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  4. καθέδριος

var. καθέδρειος (pap.)

lat. ‒


Adjective appearing only in medical sources to denote the sitting position of the patient, especially in the context of surgical operations. Thus, it seems to be a terminus technicus of the medical language. Its earliest attestations are two papyri of medical content: P.Aberd. 11,10 of the II century CE and P.Ryl. III 529r,57 (and maybe ll.70-1) of the late III century CE.


1-2. Etymology – General linguistic commentary

The adjective καθέδριος, -ον, literally «of or for sitting» (LSJ9 851 s.v.), is derived from the name of the object that concretely receives the action of sitting, καθέδρα, «seat». As to the word formation, καθέδριος is a denominative adjective in -ιος. This suffix of Indo-European origin is most widely employed to form adjectives from noun-stems, and it has been productive during the entire history of ancient Greek, from the Homeric language to the κοινή.[1]

The noun καθέδρα, a compound of ἔδρα «seat, chair» (< κατά + ἔδρα), is in itself a derivative in -ρᾱ of ἕζομαι, «seat oneself, sit» (LSJ9 478 s.v.), from the IE root *sed, «sit down».[2] All the derivatives of καθέδρα seems to be of quite late formation. Among them can be mentioned, e.g.: the neuter diminutive καθεδράριον, «little seat», in a private letter on papyrus, P.Oxy. VI 963 (II-III d.C.),[3] and the compound κλινοκαθέδριον, «easy chair» (LSJ9 961 s.v.), gloss of κλιντήρ, «couch» (LSJ9 961 s.v., cf. e.g. Et.M. 520,26-7 Kallierges).

Also the adjective καθέδριος seems to be quite late, since it does not appear before the II century CE. The earliest attestations of the term to denote the sitting position are two medical papyri, [1] and [2]. The technical value of this word is confirmed by medical authors, from Oribasius to Paulus Aegineta (vd. infra, C 1). The neuter substantive καθέδριον, «small chair» (LSJ9 851 s.v. καθέδριος II), dates back to the same period and is first attested in Soranus (Gyn. II 37, 5,4 [CMG IV, 80,24 Ilberg]: vd. infra, C 1). Two semantic extensions of this noun are recorded in late texts: «private chamber, bower» (see schol. in Aesch. 454h [p. 209,7 Smith], vd. infra, C 1) and «toilet» (see LBG IV 727 s.v. «Abtritt, Abort»). Soranus is also the only author to use the adjective καθέδριος with the meaning «sedentary» (LSJ9 851 s.v. καθέδριος 2), cf. Gyn. I 27, 3,4 (CMG IV, 18,2 Ilberg) καθέδριον διάγειν βίον.

Finally, καθέδριος is listed in some Medieval and Modern Greek dictonaries in connection with its occurrence in medical writers up to the Byzantine time,[4] but it has left no trace in current use.


3. Abbreviation(s) in the papyri

No abbreviated form had appeared, as yet.

[1] Cf. CHANTRAINE, FN 33-8.

[2] Cf. CHANTRAINE, DELG I 313-4 s.v. ἕζομαι; FRISK, GEW I 443-6 s.vv. ἔδρα and ἕζομαι; BEEKES, EDG I 374 and 376 s.vv. ἔδρα and ἕζομαι.

[3] Cf. LSJ9 851 s.v.; LBG IV 727 s.v.

[4] Cf. e.g. DIMITRAKOS, ΜΛ 3507 s.v.

B. TESTIMONIA - A selection of representative sources

1. P.Aberd. 11,10 (LDAB 4539, MP3 2342, SoSOL 2014 20) – II CE

χειρ[ουργεία τοῦ πτερυγείου.] | μετὰ τὸν καθέδρειο̣[ν ὄντα τὸν πάσχοντα κτλ.

Surgery of pterygium. After the patient is seated etc.


2. P.Ryl. III 529r,66-81 (LDAB 1082, MP3 2376, SoSOL 2011 467) – end of the III CE

οἱ] | μὲν ἄλλοι καθ̣έ̣[δριον  ̣  ̣  ̣ ]|ωσαν τὸν κάμ̣[νοντα] σ̣χ̣η̣|ματίζειν. ἡμεῖ[ς δὲ  ̣  ̣  ̣  ̣  ̣] | κεκλιμένο⟦  ̣ ⟧‵ ν ′· τὸ ’Α̣λ̣[εξάν]|δριον σχῆμά ἐστιν δυ[σαλ]|γέστατον, τὸ δὲ κεκλ[ιμέ]|νον ἀσφαλέστερον. ἀ[σφα]|λέ̣στερον δὲ ὁτὲ μὲ[ν ὕπτι]|ον σχηματίζειν τὸν [πάσ]|χοντα, ὁτὲ δὲ πρηνῇ. ὕ̣[πτι]|ον μὲν ἐπὶ τῆς ἐξωτ[έρω] | μασχάλης [  ̣] η  ̣ [  ̣  ̣  ̣  ̣  ̣  ̣  ̣  ̣  ̣] | διαφορᾶς· πρην̣[ῆ δ’ ἐπὶ τῆς] | ὀπίσω καὶ μετὰ τ̣[ὸν καταρ]|τισμὸν πρὸς τὸ̣  ̣ [  ̣  ̣  ̣  ̣  ̣  ̣  ̣  ̣]

The other physicians put the patient in the sitting position, whereas we lay him/her down: the “Alexandrian position” [but vd. infra, C 2] is extremely painful, while the lying down position is safer. It is safer to place the patient sometimes on his/her back, sometimes on his/her stomach: on his/her back for … the dislocation … of the armpit outwards, on his/her stomach for the luxation inwards, and after the reduction for…


3. Orib. Coll. XLVI 11, 2,1-3,3 (CMG VI 2,1, 219,30-5 Raeder) – IV CE

σχηματιζέσθω δ' ὁ κάμνων ὕπτιος μέν, ἐὰν τὸ τραῦμα γεγονὸς ᾖ κατὰ τὸ μέτωπον ἢ κατὰ τὸ βρέγμα, πρηνὴς δέ, ὅταν ὀπίσω κατὰ τὸ ἰνίον·[…]. ὅταν δὲ κατὰ τὴν κορυφὴν γένηται, τότε δεῖ καθέδριον σχηματίζειν, καὶ τὸ κεφάλιον στηρίζειν ἐπὶ τῶν τοῦ ἐνεργοῦντος γονάτων.

We will place the patient on his/her back if the wound is either on the forehead or on the parietal region, whereas on his/her stomach when it is backwards, in the occipital bone […]. When the wound is on the top of the head, then the patient must be seated, with his/her head on the knees of the surgeon.


4. Aët. XV 5,50-2 (19,15-7 Kostomiris) – VI CE

ἐν μὲν οὖν τῷ ἐνεργεῖν, σχηματιζέσθω ὁ πάσχων κατακεκλιμένος, τὸ γὰρ καθέδριον σχῆμα εἰς λιποθυμίαν τάχιστα προτρέπει τὸν πάσχοντα.

During the surgical operation the patient must be placed lying on the back, for the sitting position causes quickly the patient to faint.


5. Paul.Aeg. VI 8, 1,10-1 (CMG IX 2, 51,11-2 Heiberg) – VII CE

καθέδριον τοίνυν σχηματίσαντες τὸν κάμνοντα ἤτοι ἐμπρὸς ἡμῶν ἢ ἐξ εὐωνύμων ἐκστρέψομεν τὸ ἄνω βλέφαρον κτλ.

Having placed the patient in the sitting position, either in front of us or on the left hand, we turn the upper eyelid outwards etc.


6. Id. VI, 90, 4,10-1 (CMG IX 2, 139,10-1 Heiberg)

καθέδριον τοίνυν ἢ ἀνακεκλιμένον σχηματίσαντες τὸν κάμνοντα ἁρμοδίως τῷ τραύματι κτλ.

Therefore having placed the patient in the sitting position or in a reclining posture suitable to the wound etc.


7. Id. VI 99, 2,1-6 (CMG IX 2, 152,14-9 Heiberg)

ὁ δὲ Σωρανὸς οὕτως· «καθέδριον τὸν κάμνοντα σχηματίσαντες ἤ, ὅπερ ἄμεινον, ὕπτιον διὰ τὸ ἀταλαίπωρον, εἶτα βρόχῳ τὴν χεῖρα δήσαντες κατὰ τὸν καρπὸν καὶ ἐκ τοῦ αὐχένος κρεμάσαντες, ὥστε τὸ ἐγγώνιον αὐτῆς φυλάττεσθαι σχῆμα, δυσὶν προστάσσομεν ὑπηρέταις, τὸν μὲν ἄνωθεν τοῦ κατάγματος, τὸν δὲ κάτωθεν, περιθεῖναι τοὺς δακτύλους καὶ οὕτω τὴν τάσιν ἐπιτελεῖν».

Soranus so states: “having placed the patient in the sitting position or – that is better – lying on the back, since it gives less pain, then having put a lace round the wrist and suspended it from the neck in order to preserve its angular figure, we direct two assistants, the one to put his fingers above the fracture, the other below, and thus to complete the extension”.


8. Id. VI 101, 1,3-6 (CMG IX 2, 156,19-22 Heiberg)

καθεδρίου τοίνυν ἐσχηματισμένου τοῦ κάμνοντος ἐφ' ὑψηλοτέρου δίφρου προστάσσειν ἐπὶ δίφρου τινὸς ὁμαλοῦ πρηνῆ τὴν χεῖρα τιθέναι καὶ τεινομένων δι' ὑπηρέτου τῶν κατεαγότων τοῖς δυσὶν δακτύλοις αὐτὰ διαπλάττειν, ἀντίχειρι καὶ λιχανῷ.

The patient then being seated on a higher stool, we direct him/her to lay his/her hand with the palm downwards on an(other) even stool, and the fractured parts being stretched by the assistant, we reshape them with two fingers, that is the thumb and the forefinger.


1. καθέδριος and its medical sources

The adjective καθέδριος, -ον is attested only in medical sources to denote the sitting position of the patient. It is mostly used in the description of several surgical operations, but also in other medical contexts. The common formula is καθέδριος + ὁ κάμνων / πάσχων + σχηματίζω vel sim., such as in [2], [3], [5], [6], [7] and [8]. The adjective is also associated with the noun σχῆμα, like in [4].

The evidence of the papyri is particularly relevant, since the earliest extant attestations of the term are two medical texts on papyrus. The first, dating back to the II century CE, is an ophthalmic catechism, P.Aberd. 11 ([1]).[1] The word appears in the discussion on pterygium surgery immediately before the lacuna (see s.v. πτερύγιον). ὄντα τὸν πάσχοντα, with the participle dependent from μετά, ‘after’ in temporal sense, is a likely supplement, but also κάμνοντα may be considered.[2] The verb εἰμί is unparalleled in this expression, but the space is not enough for σχηματίζοντα. Furthermore, the article before the adjective seems to suggest an attributive value, whereas in medical authors καθέδριος is always in predicative position (see e.g. [2], [5], [6], [7] and [8]). The second text, P.Ryl. III 529 ([2]), of the mid- to late III century CE, is a fragment from a papyrus codex containing a surgical treatise concerned with the treatment of shoulder dislocation.[3] Some scholars have pointed out linguistic affinities between this text and the fragments of Heliodorus (I-II cent. CE),[4] but there is no certain clue to its authorship; the treatise is rather an adespoton whose unknown author reveals originality, differences in tecnique and doctrinal divergences compared to Heliodorus.[5] The adjective καθέδριος was very plausibly restored by MARGANNE 1998, 112 and 117, while the editor princeps Roberts (see 1938, 160) simply wrote κατ̣ε̣[. The term is mentioned in a discussion on the best and less painful position in which to place the patient before performing the reduction of his/her dislocated shoulder (vd. infra, C 2). As to the lacuna in l.67, we could expect the first aorist active indicative of a verb of thinking/saying (e.g. ‘think’, ‘claim’, ‘advise’) ending in ωσαν (l.68). A plausible supplement is perhaps ἠξί]|ωσαν (ἄλλοι καθ̣έ̣[δριον ἠξί]|ωσαν τὸν κάμ̣[νοντα] σ̣χ̣η̣||ματίζειν).  

The other attestations of the term are found in late antique compendiasts. In Oribasius’ work the word has six occurrences. As well known his encyclopaedia, the ‘Collectiones Medicae’, reflects the writings of the earlier authors and some of the passages in which the word appears are directly attributed to the Greek surgeons Heliodorus (I-II cent. CE)[6] and Antyllus (II cent. CE).[7] On the one hand, this aspect might confirm the first appearance and the medical use of καθέδριος around at the time of P.Aberd. 11. On the other hand, it is not always easy to understand whether a compendiast who preserves an excerpt from an earlier physician has adapted the text to his own style and language, using liberties in making the extract. Anyway, Oribasius mentions the term in several contexts. In an excerpt from the Περὶ ποιουμένων βοηθημάτων by Antyllus the author recommends the passive exercise (αἰώρα) in the sitting position to the patient who is already free from fever (Coll. VI 23, 9,4-10,1 [CMG VI 1,1, 181,23-4 Raeder] τῶν δ' ἀπυρέτων <τοὺς ......> καθεδρίῳ σχήματι αἰωρητέον): this is the first attestation of the juxtaposition καθέδριον σχῆμα. In a chapter on the fractures of the skull (Περὶ ῥωγμῶν) it is said that the patient must be seated when the wound is on the top of his head ([3]). Other times the sitting position is recommended during the reduction of dislocated joints, i.e. the thigh (μηρός)[8] and the ankle (σφυρόν).[9] A passage, taken from the aforementioned Περὶ βοηθημάτων by Antyllus and concerning the most proper couch for the patient, might conceal a textual uncertainty. It is reported that a tilted couch, i.e. with the head higher than the feet, puts the patient under strain because he is like seated on a chair, even if this position is suitable for who has head pain. The text printed by Raeder (Coll. IX 14, 6,1-3 [CMG VI 1,2, 15,21-3 R.]) is ἡ (sc. κλίνη) δ' ἀνάρροπος σφόδρα κόπου ποιητική, ἐοικυῖα καθεδρίου σχήματι, τοῖς δὲ περὶ κεφαλὴν οὐκ ἀνάρμοστος. The manuscript tradition is unanimous in recording καθεδρίου σχήματι,[10] but Bussemaker-Daremberg in their edition (Paris 1854, p. 310,4) make the emendation καθεδρίῳ σχήματι. In the former case the term in genitive is a noun, i.e. the neuter substantive καθέδριον, and is referred to the material object, a small chair. This juxtaposition is unparalleled, whereas the dative of the adjective καθέδριος + σχῆμα has sure attestations, such as in the aformentioned passage by Antyllus on the passive exercise and in [4]. Thus, despite the consensus of the manuscripts, this aspect might lead to approve the correction made by Bussemaker and Daremberg. From a semantic viewpoint, the final meaning is similar and points to the sitting position on a seat: the form καθεδρίου σχήματι specifies that the tilted couch “is like the position of/on a chair”, while καθεδρίῳ σχήματι suggests that the tilted couch “is like the sitting position”.

In Aëtius καθέδριος occurs six times in the context of various surgical procedures: lifting by sewing up and stitching the eyelid,[11] operations performed on the tongue,[12] on the uvula,[13] on the tonsils,[14] surgery of tumoral formations[15] and scrofulous swellings ([4]). In all the related passages is used the common formula καθέδριος + σχηματίζω+ ὁ πάσχων, except in [4], where appears the juxtaposition τὸ καθέδριον σχῆμα, «the sitting position».

Also in Paulus Aegineta the term is mainly referred to the surgical position. It occurs, like in Aëtius, in surgery on the tongue[16] and on the uvula.[17] In the suture of the upper eyelid due to the so called διστιχίασις, the growth of a second row of eyelashes, the patient is placed seated either in front of the surgeon or on his left hand ([5]). The sitting position is also mentioned, in alternative with the supine posture (vd. infra, C 2), in operating the fractures of the bones of the head ([6]) and of broken arms ([7]). In the last case the passage is explicitly excerpted from Soranus, but actually it is not found in any extant Soranus’ work.[18] The formula appearing in Paulus’ passages is always the usual, but in VI 25, 2,1-2 (CMG IX 2, 64,11-2 Heiberg) καθέδριον τοίνυν τὸν ἄνθρωπον πρὸς ἡλιακὴν ἀκτῖνα σχηματίσαντες, concerning the removal of the polyp in the nose, the common ὁ κάμνων (but πάσχων in VI 29, 1,9 [CMG IX 2, 66,23 Heiberg]) is replaced by the generic ὁ ἄνθρωπος. In [8], part of a chapter on the fractures of the hand and its fingers, it is specified that the patient is seated on a stool (ἐπὶ δίφρου) that is said to be higher (ὑψηλοτέρου) than the surface, another stool (ἐπὶ δίφρου τινὸς ὁμαλοῦ), on which he/she lays the palm while the surgeon arranges the portions of fractured bones. The indication ἐπὶ δίφρου makes clearer a concept that is already ideally present in the expression καθέδριος + ὁ κάμνων / πάσχων + σχηματίζω, and concretely reveals the object that receives the action of sitting. Finally, the occurrence of the term in a chapter on the insertion of the catheter in a male bladder might conceal an element of philological uncertainty. The text edited by Heiberg (VI 59, 1,9 [CMG IX 2, 98,10 H.]) is τὸν δὲ κάμνοντα σχηματίσαντες εἰς καθέδριον, literally «having placed the patient on a seat». According to Heiberg’s apparatus it seems that the only divergence in the manuscript tradition is the presence of καί following καθέδριον in two codices of the XIV century from Paris, D (cod. Paris. Gr. 2208) and F (cod. Paris. Gr. 2292), but it might be relevant that the second hand of a codex of the X century, V (cod. Paris. Gr. suppl. 446), deleted εἰς. This deletion would reflect the common expression with καθέδριος as an adjective, whereas in the printed text καθέδριον is a noun and is unparalleled in this formula. Furthermore, the preposition ἐπί could be more appropriate than εἰς (cf. the aforementioned ἐπὶ δίφρου in [8]). In case the deletion of V2 is right, the adjective καθέδριος would acquire its common predicative value, even if it is usually placed before ὁ κάμνων / πάσχων and not after, as it would be in this passage.

The fact that the adjective καθέδριος, -ον is attested only in medical sources makes likely the hypothesis that it is a terminus technicus of the medical language, as well as the formula καθέδριος + ὁ κάμνων / πάσχων + σχηματίζω and the juxtaposition καθέδριον σχῆμα. It is also interesting to note that σχηματίζω is the verb sometimes employed in medical context to mean “to place in position upon a stool, a chair”. A clear example is found in Soranus’ description of the ‘midewife’s stool’ (Gyn. II 3, 1,1 [CMG IV, 51,12 Ilberg]): δίφρον δὲ μαιωτικόν, ἵνα ἐπὶ τούτου σχηματισθῇ ἡ τίκτουσα, «‘a midewife’s stool’, in order that the laboring woman may be placed in position on it». Furthermore, σχηματίζω is frequently used for “to position the patient” in connection with the adjective expressing the position, such as ὕπτιος, «supine»,[19] and ἀνάρροπος, «tilted up».[20] Among medical papyri, this is especially evident in P.Ryl. III 529r,74-6 ([2]) ὕπτι]|ον σχηματίζειν τὸν [πάσ]|χοντα, ὁτὲ δὲ πρηνῇ and in P.Oxy. LXXIV 4972 (LDAB 119317, MP3 2354.01, SoSOL 2015 476), dating back to the II-III cent. CE, a fragmentary text organized in question-and-answer format. This papyrus contains a systematic exposition of the divisions of surgery and maybe derives from an introductory handbook on medicine in general. In ll. 3-7 are discussed the most correct positions for given operations, mentioning in particular when the patient is lying back on a sloped couch with either the head (ἀνάρροπον) or the feet (κατάρροπον) raised higher: τὸ δὲ] σχηματικόν ἐστιν τὸ τ̣ῶ[ν | ἐπιτη]δίων σχημάτων ὥσπερ̣ | ὅταν] λ̣έγωμ̣εν ἀνάροπον (l. ἀνάρροπον) ἢ | κατάρ]ο̣πον (l. κατάρροπον) σ̣χηματίζιν (l. σχηματίζειν) τόν | κάμν]ο̣ντα, «the position-based is that concerned with appropriate positions, as when we speak of positioning the patient tilted up or tilted down» (transl. D. Leith 2009b, 63).

Finally, as to the neuter substantive καθέδριον, the only certain medical attestation is Sor. Gyn. II 37, 5,1-4 (CMG IV, 80,21-4 Ilberg) μικρὸν δ' ἐν ταῖς ἀγκάλαις αὐτὸ προδιακατέχουσα μετὰ τὸ συμμέτρου μετασχεῖν γάλακτος κοιμιζέτω καθ' οἵας ὑπεδείξαμεν κοίτης, προκύπτον δὲ καὶ ἐγκλῖνον καθεδρίῳ, where καθέδριον represents the stool on which is seated and bends forwards the woman who breastfeeds the newborn. In such a case the term has no technical value being a simple (and generic) stool. Elsewhere Soranus refers to the καθέδρα as an alternative of the aforementioned δίφρος μαιωτικός, the ‘midewife’s stool’, a seat with a crescent-shaped cavity of medium size and provided with a back, that is described in details as an essential part of the midewifery equipment.[21] In particular, in Gyn. II 3, 4,1-3 (CMG IV, 52,6-8 Ilberg) δεῖ δὴ τοιοῦτον εἶναι δίφρον οἷον εἰρήκαμεν, ἢ καθέδραν ἔμπροσθεν ἢ καὶ ὄπισθεν ἐκτετμημένην, it is stated that «the stool must be such as we have said, or it must be a chair cut out in front or also in back» to allow access for the midewife and her assistant.[22] In other two medical passages previously discussed, Orib. Coll. IX 14, 6,1-3 (CMG VI 1,2, 15,21-3 Raeder) and Paul.Aeg. VI 59, 1,9 (CMG IX 2, 98,10 Heiberg), the presence of the noun καθέδριον is puzzling, or at least dubious, the adjective being preferable in both cases, despite the manuscript and printed tradition. The neuter καθέδριον occurs only two times in late non-medical texts. In Zonar. δ 524,27 Tittmann s.v. διέδριον the term καθέδριον is used as interpretamentum of διέδριον, a compound of ἔδρα meaning a «seat for two persons» (LSJ9 423 s.v., cf. also Suda δ 896,1-3 Adler s.v.). So, it is probable that the gloss καθέδριον simply represents a generic (though not recurring) word for a ‘seat’, without a more specific correlation with διέδριον. In schol. A. Th. 454h (209,7 Smith) τῶν παρθενικῶν καθεδρίων· ἑδώλιον δὲ κυρίως ὁ ζυγὸς τῆς νηός the juxtaposition παρθενικῶν καθεδρίων appears to be the explanation of Th. 454-5 πωλικῶν / θ’ ἑδωλίων. Thus, the plural of καθέδριον – as well as of καθέδρα[23] – seems to acquire the extended semantic value of «bower, abode»,[24] that is one of the meanings of the plural ἑδώλια (cf. LSJ9 478 s.v.), even though the second part of the scholium refers to the meaning of ἑδώλιον as «rowers’ benches».[25]


2. καθέδριος in practice: word and action

Placing the patient in the proper position has been an important prerequisite for surgery since ancient times. Different physical positions are required for different procedures, so it is essential to identify the correct position for any given operation, as well as its advantages and disadvantages. The aim of selecting a particular surgical position is to allow access to the surgical site while minimizing potential risks to the patient. That surgical positioning was one of the relevant aspects relating to surgery and medical practice emerges, for example, from a passage of the Hippocratic treatise ‘De officina medici’. In Off. 2 (III 275-6 L.) τὰ δ' ἐς χειρουργίην κατ' ἰητρεῖον· ὁ ἀσθενέων· ὁ δρῶν· οἱ ὑπηρέται· τὰ ὄργανα· τὸ φῶς· ὅκου· ὅκως· ὅσα· ὅκως· ὅκου τὸ σῶμα, τὰ ἄρμενα· ὁ χρόνος· ὁ τρόπος· ὁ τόπος, the adverbs ὅκου and ὅκως express respectively «where and how» and are referred to what precedes in the list, that is «the patient, the operator, the assistants, the instruments, the light». As to the patient, ὅκου means where and ὅκως how the patient is placed, i.e. his position.[26]

In Greek medical sources the sitting position (καθέδριον σχῆμα)[27] is sometimes explicitly rejected or preferred to other positions, especially the supine one, and it was mostly used to performe operations in the upper part of the body, as it has been shown by the analysis of the ancient medical sources (see C1). The first discussion on the most proper and less painful position in which to place the patient before an operation, the reduction of a dislocated shoulder, is in P.Ryl. III 529r,66-81 ([2]). It is described a method of reduction opposed to the procedures of other physicians or schools. It is said that others place the patient seated, while the author recommends lying him down.[28] According to the word restored in ll.70-1, ’Α̣λ̣[εξάν]|δριον, the so called ’Αλεξάνδριον σχῆμα is defined as δυσαλγέστατον, whereas the lying down position is less painful and safer. MARGANNE 1998, 129 considers the ’Αλεξάνδριον σχῆμα as the same as the sitting position mentioned in l.67, but other scholars refers to these as to different postures.[29] Marganne’s opinion seems to be more plausible since, in this case, the second statement (τὸ ’Α̣λ̣[εξάν]|δριον σχῆμά ἐστιν δυ[σαλ]|γέστατον, τὸ δὲ κεκλ[ιμέ]|νον ἀσφαλέστερον) would explain the reason why the author approves the lying down position, as expressed in the previous lines (οἱ] | μὲν ἄλλοι καθ̣έ̣[δριον  ̣  ̣  ̣ ]|ωσαν τὸν κάμ̣[νοντα] σ̣χ̣η̣|ματίζειν. ἡμεῖ[ς δὲ  ̣  ̣  ̣  ̣  ̣] | κεκλιμένο⟦  ̣ ⟧‵ ν ′). There is no attestation of the ’Αλεξάνδριον σχῆμα in medical literature, and Withington’s suggestion (ap. ROBERTS 1938, 162) that the ’Αλεξάνδριον σχῆμα may correspond to the position on the Thessalian straightbacked chair (μέγα ἕδος Θεσσαλικόν) used for dislocations and mentioned by Hippocrates (Art. 7,36-43 [IV 92,10-94,1 L.])[30] appears unmotivated.[31] The reading ’Α̣λ̣[εξάν]|δριον, accepted by MARGANNE 1998, 112, was restored by ROBERTS 1938, 160, who did not understand the presence of καθ̣έ̣[δριον in l. 67. But a collation with the digital image of the papyrus[32] has raised difficulties with the supplement ’Α̣λ̣[εξάν]|δριον, inasmuch the traces are incompatible with the usual shape of α and λ. At the break, indeed, part of a small horizontal trace survives, consistent with the base of an α. It is preceded by what seems the vertical and the lower diagonal of a κ. Thus, given the possible sequence κα and the ending δριον in l.71, a likely restoration might be τὸ κ̣α̣[θέ]|δριον, that would make more coherent the opposition ἄλλοι – καθέδριον / ἡμεῖς – κεκλιμένον in ll.66-73. In such a case one might ask why the author split the word, since καθέδριον could fit on the remaining part of l.70. The answer is obviously unknown; a scribal error which led the author to finish the word on the next line is just a hypothesis. An alternative supplement that maybe fits better the space is τὸ μ̣ὲ̣[ν καθέδ]|ριον. Even though the sequence με does not seem paleographically compatible with the traces, the presence of μέν would mark the opposition expressed by the content, completing the correlative clause introduced by δέ (l.72), cf. μέν in l. 67 and δέ restored in l.69. Another likely supplement that seems to be more paleographically plausible might be τὸ γ̣ὰ̣[ρ καθέ]|δριον interpreting the trace before the α like the sloping vertical of a γ. As to the end of l.69 before the break possible supplements might be: ἡμεῖ[ς δὲ μᾶλλον] | κεκλιμένο⟦ ̣ ⟧‵ ν ′ or ἡμεῖ[ς δὲ κατα]|κεκλιμένο⟦ ̣ ⟧‵ ν ′, cf. [4] σχηματιζέσθω ὁ πάσχων κατακεκλιμένος.

In [3], part of a chapter on the fractures of the skull, the position depends on the area of the τραῦμα: when it is in the front part of the head it is recommended lying the patient on the back, but on the stomach when it is in the occipital bone, whereas the sitting position is preferred when the wound is on the top of the head. Another two passages preserved by Oribasius, both concerning the reduction of the dislocation of the femur backwards, mention the sitting position. In the first (Coll. XLIX 18, 7,2-4 [CMG VI 2,2, 29,10-2 Raeder]) the patient is placed seated but in a position rather similar to the supination, leaning towards the other hip (σχηματιζέσθω ὁ πάσχων καθέδριος μέν, μᾶλλον δὲ προσανανενευκὼς πρὸς τὸ ὕπτιον σχῆμα, ἐπιρρεπὴς πρὸς τὸ ἕτερον ἰσχίον). The second passage (Coll. XLIX 34, 9,1-4 [CMG VI 2,2, 51,19-21 Raeder]) draws a more clear distinction between the sitting and lying down position: the patient must be placed neither prone nor supine, but seated and leaning towards the healthy hip (ἐπὶ δὲ τῆς ὀπίσω διαφορᾶς οὔτε τὸ πρηνὲς οὔτε τὸ ὕπτιον σχῆμα αἱρούμεθα, ἀλλὰ <τὸ> καθέδριον ὡς ἐπὶ τὸ ὑγιὲς ἰσχίον μᾶλλον [δὲ] προσκεκλιμένον).

Controindications of the sitting position are referred to by Aëtius (see [4]) describing the surgery of the scrofulous swellings of the neck: the author eschews the sitting position because it causes the patient to faint.

In [6], concerning the operation in case of fractures of the bones of the head, Paulus Aegineta does not express a preference between the sitting and the reclining position: they are evidently regarded as equivalent for perforating the affected bone around the wound. Finally, in [7], discussing the way to set the fractures of a broken arm (vd. supra, C1), the two positions are put on the same level by the disjunctive ἤ, but only apparently, since it is specified that it is better lying the patient on the back (ὅπερ ἄμεινον), for this position gives less pain (διὰ τὸ ἀταλαίπωρον).

An in depth study of terms like καθέδριος denoting the patient positioning allows us to approach such a concrete ascpect of surgery in antiquity. According to ancient Greek sources, the sitting position was considered suitable for a broader variety of surgical procedures than in modern times. Examples are the pterygium surgery (see [1]) and the eyelid stitching,[33] that now are performed with the patient in the supine position, while the tonsillectomy is still carried out in the sitting or semi-sitting position as already suggested by Aëtius.[34] As to the shoulder relocation, the main modern techniques agree with the author of P.Ryl. III 529r,66-81 (see [2]) in placing the patient in the lying down position, sometimes prone, sometimes supine, exception being, for example, the so called “Snowbird reduction method” that involves the patient sat upright and straight on a fixed chair.

Correct patient positioning is essential still nowadays.[35] An obvius difference from antiquity is that modern positioning usually occurs after the administration of the anaesthesia. Normally adopted positions include, or are variations of, supine (face-up), prone (face-down), lithotomy (face-up, with the legs elevated and hips abducted), lateral (on the side) and seated. Like in ancient times, the supine posture is the most common surgical position and is especially used for abdominal surgery, but also, for instance, for ophthalmologic, orthopedic, thoracic, urologic and plastic operations. On the contrary, the classic sitting position,[36] belonging to the cathegory of head-elevated positions, is now used almost exclusively for specific procedures, particularly in neurosurgery for posterior craniectomies and operations on the upper cervical spine. So, although this position has a long history and has the advantage of reducuing bleeding in the operation site, its use has strongly decreased because of its potential life-threatening risks, notably venous air embolism, risk of airway obstruction and hypotension.

[1] The text was republished in MARGANNE 1994a, 104-11. For previous editions, corrections and bibliography see MARGANNE1978, 313-20, as well as EAD. 1981, 35 and 1978, 313 nn. 3-6.

[2] Cf. MARGANNE 1994a, 106. On the contrary, the restoration βίον proposed by Turner 1939, 13 and very probably influenced by the aforementioned passage by Soranus (Gyn. I 27, 3,4 [CMG IV, 18,2 Ilberg] καθέδριον διάγειν βίον) makes no sense here.

[3] The text was republished in MARGANNE 1998, 110-47. For previous editions, corrections and bibliography see ibid. p. 109 and MARGANNE 1981, 277. Cf. also MARGANNE 1983, 115-61 and 1994b, 128, as well as GHIRETTI 2010, 163-72.

[4] Cf. Withington ap. ROBERTS 1938, 159. See also ANDORLINI 1993, 502 nr. 75.

[5] Cf. MARGANNE 1994a, 128 and 1998, 147.

[6] Cf. GOSSEN 1912, 41-2 s.v. [18]; KIEL 1967, 998 s.v. [8]; TOUWAIDE-HEINZE 1998, 287-8 s.v. [5].

[7] Cf. WELLMANN 1894, 2644-5 s.v. [3] and NUTTON-REPPERT BISMARCK 1996a, 818 s.v. [2].

[8] Cf. Coll. XLIX 18, 7,2-4 (CMG VI 2,2, 29,10-2 Raeder) ἀλλ' ἢ τοῦ τονίου κάτω προσδεδεμένου, σχηματιζέσθω ὁ πάσχων καθέδριος μέν, μᾶλλον δὲ προσανανενευκὼς πρὸς τὸ ὕπτιον σχῆμα, ἐπιρρεπὴς πρὸς τὸ ἕτερον ἰσχίον and ibid. 34, 9,1-4 (CMG VI 2,2, 51,19-22 Raeder) ἐπὶ δὲ τῆς ὀπίσω διαφορᾶς οὔτε τὸ πρηνὲς οὔτε τὸ ὕπτιον σχῆμα αἱρούμεθα, ἀλλὰ <τὸ> καθέδριον ὡς ἐπὶ τὸ ὑγιὲς ἰσχίον μᾶλλον [δὲ] προσκεκλιμένον.

[9] Cf. Coll. XLIX 20, 2,1-3 (CMG VI 2,2, 30,3-5 Raeder) πάλιν δὲ δεῖ, τοῦ πάσχοντος καθεδρίου ἐσχηματισμένου καὶ τοῦ σκέλους ἐκτεταμένου, βρόχον ἰσότονον περιτιθέναι τῇ κνήμῃ.

[10] Cf. ThGL V 770D s.v. καθέδριον.

[11] Cf. VII 71,1-3 (CMG VIII 2, 320,18-20 Olivieri) περὶ ἀναρραφῆς καὶ καταρραφῆς βλεφάρων Λεωνίδου. πρὸς τὴν ἀναρραφὴν καθέδριος ὁ πάσχων σχηματιζέσθω πρὸς τοῖς ἀριστεροῖς μέρεσι τοῦ ἐνεργοῦντος, ταπεινότερος αὐτοῦ, πρὸς αὐγῇ λαμπρᾷ.

[12] Cf. VIII 38,11-5 (CMG VIII 2, 454,30-455,4 Olivieri) δεῖ δὲ πρὸς τὴν χειρουργίαν καθέδριον σχηματίσαντα τὸν πάσχοντα τὴν γλῶσσαν ἄνω ὡς πρὸς τὴν ὑπερῴαν μετεωρίσαι, ἔπειτα εἰ μὲν ὑμένες εἰσὶν οἱ τῆς ἀγκύλης αἴτιοι μικροκαμπεῖ ἀγκίστρῳ τούτους ἀνατείνοντα ἐκτέμνοντα, προσέχειν μὴ συνδιαιρεῖν τὰ ὑποκείμενα ἀγγεῖα.

[13] Cf. VIII 44,6-10 (CMG VIII 2, 463,19-23 Olivieri) πρὸς δὲ τὴν χειρουργίαν καθέδριος ὁ πάσχων σχηματιζέσθω πρὸς αὐγὴν λαμπρὰν καὶ τότε διαστελλέσθω τὸ στόμα, ἔπειτα τῷ μυδίῳ ἀποτεινέσθω ἐρείδοντες τὴν σταφυλάγραν κατὰ τὸ μεσώτατον αὐτῆς ἢ μᾶλλον ἐξωτέρω καὶ ἀποταθεῖσα ἐπιστρεφέσθω.

[14] Cf. VIII 48,67-70 (CMG VIII 2, 471,13-6 Olivieri) ἐπὶ μὲν οὖν τῶν τελείων καθέδριον δεῖ σχηματίζειν τὸν πάσχοντα, ἔπειτα διαστεῖλαι τὸ στόμα καὶ τὴν γλῶτταν σπαθομήλῃ καταστεῖλαι ἢ γλωσσοκατόχῳ καὶ τότε διελεῖν τὸ ἀπόστημα σμιλαρίῳ ἢ κατιάδι.

[15] Cf. XV 7,31-3 (25,24-26,2 Kostomiris) ἐν δὲ τῇ χειρουργίᾳ καθέδριον μὲν σχηματίζειν δεῖ τὸν πάσχοντα· καὶ εἰ μὲν μικρὸς εἴη ὁ ὄγκος, ἁπλῆ διδόσθω ἡ διαίρεσις, καθὼς ἐπὶ χοιράδων προείρηται.

[16] Cf. VI 29, 1,9-11 (CMG IX 2, 66,23-5 Heiberg) καθέδριος οὖν ὁ πάσχων σχηματιζέσθω καὶ τὴν γλῶσσαν ὡς πρὸς τὴν ὑπερῷαν μετεωριζέτω, καὶ τεμνέσθω ὁ νευρώδης ἐκεῖνος δεσμὸς ἐγκαρσίως.

[17] Cf. VI 31, 2,1-4 (CMG IX 2, 68,19-22 Heiberg) καθέδριον τοίνυν σχηματίσαντες τὸν κάμνοντα πρὸς ἡλιακὴν ἀκτῖνα κελεύσαντές τε μέγα χαίνειν σταφυλάγρᾳ ἢ μυδίῳ τὸ περιττὸν ἐκπιάσαντες καὶ πρὸς τὸ κάτω μέρος ἕλξαντες ἀποκόψομεν σταφυλοτόμῳ ἢ ἀναρραφικῷ σμιλίῳ.

[18] See however Sor. Fract. 19 (CMG IV, 158,1-6 Ilberg) περὶ βραχίονος καὶ μηροῦ. βραχίονος δὲ καταγέντος ἢ μηροῦ διαστροφὴ γίνεται πρὸς τοὺς τέσσαρας τόπους, πλεοναζόντως δὲ ἐπὶ μηροῦ γίνεται πρὸς τὸν ἔμπροσθεν <καὶ πρὸς τὸν ἔξω>, καὶ γὰρ εἰς τούτους φυσικῶς γεγαύσωται. παρέπεται δὲ ὄγκος εἰς ὃ διαστρέφεται, κοιλότης δὲ ἐξ οὗ μετάγεται, κίνησις δὲ πρὸς τὴν διὰ τῶν χειρῶν παραγωγὴν καὶ ψόφος καὶ συναίρεσις τοῦ μήκους.

[19] Cf. e.g. Paul.Aeg. VI 54, 1,8 (CMG IX 2, 95,9 Heiberg) δεῖ τοίνυν σχηματίσαι τὸν κάμνοντα ὕπτιον and VI 78, 2,1-2 (CMG IX 2, 121,14-5 Heiberg) ὑπτίου τοῦ κάμνοντος ἐσχηματισμένου.

[20] Cf. e.g. Gal. De praecogn. 13 (XIV 669,1-2 K.) καὶ ἡμισείας ἀνάῤῥοπον τε τὸν κάμνοντα σχηματίσας.

[21] Cf. Gyn. II 3 (CMG IV, 51,12-52,15 Ilberg). In the previous chapter (Gyn. II 2, 1-3 (CMG IV, 51,1 Ilberg) δίφρον μαιωτικὸν ἢ καθέδραν, «a ‘midewife’s stool’ or chair» are listed among the equipment to be prepared for labor.

[22] An interesting representation of a birthing chair is found in a childbirth scene of the II century CE from the necropolis of Isola Sacra, Ostia. It is a terracotta relief from the tomb of Scribonia Attica, midewife and wife of the surgeon M. Ulpius Amerimnus. Cf. JACKSON 1988, 98-9 and fig. 24.

[23] Cf. especially schol. A. Th. 452-6a (208,4-5 Smith) ὁρμᾶν ἐκ τῶν πωλικῶν τε καὶ παρθενικῶν ἑδωλίων καὶ καθεδρῶν – πώλοις γὰρ αἱ παρθένοι εἰκάζονται – ἐκπορθῆσαι ἐμέ and 455a (209,12 Smith) ἑδωλίων· καθεδρῶν.

[24] Cf. also ibid. 454i (209,9 Smith) πωλικῶν θ' ἑδωλίων· ἀπὸ τῶν παρθενικῶν θαλάμων.

[25] Cf. e.g. Hesych. ε 547 L. s.v. ἑδώλια· τὰ τῆς νεὼς <ζυγά>, ἐφ' ὧν οἱ ἐρέσσοντες καθέζονται and Et.M. 316,5-6 Kallierges ἑδώλια·ἐπὶ τῶν ναυτικῶν καθεδρῶν· κυρίως ἐφ' ὧν οἱ ἐρέται καθέζονται. However, it must be said that also καθέδρα has sometimes the meaning of «rowers’ seats» (cf. LSJ9 851 s.v.).

[26] See comm. ad l. by Littré (Paris 1841) 276. Cf. also Gal. In Hipp. Off. Med. comment. I 6 (XVIIIb 668,9-670,5 K.).

[27] A patient seated on a stool in a doctor’s surgery is represented in the so called aryballos Peytel (Athens, 480-470 BCE; Louvre, CA 1989-CA 2183). It is an Attic red-figure vase (H. 8,80 cm; D. 8,60 cm) that provides a unique glimpse of a medical consultation in Ancient Greece. The doctor is seated while applying the scalpel to the right forearm of a patient in the process of bleeding. On the other side of the aryballos is depicted the waiting line of patients, among whom is the man seated on a stool. See BLIQUEZ 2014, 25 n.13.

[28] Interesting is P.Lit.Lond. 166, col. IV,6-9 (LDAB 1085, MP3 2374), a surgical fragment of the II century CE on the reduction of the dislocated mandible, in which the author specifies that supination on a flat surface such as a bench is the common position for any kind of dislocation (σχηματίσαντες | γὰρ τὸν πάσχοντα κοινότερον | ἐπὶ̣ πάσης διαφορᾶς [ὕ]πτιον κα|[τὰ] βά[θ]ρου ἢ [κα]τὰ σαν[ι]δώ[μα]τ̣ος).

[29] See LEITH 2009b, 64. Cf. also GHIRETTI 2010, 171.

[30] Cf. also Gal. In Hipp. Artic. comment. I 22 (XVIIIa 344,1-345,8 K.).

[31] See MARGANNE 1998, 129 n. 29: «Le remarque de Withington […] est superflue. Il est vrai que ni lui, ni Roberts n’avaient restitué, à la l. 67, καθ̣έ̣[δριον». Cf. also EAD. 1981, 279 n. 1.

[32] I would like to express all my gratitude to Prof. Marganne for providing me with the digital image of the papyrus from the photographic archive of the University of Liège. See at the address http://web.philo.ulg.ac.be/cedopal/.

[33] Cf. Aët. VII 71,1-3 (CMG VIII 2, 320,18-20 Olivieri).

[34] Cf. VIII 48,67-70 (CMG VIII 2, 471,13-6 Olivieri).

[35] Cf. e.g. KNIGHT-MAHAJAN 2004, 160-3; ROTHROCK 2015, 155-85 with references.

[36] Cf. e.g. PORTER-PIDGEON-CUNNINGHAM 1999, 117-28; KNIGHT-MAHAJAN 2004, 162; BELOIARTSEV-THEILEN 2011, 863-77.


1. Lexicon entries

ThGL V 770D s.v. καθέδριον; LSJ9 851 s.v. καθέδριος


2. Secondary literature

MARGANNE 1998, 129; LEITH 2009b, 64

E. CPGM reference(s)

P.Aberd. 11,10 – SoSOL 2014 20.

P.Ryl. III 529r,57 – SoSOL 2011 467.


Isabella Bonati

Accepted term: 08-Nov-2015