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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2.t1: § 55. The Clavicle or Collar-bone

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2.t1

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§ 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).

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