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Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s3.t2: § 62. The Windpipe

Studies in the Medicine of Ancient India, Part I: Osteology, or the Bones of the Human Body c7.s3.t2

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§ 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.

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