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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s3: C. The Head and Neck

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s3

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Contents

C. The Head and Neck

§ 61. The Cervical Vertebrae, or Neck-bones

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1. *Grīvā*, neck. This term is used in all the three lists, of Ātreya-Charaka, Suśruta, and Vāgbhaṭa I, to denote the cervical column in the posterior part of the neck. The list in the Atharva Veda (§ 43) uses the term *skandha* in the plural number to denote the neck-bones.

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FIG. 21. THE ATLAS, viewed from above. a. Arch.

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FIG. 22. THE AXIS. Anterior View. a. Body. b. Odontoid process.

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2. There is no part of the skeleton with regard to the number of bones of which the lists differ more widely. The list of Ātreya-Charaka (§ 4) makes the number of neck-bones to be fifteen. The Traditional Recension of the list of Suśruta (§ 27) makes it to be only nine, while the list of Vāgbhaṭa I (§ 37) makes it to be thirteen. As a matter of fact, the number of the cervical vertebrae is seven; but they greatly differ among themselves in some respects. The first vertebra, called the atlas (Fig. 21), is practically a mere ring. It lacks the body and spinous process of the normal vertebra. The second vertebra, called the axis (Fig. 22) consists practically only of a large strong body, surmounted by the odontoid process, on which as a pivot the atlas rotates.¹ The remaining five vertebrae possess the normal type (§ 59, cl. 3), and consist of a body and three (one spinous and two transverse) processes; but these processes, in all except the seventh, are short and bifid at the extremity (Fig. 23), and hence not very prominent. The seventh vertebra is exceptional: it approaches in shape the upper thoracic

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¹ See Dr. Gerrish’s *Textbook of Anatomy*, 2nd ed., p. 117. The odontoid process, in fact, is the body of the atlas from which it has become separated, and become ankylosed to the axis.

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[Figure: FIG. 23. A CERVICAL VERTEBRA, viewed from above. a. Body. b. Bifid spinous process. c, c. Transverse processes.]

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vertebrae, having a very long spinous process, whence it is called vertebra prominens, as well as large transverse processes.²

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² *Ibid.*, pp. 117, 124, ‘The spinous processes of the upper vertebrae are not readily felt in the living body, until we reach the 7th or sometimes the 6th spine.’

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3. These considerations fully explain Suśruta’s count of nine neck-bones. He counted each of the six upper vertebrae as a single bone; but the seventh he treated in the same way as he treated the thoracic vertebrae (§ 59, cl. 3), that is to say, he counted it as consisting of three bones; viz. a body plus spine, and two transverse processes. He thus obtained 6 + 3 = 9 bones.

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4. Ātreya-Charaka obtained his total of fifteen bones by treating the cervical column somewhat similarly to the vertebral column (§ 59). He gave two transverse processes to each vertebra, counting them as separate bones, and looked upon the bodies of the vertebrae as constituting together a single columnar bone. He thus had twice seven transverse processes, or fourteen bones, plus one columnar body, or a total of fifteen bones. That this was really Ātreya's procedure is shown by a statement of the Śatapatha Brāhmaṇa, which is evidently based on Ātreya's theory of the cervical bones, and which says (§ 42, cl. 3) of the neck-bones, ‘Fourteen are the transverse processes, and their strength (or strong bone) is the fifteenth; hence by means of them, though they are very small, man can bear a heavy load.’ At the same time, Ātreya's procedure shows that his knowledge of the structure of the cervical bones was not so intimate as that of Suśruta; for there is no single central columnar bone in the neck, and the transverse processes of the vertebrae are far less prominent in the neck than in the back¹ (Fig. 18).

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¹ ‘The transverse processes are rather short.’—Ib., p. 116.

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4. As regards the count of Vāgbhaṭa I, his total of thirteen bones probably represents, as usual, a compromise between the systems of Ātreya-Charaka and Suśruta. He appears to have counted two bones (transverse processes) for each of the cervical vertebrae, except the first, which, being a mere bony ring, without body and spinous process, was reckoned as a single bone. He would thus obtain his total of thirteen bones (i.e. 6 × 2 = 12 + 1 = 13).

§ 62. The Windpipe

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1. Kaṇṭhanāḍī, lit. throat-pipe, or jatru, windpipe. The former term is peculiar to the list of Suśruta (§ 27), the latter is employed in the list of Atreya-Charaka (§ 4). In the list of Vāgbhaṭa I both terms occur, though they denote the same organ, this being (as explained in § 38, cl. 4) one of its conspicuous incongruities.

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2. The windpipe consists of four parts, the larynx, trachea, and two bronchi (Fig. 24). These four parts are enumerated by Suśruta as four distinct bones. On the other hand, Ātreya-Charaka counts the whole organ as a single bone. Strictly speaking, of course, the organ consists not of bone at all but of cartilage; but by the ancient Indian anatomists cartilage is regarded as a kind of tender, or immature (*taruṇa*) bone (§ 30, p. 80).

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3. The word *jatru*—so far as I am aware—is explained in all Sanskrit dictionaries (native Indian, as well as European) to

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[Figure: FIG. 24. THE WINDPIPE, *Jatru* or *Kaṇṭhanāḍī*. *L.* Larynx. *Tr.* Trachea. *B, B.* Bronchi.]

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mean, not the windpipe, but the clavicle or collar-bone. This—so far as the occurrence of the word in medical literature is concerned—is a total mistake. It becomes, therefore, necessary to discuss more fully the correct meaning of the word.¹

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¹ See also a fuller discussion of this point in my article on ‘Ancient Indian Medicine’ in the Journal of the Royal Asiatic Society for 1906, pp. 922 ff.

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4. In the earliest medical compendia the term *jatru* is either synonymous with *grīvā*, neck, or signifies more especially a particular aspect of it. The neck contains two structures, posteriorly the cervical column, denoted more particularly by the term *grīvā*, and anteriorly the windpipe, denoted more particularly by the term *jatru*. As the latter term, in a general way, also denotes the whole neck, Suśruta prefers, in his list of bones (§ 27), to employ the more specialized term *kaṇṭhanāḍī*, throat-pipe, to indicate the windpipe as distinguished from the cervical column. On the other hand, outside his list, he frequently uses the two terms *jatru* and *grīvā* as practically synonymous, to denote sometimes the windpipe, sometimes the neck generally. Thus in his class-list of the bones (§ 30), enumerating the cartilages, or tender bones (*taruṇa*), he makes them to include ‘the nose, ears, neck (*grīvā*), and eyeballs’ (Original Text in § 88). Here obviously the term *grīvā* cannot refer to the cervical column, but must denote the windpipe. Again in the sixth chapter of the Anatomical Section (*Śārīra Sthāna*), speaking of certain thirty-seven ‘vital spots’ (*marman*), he says (Jīv. ed., p. 336, cl. 4) that they are situated ‘from the neck (*grīvā*) upwards’; but afterwards (Jīv., pp. 342–3, cl. 32), mentioning them in detail, he describes them as ‘situated from the neck (*jatru*) upwards’;

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and then, enumerating them, he mentions among their number some which are situated in the windpipe (*kaṇṭhanāḍī*) and others in the cervical column (*grīvā*). Here we have Suśruta employing the term *jatru* as synonymous with *grīvā*, neck, in a general way, and, again, specializing, he uses *grīvā* for the posteriorly-lying cervical column, but *kaṇṭhanāḍī* for the anteriorly-lying windpipe. Similarly Vāgbhaṭa II (in his *Aṣṭāṅga-Hṛdaya*, II. 4, verse 2, in 1st ed., vol. I, p. 592), speaking of the same thirty-seven vital spots, says that they are situated *ūrdhvaṃ jatroḥ*, or upwards of the neck, using *jatru* synonymously with *grīvā*. Again in the fifth chapter of the Pathological Section (*Nidāna Sthāna*), speaking of the rheumatic disease *manyā-stambha*, or rigidity of the neck, Suśruta says (Jīv. ed., p. 249, verse 69) *grīvā apavartate*, ‘the neck becomes awry.’ Similarly Charaka, or rather Dṛḍhabala¹ (VI. 26, verse 41a, Jīv. ed., 1896, p. 775), referring to the same disease, says grīvā antar-āyamyate, ‘the neck becomes bent inward.’ On the other hand, Vāgbhaṭa I (Aṣṭāṅga Saṃgraha, III. 15, vol. I, p. 300, last line, quoted by Vāgbhaṭa II in Aṣṭāṅga Hṛdaya, III. 15, verse 22, in 1st ed., vol. I, p. 831), says jatrur-āyamyate.¹ This shows that grīvā and jatru are synonymous terms. Again, in the thirteenth chapter of the same section, speaking of the Valmīka disease,² Suśruta tells us (Jīv. ed., p.

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286) that, among other places, it occurs grīvāyām-ūrdhva-jatruṇi, in the cervical column and upwards of the windpipe, that is, in the neck generally. Vāgbhaṭa I, speaking on the same subject (Aṣṭāṅga Saṃgraha, VI. 36, vol. II, p. 316, l. 3, quoted by Vāgbhaṭa II, in Aṣṭāṅga Hṛdaya, VI. 31, in 1st ed., vol. II, p. 682, verse 19b), says simply jatrūrdhvam, from the neck upwards, omitting grīvā, and therefore using jatru as indicating the neck generally. On the other hand, Mādhava, in his Nidāna (Jīv. ed., p. 276), paraphrasing the statement of Suśruta, uses the two terms grīvā, cervical column, and gala, windpipe, instead of Suśruta’s grīvā and jatru, thus showing that he took jatru to be synonymous with gala, windpipe. Again, in the fifteenth chapter of the Supplementary Section (Uttara Tantra), speaking of hikkā, or hiccough, Suśruta uses the term jatru-mūlāt, ‘from the base of the neck’ (Jīv. ed., p. 849, verse 9, quoted by Mādhava, in his Nidāna, p. 105). The same phrase is used by Charaka (or rather Dṛḍhabala, VI. 19, in Jīv. ed., 1896, p. 689, verse 30a) and Vāgbhaṭa I (Aṣṭāṅga Saṃgraha, III. 5, vol. I, p. 270, l. 6, quoted by Vāgbhaṭa II in Aṣṭāṅga Hṛdaya, III. 4, verse 22, in 1st ed., vol. I, p. 716). Gayadāsa, in his commentary on the Compendium of Suśruta (according to Vijaya Rakshita, in the Madhukoṣa, Jīv. ed., p. 105), explains here jatru by grīvā, neck, or kaṇṭha, throat.

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The two terms ūrdhva-jatru and jatrūrdhva are synonymous, and denote one of the three parts into which the body is divided. These three parts are: (1) the four extremities (*śākhā*), (2) the trunk or middle (*antarādhi* or *madhya*), and (3) the neck and head (*śiro-grīvā*). It is the last-named portion which is also called *ūrdhva-jatru* or *jatrūrdha*, i.e. ‘the portion from the neck upwards’, and inclusive of the neck. Both forms of the term are frequently met with. Thus Suśruta, describing the respective scope of the various parts of Medical Science, in the first chapter of the Introductory Section (*Sūtra Sthāna*, Jīv. ed., p. 2), says of Minor Surgery, that it concerns itself with ‘the cure of the diseases which have their seat in the portion of the body from the neck upwards (*ūrdhva-jatru*), that is, those maladies which affect the ears, eyes, mouth, nose, and other organs’. Chakrapāṇidatta, in his Commentary (*Bhānumati*, p. 20), here says that the term *jatru* means ‘the base of the neck’ (*grīvā-mūla*), and explains the phrase *ūrdhva-jatru* to mean ‘from the neck (base of the neck) upwards’ (*jatruṇa ūrdhvam*). Daḷḷana, in his comment on the same phrase (Jīv. ed., p. 7), says that according to some ‘*jatru* means the base of the neck, and according to others, the point of junction of the sternum and clavicles’. In accordance with this definition, Suśruta, in the Anatomical Section, chap. III, cl. 7 (Jīv. ed., p.

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337), enumerates certain vital spots (*marman*) as situated in the body from the neck upwards (*jatrūrdhvam*). In the Pathological Section, chap. I, verse 14, Suśruta again speaks of ‘diseases seated in the organs from the neck upwards (*ūrdhva-jatru*); and Daḷḷana (Jīv., p. 459) once more explains those diseases to be ‘those affecting the eyes, mouth, nose, ears, and cranium’. Many other examples of this use of the phrase *ūrdhva-jatru* might be quoted from the Compendium of Suśruta, e.g. *Sūtra Sthāna*, XXI. 30 (Jīv. ed., p. 68, l. 20); *Cikitsita Sthāna*, XXXVI, 24 (Jīv., p. 569), &c. The same usage is very common in the Summary of Vāgbhaṭa I. The following examples may be quoted: the form *jatrūrdhva* occurs in *Sūtra Sthāna*, chap. XXIX (vol. I, p. 153, l. 14), and chap. XXXVI, (vol. I, p. 176, l. 19); *Nidāna Sthāna*, chap. XV (vol. I, p. 304, l. 5), and *Uttara Sthāna*, chap. XXXVI (vol. II, p. 315, l. 21), quoted by Vāgbhaṭa II in his Compendium (*Aṣṭāṅga Hṛdaya*), *Sūtra Sthāna*, chap. XX, verse 17; chap. XXVII, verse 11; *Nidāna Sthāna*, chap. XVI, verse 22; *Uttara Sthāna*, chap. XXXI, verse 16 (in 1st ed., vol. I, pp. 373, 433, 842; vol. II, p. 681). The other form *ūrdhva-jatru* occurs in the Compendium of Vāgbhaṭa II, *Sūtra Sthāna*, chap. XX, verse 1 (vol. I, p.

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368), where he refers to *ūrdhva-jatru-vikāra*, that is, ‘diseases affecting the body upwards from the neck.’ The commentary of Aruṇadatta here explains the phrase to refer to ‘headache and similar diseases’. (For the original texts of the passages quoted above, see § 98.)

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¹ The statement is really one of the Complementor Dṛḍhabala, who wrote the chapter in question. He is expressly named as its author by Vijaya Rakshita, the commentator of the Nidāna (Jīv. ed., p. 152).

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¹ Both terms, apavartate and āyamyate, according to the commentators, are synonymous of vakrī-bhavati or vakrī-kriyate, ‘it becomes crooked’ (Nidāna, p. 152 ; Aṣṭāṅga Hṛdaya, p. 831).

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² Suppurating scrofulous glands, according to Dr. U. C. Dutt’s translation in his edition of the Mādhava Nidāna, p. 193.

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5. We will now turn to the commentators. Suśruta, speaking about hiccough in the passage above quoted, mentions *jatru-mūla*, the base of the neck. His statement is quoted by Mādhava in the seventh verse of the twelfth chapter of his *Nidāna* (Jīv. ed., p. 105). Vijaya Rakshita, commenting on this statement, quotes the explanations of Jaijjaṭa and Gayadāsa, two of the oldest commentators on the Compendium of Suśruta. Jaijjaṭa explains *jatru-mūla* to be *kaṇṭh-orasoḥ sandhiḥ*, that is, the junction of the throat with the breast-bone.¹ This shows that he understood *jatru* to be synonymous with *kaṇṭha*, throat, and to denote the anterior part of the neck (*grīvā-purobhāga*). Gayadāsa explains *jatru-mūla* by *grīvā-mūla*, base of the cervical column, which shows that by him *jatru* was understood to be a synonym of *grīvā*, neck. Again Chakrapāṇidatta (c. 1070 A.D.), in his *Bhānumatī* commentary on Suśruta, explains the phrase *jatruṇa ūrdhvam* in Suśruta I. 7, (Jīv.ed., p. 71, top line), by *hanu-sandhau*, ‘at the point of junction of the jaw (apparently the temporo-mandibular articulation).’ This shows that he also took *jatru* to denote the throat (*kaṇṭha*). Again Daḷḷana, in his commentary on Suśruta, IV. 1, verse 139 (Jīv. ed., p. 644), explains *jatru* by *vakṣo-’ṃsayoḥ sandhi*, the point of junction of the breast-bone and clavicle, which points to the base of the neck. In fact, in his comments on Suśruta, I. 23, clause 2 (Jīv. ed., p. 91, top line), as well as on Suśruta, I. 21, clause 30 (Jīv. ed., p. 86, l. 20), he explicitly identifies *jatru* with *grīvā-mūla*, the base of the neck. Again Aruṇadatta in his comments on Vāgbhaṭa II’s *Aṣṭāṅga* Hṛdaya, I. 20, verse 1 (in 1st ed., vol. I, p. 368), repeats the explanation of Dallana that jatru signifies vakṣo-'ṃsayoḥ sandhi, the articulation of breast-bone and clavicle. This definition is noteworthy as it modifies the meaning of jatru, which is no longer the throat or neck, but the base of the neck, and, for the first time, brings it into connexion with the clavicles. (For the original text of the passages, see § 98.)

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¹ Daḷḷana, in his commentary, also quotes that explanation. But Jīv. ed., p. 1249, reads it falsely *kakṣ-orasoḥ sandhiḥ*, junction of the armpit with the breast-bone, which makes no sense.

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6. The writers hitherto discussed are all medical. It will be observed that they never use the dual number with reference to jatru, as they would do if they were thinking of the pair of clavicles. They always use the singular number, indicating a single bone. Their evidence, on the whole, is uniformly and clearly in favour of jatru denoting in a general way the neck, or more particularly the throat, that is, the anterior part of the neck (grīvā-purobhāga), in short the windpipe. In the list of Suśruta (§ 27) jatru does not occur at all, but it enumerates the pair of bones, grīvā and kaṇṭhanāḍī, the cervical column and the windpipe. The list of Charaka (§ 4), on the other hand, does not name kaṇṭhanāḍī, but gives the pair grīvā and jatru. It is obvious that Suśruta’s kaṇṭhanāḍī must be identical with Charaka’s jatru, and that both those terms denote the same organ, that is, the windpipe.

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7. Turning now to the non-medical evidence, we have the earliest in the Vedas. Here we find in the Rigveda, VIII. 1¹², jatru used in the plural number: purā jatrubhya ātrdaḥ, i.e. ‘before making an incision in the costal cartilages.’ So also in Rigveda, XI. 3¹⁰, antrāṇi jatravaḥ, i.e. ‘the entrails are (represented by) the costal cartilages.’ Whatever else jatru may mean, it can in these two passages not denote the clavicles, of which there are only two, and which would be expressed by the dual number. The plural excludes any reference to the clavicles. The meaning of jatru in the plural, however, is clearly indicated in a later Vedic work, the Śatapatha Brāhmaṇa. It says (§ 42, cl. 4), ‘the ribs are fastened at either end, exteriorly to the thoracic vertebrae, and interiorly to the costal cartilages (jatru).’ It even mentions their number to be sixteen (§ 42, cl. 3), ‘there are eight costal cartilages (jatru) on the one side, and eight on the other; the sternum is the seventeenth (bone of the breast).’

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At the same time, it may be noted that Sāyaṇa, in his great commentary on the Rigveda, commenting on the first of the two above-quoted passages, explains jatrubhyaḥ by grīvābhyaḥ. He, therefore, took jatru to mean the neck (grīvā). If his interpretation should be preferred, it might refer to the cartilaginous rings of the trachea of which there are from sixteen to twenty (Fig. 24). But the important point is that in the opinion of Sāyaṇa jatru does not denote the clavicles. In the Epics and Purāṇas, jatru seems to have always the meaning of the anterior part of the neck or the throat. Thus Mahābhārata, III. 713, jatrudeśe vgavāsīdat, i. e. he fell on his throat; and Bhagavat Purāṇa, VIII. 11¹⁴, jatrāv=atāḍayat, he struck him in the throat. The singular number shows that the clavicles are not intended. Again, in Rāmāyaṇa, I. 1¹² and V. 32¹⁰, we find the phrase dṛḍha-jatru, and in Bhagavat Purāṇa, I. 19²⁷, the phrase nigūḍha-jatru, both meaning ‘strong-necked’, in the description of a hero. Here, indeed, the late commentators Rāmānuja and Śrīdhara expressly interpret jatru of the two clavicles, using that word in the dual number. Thus Rāmānuja on Rāmāyaṇa, I. 1¹², says: Jatruṇī vakṣo-’ṃsa-sandhi-gate asthinī, i. e. ‘The two clavicles are the two bones which constitute the connexion between the breast (sternum) and the shoulder (acromion).’ Similarly Śrīdhara, commenting on Bhagavat Purāṇa, I. 19²⁷, says: Kaṇṭhasya adho-bhāgayoḥ sthite asthinī jatruṇī, i. e. ‘The two clavicles are the two bones which are situated on both sides of the lower part of the throat.’ But though in these explanations Rāmānuja and Śrīdhara have obviously in view the traditional medical definition of jatru, as above quoted from the commentaries of Daḷḷana and Aruṇadatta, they understand that definition in the false sense to which, as we shall see below, the celebrated Indian dictionary, the Amara-koṣa, had given currency. Anyhow, in the passages of the Epics and Purāṇas, commented on by them, the most natural interpretation of jatru is that it means the throat or windpipe.

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8. In the Non-medical Version (§ 16) of the statement on the skeleton, as found in the Law-book of Yājnavalkya and in the Institutes of Vishnu, jatru clearly has the meaning of windpipe, for it explicitly says that there is a single jatru. It is true that the text of Yājnavalkya, published by Professor Stenzler (p. 89), reads *jatrv-ekaikam*, which, of course, can only mean ‘one collar-bone on either side’, that is, two collar-bones. But, as may be seen from the evidence set out in § 77, the true manuscript reading is *jatrv-ekam ca*, that is ‘and one windpipe’. It is unfortunate that the editors and translators of two legal treatises allowed themselves to be misled by the ill-considered explanations of the legal commentators (§ 20) into ascribing to those treatises the doctrine that *jatru* referred to the two clavicles.

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9. So far as the matter can be traced at present, the first, and really the sole, authority for interpreting *jatru* of the clavicles is the *Amarakoṣa*, an ancient Sanskrit dictionary written by Amara Siṃha, probably in the seventh century A.D. In that work, after explaining the word *aṃsa* to be a synonym of *bhuja-śiras*, or head of the arm, Amara Siṃha proceeds to say (II. 6⁷⁸), *Sandhī tasya eva jatruṇī*, i.e. ‘The two junctions of that (*aṃsa*, or head of the arm) are the two collar-bones.’ Though not very clearly expressed, it is yet clear from the context and the dual number that, in explaining the word *jatru*, he was thinking of the two clavicles. His idea seems to have been that *jatru* was the name of the two bones which run horizontally across the body from one ‘head of the arm’ (or acromion process) to the other, connecting them with each other and with the base of the neck (Fig. 4). How this idea originated is not exactly known; but the following explanation may be suggested. It seems to be a misunderstanding of the two anatomical terms *aṃsa*, collar-bone, and *sandhi*, joint or articulation. The former, as stated already, is interpreted by Amara Siṃha to mean ‘the head of the arm’ (*bhuja-śiras*)¹—a term which evidently is the popular, though inexact, equivalent of the anatomical term *aṃsa-kūṭa*, peak of the shoulder (acromion process, § 55, cl. 5). It is possible that this interpretation was suggested to Amara Siṃha by the peculiar use of the term *aṃsa* in the osteological summary of Vāgbhaṭa I.¹ In that summary, as shown in §§ 39, cl. 4, and 56, cl. 2, *aṃsa* occurs by the side of *akṣaka*, clavicle, and *aṃsa-phalaka*, shoulder-blade, and therefore, if it has any specialized meaning, it can mean only the peak of the shoulder, or the head of the arm. Having once adopted this interpretation, Amara Siṃha was naturally led, by the traditional medical definition of *jatru*, to the further misinterpretation of the latter term. That definition (as reported by Dallana and Aruṇadatta, *ante*, cl. 4) was that *jatru* signified *vakṣo 'ṃsayoḥ sandhi*, that is, the sterno-clavicular articulation. But Amara Siṃha, having taken *aṃsa* to mean the head of the arm, was of necessity driven to interpret the term *sandhi* to signify ‘a connecting bone’, and the definition in question to mean that *jatru* signified the clavicle, because it was the connecting bone (*sandhi*) between the sternum (*vakṣas*) and the head of the arm (*aṃsa*).² But this is not in accordance with anatomical usage: in the latter, *aṃsa* signifies the collar-bone, and *sandhi*, an articulation, that is, the connexion between two contiguous bones. The two terms do not signify, respectively, the summit of the shoulder, and a joint in the sense of a bone that lies between two articulations and connects two other bones. The true anatomical definition of *jatru* is that it is the sterno-clavicular articulation, or, as it is also sometimes, though less technically, expressed, the base of the neck (*grīvā mūla*). Outside the medical schools, the false interpretation of *jatru*, apparently started by the *Amarakoṣa*, that it meant the two clavicles, succeeded in winning general acceptance, so much so that its original and real meaning is, at the present day, practically lost sight of.

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¹ Hemachandra (c. 1140 A.D.) in his well-known dictionary called *Abhidhāna Cintāmaṇi*, adopts Amara Siṃha’s interpretations. In Section V, verse 588, he says *aṃso bhuja-śiraḥ skandho jatru sandhir-uro-’ṃsagaḥ*, i.e. *aṃsa* or *skandha* is the head of the arm, and *jatru* is the connecting bone between sternum (*uras*) and the head of the arm (*aṃsa*).

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¹ This seems to me the more probable view, though pending the exact determination of the date of Amara Siṃha and Vāgbhaṭa I, the question of priority—assuming that there was any interdependence—must remain uncertain.

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² The natural corollary of giving to *aṃsa* and *jatru* the meaning of ‘head of the arm’ and ‘collar-bone’ respectively is that *aṃsa-kūṭa* and *akṣaka* become superfluous; and, as a fact, both those words are omitted in the *Amarakoṣa*.

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10. To sum up: from the foregoing discussion the conclusion suggests itself that the original meaning of the word jatru may have been ‘immature bone’ or cartilage. Originally the word was used to denote the cartilaginous portions of the neck and breast, that is, the windpipe and the costal cartilages. In the Vedas it still has this undefined meaning. In the medical textbooks its use is limited to the cartilaginous portion of the neck, i.e. the windpipe (Charaka), and hence, either to the neck generally, or to the sterno-clavicular articulation at the base of the neck (Suśruta). At a comparatively late date (sixth or seventh century A.D.), and in general literature, owing to a misinterpretation of the anatomical terms sandhi and amsa, it was made to mean clavicle.

§ 63. Cranial Bones

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1. Śiras, cranium or brain-case; śiraḥ-kapāla, cranial pan-shaped bone. These two terms are employed in all the three lists, which differ only in respect of the number of the bones. While Charaka (§ 4) counts four, Suśruta (§ 27) counts six bones; and Vāgbhaṭa I (§ 37) adopts the count of Suśruta.

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² The brain-case or cranium is a hemispheroidal, oval box, made up of eight bones, namely the frontal, the two parietal, the two temporal, the occipital, the sphenoid and the ethmoid (Figs. 25, 26). Nearly the whole of it, viz. the entire vault and the larger portion of the base, is externally visible: the remainder of the latter lies internally within the skull. The externally visible portion of the cranium comprises six bones, the frontal, the two temporal, the two parietal, and the occipital. The interior, invisible portion comprises two bones, the sphenoid and the ethmoid. These two interior bones, including the small portion of the sphenoid, which shows externally by the side of the frontal (Fig. 25), were not known to the Indian anatomists. As pointed out in § 45, cl. 3, their method of dissection would not enable them to discover them; and so far as the two cranial surfaces of the sphenoid bone (Fig. 32) are concerned, they do not seem to have recognized their existence as separate from the frontal bone and as belonging to the sphenoid. In all probability

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they took them to be but continuations of the contiguous frontal bone. As to the temporal bones, they are peculiarly liable to detachment from the rest of the bony case; and it may have been for this reason that they were separately enumerated by the Indian anatomists; they are dealt with

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[Figure: FIG. 25. PROFILE OF THE SKULL. From the right. Showing—Fr. = Frontal bone Pa. = Parietal ,, } Śiraḥ-kapāla. Oc. = Occipital ,, Tm. = Temporal, Śaṅkhaka. Sp. = Sphenoid. E. = Ethmoid (in inner wall of orbit). Ma. = Malar, Gaṇḍakūṭa. N. = Nasal, Nāsikā. S. Mx. = Superior maxillary } Hanu. I. Mx. = Inferior maxillary]

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in the next paragraph. There remain only four bones, the frontal, the two parietal, and the occipital; and there can be no doubt that it is these four bones which are referred to in the list of Charaka as ‘the four pan-shaped bones of the cranium’. They are more or less decidedly concave bones, and therefore are rightly described as pan-shaped (Figs. 27, 28).

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3. The list of Suśruta substitutes six pan-shaped bones in the place of the four bones of Charaka. In order to understand this

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Ma. P P Ma. Mx Mx Sph Sph Tm. Tm. Pa. Pa. Oc.

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FIG. 26. OUTLINE OF BASE OF SKULL. Viewed from below. Showing—Oc. = Occipital. Mx. = Superior maxillary. Pa. = Parietal. Ma. = Malar. Tm. = Temporal. P. = Palate. Sph. = Sphenoid. E. = Ethmoid (not visible).

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a

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FIG. 27. FRONTAL BONE, Śiraḥ-kapāla. Internal Surface, showing frontal crest a.

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difference we must remember that Suśruta’s osteological system is strictly dominated by the principle of homology (§ 28), according to which the skeleton is considered as consisting of two lateral halves divided by a mesial plane running through the vertebral column. This plane cuts the frontal and occipital bones into two halves. As a matter of fact, these two bones consist of two halves, indicated by the frontal and occipital crests respectively (Figs. 27 and 28). In the case of the occipital bone, it is true, the two halves coalesce into one from the beginning of

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FIG. 28. THE OCCIPITAL BONE, Śiraḥ-kapāla. Internal Surface, showing occipital crest a, a.

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embryonic development; but in the case of the frontal bone they remain separated by the metopic suture, and do not become fused till about the fifth or sixth year after birth. In fact, traces of the metopic suture persist throughout life between the two superciliary ridges of the frontal bone; and in a certain percentage (about 8 per cent.) of individuals even the whole of it persists in the adult¹ (Figs. 29, 32). Either of the two halves of the frontal and occipital bones forms a separate cavity, divided by their respective crests (Figs. 27 and 28). Thus Suśruta is justified in counting ‘six pan-shaped bones of the cranium’, these being, on his principle of division, two frontal, two parietal, and two occipital. In fact in this particular, his system marks an advance on that of Ātreya-Charaka, inasmuch as it shows Suśruta’s acquaintance with the existence of the metopic suture. He had, no doubt, observed its surviving traces between the superciliary

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¹ I am indebted to Professor Arthur Thomson for the suggestion of this explanation.

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[Figure: FIG. 29. FRONTAL BONE, Siraḥ-kapāla. Anterior view, showing—a. Metopic suture. b, b. Superciliary ridges.]

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ridges, and may even have noticed the exceptional occurrence of a ‘metopic skull’. The division of the occipital bone into two halves, however, was the natural resultant of his homological principle.

§ 64. Continuation : the Temples

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1. *Śaṅkha*, temple; *śaṅkhaka*, temporal bone. The latter form of the term is found only in the Non-medical Version (§ 16), though, of course, there is no real difference of meaning between the two terms.

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2. All the three lists give the number of the temporal bones as two. Suśruta, moreover, rightly classes them among the pan-shaped (*kapāla*) bones (§ 30). They are, without any doubt identical with the two temporal bones which are recognized also by modern Anatomy as bones of the cranium, one on either side (Figs. 25, 26).

§ 65. Facial Bones: Maxillaries

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1. *Hanu*, jaw; *hanv-asthi*, jaw-bone, or chin; *hanu-mūla-bandhana*, bond, or tie-bone, at the base, or back, of the jaw; *hanu-citya*, pile or structure of the jaws. The term *hanu* properly means simply a jaw, and ordinarily may indicate both, the upper as well as the lower jaw. But it is in the treatment of these bones, as well as of the other bones of the face which are discussed in the next paragraph, that the second of the most striking differences (for the first, see § 59, cl. 3) between the systems of Ātreya-Charaka and Suśruta discloses itself. The difference, stated briefly and roughly, is that the system of Ātreya-Charaka (§ 4) recognizes the existence of only one jaw, viz. the lower, while the system of Suśruta includes two jaws, the lower and the upper. Accordingly, in the former system, the term *hanv-asthi* signifies the bone (or ‘body’) of the lower jaw, and particularly its more prominent portion, the chin, while the term *hanu-mūla-bandhana* signifies the two attachments (or ‘rami’) at the base, or back, of the lower jaw. In the list of Vāgbhaṭa I (§ 37) there occurs only the term *hanu-bandhana*, jaw-attachment, which is used in a loose way as synonymous with simple *hanu*, jaw (see § 38, cl. 6). The term *hanu-citya* is peculiar to the Atharva Veda (§ 43).

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2. Suśruta’s way of counting the jaw-bones agrees generally with that of modern Anatomy. The two maxillaries really consist each of two bones, but their two lateral halves are so intimately united by harmonic sutures that they are counted each as a single bone. In the same way Suśruta counts two *hanu* or jaw-bones, which, therefore, practically correspond to the maxillaries. Ātreya-Charaka, on the other hand, does not recognize the existence of a maxillary as a single bone. He divides either of them horizontally into a number of separate bones (Figs. 31 and 32). The superior maxillary (Fig. 30) consists of two parts, the body and certain processes. The chief of the latter are, (1)

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the palatine process which forms the hard palate (*tālu* or *tālūṣaka*), and which is counted by both Ātreya-Charaka and Suśruta as a separate bone (§ 67); and (2) the alveolar process which contains sockets of the teeth. This alveolar process, too, is counted as a separate bone, but by Ātreya-Charaka alone, who calls it *dant-olūkhala*, or tooth-socket bone. As to the ‘body’ of the superior maxillary, it would appear that Ātreya-Charaka looked upon it as being continuous with and forming part of the malar bones (§ 66). In the system of Ātreya-Charaka, therefore, there

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FIG. 30.

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SUPERIOR MAXILLARY, *Hanu*. From below. *a, a.* Palatine process, or hard palate, *Tālūṣaka*. *b, b.* Alveolar process, *Dant-olūkhala*. *c, c.* Body of maxillary.

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is practically no superior maxillary. It is replaced by three bones, (1) the hard palate (*tālūṣaka*, § 67); (2) superior alveolar process, or tooth-socket bone (*dant-olūkhala*, § 68);¹ (3) the malar bone, of which the ‘body’ of the maxillary forms a part (Fig. 32). On the other hand, the system of Suśruta, consequent on its recognizing a superior maxillary bone (*hanu*), does not admit any separate tooth-socket bone. At the same time Suśruta’s *hanu*, or upper jaw-bone, does not fully correspond to the superior maxillary, because of its excluding the palatine process, which Suśruta (equally with Ātreya-Charaka) counts as a separate bone (*tālu*, § 67).

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¹ That is, strictly, the set of thirty-two superior tooth-socket bones.

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3. The inferior maxillary (Fig. 31) is a large, strong, horse-shoe-shaped bone, which consists of a nearly horizontal body, and two posterior vertical portions, or rami. The body itself consists of three portions, the alveolar process above, the base beneath, and the mental protuberance, or chin, in front. The whole of this inferior maxillary is counted as a single bone by Suśruta, and constitutes his other *hanu*, or jaw-bone. Ātreya-Charaka, on the other hand, treats it as consisting of four bones: (1) the alveolar process (*dant-olūkhala*); (2) the base with the chin, which he calls *hanv-asthi*, or jaw-bone (chin-bone); (3) and

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FIG. 31. INFERIOR MAXILLARY, *Hanu*. Seen from the left. Showing—*a*. The base of the body, *Hanv-asthi*. *b, b*. The rami, *Hanu-mūla-bandhana*. *c*. Alveolar process, *Dant-olūkhala*. *d*. Mental protuberance, or chin, *Hanv-asthi*.

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(4) the two rami, which he calls *hanu-mūla-bandhana*, bonds at the root, or back, of the jaw-bone. He calls the rami by this name on account of their being the bones by which the ‘body’ of the lower jaw is attached to the rest of the skull.

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4. To sum up: irrespective of the hard palate, which both Ātreya-Charaka and Suśruta count separately, the list of Suśruta represents the two maxillaries by two *hanu*, or jaw-bones, while the list of Charaka breaks them up into—(1) two alveolar processes (*ulūkhala*), (2) one (lower) jaw-bone (*hanv-asthi*), (3) two rami (*hanu-mūla-bandhana*), and (4) probably a portion of his peculiar central facial bone (§ 66). This is shown in the subjoined tabular statement:

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| Modern Anatomy. | Ātreya-Charaka. | Suśruta. | Vāgbhaṭa II. |
| Sup. Max. { 1. palatal process 2. alveolar process 3. body | *tālūṣaka* *ulūkhala* facial bone (K, fig. 32) | *tālu* 1st *hanu* | *tālu* *ulūkhala* 1st *hanu-bandhana* |
| Inf. Max. { 1. alveolar process 2. base 3. chin 4. rami | *ulūkhala* *hanvasthi* *hanu-mūla-bandhana* | 2nd *hanu* | *ulūkhala* 2nd *hanu-bandhana* |

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5. The system of Vāgbhaṭa I represents, as usual, a compromise between the two systems of Ātreya-Charaka and Suśruta. From the latter he adopts the two *hanu* or jaw-bones, and from the former the two *dant-olūkhala*, or tooth-sockets. In the main, therefore, inasmuch as he holds not one, but two jaw-bones or maxillaries, he is a follower of Suśruta; but as a concession to the doctrine of Ātreya-Charaka, he divides each maxillary into two separate bones, viz. its alveolar process (*dant-olūkhala*) and its body (*hanu-bandhana*), the latter including, in the case of the inferior maxillary, its two rami. Another concession to that system appears to be Vāgbhaṭa’s use of the term *hanu-bandhana*, instead of the simpler Suśrutiyan term *hanu*. It seems probable that Vāgbhaṭa I failed to understand the significance of the word *mūla* in the Charakiyan term *hanu-mūla-bandhana*, bond at the base, or back, of the jaw. That word renders the term applicable only to the lower jaw-bone, and signifies its two rami, by which it is attached to the rest of the skull. The omission of the word *mūla* shows that Vāgbhaṭa I understood the term *hanu-bandhana* to be applicable to both jaw-bones, and to indicate that the jaw-bones were attachments of the skull. In his system, therefore, the term *hanu-bandhana* is a mere descriptive synonym of the simpler term *hanu* (§ 38, cl. 6).

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6. The system of the Atharva Veda (§ 43) appears to be essentially the same as that of Ātreya-Charaka. This seems to be indicated by its term hanvoḥ citya, or structure (pile) of the two jaws, inasmuch as that term points to the view of the jaw being a composite organ built up, as Ātreya-Charaka holds, of the separate bones which he calls dant-olūkhala, alveolar process, hanv-asthi, jaw-bone, and hanu-mūla-bandhana, two rami.

§ 66. Continuation: Malar and Nasal Bones, Superciliary Ridges

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1. Nāsā or nāsikā, nose, nasal bone; gaṇḍa, cheek, cheek-bone, malar bone; gaṇḍa-kūṭa, or hanu-kūṭa, malar prominence; lalāṭa, brow or superciliary ridge; kakāṭikā, denoting the combined nasal and malar bones. The last term is peculiar to the Atharva Veda. The term lalāṭa is only found in the several versions of the system of Atreya (§§ 4, 12, 16), and in the Atharva Veda (§ 43). The term hanu-kūṭa is peculiar to the list of Bheḍa (§ 12); Charaka prefers the term gaṇḍa-kūṭa, and Suśruta, its shorter alternative gaṇḍa.

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2. Beside the two maxillary bones which have been discussed in the preceding paragraph, and the palatal bones which will be discussed in the next paragraph, the face of the skeleton (Fig. 32) comprises the following bones: two malar, two nasal, two lachrymal, two inferior turbinated, and one vomer. Of these bones the five last-mentioned are very small, and lie in the interior of the skull. It cannot, therefore, surprise us that they escaped the observation of the ancient Indian anatomists. The only bones which, forming a portion of the external skull, came under their notice, are the malar and nasal bones of the cheek (gaṇḍa) and nose (nāsā or nāsikā) respectively. But regarding the nature of these bones, and, in fact (as already stated in § 65, cl. 1), regarding the structure of the face generally, the opinions of Ātreya-Charaka and Suśruta differ very considerably. It is on this point that the two systems show one of their two most striking divergences (for the other see § 59, cl. 3).

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3. In the systems of Ātreya-Charaka (§ 4) those four bones, the two malar (gaṇḍa-kūṭa) and the two nasal (nāsikā), are considered as forming, together with the two superciliary ridges, or brows (lalāṭa), a single continuous central bone which lies across the middle of the face of the skull, bounded by the frontal bone above, the alveolar process of the superior maxillary below, and the two temporal bones on either side. The configuration of this central bone, and its position in the face, are indicated by dotted

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FIG. 32. ANTERIOR VIEW OF SKULL. Showing, within dotted lines, the central facial bone (K, L, M, N).

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Fr. = Frontal bone P. = Parietal bone } Śiraḥ-kapāla. S. = Sphenoid bone T. = Temporal bone, Śaṅkhaka. L. = Superciliary ridges, Lalāṭa. N. = Nasal bones, Nāsikā. M. = Malar bones, Gaṇḍa-kūṭa. K. = Body of superior maxillary, Kakāṭikā. A. = Alveolar process, dant-olūkhala.

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lines in Fig. 32. It will be seen from it that the central facial bone must include also the ‘body’ of the superior maxillary, which appears to have been looked upon as forming a continuous whole with the contiguous cheek or malar bones (gaṇḍa, or *gaṇḍa-kūṭa*). A more experienced anatomist, such as Suśruta was, could not fail to see that what was supposed to be an undivided central bone was in reality a very composite structure, made up partly of a number of separate small bones, partly of portions of the bones contiguous to the hypothetical central bone. The former are the two malar bones and the two nasal bones, which accordingly Suśruta counted separately in his list (§ 27). The latter are (1) the superciliary ridges which form merely two prominent portions of the frontal bone, and (2) the lower part of the hypothetical central bone which forms really the ‘body’ of the superior maxillary. Consequently Suśruta altogether omitted the two superciliary ridges, or brows (*lalāṭa*), from his list, while he included (as shown in § 65) the lower part of the central bone in one—the upper—of his two jaw-bones (*hanu*). With regard to the nose, including its cartilaginous portion, Suśruta counted three bones. In accordance with his homological principle, he took the two nasal bones as constituting a single bone in the median line, and added the two lateral cartilages of the external nostrils. That he included the latter is proved by the fact of his enumerating the nose (*ghrāṇa*) among the tender bones (*taruṇa*): see the class-list of the bones in § 30.

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4. As to Vāgbhaṭa I, he follows his usual practice of compromise. With Suśruta he holds the separate existence of two nasal, two malar, and two maxillary bones, and with Ātreya-Charaka the separate existence of the superior alveolar process. In the main, therefore, his system agrees with the system of Suśruta, the only difference being that (as already pointed out in § 65, cl. 5) he divides the superior maxillary horizontally into two separate bones, an upper and a lower, the upper being the ‘body’ (*hanu-bandhana*), and the lower the alveolar process (*dant-olūkhala*), that is, K and A in Fig. 32. It is a difference which indicates a distinct decadence in anatomical knowledge.

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5. Ātreya-Charaka’s hypothesis of a single, undivided central bone, as reported by Charaka (§ 4), though erroneous, has at least the merit of presenting a consistent view of the structure of the face. In itself, the traditional text of Bheḍa’s report (§ 12) of that hypothesis need not necessarily involve an inconsistency. It makes Ātreya hold three central bones, constituting the nose, the cheeks, and the brows respectively. On referring to Fig. 32, it will be seen that the nasal bones might easily be taken to form a single bone; and the two superciliary ridges, irrespective of the metopic suture, do form a single bone (of the brow, lalāṭa). With respect to the two malar bones (including the ‘body’ of the superior maxillary) there would be some difficulty by reason of the nasal aperture; still, the extension of the bones downwards being undefined, they might, at a pinch, be taken to constitute a single bone. But, as has been shown in § 13, cl. 4, Bheḍa’s account of the system of Ātreya cannot be correct, because it works out the incorrect total 362, instead of 360. It is probable, therefore, that the traditional text of that account is corrupted, and that the genuine list of Bheḍa agreed with that of Charaka in counting a single undivided central bone of the face. In confirmation of this view the curious fact should be noted that the traditional text of the list of Bheḍa substitutes the term hanu-kūṭa, lit. prominence of the jaw, for the term gaṇḍa-kūṭa, prominence of the cheek, in order to indicate the malar bone. It has been pointed out above that in Ātreya’s view of the structure of the face the ‘body’ of the superior maxillary forms an extension of the malar bones. Hence, in itself, the malar prominence might be correctly described by either of the two terms, gaṇḍa-kūṭa, prominence of the cheek, or hanu-kūṭa, prominence of the (upper) jaw. But the difficulty is that the system of Ātreya knows no more than one hanu, and that that hanu is the inferior maxillary (see § 65), while the term hanu-kūṭa would introduce a reference to the superior maxillary, and thus be inconsistent with the system of Ātreya. For this reason it is practically certain that the word hanu-kūṭa in the traditional text of Bheḍa is a false reading for gaṇḍa-kūṭa. The case of the Non-medical Version of the system of Ātreya is still more unsatisfactory. That version counts four central bones in the place of the single central bone of Charaka; viz. one each for the nose, brows, cheeks, and eyes (§ 16, also § 17, cl. 4). Referring again to Figure 32, it may be seen that that count represents an impossible view of the structure of the face. The brows, or superciliary ridges, as above explained, do, indeed, form a single bone; so might the two nasal bones, and the two malar bones;

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but how the two eyes (or eyeballs) should form but a single bone is not conceivable. This only proves how little the system of Atreya was understood by the author of the Non-medical Version, and how deficient was his knowledge of anatomy—a circumstance, however, hardly surprising in a writer who was not an expert in medicine but in law.

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6. The system presented in the Atharva Veda (§ 43) agrees in the main with that of Ātreya-Charaka. The central facial bone of the latter system appears in the Atharva Veda divided into two portions, an upper and a lower. The upper portion consists of the two superciliary ridges, and is called lalāṭa, or the brow. The lower portion comprises the body of the superior maxillary together with the malar and nasal bones, and is called kakāṭikā.

§ 67. The Hard Palate

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1. Tālu, palate; tālūṣaka, palatal cavity. The former term is used by Suśruta (§ 27) and Vāgbhaṭa (37). The latter is peculiar to the system of Ātreya, and is found in the lists of Charaka (§ 4) and Bheḍa (§ 12) as well as in its Non-medical Version (§ 16).

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2. Both Ātreya-Charaka and Suśruta enumerate two palate bones in their lists; but these bones are not identical with what are called the palate bones in modern anatomy. The latter being very small bones, situated in the interior of the skull, do not appear to have been observed as separate bones by the ancient Indian anatomists. The two bones which the latter call palate bones are identical with the so-called palatine process, which is a portion of the superior maxillary bone (Fig. 30). This process consists of halves, which, projecting from either side of the junction of the alveolar process and ‘body’ of the superior maxillary, meet in the median line, in a ridge or raphé, and thus form the roof of the mouth, or what is the major portion of the hard palate.¹ These halves of the hard palate form two shallow concavities; and it is these, no doubt, which Atreya-Charaka appropriately denotes by the term tālūṣaka, or palatal cavity, and which Suśruta, in his class-list of the bones (§ 30) describes as being kapāla, or pan-shaped. From this point of view those two medical authorities are quite correct in counting, in their lists, two palates (*tālu*) or two palatal concavities (*tāluṣaka*). Vāgbhaṭa I, who ignores the median ridge, counts only one palate (*tālu*).

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¹ See Dr. Gerrish’s *Textbook of Anatomy*, 2nd ed., pp. 195, 717.

§ 68. The Teeth and their Sockets

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1. *Danta*, tooth; *dant-olūkhala*, tooth-socket, or *sthāla*, socket, or *sūkṣma*, minute bone. The term *dant-olūkhala* for the socket of a tooth occurs in the Medical Version of the system of Ātreya, as reported by Charaka (§ 4) and Bheḍa (§ 12), and adopted by Vāgbhaṭa I (§ 37), while the other two terms, *sthāla* and *sūkṣma*, are peculiar to the Non-medical Version (§§ 16, 22, cl. 4).

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2. The term *dant-olūkhala*, or tooth-socket, denotes the alveolar processes. These processes are, in reality, only portions of the maxillary bones; but Ātreya-Charaka, with whom Vāgbhaṭa I agrees, counts them as separate bones—a procedure which affects his general view of the two maxillaries, fully explained in § 65. Suśruta, in consequence of his counting the maxillaries as a pair of single, undivided bones, discards the socket-bones altogether from his list (§ 27) and counts only the teeth.

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3. With reference to the number of the teeth (*danta*) Ātreya-Charaka and Suśruta agree. Both state them correctly to number thirty-two. Ātreya-Charaka goes even so far as to count a corresponding number of sockets. Accordingly he divides either alveolar process into thirty-two alveoli, each of which is counted, in his list (§ 4), as a separate bone.

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4. As to the real morphological character of the teeth, the ancient Indian anatomists, of course, were uninformed. They took them to be bone, on account, obviously, of their hardness, and probably also of their white appearance, and because they were found to remain in the skull after every vestige of other tissue had disappeared. As a matter of fact, they ‘resemble compact bone in appearance and in composition’,¹ yet in reality they are more closely allied to the hair. For both are modifications of a papilla of the outer integument of the body. The tooth, ‘though intimately connected with the bony skeleton, is really a calcified papilla of the mucous membrane.’¹

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¹ See Dr. Potter’s *Compend of Human Anatomy*, p. 142, and Dr. Gerrish’s *Textbook of Anatomy*, 2nd ed., p. 723.

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§ 69. The Nails

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Nakha, nail. The case of the nails is similar to that of the teeth. They, like the teeth, are allied to the hair, being modifications of the cutaneous membrane. The ancient Indian anatomists looked upon the nails as a waste product (mala) of the body secreted in the process of growth of the bones. Consistently with this theory, Suśruta excludes the nails from his count of the bones (§ 27). On the other hand, Ātreya, rather inconsistently as the commentator Chakrapāṇidatta indicates (ante, p. 35), includes them in his list of bones; and, of course, as all the three versions of his system (Charaka, § 4, Bheḍa, § 12, Non-medical, §§ 16, 22) state, he counts twenty of them, one for each finger and each toe.

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