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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2: B. The Trunk

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2

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Contents

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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4. Both views are represented in the lists of the ancient Indian anatomists. Suśruta counts sixteen bones; and these sixteen, together with the median bone of the sternum, make up the seventeen bones of the uras or breast, which we find in the genuine form of his list (§ 34). Charaka, on the other hand, counts only fourteen bones (§ 4). The difficulty in his case is that apparently he ignores the existence of the sternum: one expects that he would count fifteen bones. Considering that the sternum is a very prominent bone which even a less experienced anatomist would have no difficulty in feeling under the skin, it is inconceivable that Charaka (or rather Ātreya, whose system Charaka reports) should have failed to recognize it. The probability is that Ātreya merely omitted to distinguish between bone and cartilage, that is, between the hard bone of the sternum and the ‘tender’ bone of the costal cartilages. To him probably the sternum appeared to be merely a continuation of the latter which he considered as meeting in the median line of the breast. He looked upon the front of the thoracic cage as formed by a series of seven long bones, placed horizontally one above the other, and attached to one another in the median line. On the homological principle, he divided this series of bars into two halves, and thus obtained his total of fourteen bones.

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5. Suśruta’s treatment of the bones of the breast marks an anatomical advance, inasmuch as he distinguishes the sternum from the adjacent costal cartilages, and the cartilaginous attachments of the eighth, ninth, and tenth ribs from the cartilage of the seventh rib. Incidentally, moreover, Suśruta’s count of seventeen bones of the breast has an important chronological bearing, inasmuch as the same count is found in the ritual Śatapatha Brāhmaṇa (see §§ 42, 62), the reputed author of which, Yājñavalkya, not being a medical expert himself, must have obtained his knowledge of the skeleton from the current surgical school of his time. Suśruta, therefore, must be placed earlier in date than the Śatapatha Brāhmaṇa.

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6. It is not quite so easy to recognize a rational ground for the number eight of the list of Vāgbhaṭa I. The only explanation that can be suggested is that it arose from an unintelligent attempt at combining the doctrines of Ātreya-Charaka and Suśruta. While accepting the former’s theory of a series of bars, Vāgbhaṭa I added to it an additional eighth bar, in conformity with the count of Suśruta. At the same time he abandoned the homological division into halves, which would have given him sixteen bones for the breast. The reason of this abandonment, probably, was that the duplication of the number eight (or, for that matter, of the number seven) would have interfered with his obtaining the requisite total of 360 bones for the whole skeleton (§§ 38, 41).

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§ 58. Continuation: the Ribs, and their Appendages

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1. Pārśva, region of the ribs; stana, breast; pārśvaka or parśuka, rib; sthālaka, socket; arbuda, tubercle. The last three terms are peculiar to the list of Ātreya-Charaka (§ 4), from which they are adopted into the list of Vāgbhaṭa I (§ 37). Suśruta uses only the first term, but that he agrees with the theory of Ātreya-Charaka, implied in the use of the other three terms, is evident from the fact that both hold the same number of bones to constitute the pārśva, or region of the ribs. According to Ātreya-Charaka these bones number seventy-two, while according to Suśruta they number thirty-six on either side, and therefore seventy-two altogether. The term stana occurs in the list of the Atharva Veda (§ 43).

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2. Suśruta does not explain how this number is arrived at, but Charaka states that there are twenty-four pārśvaka or parśuka, ribs, twenty-four sthālaka, sockets, and twenty-four arbuda, tubercles. And, of course, as indicated by Suśruta's manner of counting, it is to be understood that there are twelve of each kind, that is, altogether thirty-six, on each side. Each rib (Figs. 15, 16, 17) consists¹ of a shaft, and of a head with neck; also at the point of junction of these two parts there is a tubercle which articulates with the transverse process of the corresponding vertebra; and this transverse process has a facet, or very shallow cavity, for the reception of the tubercle. It is from this facet that the transverse process takes its name sthālaka, which word means a shallow socket. The transverse processes, though really a part of the vertebral system, are considered by the ancient Indian anatomists a part of the system of ribs by reason of their containing the sockets, or facets, for holding the ribs. The word sthālaka is a diminutive of the word sthāla, vessel, cup, or pan, and means a small or shallow cup or pan. In anatomical terminology the two words, sthāla and sthālaka, mean, respectively, socket for a tooth (§ 68) and shallow socket (or facet) for a rib. The name of the tubercle is arbuda, and the

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¹ See Dr. Potter's Compend of Human Anatomy, p. 38.

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[Figure: FIG. 15. THE FIRST AND SIXTH RIBS. a. Head } Sthālaka. b. Neck } c. Tubercle, Arbuda. e. Shaft, Pārśvaka. f. Extremity of Shaft, articulating with costal cartilage.]

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name of the shaft (including the neck), or rib proper, is *parśuka* or *pārśvaka*. Each of the three parts, the rib, its tubercle, and its corresponding transverse process, as usual with the ancient Indian anatomists (§ 44), is counted as a separate bone. It may be noted, however, that even admitting the Indian way of

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[Figure: FIG. 16. DIAGRAM OF TRANSVERSE SECTION OF THORAX. Showing—I. Vertebra, *Pṛṣṭhāsthi*, with *a*. Body. *b, b*. Transverse process, *Sthālaka*. *c, c*. Spinous process. II. Rib, with *d, d*. Shaft, *Pārśvaka*. *e, e*. Tubercle, *Arbuda*. *f, f*. Costal cartilage, *Uras*. III. Sternum, *Uras*.]

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counting, there would strictly be only sixty-eight bones (or thirty-four on either side), because in reality there exist only ten tubercles on either side, the two lowest, or ‘floating’, ribs (the eleventh and twelfth) having no tubercles. But the Indian anatomists, owing to their usual fancy for symmetry (§ 44), count twelve tubercles, just as they count fifteen joints in the fingers and toes.

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3. The only Indian writer, who, so far as I know, attempts to give a detailed explanation of the three terms *pārśvaka*, *sthālaka*, *arbuda*, and of their respective numbers, is Nanda Paṇḍita. As his explanation differs from that above given, it becomes necessary to consider its claims to acceptance. It occurs

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[Figure: FIG. 17. THORACIC VERTEBRA, *Kīkasā*. A. Lateral View. B. Posterior View. *a*. Body. *b*. Spinous process. *c, c*. Transverse processes, *Sthālaka*, with *d*. Facet for tubercle of rib.]

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in his commentary on the Institutes of Vishnu, and runs as follows:

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There are thirteen ribs (*pārśvaka*) on either side, which aggregate to twenty-six. The tubercles, (*arbuda*), being the bones which connect the ribs with the breast (*vakṣas*), are ten on either side, which make twenty. The sockets (*sthālaka*), being the bones which connect them with the back (*pṛṣṭha*), are thirteen on either side, which make twenty-six. In this way, the ribs together with their tubercles and sockets amount to seventy-two (i.e. 26 + 20 + 26 = 72). (Original Text in § 85.)

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It is evident that in this explanation the tubercles (*arbuda*) are identified with the costal cartilages which connect the upper ten ribs with the sternum (Fig. 16). But the term tubercle, *arbuda*, would be most inappropriate as applied to the costal cartilages. Moreover, the latter do not belong to the ‘region of the ribs' (*pārśva*), but to the front of the thoracic cage, or the breast (*uras*); see § 57. Further, there are, strictly speaking, not ten costal cartilages, but only seven; for the four lowest connected ribs have, between them, only one cartilage. On this last point, indeed, theories of counting might differ; but what is fatal to the explanation of Nanda Paṇḍita is the explicit statement in the list of Charaka that the numbers of the ribs, sockets, and tubercles are equal, there being twenty-four of each kind. Another fatal objection is that there are, as a fact, not 'thirteen ribs on either side', but only twelve. A thirteenth rib does occur in exceptional cases; but twelve is the normal number, and obviously that number alone can serve for the count. Moreover, it is most improbable that Nanda Paṇḍita had any knowledge of the rare occurrence of an exceptional thirteenth rib. In all probability, he adopted his count of thirteen ribs from the *Śatapatha Brāhmaṇa* (see § 42, cl. 9), which treats the collar-bone as a thirteenth rib, not realizing that by doing so he was duplicating the collar-bones which are separately enumerated in the list of the Institutes of Vishnu under the name *akṣa* (*akṣaka*).

§ 59. The Vertebral Column

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1. *Pṛṣṭha*, back; *pṛṣṭha-vaṃśa*, lit. back-row, i. e. vertebral or spinal column; *pṛṣṭh-āsthi*, back-bone, or *pṛṣṭha-gat-āsthi*, bone belonging to the back, or *pṛṣṭi*, back-bone, all three denoting the vertebra. The first two terms are chiefly found in Suśruta; the next two chiefly in Charaka and in the Non-medical version of the Institutes of Vishnu. The last term, *pṛṣṭi* (or *pṛṣṭī*), which properly denotes the transverse process of a vertebra, and thence the vertebra itself, is peculiar to the Vedas (§§ 42, 43), where it occurs in the plural number to denote the series of vertebrae or the vertical column.¹ 2. The actual number of the bones of the entire vertebral column is twenty-six, consisting of twenty-four simple and two composite bones. The former are the true vertebrae, and comprise the seven cervical, the twelve thoracic, and the five lumbar

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¹ In the Vedas there occur the following further terms: *kīkasa* for the entire spinal column, or for its cervical, or thoracic, portion; *anūka* or *anūkya* and *karūkara*, for its truncal portion; *anūka*, for its thoracic, or lumbar portion, and *udara* for its lumbar portion; also *karūkara* and *kuntāpa* for the transverse processes of the vertebra. See § 42, cl. 3 and 4; also my article on Ancient Indian Medicine, in the Journal of the Royal Asiatic Society for 1907, pp. 2–10.

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FIG. 18. VERTEBRAL COLUMN, Pṛṣṭha-vaṃśa. A. Lateral View. B. Dorsal View. I. Cervical, Grīvā. II. Thoracic, Anūka. III. Lumbar, Udara. IV. Sacrum, Trika. V. Coccyx, Guda.

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vertebrae. The two composite bones are the sacrum or sacral bone, and the coccyx or anal (caudal) bone (Fig. 18). Either of these consists of five vertebrae fused together, and hence known as the false vertebrae. It is to be noted, however, that the first sacral vertebra is of a transitional and partly lumbar character, and occasionally remains permanently separate.¹ It is this fact which appears to have caused Suśruta to count six lumbar vertebrae.

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¹ In some quadrupeds, e.g. the gibbon, the normal number of the lumbar is six, and of the sacral four. See Dr. Gerrish, Textbook of Anatomy, 2nd ed., p. 133, Dr. Wiedersheim, Structure of Man, p. 34.

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3. As regards the cervical vertebrae, they are counted by the Indian anatomists separately, as constituents of the neck (§ 61). Moreover, in Suśruta’s system, the sacral and anal bones also are

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[Figure: FIG. 19. THORACIC VERTEBRA, Pṛṣṭhāsthi or Pṛṣṭi. Superior Aspect. a. Body. b, b. Transverse processes, Sthālaka. c. Spinous process. d, d. Facets for tubercle of ribs. e. Arch.]

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counted separately as constituents of the pelvis (§ 60). There remain, therefore, only the twelve thoracic and five lumbar vertebrae, altogether seventeen, or, if we include the sacral and anal bones, nineteen bones to be accounted for. Against these seventeen or nineteen bones Suśruta counts thirty, and Charaka forty-five. In order to appreciate these large numbers correctly, we must remember the peculiar practice of the Indian anatomists to count ‘processes’ as separate bones (§ 44, cl. 1). Each vertebra (Fig. 19) consists of a ‘body’ and an ‘arch’, the latter being constituted of three particularly prominent ‘processes’, viz. the two transverse processes and the spinous process. Charaka counts these four parts, that is, the body and the three processes of the arch, as separate bones. On this point, Suśruta differs from Charaka; and it constitutes one of the two cardinal points of difference between the two systems (for the other, see §§ 65, 66). In the view of Suśruta, with his more thorough application of the principle of homology (§ 28, cl. 2), the body and spinous process, both of which lie in the median line of the body, constitute but a single bone, while the two transverse processes, being homologous on the right and left sides of the body, are separate bones. Accordingly, while Charaka counts four, Suśruta counts only three bones to each vertebra. Moreover, with regard to the thoracic vertebrae, another point must be remembered Their transverse processes were reckoned by the Indian anatomists along with the ribs as their *sthālaka*, or sockets, and have been already disposed of in the preceding paragraph. It is only the body and spinous process of the thoracic vertebrae which are counted by them as ‘bones belonging to the back’ (*pṛṣṭha-gat-āsthi*).

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4. The system of Suśruta counts thirty bones, exclusive of the vertebrae of the neck (§ 61) and the pelvis (§ 60). This number is made up thus:

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| 12 thoracic vertebrae (excl. transverses) . . . . 12 bones | |
| 6 lumbar vertebrae (incl. first sacral, and dividing | |
| each into body and two transverses) × 3 . . 18 bones | |
| Total . 30 bones | |

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In the case of the first sacral vertebra, its two alae (Fig. 20, *i i*) correspond to the two transverse processes of the ordinary lumbar vertebra.

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5. The system of Charaka counts forty-five bones. Like Suśruta’s system it excludes the vertebrae of the neck; but, unlike it, it includes those of the pelvis (the sacral and anal bones). Accordingly its numeration is made up thus:

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12 thoracic vertebrae (excl. transverses, but separating body and spine) × 2 . . . . . 24 bones 5 lumbar vertebrae (separating body, spine, and two transverses) × 4 . . . . . 20 bones 1 pelvic bone (incl. sacrum and coccyx) . . 1 bone

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Total . . . . . 45 bones

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6. The treatment of the pelvic bones by Suśruta and Charaka respectively shows the former's advance in anatomical knowledge. That Charaka took the sacrum and coccyx to constitute a single bone is shown by the circumstance (infra, cl. 7) of Vāgbhaṭa I adopting that count from him. Suśruta's more intimate knowledge of the structure of the pelvis is shown not only by the fact that he recognized the separate existence of the sacrum and coccyx, but also by the fact that he realized the peculiar shape of the sacrum as being triangular (§ 60, cl. 3), and especially of its first vertebra as resembling that of the fifth lumbar, on which account, in fact, he counted the first sacral rather as a lumbar vertebra.

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7. The system of Vāgbhaṭa I is peculiar. Its aim is to combine the systems of Charaka and Suśruta (§ 38). Following the doctrine of the latter, Vāgbhaṭa I counts thirty back-bones, excluding the sacral and anal bones from the vertebral column, and relegating them to the pelvis. But if he had reckoned these two as separate bones, he would not have been able to secure the required total of 360 bones for the whole skeleton. Accordingly, with regard to this count, he adopted the system of Charaka, and counted the sacrum and coccyx as constituting a single bone. In the system of Vāgbhaṭa I, therefore, the term trika, or triangular bone, which he took over from Suśruta, includes both the sacral and anal bones (§ 60, cl. 4).

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§ 60. The Pelvis: Hip-bones, Pubes, Sacrum, Coccyx

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1. Śroṇi, pelvis, or the pelvic cavity, consisting of śroṇi-phalaka, or nitamba, hip-blade; bhaga or bhag-āsthi, pubes or pubic bone; trika, sacrum or sacral bone; and guda or gud-āsthi, coccyx or anal (caudal) bone. The term śroṇi-phalaka is peculiar to the list of Charaka (§ 4), while Suśruta (§ 27) and Vāgbhaṭa I (§ 37) use the term nitamba. The full form bhag-āsthi, bone of the pubes, or the pubic arch, is employed in the list of Charaka. The shorter form bhaga occurs in the lists of Suśruta and Vāgbhaṭa I. In literary Sanskrit, and in popular usage, the word bhaga has the narrower meaning of the external female sexual organ, the vulva¹ (yoni); but in medical usage it has a wider meaning, irrespective of sex. There it denotes the inferior part, or base, of the trunk, that is, in the male, the space between the anus and scrotum, or the perinaeum; in the female, the space occupied by the vulva and the perinaeum. When not referring to the trunk as a whole, but to its bony constituents, bhaga, or more accurately bhag-āsthi, or bone of bhaga, denotes the bone contained in that inferior part, namely, the pubic arch, made up by the two ossa pubis and the symphysis (Figs. 4, 21). It is quite correctly described by Chakrapāṇidatta (§ 11, cl. 2, p. 36) as ‘the cross (tiryak) bone which binds together the haunch-bones (ilium plus ischium) in front’. The full form gud-āsthi, or bone of the anus, anal (or caudal) bone, occurs in the Compendium of Vāgbhaṭa II.² But in the lists of Suśruta and Vāgbhaṭa I the shorter form guda is used. That word ordinarily means anus, but of course in the lists, being the denotation of a bone, it must signify the anal, or caudal bone, that is, the coccyx.

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¹ It is this circumstance which led to the absurdity, explained in § 9, of the inclusion of the male and female generative organs, medhr-āsthi, penis, and bhaga, vulva, by Gaṅgādhar in his recension of Charaka’s list of the bones of the skeleton. The usage of literary Sanskrit is taught in the great vocabulary, the Amarakosa, while the medical usage is defined in the medical vocabulary, Rājanighaṇṭu; see § 97, cl. 7.

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² e.g. Aṣṭāṅga Hṛdaya, Nidāna Sthāna, chap. ix, verse 1, in 1st ed., vol. i, p. 758.

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2. Suśruta, in his statement on the skeleton (§ 27), explicitly states that the pelvic cavity is constituted of five bones, namely, the anal bone (guda), the pubic bone (bhaga), the two hip-bones (nitamba or śroṇi-phalaka), and the triangular bone (trika, or sacrum). This agrees with the actual constitution of the pelvic cavity. For the pelvis includes the coccyx or caudal bone (guda), the triangular sacrum (*trika*), and the two ossa innominata. These last-mentioned bones consist, each of three parts, the ilium, ischium, and os pubis. The Indian anatomists prefer to divide the ossa innominata into two parts, namely a posterior and an anterior portion. The former, consisting of the ilium and ischium, exists in duplicate, one on the right, the other on the left side of the skeleton, and is named *śroṇi-phalaka* (or *nitamba*), blade of the pelvis, hip-blade. The latter is formed by the prominent pubic arch, and is called *bhag-āsthi*, bone of

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FIG. 20. Pelvis, Śroṇi. Anterior View. Showing—a, a. Ilium plus (below) Ischium, Nitamba. b, b. Ischio-pubic arch, Viṭapa. c. Coccyx, Guda (see Fig. 18). d. Fifth lumbar vertebra. e. First sacral or sixth lumbar vertebra. f. Sacrum (2nd-5th vertebrae), Trika. g. Pubic arch, Bhag-āsthi. h. Ridge between first and second sacral vertebrae. i, i. Alae of first sacral or sixth lumbar vertebra. k, k. Acetabulum, Guda-bhaga-nitamba.

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the pubes (Figs. 4, 20). As this bone lies in the median line of the skeleton it is not subject to duplication by the homological principle, but (like the penis and vulva to which it gives attachment) it is counted, in the Indian anatomical system, as a single bone. In fact, it corresponds, in the lower part of the body, to the breast-bone or sternum, in the upper part; and thus the ischio-pubic arch (*viṭapa*, § 28, footnote on p. 72), connecting the pubic arch with the ischium, is the homologue of the clavicular arch (*kakṣa-dhara*, clavicle), connecting the sternum with the shoulder. The pubic arch, of course, does not really consist of a single bone, but is made up of two bones, the ossa pubis, which form the two sides of the arch, and which are bound at the top of the arch by means of a cartilaginous disk forming the symphysis pubis. But it must be remembered that for the Indian anatomist cartilage is bone (§ 30), and from his point of view he was justified in regarding the whole arch as composed of a single bone. We must also remember that the mode of counting the bones of the skeleton is more or less arbitrary at all times. Modern anatomy counts the ilium and ischium as two separate bones, though, as a matter of fact, they are ankylosed in the adult: it does so as a matter of scientific convenience, and is justified in doing so by the circumstance that they are really separate in early life. Indian anatomists, on the other hand, having regard to the adult condition, count the ilium and ischium as constituting a single bone.

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3. On the other hand, in the system of Ātreya-Charaka, the anal (*guda*) and sacral (*trika*) bones are not reckoned as parts of the pelvis, but as a portion of the vertebral column. In that system, indeed, those two bones are considered to constitute but a single bone, which is included among the forty-five vertebrae (§ 59, cl. 5) without being named separately. This, as has been stated (§ 59, cl. 6), is one of the marks of the divergent pelvic systems of Suśruta and Ātreya-Charaka. Suśruta seems to have been the first to count the sacrum and coccyx separately, and thus to recognize the distinction between true and false vertebrae. It is also not improbable that he was the first particularly to observe the triangular shape of the sacrum, and to give it the name *trika*, or triangle, which expresses that fact, and by which it is now generally known. It should be noted, however, that Suśruta’s *trika* is not quite identical with the sacrum of modern anatomy. He treats the first sacral vertebra as belonging to the lumbar region, and as forming a sixth lumbar vertebra (§ 59, cl. 2, 4). His sacrum, therefore, comprises only four vertebrae, and it constitutes the triangular bone which is made up of these four, and which subtends the ridge that connects the two uppermost foramina of the sacrum (Fig. 20, *h*).

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4. Vāgbhaṭa I, as usual, attempts to combine the systems of Ātreya-Charaka and Suśruta. From the latter he adopts the transfer of the sacral and anal bones from the vertebral column (*pṛṣṭha*) to the pelvis (*śroṇi*). But he follows the former in counting them as forming together a single bone, which he names *trika*, or triangular (§ 38, cl. 3, § 39, cl. 7).

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