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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7: Section III. Anatomical Identifications

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7

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Contents

Section III. Anatomical Identifications

§ 44. Preliminary Remarks

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1. BEFORE proceeding to the detailed identification of the bones which, according to the early Indian anatomists, compose the human skeleton, it may be useful to note the following preliminary points.

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2. According to modern Anatomy, there are about 200 bones in the adult human skeleton.¹ The early Indian anatomists, on the other hand, count either 360 (Ātreya) or 300 (Suśruta) bones. This large excess is principally due to the fact that (besides including the teeth, nails, and cartilages) they counted prominent parts of bones, such as are now known as ‘processes’ or ‘protuberances’, as if they were separate bones. Their reasons for counting in this manner were mainly three.

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¹ See Dr. Gerrish's *Textbook of Anatomy*, p. 113.

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3. Sometimes processes, or protuberances, of bones were popularly known by special names, and regarded as special bones. Examples are the malleoli, or ankle-bones, and the styloid processes, or wrist-bones. In such cases it was probably a mere concession, made by the early Indian anatomists, to popular usage that they enumerated them in their lists as separate bones. In other cases the separate enumeration of processes or protuberances was due to an exaggerated regard for the homological principle. For example the right and left halves of the skeleton were regarded as homologous. Hence, seeing that the vertebral column lay in the median line, the transverse processes on the right and left of the several vertebrae were counted as separate homologous bones (§ 59). Sometimes, again, it was a fancy for artificial symmetry which led to the multiplication of bones. To this cause, probably, is due the assumption of the existence of a third joint in the thumb and great toe (§ 47), and of twelve costal tubercles instead of ten (§ 58).

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4. All these cases are examples of the multiplication of bones; but the opposite process of unification also occurs. Here a number of bones is counted as a single bone, either from deference to an older or popular theory, or because they were thought to constitute a peculiar unity. Conspicuous examples are the bones of the carpus and tarsus (§ 49), and, in Suśruta’s system, the ankle-bones (§ 52).

§ 45. The Practice of Dissection

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1. Allowing for the modifying causes explained in the preceding paragraph, the views of the early Indian anatomists are surprisingly accurate. This is due to the fact that they were accustomed to the practice of preparing the dead human body for actual examination, and that, therefore, their views were the direct result of an experimental knowledge of the skeleton. It is true that the Compendium of Charaka contains no reference whatever to the practice of human dissection; and it must, therefore, remain doubtful whether, and to what extent, that practice was observed in the school of Atreya. But there can be no doubt as to the practice being known and observed in the school of Suśruta; for his Compendium contains a passage which gives detailed instructions regarding the procedure to be adopted in preparing a dead body for anatomical examination.

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2. The passage in question occurs at the end of the fifth chapter of the Anatomical Section (*Śarīra Sthāna*) of the Compendium, and runs as follows:

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‘No accurate account of any part of the body, including even its skin, can be rendered without a knowledge of anatomy. Hence any one who wishes to acquire a thorough knowledge of anatomy must prepare a dead body, and carefully examine all its parts. For it is only by combining both direct ocular observation and the information of text-books that thorough knowledge is obtained. For this purpose one should select a body which is complete in all its parts. It should also be the body of a person who was not excessively old, nor who died

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of poison or of a protracted disease. Having removed all excrementitious matter from the entrails, the body should be wrapped in rush, or bast, or grass, or hemp, and placed in a cage. Having firmly secured the latter, in a hidden spot, in a river with no strong current, the body should be allowed to decompose. After an interval of seven days the thoroughly decomposed body should be taken out, and very slowly scrubbed with a whisk made of grass-roots, or hair, or bamboo, or bast. At the same time, every part of the body, great or small, external and internal, beginning with the skin, should be examined with the eye, one after the other, as it becomes disclosed in the course of the process of scrubbing.’ (Original Text in § 95.¹)

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¹ A German translation is given in Professor Jolly’s *Indian Medicine*, pp. 44, 45, in the *Cyclopedia of Indo-Aryan Research*. See also Dr. Wise’s *Hindu System of Medicine* (new issue), pp. 68, 69.

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3. The procedure, thus described, will doubtlessly enable the observer to recognize such structures as the clusters (*kūrca*) of small bones which make up the carpus and tarsus. But it would hardly suffice to enable him to discover bones lying interiorly; such, for example, as the ethmoid, sphenoid, vomer, and others in the interior of the head. As a matter of fact, we do not find these latter bones mentioned even in the more accurate list of Suśruta.

§ 46. Conspectus of the Ancient Indian and Modern Systems

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1. The subjoined comparative table, setting side by side the system of Modern Anatomy and the systems of Ātreya-Charaka and Suśruta, as well as the skeleton shown in Figs. 4 and 5, may serve as a guide to the detailed identification of bones discussed in the succeeding paragraphs. Column I on Modern Anatomy is based on Dr. Samuel O. L. Potter’s *Compend of Human Anatomy* (5th ed., 1893), pp. 9, 10; column II on §§ 4, 7; and column III on § 34.

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| | I. Potter. | | II. Charaka. | | III. Suśruta. | |
| | | | | | | |
| | **A. Four Extremities.** | | | | | |
| 1 | Phalanges, or joints of fingers and toes | 56 | pāṇi-pād-aṅguli | 60 | pāṇi-pād-aṅguli | 60 | § 47 |
| 2 | Metacarpus and Metatarsus, Long bones | 20 | śalākā | 20 | tala | 20 | § 48 |
| 3 | Carpus and tarsus, Clusters, or Bases | 30 | adhiṣṭhāna | 4 | kūrca | 4 | § 49 |
| 4 | Os calcis, heel | 2 | pārṣṇi | 2 | pārṣṇi | 2 | § 50 |
| 5 | Forearm (Radius, Ulna) | 4 | aratni | 4 | aratni | 4 | § 51 |
| 6 | Styloid processes, wrist-bones | 4 | maṇika | 4 | maṇibandha | 2 | § 52 |
| 7 | Olecranon, elbow-pan | 2 | kapālikā | 2 | kūrpara | 2 | § 53 |
| 8 | Leg (tibia and fibula) | 4 | jaṅgha | 4 | jaṅgha | 4 | § 51 |
| 9 | Malleoli, ankle-bones | 4 | gulpha | 4 | gulpha | 2 | § 52 |
| 10 | Patella, knee-cap | 2 | jānu | 2 | jānu | 2 | § 53 |
| 11 | Arm (humerus) | 2 | bāhu-nalaka | 2 | bāhu | 2 | § 54 |
| 12 | Thigh (femur) | 2 | ūru-nalaka | 2 | ūru | 2 | § 54 |
| | | 120 | | 110 | | 106 | |
| | **B. Trunk.** | | | | | |
| 13 | Shoulder : Clavicle, collar-bone | 2 | akṣaka | 2 | akṣaka | 2 | § 55 |
| 14 | Scapula, shoulder-blade | 2 | aṃsa-phalaka | 2 | aṃsa-ja | 2 | § 56 |
| 15 | Thorax : Ribs | 24 | pārśvaka, &c. | 72 | pārśvaka, &c. | 72 | § 58 |
| 16 | Sternum, breast-bone | 1 | uras | 14 | uras | 17 | § 57 |
| 17 | Vertebrae, thoracic and lumbar | 17 | | | pṛṣṭha | 30 | § 59 |
| 18 | Pelvis : Sacrum | 1 | pṛṣṭha | 45 | trika | 1 | § 60 |
| 19 | Coccyx | 1 | | | guda | 1 | § 60 |
| 20 | Ilium, ischium | 2 | śroṇi-phalaka | 2 | nitamba | 2 | § 60 |
| 21 | Pubes | | bhag-āsthi | 1 | bhaga | 1 | § 60 |
| | | 50 | | 138 | | 128 | |

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| I. Potter. | II. Charaka. | III. Suśruta. |

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C. Head and Neck.

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| 22 | Cervix : | | | | | |
| | Vertebrae, | | | | | |
| | Neck-bones | 7 | grīvā | 15 | grīvā | 9 | § 61 |
| 23 | Trachea, bron- | | | | | | |
| | chi, wind- | | | | | | |
| | pipe | | jatru | 1 | kaṇṭha-nāḍī | 4 | § 62 |
| 24 | Cranium, | | | | | | |
| | Frontal | 1 | | | | | |
| | Parietal | 2 | śiraḥ-kapāla | 4 | śiraḥ-kapāla | 6 | § 63 |
| | Occipital | 1 | | | | | |
| | Sphenoid | 1 | | | | | |
| | Ethmoid | 1 | | | | | |
| 25 | Temporal | 2 | śaṅkhaka | 2 | śaṅkha | 2 | § 64 |
| 26 | Face : | | | | | | |
| | Superior | | | | | | |
| | Maxillary | 2 | | | | | |
| | Inferior do. | 1 | hanu, hanumūla | 3 | hanu | 2 | § 65 |
| | Superciliary | | | | | | |
| | ridges, brows | | lalāṭa | | | | § 66 |
| 27 | Malar | 2 | gaṇḍa-kūṭa | 1 | gaṇḍa | 2 | § 66 |
| 28 | Nasal | 2 | nāsikā | | nāsā | 3 | § 66 |
| 29 | Palate bones | 2 | tālūṣaka | 2 | tālu | 2 | § 67 |
| | Lachrymal | 2 | | | | | |
| | Inferior tur- | | | | | | |
| | binated | 2 | | | | | |
| | Vomer | 1 | | | | | |
| | Hyoid | 1 | | | | | |
| 30 | Additional : | | | | | | |
| | Teeth | | danta | 32 | danta | 32 | § 68 |
| | Sockets of teeth | | ulūkhala | 32 | | | § 68 |
| | Nails | | nakha | 20 | | | § 69 |
| | Eyeballs | | | | akṣi-koṣa | 2 | § 70 |
| | Ears | | | | karṇa | 2 | § 71 |
| | Total : | 30 | | 112 | | 66 | |
| | Grand total : | 200 | | 360 | | 300 | |

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Cranial Bone, *Śiraḥkapāla*

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Superciliary Ridge, *Lalāṭa*

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Temporal Bone, *Śaṅkha*

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Nasal Bone, *Nāsikā*

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Ramus, *Hanumūla-bandhana*

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Jawbone, *Hanu*

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Teeth, *Danta*

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Cheekbone, *Gaṇḍakūṭa*

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Eyeball, *Akṣikośa*

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Ribs, *Pārśvaka*

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Collarbone, *Akṣaka, Aṃsa*

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Breastbone, *Uras*

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IIIᵃ Upper Limbs, *Bāhu* (3,4)

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Pelvis, *Śroṇi*

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Hipbone, *Śroṇiphalaka, Nitamba*

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Sacrum, *Trika*

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Coccyx, *Guda*

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Pubic Arch, *Bhaga*

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IIIᵇ Lower Limbs, *Sakthi* (5,6)

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Kneecap, *Jānu*

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Astragalus, *Kūrca-śiras*

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Metatarsus, *Śalākā, Tala*

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Phalanges, *Aṅguli*

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Nails, *Nakha*

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FIG. 4. HUMAN SKELETON. *Asthi-saṃgraha*. Front View.

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Cranial Bones, Śiraḥkapāla

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Ear, Karṇa

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Neck, Grīvā

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Vertebral Column, Pṛṣṭhavaṃśa

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Acromion Process, Aṃsakūṭa

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Shoulderblade, Aṃsaphalaka

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Arm, Bāhu-nalaka

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Olecranon Process, Kūrpara, Kapālikā

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Forearm, Aratni < Ulna, Radius

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Styloid Processes, Maṇika

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Carpus, Adhiṣṭhāna, Kūrca

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Metacarpus, Śalākā, Tala

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Phalanges, Aṅguli

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Nails, Nakha

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Thigh, Ūru-nalaka

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Leg, Jaṅgha < Tibia, Fibula

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Malleoli, Gulpha

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I. Head and Neck, 'Śiro-grīvā, (1)

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II. Trunk, Antarādhi, (2)

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III. Limbs, 'Śākhā, (3-6)

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FIG. 5. HUMAN SKELETON. Asthi-saṃgraha. Back View.

A. The Four Extremities

§ 47. The Phalanges

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Pāṇi-pād-āṅguli, or phalanges of the hands and feet. Both Atreya-Charaka and Suśruta count sixty of these phalanges,

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FIG. 6. OUTLINES OF THE HAND.

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FIG. 7. OUTLINES OF THE FOOT.

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1-8. Carpus, Kūrca.
1. Scaphoid } Kūrca-śiras.
2. Semilunar }
3. Cuneiform.
4. Pisiform.
5. Unciform.
6. Os magnum.
7. Trapezoid.
8. Trapezium. I-V. Metacarpus, Śalākā. a-c. Phalanges, Aṅguli. S. S. Styloid Processes, Maṇika.

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1-7. Tarsus, Kūrca.
1. Os calcis, Pārṣṇi.
2. Astragalus, Kūrca-śiras.
3. Navicular.
4. Cuboid.
5. External cuneiform.
6. Middle ,,
7. Internal ,, I-V. Metatarsus, Śalākā. a-c. Phalanges, Aṅguli. M. M. Malleoli, Gulpha.

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giving three to each finger and toe. The actual number is only fifty-six, there being in reality only two phalanges in the thumb and great toe. Professor Pancoast, however, counts fifteen phalanges in either hand, classing the first metacarpal bone among the phalanges of the thumb,¹ and thus making the total of the phalanges to be fifty-eight. He would seem to consider the trapezium (Fig. 6), one of the carpal bones with which the first metacarpal articulates, to be the real metacarpal of the thumb, and the real homologue of the metacarpals of the other four fingers. According to the usual view the clusters of carpal and tarsal bones contain eight and seven bones respectively. Professor Pancoast’s theory would equalize their numbers by the exclusion of the trapezium. It is interesting to observe that Chakrapāṇidatta’s somewhat obscure remarks on the phalanges seem to indicate his having held a similar view. For he says (§ 11): ‘As to the third joint of the thumb and great toe, it must be understood to be contained within the respective hand or foot,’ that is, within the palm or sole or, in other words, among the metacarpal or metatarsal bones. And he adds: ‘The long bones belonging to the thumb and great toe are also of small size’; that is, he appears to have identified the trapezium as the first metacarpal, and the internal cuneiform bone of the tarsus (Fig. 7) as the first metatarsal. How far the explanation of Chakrapāṇidatta may be the survival of an ancient tradition going back to the time of Atreya and Suśruta, it is, at present, impossible to say. But on the whole it seems more probable that the reckoning of sixty phalanges by the ancient Indian anatomists is based on fancied claims of symmetry (§ 44).

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¹ Dr. Potter’s Compend of Human Anatomy, pp. 49, 50.

§ 48. The Long Bones

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1. *Pāṇi-pāda-śalākā*, or the long bones of the hands and feet. These are the metacarpal and metatarsal bones. Charaka counts twenty of them, five in either hand and foot (§ 4), which agrees with the actual number. Suśruta, in his list (§ 27), aggregates them under the term *tala*, which signifies the palmar and plantar portion of the hand and foot respectively. The Atharva Veda (§ 43) denotes that portion by the term *uchlakha*.

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2. It may here be useful to note that the combined term *tala-kūrca-gulpha*, sole-cluster-ankle, employed by Suśruta in his list (§ 88) denotes the whole (roughly rectangular) portion of the foot and hand, as shown in Figs. 6 and 7, exclusive of the phalanges. That is to say, it signifies the metatarsus (tala), tarsus (kūrca), and malleoli (gulpha) of the foot, and similarly the metacarpus (tala), carpus (kūrca), and styloid processes (maṇibandha) of the hand.

§ 49. Bases or Clusters

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1. Pāṇi-pāda-śalāk-ādhiṣṭhāna, base (prop) of the long bones of the hand and foot; or simply sthāna or pratiṣṭhā, base; or kūrca, cluster (of bones). The first-mentioned term occurs in the lists of Charaka (§ 4) and Bheḍa (§ 12); the second and third in the lists (non-medical) of Yājñavalkya (§ 16) and the Atharva Veda (§ 43) respectively; the fourth in the list of Suśruta. See Figs. 6 and 7.

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2. Ātreya, whose system is reported by Charaka and Bheḍa, appears to have held the opinion that the long bones (metacarpals and metatarsals) were fixed in one bone as their common base. He may have known that this base (the carpus, or tarsus) was really composed of a cluster of small bones, but the term adhiṣṭhāna (or sthāna) which he chose as its name, rather suggests that he thought it to be a single undivided bone. Actual examination of a prepared skeleton, such as Suśruta certainly practised (§ 45), would, of course, have set him right; but it may be doubted whether he ever went beyond a superficial examination of a dead body.

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3. Suśruta’s use of the term kūrca, cluster, which he substitutes for adhiṣṭhāna, base, is by itself sufficient to show that he was aware of the true nature of the ‘base’, as being made up of a cluster of small bones. It is not improbable that he knew even the exact number of the small bones which constitute each cluster (eight in the carpus and seven in the tarsus), but, so far as I know, there is no passage in his Compendium which definitely proves it. Rather inconsistently, but probably in deference to the older view, he continued, for the purpose of his list, to count his ‘cluster’ as one bone. But of course, properly interpreted, this only means that he counted the ‘cluster’ as a composite bone, or rather as a set of bones.

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4. The identity of the organ which Suśruta calls *kūrca*, cluster, may also be inferred from a passage in which he describes its position in the limb. In the sixth chapter of the Anatomical Section (*Śārīra Sthāna*), explaining his doctrine of the ‘vital spots’ (*marman*), he says:

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‘Between the great toe and the toe next to it, there lies the vital spot called *kṣipra*. Upwards of this *kṣipra*, both ways (i.e. exteriorly and interiorly), there lies the vital spot called *kūrca*.’ (Original Text in § 97, cl. 1.)

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Referring to Fig. 7, it will be seen that Suśruta’s *kūrca*, or cluster (of bones), lies on the exterior and interior sides of the foot, beyond the great and second toes. As a matter of fact, the seven bones of the tarsal cluster are in modern Anatomy considered as ‘placed in two rows, side by side, two bones in the external row, five in the internal, as follows: externally, os calcis (No. 1), and cuboid (No. 4); internally, astragalus (No. 2), scaphoid or navicular (No. 3), and the three cuneiform (Nos. 5, 6, 7).’¹ *Mutatis mutandis* these remarks apply also to the carpal cluster. The eight bones of that cluster are now usually considered as ‘placed in two rows, one in front of the other, with four bones in each row.’¹ But they may also be considered as placed (Fig. 6) in two rows, side by side, four bones externally (Nos. 3, 4, 5, 6, unciform, pisiform, cuneiform, os magnum); and four internally (Nos. 1, 2, 7, 8, scaphoid, semilunar, trapezoid, trapezium).

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¹ See Dr. Potter’s *Compend of Human Anatomy*, pp. 48 and 53.

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5. The only difficulty about Suśruta’s *kūrca*, or cluster, arises from the fact that the Traditional Recension of his statement on the skeleton (§ 27) ascribes to him, by implication, the doctrine that there are eight *kūrca*, or clusters, in the four extremities, two in either hand and two in either foot. It has been shown, however, in § 31, that this is a complete error, foisted into the system of Suśruta, in all probability, from the system of Vāgbhaṭa I (§ 37, also pp. 99, 103). The true doctrine of Suśruta, stated by himself in explicit terms (§ 31), knows only four *kūrca*, or clusters, one in either hand, i.e. the carpus, and one in either foot, i.e. the tarsus.

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6. It might be thought that Vāgbhaṭa I derived his doctrine that there are eight *kūrca*, two in either hand and two in either foot, from the circumstance, above referred to, that the small bones of the carpi and tarsi are placed in two rows. One would thus obtain eight rows of small bones, two in either hand and two in either foot; and it might be thought that Vāgbhaṭa I wanted to express that circumstance by his count of eight *kūrca*, or rows. In support of this view it might be said that Vāgbhaṭa I also counts four *gulpha*, or ankle-bones, as well as four *maṇibandha*, or wrist-bones (§ 37). Seeing that there are actually two malleoli (or ankle-bones) in either leg, and two styloid processes (or wrist-bones) in either forearm, it seems a very plausible conclusion that Vāgbhaṭa I was really thinking of the four malleoli and four styloid processes when in his list of bones he enumerates four *gulpha* and four *maṇibandha*; and similarly that he was thinking of the eight rows of small bones in the two carpi and tarsi, when he counted eight *kūrca*. But such a view would credit Vāgbhaṭa I with more consistency and more accurate knowledge of anatomy than he really possessed. How little of both qualities his statement on the skeleton exhibits has been already shown in § 38. A striking proof of his imperfect knowledge of the skeleton is the circumstance that in his list (§ 37) he enumerates both *adhiṣṭhāna* and *kūrca* as two distinct kinds of bone. By the former he understood the carpus and tarsus. This is clear from the term *pratibandhaka*, or interlocker, by which he calls them. He says: ‘There are five long bones, and one bone interlocking them’ (Original Text in § 93). This shows that (whatever Ātreya-Charaka’s view of the real nature of *adhiṣṭhāna* may have been) Vāgbhaṭa I took it to be a single undivided bone, on which the five long bones articulated. But as he had thus provided for the carpus and tarsus, it is difficult to understand what he could have imagined the additional *kūrca* to be. Seeing that all actually existing bones (Figs. 6 and 7), phalanges, metacarpus (or metatarsus), carpus (or tarsus), and styloid processes (or malleoli) were already covered by the terms *aṅguli*, *śalākā*, *pratibandhaka* (or *adhiṣṭhāna*), and *maṇibandha* (or *gulpha*), there was no bone left to be named *kūrca*. It may be doubted whether Vāgbhaṭa I had any idea as to what the Suśrutiyan term *kūrca* meant. He certainly failed to see that it signified the equivalent of the Charakiyan term *adhiṣṭhāna*; and his anatomical knowledge was too imperfect to prevent that failure. It thus came to pass that, dominated by his desire of combining the two systems of Suśruta and Charaka, he not only superfluously counted the *kūrca*, by the side of his *pratibandhaka* (Charaka’s *adhiṣṭhāna*), but actually duplicated its numbers, counting eight *kūrca* instead of four.

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7. In connexion with the cluster of bones (*kūrca*) it may be well to discuss the case of a bone which is not especially enumerated in the list of Suśruta, but which he mentions in the sixth chapter of the Anatomical Section (*Śārīra Sthāna*), in discussing the ‘vital spots’ (*marman*). It is there named by him *kūrca-śiras*, or head of the cluster, that is, head-bone within the cluster. He defines its position as follows:

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‘Below the ankle-joint, but not on both sides, there lies what is called the head of the cluster.’ (Original Text in § 97, cl. 1.)

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By referring to Fig. 7, it will be seen at once that the bone here described as the head of the cluster is the astragalus (No. 2). It forms the lower part of the ankle-joint, and lies below the distal ends of the tibia and fibula with both of which it articulates. In the list of Suśruta (§ 27) it is not specially enumerated, because, of course, it is included in the cluster (*kūrca*) of which it merely forms the head-bone. But in his chapter on the ‘vital spots’ it had to be mentioned separately by the side of the cluster, on account of its being the location of a particularly dangerous spot, in addition to another dangerous spot located in the remainder of the cluster (Nos. 3, 4, 5, 6). The astragalus (No. 2) and the os calcis (No. 1) are the two largest bones of the tarsal cluster, and Suśruta distinguishes them by the names ‘head of the cluster’ (*kūrca-śiras*) and ‘heel’ (*pārṣṇi*) respectively. That fact definitely proves that he was aware of the real nature of the tarsus as being composed of a cluster (*kūrca*) of bones. Ātreya-Charaka, on the other hand, knew nothing of a head of the cluster, and his heel (*pārṣṇi*), as we shall see in the next paragraph, is merely the projecting tuberosity of the os calcis. With him both the astragalus and the os calcis are included in his *adhiṣṭhāna*, or base, and there is nothing to prove definitely that he knew anything of the real composite nature of the organ which he called *adhiṣṭhāna*.

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8. It should be mentioned that Suśruta teaches the existence of four *kūrca-śiras*, or heads of clusters. He says:

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‘There are two ankles, two wrists, and two pairs of cluster-heads. These eight an experienced surgeon should know to be vital spots that are apt to cause diseases.’ (Original Text in § 96, cl. 6.)

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What Suśruta means is, of course, that there is a head-bone in each of the four clusters (*kūrca*), that is, in either of the two carpi and tarsi. The head-bones of the two tarsi are their respective astragali. Those of the two carpi would appear to be their respective semilunar bones (No. 2 in Fig. 6). Charaka (i.e. Ātreya), as has been already indicated, does not mention the existence of any of these four head-bones.

§ 50. The Heel

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*Pārṣṇi*, or the heel. See Fig. 7. This term, as used by Charaka, denotes the backward and downward projection of the os calcis, that is, that portion of it which can be superficially seen and felt, and is popularly known as the heel. Accordingly, in Ātreya’s statement of the skeleton, as reported by Charaka and Bheḍa (§§ 4, 12), the number of heels is rightly said to be two. In the list of Vāgbhaṭa I (§ 37), rather grotesquely a heel is ascribed to each of the four extremities, two in the feet and two in the hands, giving a total of four heels. The reason of this incongruous conception has been explained in § 32. It arose from a false construction of Suśruta’s direction regarding the method of counting the bones of the four extremities, and it actually succeeded, probably on the authority of Vāgbhaṭa I himself, in being received into the Traditional Recension of Suśruta’s statement on the skeleton (§ 27). There can hardly be any doubt that the statement of Suśruta, in its original and genuine form, taught no more than two heels. From the general tenor of it, it is evident that Suśruta knew the true nature of the tarsus; namely, that it is a cluster (*kūrca*) of small bones. The two largest of these small bones he distinguished by special names; namely, the astralagus (No. 2) by *kūrca-siras*, or head of the cluster (§ 49), and the os calcis (No. 2), by *pārṣṇi*, or heel. In his detailed list of the bones (§ 27) he did not enumerate the ‘head of the cluster’ separately; for of course it was implicitly included in the term ‘cluster’ (*kūrca*). But the heel (*pārṣṇi*) he counted separately, either as a concession to the older system of Ātreya, and to popular usage, or, perhaps on the whole more probably, because he did not consider the os calcis as constituting one of the component bones of the cluster (*kūrca*). In all probability Suśruta’s real view of the lower portion of the lower extremity (the portion shown in Fig. 7) was that it was formed by five constituents : 1, phalanges (*aṅguli*); 2, metatarsals (*tala* or *śalākā*); 3, tarsal cluster (*kūrca*) of six small bones (Nos. 2–7 ; 4, ankles (*gulpha*); and 5, os calcis or heel-bone (*pārṣṇi*, No. 1). The view of Ātreya-Charaka differed from the view of Suśruta only in considering the tarsus to consist, not of a cluster of bones, but of a single, undivided supporting bone (*adhiṣṭhāna*), which included the body of the os calcis, but excluded its posterior downward projection, the latter being counted separately and named *pārṣṇi*. In § 65 it will be shown that there exists a similar difference of opinion with respect to the term *hanu* between Suśruta and Ātreya-Charaka. The former uses it as denoting the whole lower jaw-bone (inferior maxillary), while with Ātreya it denotes its (roughly) triangular ‘mental protuberance,’ popularly known as the chin (Fig. 31).

§ 51. Forearm and Leg

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Aratni or *prabāhu*, forearm, and *jaṅgha*, leg. The term *prabāhu* occurs only in certain manuscripts of the Vishnu Smriti (see § 84). In all the three statements, of Ātreya (that is, Charaka and Bheḍa, §§ 4, 12), Suśruta (§ 27), and Vāgbhaṭa I, (§ 37) these two organs are correctly described as consisting of two bones each—viz. the radius and ulna in the forearm, and the tibia and fibula in the leg. In the Atharva Veda (verse 3 in § 43) the figure made by the two bones of the leg is appropriately described as ‘a four-sided frame having its ends firmly knit together’; and this description of course is intended also to apply to the bones of the forearm. See Figs. 8 and 9.

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FIG. 8. FOREARM, Aratni. a. Radius. b. Ulna. c, c. Styloid processes, Maṇika. d. Olecranon process, Kapālikā.

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FIG. 9. LEG, Jaṅgha. a. Tibia. b. Fibula. c, c. Malleoli, Gulpha.

§ 52. Ankles and Wrists

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Maṇika or maṇibandha, wrist-bone, and gulpha, ankle-bone. See Figs. 6 and 7. In literary Sanskrit these terms denote the wrist-joint and ankle-joint respectively; but as anatomical terms they signify more precisely the wrist-bones and ankle-bones, that is, the distal processes of the two bones of the forearm and leg which are known respectively as the styloid processes and the malleoli. By the ancient Indian anatomists, according to their peculiar method (§ 44, cl. 3), they are reckoned as separate bones; but while Ātreya counts them all singly, and thus in the list, reported by Charaka (§ 7), enumerates four wrist-bones and four ankle-bones, Suśruta counts them by pairs, and thus in his list (§ 34), has only two wrist-bones and two ankle-bones, one in each forearm, and one in each leg. The Traditional Recension, of the list of Charaka (§ 4), it is true, counts only two wrist-bones; but it has been shown in §§ 6 and 25 (p. 67) that the original and genuine list (§ 7) must have contained four wrist-bones. On the other hand, the Traditional Recension of Suśruta’s list (§ 27) gives four wrist-bones and four ankle-bones. This, as shown in §§ 31, 41, is also an error, due to the influence of Vāgbhaṭa I (§ 37), who, in pursuance of his aim of combining and harmonizing the two systems of Charaka and Suśruta, adopted Charaka’s way of counting the wrist-bones and ankle-bones.

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2. The truth regarding the way in which Suśruta contemplated the styloid processes and malleoli is clearly brought out by the term valaya, wristlet or anklet, which he applies to them (§ 30). It is obvious from this comparison that he looked upon each pair of styloid processes and malleoli as forming but a single composite bone encircling the lower part of the forearm, or leg, like a wristlet, or anklet (see Fig. 2, p. 80). It must be admitted that this is a rather fanciful way of treating those organs. At the same time, it is quite consistent with Suśruta’s methods; he treats the carpus and tarsus in exactly the same way. For him both are single, composite bones, or clusters (kūrca) as he calls them (§ 49). For the purpose of enumeration in the list of bones, the clusters, though consisting of a number of small bones, are reckoned each as a single bone, or—it would be better to say—as a single system of bones. Similarly, the pairs of styloid processes and malleoli are counted, in the list, each as a single bone, or rather as a single system of bones.

§ 53. Elbow-pan and Knee-cap

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1. Kapālikā or kūrpara, elbow-pan, and jānu or jānuka, knee-cap. There can be no doubt regarding the bones to which these terms refer. They are the olecranon process of the elbow, and the patella of the knee. The former, which ‘in its function and structure resembles the patella’,¹ is not a separate bone, but a process of the ulna (Fig. 8). But by the ancient Indian anatomists, according to their usual practice (§ 44), it is counted as a separate bone. They follow herein our own popular usage which speaks of it as the ‘funny bone’ or ‘crazy bone’.

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¹ Dr. Potter’s Compend of Human Anatomy, p. 47.

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2. The term *kūrpara* is peculiar to Suśruta, who expressly defines it as denoting the homologue of *jānu*, the knee-cap (p. 72), and who may, therefore, have been the first to use it as a denotation of the olecranon process. The term *kapālikā* is peculiar to Ātreya (Charaka and Bheḍa). It means, literally, a small shallow dish, and is therefore identical in meaning with patella, the Latin name of the knee-cap. It well describes the appearance of the olecranon process, which presents, in the ventral view, a concave surface, the so-called great sigmoid cavity (Fig. 8). Accordingly, in this treatise, it has been rendered by ‘elbow-pan’.

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FIG. 10. THE PATELLA, Jānu. From the back, showing interior concave surface.

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3. The term *kapola*, for the elbow-pan, which is found in the Non-medical Version (§ 16), is undoubtedly, as has been explained in § 19, cl. 4, an ancient misreading for *kapāla*, pan, of which *kapālikā* is a diminutive. By way of corroboration it may be mentioned that the Smaller Petersburg Dictionary quotes the form *kapolaka* as a misreading for *kapālaka*, pan. The antiquity of the misreading may be seen from the fact that ancient Sanskrit dictionaries mention *kapoli*, with the meaning knee-cap. The true form, of course, is *kapālī*, a feminine diminutive of *kapāla*, meaning a small pan, or any small pan-like bone, such as the knee-cap or elbow-pan. Similarly, *kapāla* itself is used to denote the larger pan-shaped bones of the cranium (§ 63).

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4. The Atharva Vedic list (§ 43) has the two synonymous terms jānu and aṣṭhīvat. The latter literally means ‘the organ (knee) which possesses a bone (patella)’, and thus, like jānu, comes to denote specifically the knee-cap.

§ 54. Arms and Thighs

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Bāhu, arm, and ūru, thigh. These two terms are employed by Suśruta (§ 27) and Vāgbhaṭa I (§ 37). Charaka uses the fuller terms bāhu-nalaka, reed-like or hollow bone of the arm, and ūru-nalaka, reed-like, or hollow bone of the thigh (§ 4). All three correctly ascribe to either organ a cylindrical bone, the humerus and the femur respectively, with a hollow shaft, the so-called medullary cavity. See Figs. 4 and 5.

B. The Trunk

§ 55. The Clavicle or Collar-bone

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1. Akṣaka or akṣa, also aṃsa or aṃsaka, clavicle or collar-bone (Fig. 11). All three writers, Ātreya-Charaka, Suśruta, and Vāgbhaṭa I, in their lists (§§ 4, 27, 37), correctly state the number of these bones to be two.

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FIG. 11. THE RIGHT CLAVICLE, Akṣaka. a. Shaft. b. Sternal end. c. Acromial end.

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2. The first-named term, akṣaka, is the strictly technical denotation of the collar-bone. It is uniformly explained by the commentators to have that meaning. Thus Daḷḷana, in his commentary on the thirty-fourth and forty-eighth verses of the third chapter of the Therapeutical Section (Cikitsita Sthāna) of the Compendium of Suśruta, explains it by saying: ‘The akṣaka is located above the shoulder-joint,’ and again, ‘The akṣaka is the part above the shoulder-joint' (Original Texts in § 97, cl. 2). Similarly Gaṅgādhar, in his commentary on Charaka's skeletal statement, says: 'The two akṣaka are the two shoulder-bones (aṃsaka) which lie below the throat' (Original Text in § 97, cl. 2). But the matter is clinched by Chakrapāṇidatta, who (§ 11, p. 36) very aptly likens the two akṣaka to two kīlaka or 'pegs that run athwart the anterior part of the trunk'. Referring to Figures 4 and 12, it will be seen that the external end of the

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FIG. 12. DIAGRAM OF RIGHT HALF OF SHOULDER-GIRDLE. Ventral view showing—Clavicle, Akṣaka, above. Scapula, Aṃsa-phalaka, below (shaded). with a. Coracoid process. b. Acromion process, Aṃsa-kūṭa. c. Glenoid cavity, Aṃsa-pīṭha.

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clavicle lies exactly above the shoulder-joint, and its internal end below the throat, while the whole clavicle runs, like a peg, across from the throat to the shoulder-joint.

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3. In the shorter form akṣa, the term occurs only in the Non-medical Version of the system of Ātreya (§ 16),¹ where, however, as stated in § 20, cl. 4, it is wrongly explained by the commentators of the Law-book of Yājñavalkya to signify ‘a bone on the edge of the eye’, or, ‘a bone between the eye and the ear.’ And this unintelligent guess at the meaning of akṣa was copied from them by Nanda Paṇḍita, in his Commentary on the Institutes of Vishnu, where he says that the term means ‘the part below the temples, between the ear and the eye’.¹ In medical works the term never occurs with that meaning. The only other way in which I have noticed it used in a medical work is as a synonym of indriya, or organ of sense. With this meaning it occurs not unfrequently in the Compendium of Vāgbhaṭa II (e.g. Sūtra Sthāna, chap. I, verse 33; X. 2; XII. 17; Śārīra Sthāna, III. 5), where the commentator expressly says that ‘the organs of sense are called akṣa’ (akṣāṇi indriyāṇi ucyante). It may be noted, however, that Vāgbhaṭa I, in his Summary, in the corresponding passages never uses the term akṣa, but always indriya (Sūtra Sthāna, chap. XIX, vol. I, p. 96, l. 21; XIX, p. 106, l. 16; Śārīra Sthāna, chap. V, p. 220, l. 8).²

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¹ It also occurs in the Śatapatha Brāhmaṇa: see Monier Williams's Dictionary, 2nd ed.

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¹ Curiously enough, in the exact position indicated by Nanda Paṇḍita, there is a small elongated bone, called the Zygomatic Process (see Figs. 211, 239, on pp. 184, 204, of Dr. Gerrish’s Textbook of Anatomy, 2nd ed., 1903). But, even granting the improbable assumption that this process was known to the legal commentators, the explanation is out of place, because akṣa is enumerated, not among the bones of the head, but among those of the trunk.

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² It is this meaning of akṣa, which appears to have suggested to Aparārka the interpretation of akṣa-tāṭuṣaka, as ‘edge of the eye’, see p. 55, footnote 1.

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4. As to amsa, it is properly an indefinite term, denoting the shoulder-girdle generally. But in the Compendium of Suśruta it is frequently used as a synonym of akṣaka to denote the collar-bone, as distinguished from amsa-phalaka, which denotes the shoulder-blade or scapula. This usage is explicitly explained in a passage in the sixth chapter of the Anatomical Section (Śārīra Sthāna), where Suśruta defines the names and positions of those two parts of the shoulder-girdle. He says:

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‘In the upper part of the back, and on both sides of the vertebral column, there lie what are called the shoulder-blades (amsa-phalaka), being of triangular form (trika-sambaddha). Be-

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tween the head of the arms and the neck there lie what are called the collar-bones (*aṃsa*), connecting the shoulder-seat (*aṃsa-pīṭha*, i.e. the glenoid cavity)¹ with the nape of the neck. (Original Text in § 97, cl. 3.)

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¹ This is not quite correct. The clavicle does not connect with the glenoid cavity (*aṃsa-pīṭha*), but with the acromion process (*aṃsa-kūṭa*). Possibly the traditional reading of Suśruta’s text is at fault.

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In another passage in the same sixth chapter, in which Suśruta describes the forty-four ‘vital spots which cause weakness’ (*vaikalya-karaṇi marmāṇi*), he enumerates (Original Text in § 97, cl. 4) among their number the two *aṃsa* or collar-bones, and the two *aṃsa-phalaka* or shoulder-blades. Exceptionally, it would seem that Suśruta employed the term *aṃsa* also to denote the shoulder-blade. Thus in the passage, quoted in § 30, in which he divides the bones of the skeleton in five classes, according to their shapes, he places the bones which he there calls *aṃsa* among the pan-shaped ones. It is obvious from this very classification that by the term *aṃsa* Suśruta can there mean no other than the shoulder-blades, for these, as a fact, are pan-shaped, broad, and flat bones, while the collar-bones are short, cylindrical bones which belong to the class described by Suśruta as *nalaka*, or reed-like. In another passage of the fifth chapter, in which Suśruta enumerates the muscles (*peśī*) of the body, he says that ‘there are seven muscles round about the collar-bone (*akṣaka*) and shoulder-blade (*aṃsa*, Original Text in § 97, cl. 4). Here again it is obvious that by the term *aṃsa* Suśruta cannot mean the collar-bones, which are already indicated by the term *akṣaka*. The term *aṃsa*, therefore, can only refer to the shoulder-blades. It is possible that Suśruta might have used the term *aṃsa*, which in the ordinary Sanskrit is only a general name for the shoulder, indifferently to denote sometimes the collar-bones, and at other times the shoulder-blades. But such a practice is obviously very inconvenient, and it is not at all probable that Suśruta was guilty of it. It is far more probable that the traditional text of the passages in which Suśruta is made to use the term *aṃsa* to denote the shoulder-blades is corrupt; and that in every such case, instead of *aṃsa* we should read *aṃsa-ja*, ‘sprung from the shoulder.’ The latter term quite properly describes the shoulder-blades as springing from the shoulder (Fig. 12). It has already been explained in § 29 that the term *saṃjñā*, ‘so-called,’ which is so unaccountably found in the Traditional Recension of Suśruta’s list of the skeletal bones, suggests itself to be a corruption of the term *aṃsaja*, caused by copyists unfamiliar with skeletal anatomy and its terms. It may be suggested that probably in the two passages above referred to we should also read *aṃsaja* instead of *aṃsa*.¹ It would thus appear that Suśruta employs the following pairs of terms: (1) *akṣaka* and *aṃsa*, to denote the collar-bones; (2) *aṃsaphalaka* and *aṃsa-ja*, to denote the shoulder-blades; the last-mentioned term *aṃsa-ja* being misunderstood by copyists and changed either into *saṃjñā* or simply into *aṃsa*.

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¹ It may be useful to collect the passages in question. They are (1) in the Number-list (§ 29), for *akṣaka-saṃjñe* read *akṣak-āṃsaje*; (2) in the Class-list (§ 30), for *aṃsa* read *aṃsaja*; (3) in the list of muscles, for *akṣak-āṃsau* read *akṣak-āṃsajau*.

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5. In this connexion it may be useful to identify two other terms occasionally used by Suśruta, namely *aṃsa-kūṭa* and *aṃsa-pīṭha*. The former occurs in a passage of the sixth chapter of the Anatomical Section (*Śārīra Sthāna*), in which Suśruta describes two ‘vital spots’ (*marman*) of the body (see the Original Text in § 97, cl. 5), called by him *apalāpa* (apparently the upper attachment of the coraco-brachialis muscle: see Figs. 295, 303, 304, in Dr. Gerrish’s *Textbook of Anatomy*, 2nd ed., pp. 274 and 277). These two vital spots (one, of course, on either side of the body) he says are situated ‘below the two summits of the shoulder’ (*aṃsa-kūṭa*). The ‘two summits of the shoulder’ (Fig. 22), are the two acromion processes of the right and left scapula, below which the caraco-brachialis attachment is situated. The *aṃsa-pīṭha*, lit. shoulder-seat, is mentioned in a passage in the fifth chapter of the Anatomical Section (Original Text on § 97, cl. 6), in which Suśruta describes eight kinds of differently shaped joints.² There two joints are described as being *sāmudga*, that is shaped like a round casket (*samudga*).

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² Another mention occurs in the passage on *aṃsa*, quoted earlier in this paragraph.

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These are the shoulder-joint and the hip-joint. The former is called *aṃsa-pīṭha*, or shoulder-seat, and indicates the glenoid cavity, into which the head of the humerus is inserted (Fig. 13). The latter is described as being formed of the anal bone (*guda*, coccyx), pubic bone (*bhaga*, pubic arch), and hip-bone (*nitamba*, ilium and ischium), and indicates the acetabulum or cotyloid cavity, in which the head of the femur is lodged¹ (Fig. 20).

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¹ As a fact, the acetabulum is formed by the union of three bones, the ilium, ischium, and os pubis. The anal bone or coccyx does not enter into its formation, and should be omitted. The Suśrutiyan text is probably corrupt, as the confused manuscript readings indicate: see § 97, cl. 6.

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6. The longer form *aṃsaka* occurs, e. g. in the passage above quoted from the Commentary of Gaṅgādhara. It is a derivative of *aṃsa*, shoulder, and means shoulder-bone, that is, collar-bone. A similar formation is that of *śaṅkhaka*, temporal bone, from *śaṅkha*, temple (§ 64), and *pārśvaka*, rib, from *pārśva*, side (§ 57).

§ 56. The Shoulder-blade or Scapula

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1. *Aṃsa-phalaka*, flat bone of the shoulder, *aṃsa-ja* or *aṃsa-samudbhava*, (bone) springing from the shoulder. All three terms are employed to denote the shoulder-blade or scapula, but the first-named, *aṃsa-phalaka*, is the term which is commonly used by Ātreya-Charaka, Suśruta, and Vāgbhaṭa I. The term *aṃsa-ja* is conjectural and only occurs in the Compendium of Suśruta (§§ 29, 55). The term *aṃsa-samudbhava* is found only in the Non-medical Version of Ātreya’s statement on the skeleton, and is probably a synonymous variation of the Suśrutiyan term *aṃsa-ja* (§§ 16, 17, 21). The Atharva Veda has the peculiar term *kaphoḍa* to denote the shoulder-blade (§ 43, cl. 6).

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2. All three lists of Ātreya-Charaka (Bheḍa), Suśruta, and Vāgbhaṭa I, correctly state the number of shoulder-blades to be two; but there is a difficulty attending them which requires a word of explanation. The shoulder-girdle (Fig. 12) comprises two bones, and no more. These are the scapula or shoulder-blade, and the clavicle or collar-bone. Examining the traditional lists of Ātreya-Charaka, Suśruta, and Vāgbhaṭa I, we find a curious state of things. Charaka apparently enumerates three bones (§ 4)—*aṃsa*, shoulder, *aṃsa-phalaka*, shoulder-blade, and *akṣaka*, collar-bone. Vāgbhaṭa I has the same threefold enumeration (§ 37). On the other hand, Suśruta appears to enumerate only a single bone, namely *akṣaka*, or the collar-bone (§ 27). As regards Charaka, it has been shown in § 6 that the separate mention of *aṃsa*, shoulder, is an early error of the manuscript text caused by an inadvertent repetition, by some scribe, of the word *aṃsa* inherent in *aṃsa-phalaka*. In reality, therefore, the genuine list of Charaka (§ 7) knows only two bones as comprised in the shoulder, viz. *akṣaka*, clavicle, and *aṃsa-phalaka*, scapula. It is different with the list of Vāgbhaṭa I. That list deliberately enumerates the shoulder-peak as a third bone by the side of the shoulder-blade and the collar-bone; for otherwise (see § 37) its total of 120 bones does not work out correctly. This, however, is only one of the numerous incongruities and blunders of the list of Vāgbhaṭa I; and how he came to be betrayed into committing it has been explained in § 39, cl. 4.

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³ As regards Suśruta, it has been shown in §§ 29, 30, 56, that the omission of the shoulder-blades from his list is a textual error, due in all probability to an ancient misreading (or false emendation), by some ignorant scribe who wrote *saṃjña*, so-called, for *aṃsaja*, shoulder-blade; and that, as a matter of fact, Suśruta explicitly mentions the shoulder-blade as one of those bones which he classifies as pan-shaped (*kapāla*). In reality, therefore, the genuine list of Suśruta (§ 34) enumerates both bones which constitute the shoulder-girdle, the clavicle as well as the scapula. His explicit statement regarding the existence of the two bones, together with other evidence on the subject, has already been quoted in the preceding paragraph. An additional piece of evidence, however, may here be adduced. In the sixth chapter of his Anatomical Section (*Śārīra Sthāna*), in which Suśruta enumerates the so-called ‘vital spots’ (*marman*) in the body, he says that ‘there are eight such places in the bones’, and among these eight bones he enumerates the *aṃsa-phalaka*, or shoulder-blades (Original Text in § 97, cl. 4).

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4. The scapula is a large, flat, triangular bone (Fig. 13). That the ancient Indian anatomists knew it to be a large, flat bone is shown by the fact of their calling it *phalaka*, which word means a board or slab. But it is Suśruta alone who also notes its triangular shape. In the passage quoted in the preceding paragraph he particularly describes it as *trika-sambaddha*, trebly bounded, that is, as being of a triangular form. For the same reason of its triangular shape the sacrum likewise is called

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FIG. 13. LEFT SCAPULA, *Aṃsa-phalaka*. Posterior View. Showing—a. Acromion process, *Aṃsa-kūṭa*. b. Coracoid process. c. Glenoid cavity, *Aṃsa-pīṭha*.

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*trika* : see § 60. In this connexion Daḷḷana’s explanation of the Suśrutiyan phrase *trika-sambaddha*, triangular in form, is significant as showing the decay of anatomical knowledge subsequent to the time of Suśruta. He says: ‘The place where the two collar-bones connect with the neck, that place is meant by the term *trika*.’¹ This place, as may be seen by referring to Fig. 4, has no apparent connexion with the scapula, and its mention in a description of the latter bone, accordingly, is quite out of place. The explanation of Dallana, however, would appear to be a tradition of considerable antiquity. For its incongruity would seem to have induced Vāgbhaṭa I to change the text of Suśruta’s description of the scapula. In the seventh chapter of the Anatomical Section of his Summary, quoting Suśruta’s description, Vāgbhaṭa I replaces the Suśrutiyan phrase *trika-sambaddha*, trebly bounded or triangular, by the phrase *bāhumūla-sambaddha*, joined to the root of the arm, i. e. to the head of the humerus. Here we see that Vāgbhaṭa I replaces the incongruous expression ‘junction of the collar-bone with the neck’ by the phrase ‘junction with the head of the humerus’. Though this alteration doubtlessly now states a correct fact—the junction of the scapula with the head of the humerus in the glenoid cavity—it entirely abandons Suśruta’s striking description of the triangular shape of the scapula, apparently because Vāgbhaṭa I also did not know what to make of the Suśrutiyan term *trika*.

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¹ This explanation is also quoted in the *Bhāva Prakāśa* (Jīv. ed., p. 60). In the Bengali commentary, appended to the edition of that

§ 57. The Thorax: Sternum and Ribs

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1. *Uras* or *vakṣas*, breast, chest; *pārśva*, region of the ribs; *pārśvaka* or *parśuka*, rib. The organs denoted by these terms, which are common to all three writers, Ātreya-Charaka, Suśruta, and Vāgbhaṭa I, form three sides of the thoracic cage (*pañjara*), the fourth side being formed by the *pṛṣṭha*, or back. The four sides of the thoracic cage are made up thus: the back by the thoracic vertebrae, which are included in the term *pṛṣṭha*, back (§ 58); the two sides by the ribs, denoted by the term *pārśvaka* or *parśuka* (§ 57), and the front, by the sternum and costal cartilages, which are jointly denoted by the term *uras* or *vakṣas*, breast.

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2. Regarding the number of bones of the front of the thorax, that is, the breast (*uras*), the lists differ very considerably. Charaka’s list (§ 4) counts fourteen, while the traditional

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work by Debendranath and Upendranath Sengupta, p. 597, the place in question is explained as ‘the most depressed spot of the vertebral column, well known under the name *trika*’ (*merudatter sarva-nimna trika nāme prasiddha*)!

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Recension of Suśruta’s list (§ 27) counts only eight, and the list of Vāgbhaṭa I (§ 37) agrees with the latter. Again, the Non-medical Version of Ātreya’s list counts not less then seventeen. It has already been shown to be very probable that the latter number represents the true count of Suśruta, and that the number eight is properly the count of the list of Vāgbhaṭa I, from which subsequently it was foisted into the list of Suśruta (§§ 33, 34, 40).

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[Figure: FIG. 14. THE THORAX. Anterior View. Showing—1-7, a. Costal cartilages, Jatru. 1-12, b. Ribs, Pārśvaka. I. Sternum, Uras. II. Vertebral column, Pṛṣṭha-vaṃśa.]

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3. The bones of the organs that constitute the sides and back of the thoracic cage are satisfactorily accounted for in the next two paragraphs. The only bones that remain to be accounted for are those of the organs that constitute the front, that is, the sternum and the costal cartilages (Figs. 14 and 16). It may, therefore, be justly concluded that these must account for the numbers mentioned by the Indian anatomists. The cartilages, we may remember (§ 30), are reckoned by them as ‘tender’

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(taruṇa) bones. The costal cartilages (1-7, a, in Fig. 14) form the links that connect the sternal end of the shafts of the ribs with the sternum. But only the seven upper ribs (distinguished as the ‘true’ ribs) are in this way connected. The cartilages of the upper three ‘false’ ribs (eighth, ninth, tenth) are attached to the cartilage of the seventh rib. The remaining two ribs (eleventh and twelfth) do not connect at all with the sternum, being ‘floating’ ribs. It will be seen that these facts admit of two ways of counting the number of costal cartilages. One may take them to be either seven or eight. We have only seven cartilages, if we take those of the seventh, eighth, ninth, and tenth ribs which are attached to one another as constituting but a single cartilage; or we obtain eight cartilages, if we count the cartilage of the seventh rib and the cartilaginous attachments thereto of the eighth, ninth, and tenth ribs as two distinct cartilages. Applying these alternative views to the whole of the cartilages, or ‘tender’ bones, of the breast, we have to count either seven or eight cartilages on either side of the sternum, that is, a total of either fourteen or sixteen cartilages, or ‘tender’ bones.

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