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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2.t3: § 57. The Thorax: Sternum and Ribs

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2.t3

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§ 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*).

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