wiberg, R. S. Violence among foragers: the bioarchaeological record from central California. J. Anthropol. Archaeol. 33, 66–83 (2014).

    Article  Google Scholar 

  27. Cohen, H. et al. Trauma to the skull. A historical perspective from the Southern Levant (4300bce–1917ce). Int. J. Osteoarchaeol. 24, 722–736 (2014).

    Article  Google Scholar 

  28. Glencross, B. & Sawchuk, L. The person-years construct: ageing and the prevalence of health related phenomena from skeletal samples. Int. J. Osteoarchaeol. 13, 369–374 (2003).

    Article  Google Scholar 

  29. Boldsen, J. L., Milner, G. R. & Weise, S. Cranial vault trauma and selective mortality in medieval to early modern Denmark. Proc. Natl Acad. Sci. USA 112, 1721–1726 (2015).

    Article  ADS  CAS  PubMed  Google Scholar 

  30. Milner, G. R. & Boldsen, J. L. Life not death: epidemiology from skeletons. Int. J. Paleopathol. 17, 26–39 (2017).

    Article  PubMed  Google Scholar 

  31. Eriksson, M., Brattström, O., Larsson, E. & Oldner, A. Causes of excessive late death after trauma compared with a matched control cohort. Br. J. Surg. 103, 1282–1289 (2016).

    Article  CAS  PubMed  Google Scholar 

  32. Mitchell, R. J., Cameron, C. M. & McClure, R. Higher mortality risk among injured individuals in a population-based matched cohort study. BMC Public Health 17, 150 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Buikstra, J. E. & Ubelaker, D. H. (eds) Standards for Data Collection from Human Skeletal Remains. Arkansas Archeological Survey Research Series No. 44 (Arkansas Archeological Survey, Fayetteville, 1994).

  34. Judd, M. A. Comparison of long bone trauma recording methods. J. Archaeol. Sci. 29, 1255–1265 (2002).

    Article  Google Scholar 

  35. Hadfield, J. D. MCMC Methods for Multi-Response Generalized Linear Mixed Models. The MCMCglmmR Package. J. Stat. Softw. 33, 1–22 (2010).

    Article  Google Scholar 

  36. R Core Team. R: A Language and Environment for Statistical Computing (R Foundation for Statistical Computing, Vienna, 2017).

  37. Walker, P. L. Cranial injuries as evidence of violence in prehistoric southern California. Am. J. Phys. Anthropol. 80, 313–323 (1989).

    Article  CAS  Google Scholar 

  38. Hadfield, J. MCMCglmm Course Notes (2017).

  39. Gelman, A. & Hill, J. Data Analysis Using Regression and Multilevel/Hierarchical Models (Cambridge Univ. Press, Cambridge, 2006).

    Book  Google Scholar 

  40. Gelman, A. & Rubin, D. B. Inference from iterative simulation using multiple sequences. Stat. Sci. 7, 457–472 (1992).

    Article  Google Scholar 

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We thank J. Svoboda, S. Sázelová (Paleolithic and Paleoanthropology Research Center, Dolní Vĕstonice), M. Oliva and Z. Tvrdý (Moravian Museum, Anthropos Institute, Brno) for permission to study the Dolní Vĕstonice, Pavlov and Brno collections, and L. Limmer for her contribution. This research is funded by the German Research Foundation (DFG-HA-5258/12-1, DFG-WA-2808/2-1) and supported by the University of Tübingen and Senckenberg Gesellschaft für Naturforschung. K.H. is supported by ERC-CoG-724703 and DFG-FOR-2237.

Reviewer information

Nature thanks S. Black, M. Mirazón Lahr and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Authors and Affiliations



J.B., J.W. and K.H. conceived the study. J.B. collected data. J.B., J.W., K.H. and N.A. developed the methods. J.B. and N.A. analysed the data. J.B., J.W., K.H. and N.A. wrote the manuscript.

Corresponding author

Correspondence to Katerina Harvati.

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The authors declare no competing interests.

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Extended data figures and tables

Extended Data Fig. 1 Ratio of skeletal elements with and without trauma.

a, Ratios of skeletal elements with and without trauma per preservation category for the full dataset of n = 836 skeletal elements. b, Ratios of skeletal elements with and without trauma per age cohort (young or old) and taxon (Neanderthals or Upper Palaeolithic modern humans), excluding sex unknown and age indeterminate skeletal elements (n = 604). Sample sizes given below bars represent numbers of skeletal elements of each subsample.

Source data

Extended Data Fig. 2 Preservation of skeletal elements of Neanderthals and Upper Palaeolithic modern humans.

a, Number of skeletal elements in each preservation category for Neanderthals and Upper Palaeolithic modern humans for the full dataset of n = 836 skeletal elements. be, Percentages of the four preservation categories for each skeletal element for Neanderthals (b; full dataset, n = 295 skeletal elements), Upper Palaeolithic modern humans (c; full dataset, n = 541 skeletal elements), Neanderthals (d; reduced dataset, excluding age indeterminate and sex unknown elements, n = 198) and Upper Palaeolithic modern humans (e; reduced dataset, excluding age indeterminate and sex unknown elements, n = 406). L and R indicate left and right, respectively.

Source data

Supplementary information

Supplementary Tables

This file contains Supplementary Tables 1-3. Supplementary Table 1: Individual data of Neanderthal specimens used in this study. Supplementary Table 2: Individual data of Early Upper Paleolithic modern human specimens used in this study. Supplementary Table 3: Catalogue of single cranial traumatic lesions of Neanderthals and early Upper Paleolithic modern humans used in this study with referenced short descriptions. Supplementary References: Bibliography of references cited in Supplementary Tables 1-3.

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Beier, J., Anthes, N., Wahl, J. et al. Similar cranial trauma prevalence among Neanderthals and Upper Palaeolithic modern humans. Nature 563, 686–690 (2018).

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