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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2.t4: § 59. The Vertebral Column

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s2.t4

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§ 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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