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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s1.t3: § 49. Bases or Clusters

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s1.t3

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§ 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.

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