Giorgina Barbara Piccoli, MD and Martina Ferraresi, MD
SS Nephrology, Department of Clinical and Biological Science, University of Turin – ASOU San Luigi Gonzaga, Orbassano, Torino, Italy

Figure 1 - Sts. Cosmas and Damian
Riace, Italy
GB Piccoli

In a time of war, terror, and religious intolerance, it may be worth reconsidering our roots as physicians and healers. Most physicians are acquainted with some aspects of the story of the twin brothers, Cosmas and Damian, protectors of medicine and surgery, often mentioned as the first to perform an allo-transplantation. They are well-known in medicine, as well as in art, because of the splendid paintings of Fra Angelico (one of the very few painters to be beatified) and of other wonderful icons and Byzantine paintings.1-5 However, the saints’ story is more complex; and, as happens with important long-lasting legends, traditions change throughout the world, each variation having a particular nuance, interest, and fascination.

What is known, or at least is almost uniformly told, is that the two saints were born in Egea, a Cilician town. They were brothers, working together and martyred together during the Domitian prosecution, probably in 303 AD.6 However, the details of their life, their family history, and even their age differ among the various sources.6 There are at least three pairs of brother saints called Cosmas and Damian in Christianity. Two pairs belong to the Byzantine church: one of the pairs is younger than the other (in Byzantine depictions, they usually wear beards). The third pair belongs to the Catholic church: the saints are usually young, unexpectedly so given the dozens of miracles attributed to them(Figure 1).6

Tradition calls the saints “anarghiroi”, meaning “without money or not dealing with money.” This, indeed, is a constant motif in their history and miracles. The practice of curing without monetary rewards dates back to Hippocrates, who wrote that a physician has the obligation to heal the poor and foreigners.7 In the story of Cosmas and Damian, there is only one exception to the rule, probably underlined in their hagiography to stress their probity and honesty: Damian once accepted the gift of three eggs from a woman, usually called Palladia, who was healed by the twins. Cosmas was so upset he ordered that at their death his corpse should be buried far away from his brother’s. However, the legend recounts that during the night God appeared to Cosmas telling him to forgive his brother, or, in different versions, that at their death, a female camel appeared to the faithful burying the saints after their martyrdom (according to several sources, they were martyred together with three other brothers, all physicians). The camel spoke with a human voice, saying that “Cosmas and Damian cured not only you, men, but us too, wordless animals. Therefore I come, grateful to them, to tell you that the Lord orders you to bury them together.”6 Because of their varied healing abilities, Cosmas and Damian are honoured as the saints of physicians, pharmacists, veterinarians [according to the prophet David: “Lord you heal men and animals” Psalm 36] barbers and, more recently hairdressers (despite the lack of a current relationship with medicine).6

As is immediately evident from the vast array of professions under the saints’ protection, the Mediterranean tradition is tolerant of other cultures. This stems from its ability to be “contaminated” by preceding traditions, which are absorbed, digested, and tolerated (in Latin, contamination has a meaning of integration and does not have the negative connotation of “contamination” as in current language). This same flexibility leads to the formation of new myths and changing practices. Drawn from Greek, Roman, Christian, and pagan beliefs, the teachings and saints honoured in the Eastern and Western churches are so deeply entangled in southern Italy that it is often difficult to assess which of the elements came first.

Figure 2 - Vigil of Sts. Cosmas and Damian
Riace, Italy
Aldo Bressi

An interesting example of this can be seen in the province of Reggio Calabria, where several churches and sanctuaries are dedicated to Saints Cosmas (or Cosimo) and Damian. One of the feasts and honours to the saints is particularly famous and interesting: it takes place in the small village of Riace, whose name is well-known due to the discovery (offshore of Riace Marina in the 1970s) of the so-called Riace Bronzes, among the best-preserved bronze statues of the Greek world.

The tradition in Riace is fascinating: it involves holiness, medicine, brotherhood and faith, but also tolerance, dreaming and visions, sex, and magic. This lively complexity and richness, not devoid of some irony, is probably what distinguishes the southern Mediterranean traditions from the more codified northern ones.

As for holiness, the tradition states that the cult of the saints was brought to Riace by the two twin brothers themselves, who appeared to a young shepherd, looking for a good place to build their hermitage. The two saints were probably two Byzantine monks, part of the process of “Hellenization” or “Byzantinization” of southern Italy during the Byzantine political, cultural, and religious domination of the period 553-1085. Byzantine monks were often aware of the basic principles of medical art and were commonly called “holy” or “saints” by laymen.4 Due to the Arabian invasions on the coasts, the monks often sought suitable sites for concealed hermitages in the hills. The communities were well-tolerated in southern Italy, being a bridge to culture and commerce; it was only several centuries later that small communities usually built churches or sanctuaries (the small sanctuary in Riace dates to the 10th century). The monks brought culture, scrolls of holy stories, the practice of medicine, and the legends of some of their saints, such as Cosmas and Damian, Saint Nicholas (particularly honoured in the southern Italian city of Bari), Saint Basil, and Saint Gregory.

As for religion and tolerance, the cult of Cosmas and Damian was particularly predisposed to contamination by the long-lasting pagan traditions: in particular, it integrated the cult of two other magical physician twins, the Dioscuri (identical twins were considered magical in the Greek world). The Dioscuri share several aspects of iconography with Cosmas and Damian and are often depicted with medical instruments, such as phials or surgical instruments. As often reported for the twin saints, one of them depicts Medicine and one Surgery, identical twins of comparable value but unable to live apart from each other.

In Riace, the procession with the two saints takes place twice a year, once on the occasion of the harvest and once in autumn. The harvest means fertility, and a strict link with the earth and female fertility is clear, as is the relationship with the cult of the earth mother (Cybele). Yet, fertility also means the cult of Priapus, whose roots are still evident in the tradition of bringing to the sanctuary ex-voti with parts of the body to be healed (including phalli and uteri). Along this line, the cult of Priapus is closely linked to the twin saints, and not only in Riace: in the important sanctuary in the city of Isernia, in Abruzzo, a toe of the saints is kept as a sacred relic. In the 19th century, Hamilton, the scholar gave a large collection of ex-voti to the British Museum together with a detailed account of the feast of Cosmas and Damian in Isernia:

I mean to send the Ex voti & a faithfull description of the annual fete of St. Cosmo’s great Toe, (for so the Phallus is here called, tho’ it is precisely the same thing).8

Figure 3 - Beato Zeffirino
Riace, Italy
GB Piccoli

In the southern Italian tradition, religion and contamination often merge with magic. This is not only the case of the Priapus cult, but also of the rain rites, in turn a contamination of the Jupiter Pluvius cult. In Riace, the call for rain takes the form of a procession, in which the holy relic (an arm of Saint Cosmas) is taken to the sea and brought onto a cliff called the “Scoglio dei Santi Martiri” [“Cliff of the Holy Martyrs”], with the saying “Santu Cosimu e Daminau o n’abbagni o t’abbagnamu” [“Saints Cosimas and Damian either you wet us (give us rain) or we wet you (in the sea)”].

Magic, medicine, and tradition are also present in one of the most fascinating rites in the Riace tradition, directly derived from the Greek (and later Byzantine) tradition: the incubation. This practice, dear to modern psychoanalysis (in particular of Jungian origin), and to some schools of psychodrama, refers to the healing of diseases during sleep (incubation from the Latin incubare – to sleep). In several asclepions, some still preserved in Asia Minor, the appearance of a dream presaged the healing of the patient, and according to some of the schools, only patients who dreamed were allowed to be seen by the physicians, as dreaming meant a good equilibrium between the soul (the wish to be healed, reflected in the dreams) and the body. This cure was also indicated for sterile women.

Healing in sleep is deeply embedded in the southern Italian tradition. It may also be found in a nursery rhyme of the Isernia region, recorded by the anthropologist Anne MacDonell in 1908: saying:

Sande Cosem e Damijane
Ji’ m’addormo et  tu me chiame.
[Saints Cosmas and Damian
I go to sleep and you call me]8

Figure 4 - Ex-voti
Riace, Italy
GB Piccoli

The artist and photographer Aldo Bressi (Figure 2) has depicted several scenes from the feast of Cosmas and Damian in Riace in the 1980s. The image shown here illustrates the vigil (from the Latin vigilia – being vigilant, awake), in which the pilgrims invoke the protection of the saints to heal their own diseases and those of their loved ones. The incubation follows, during which the pilgrims sleep in the church waiting for the dreams sent by the saints. The feast concludes with a procession.

In the Riace tradition, the long list of professions and situations protected by the saints is joined another unusual element. The autumn feast is also the feast of the Italian Zingari (mainly Rom and Sinti families), a rather neglected minority in the hagiography of the Catholic Church. There are probably two reasons for this tradition: one is the gathering at the end of September for a large fair, originally characterized by horse and livestock trading, a traditional Zingari activity; the second is the much more recent cult of Beato Zeffrino (Ceferino Jiménez Malla, a Spanish Rom executed during the Spanish Civil War in 1936), the only Rom to be beatified by the Catholic Church. The large and somewhat naïf painting of Beato Zeffirino is a relatively recent acquisition of the sanctuary, one of the many testimonials to a cult still alive and deeply felt by the population (Figure 3).

The tradition of the Zingari gives a particular hue to the feast: the gathering of the Sinti and Rom families still occurs in Riace, and is probably one of the reasons for the persistence of a tradition of tolerance, magic, and medicine. Indeed, the windows of the local tobacconist, on the small square in front of the “mother” church that usually houses the relics of Saints Cosmas and Damian, contain colorful plaster reproductions of the “santi medici” [physician saints] on the upper shelf, above small Riace bronzes and assorted souvenirs. On another simple shelf in the nearby church, a vast array of wax ex-voti rest, one limb on top of the other, recalling a pagan tradition at least two millennia old (Figure 4).

The ability to contaminate and be contaminated by different cultures, keeping alive for millennia such rites as the incubation or the call for rain but also keeping pace with history and giving space to new saints, such as Zeffirino, alongside older ones, such as Cosmas and Damian, might be a valuable lesson for our difficult times of religious integration and political intolerance.

We would like to thank Dr. Peter Christie for reviewing this piece.



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  6. Pazzano C and Capponi D. I santi Medici Cosmas e Damiano. Vita e miracoli. Storia, Culto e Religiosità popolare del Santuario di Riace. Laruffa Editore (Reggio Calabria) 2000.
  7. Hippocrates. Oevres Completes. Edited by Littrè.
  8. Carabelli G. Veneri e Priapi: Culti di fertilità e mitologie falliche tra Napoli e Londra nell’età dell’illuminismo. Bari: Argo, 1996.


GIORGINA BARBARA PICCOLI, MD, is a university researcher and aggregate professor at the Nephrology, Department of Clinical and Biological Science, University of Turin, and head of the Nephrology Unit in the san Luigi Hospital. She graduated from medical school in 1985 and completed her post-graduate work at the University of Turin, Italy in 1989. She is author of over 160 papers indexed on Medline, on different aspects of Clinical Nephrology; due to her interest in humanities in medicine, she is “Art consultant” of the jounal Nephrology Dialysis and Transplantation (NDT).

MARTINA FERRARESI, MD, graduated from the san Luigi Medical School in 2010 and is presently attending the Nephrology Specialization School of the University of Turin. She has cooperated with Dr. Piccoli since the start of her clinical training and takes care of the systematic bibliographic searches of the group.