Hektoen International

A Journal of Medical Humanities

Partners in healing: An early renaissance painting depicting the partnership of the divine with the physicians Cosmas and Damian

Susan Brunn Puett
J. David Puett
Chapel Hill, North Carolina, United States


St. Cosmas and St. Damian
by Matteo di Pacino (painted 1370-1375).
Located in the North Carolina Museum of Art, Raleigh, North Carolina, USA. Although the original location of the painting is not known, it was probably commissioned by the Guild of Physicians, Pharmacists, and Artists for either a church or a hospital chapel or cloister.

In many cultures the practice of healing was perceived as a combined effort by physicians and the divine. Florentine Renaissance hospitals had churches and cloisters in their complexes where displayed works of art reminded patients and their families of God’s curing powers. Meant to invoke prayer and contemplation, these paintings, created by some of the greatest artists of the time, were religion-based and found in particular abundance in Florence.

In most of these sacred paintings the physicians and the divine were not depicted on the same canvas. A particularly interesting exception to that genre of curing art is a fourteenth-century painting by Matteo di Pacino (known as the Master of the Rinuccini Chapel, Basilica of Santa Croce, Florence). It uniquely depicts God in relationship with Saints Cosmas and Damian, third century twin physicians.


Background of Saints Cosmas and Damian

Much has been written about the twin Saints Cosmas and Damian, who practiced in the latter part of the third century and became early in the Florentine Renaissance the patron saints of the Guild of Physicians, Pharmacists, and Artists. A primary source of information about these two saints is Jacobus de Voragine (c. 1229–1298), an Italian Dominican prior who before 1270 compiled a hagiography, The Golden Legend (Legenda aurea).1 Cosmas and Damian were Arabians, born in about 270 CE, to Christian parents in Egea (now Ayas), located between Tarsus and Antioch in present day Turkey. Losing their father at an early age, the twins and their three brothers were raised by their mother Theodoche. After studying in Antioch, Cosmas and Damian returned to their hometown to practice medicine and pharmacy, with the guidance of God and to proselytize their Christian religion. According to legend, they treated both humans and animals, never requesting to be paid for their services.

They were credited with cures, some miraculous, during the persecutions of the Christians by the Emperor Diocletian, and after becoming famous throughout the area were ordered by the Proconsul Lysias to renounce their Christian faith and sacrifice to Roman idols. When the brothers refused they were sentenced to death. Lysias ordered them chained and thrown into the sea but an angel rescued them unharmed. They then survived burning and torture on a rack. Frustrated, Lysias had them stoned and shot by arrows, all of which rebounded, hitting bystanders and archers; so it was decided that they were to be beheaded.

One of the more famous medical procedures attributed to Cosmas and Damian is their amputation of a man’s diseased leg and the subsequent replacement with that of an Ethiopian man who had recently died and been buried. The legend of this miraculous transplantation has catalyzed interesting reports in the medical literature and has stimulated artists to render the event in woodcuts and also in paintings, notably the famous altarpiece by Fra Angelico.2,3,4,5,6


Human and Divine Healing in Context

Medicine in the Roman Empire had its origins in early Greece, notably from the work of Asclepius and Hippocrates, themselves influenced by the ancient practices of Mesopotamia, India, and Egypt. Although considered to be the founder of Greek medicine, it remains controversial whether Asclepius, mentioned in Homer’s Iliad, was but a legend. Nonetheless, the Asclepian approach to medicine was practiced. It required the patient to travel to a temple or shrine where they were given massages, a healthy diet, and exercise, followed by prayer and sacrifice to the healing god. The most important component of “temple medicine” was rest and sleep in a special room with the expectation that a god would appear to the patient in a dream and either effect a cure or give advice to a temple physician on the proper course of treatment.7 Here, the combination of the physician and divine intervention formed a cooperative unit.

Later, the teachings of Hippocrates (c. 460–370 BCE) emphasized a pathophysiological role for disease as opposed to the earlier concept of supernatural causation. Hippocrates introduced the notion of four humors—blood, phlegm, yellow bile, and black bile—which had to be maintained in balance for proper health; healing thus relied on a restoration of bodily balance of the humors. Greek medicine flourished in Alexandria, Egypt, during the Ptolemaic Dynasty where significant advances were made.

With the rise of the Roman Empire, the earlier Greek approaches to healing were continued by several physicians from Asia Minor, notably Dioscorides of Cilicia (c. 40–90 CE), best known for his five-volume treatise on the use of plant, mineral, and animal-based medicinals; and Galen of Pergamon (c. 129–201 CE), a prolific author who supported and promulgated the theory of the four humors as introduced by Hippocrates, an approach that persisted in medical teaching and practice through the Renaissance.8

In the period when Saints Cosmas and Damian were practicing medicine, they understood themselves to be the intermediaries for the intervention of the Christian God. Shortly after their martyrdom, Saint Augustine (354–430 CE) underscored in his sermons the notion of the Christus Medicus in which the Divine Physician and the human physician collaborate in the healing process. Augustine’s sermons and writing influenced medieval and Renaissance medicine such that hospitals incorporated paintings and sculptures of Christ, emphasizing to the patients Christ’s suffering and spiritual salvation.9 Such belief in supernatural intervention persisted and continued through the medieval period and Renaissance.


Painting by Matteo di Pacino

The painting (Figure 1), executed c. 1370–1375, represents a transition between the innovative work of Giotto (c. 1267–1337) and Masaccio (1401–1428). In the early trecento, Giotto began to break from stylized Byzantine painting by incorporating a more natural rendering of scenes, using bold colors, more life-like portraits, and greater realism by using light and shade. Some one hundred years later Masaccio used the vanishing point described by polymath Brunelleschi and took that realism further by incorporating mathematically correct linear perspective, thereby drawing the viewer into the scene depicted.10 Matteo di Pacino painted midway between the time of Giotto and Masaccio. In St. Cosmas and St. Damian he adopted the bold colors and life-like quality of Giotto and presented a feeling of depth in his scenes, while not yet incorporating the linear perspective later achieved by Masaccio, Uccello, and others. The painting, nonetheless, has reasonably correct human dimensions, and the flowing robes are depicted with appropriate shadowing.

The rendering of St. Cosmas and St. Damian makes explicit the interplay between God and the physician. God, with arms outstretched toward the heads of the Saints, is portrayed as having a connection to both, each of whom is holding a book symbolic of their roles as learned men, one with an upraised hand blessing the viewer. The dominant position of the God figure, floating in a sea of clouds, emphasizes that the power of healing emanates from the Divine. The predella relates a portion of the Saints Cosmas and Damian legend. The double scene at the left shows the deceased Ethiopian in his open coffin and one of the brothers carrying the amputated leg to the recipient. The first portion depicts the patient with the attached black donor leg replacing his own. The right portion of the predella shows the martyrdom of Cosmas and Damian, both refusing to renounce their belief in Christianity and in the role of the Divine as a healer.

The purported success of such a miraculous medical procedure, nearly two millennia ago, would obviously have required the hands of the Divine, making this painting a particularly valuable contribution to the genre of curative art.



  1. de Voragine, Jacobus. The Golden Legend, Translated by Christopher Stace. London: Penguin Books Ltd., 1998. De Voragine, Golden Legend, 248-249.
  2. Matthews, Leslie G. “SS. Cosmas and Damian-Patron Saints of Medicine and Pharmacy: Their Cult in England.” Medical History 12 (1968): 281-288.
  3. Duffin, Jacalyn. Medical Saints: Cosmas and Damian in a Postmodern World. New York: Oxford University Press, 2013.
  4. Maggioni, F. and Maggioni, G. “A Closer Look at the Depictions of Cosmas and Damian.” American Journal of Transplantation 14 (2014): 494-495.
  5. Friedlaender, Gary E. and Linda K. Friedlaender. “Saints Cosmas and Damian: Patron Saints of Medicne.”  Clinical Orthopaedics and Related  Research 474-8 (2016): 1765-1769.
  6. Perciaccante, Antonio, Frank J. Rühli, Francesco M. Galassi and Rafaella Bianucci. “Gangrene, Amputation, and Allogeneic Transplantation in the Fifth Century AD: A Pictorial Representation.” Journal of Vascular Surgery 64 (2016): 824-825.
  7. Hart, Gerald D. “Asclepius, God of Medicine.” Canadian Medical Association Journal 92 (1965): 232-236.
  8. Puett, Susan and J. David Puett.  Renaissance Art & Science @ Florence. Kirksville, MO: Truman State University Press, 2016 (University Park, PA: Penn State University Press, 2018).: 116-118.
  9. Henderson, John.  The Renaissance Hospital: Healing the Body and Healing the Soul. New Haven: Yale University Press, 2006: 113-114.
  10. Puett and Puett, Renaissance Art & Science, 82-84, 90-93.



SUSAN BRUNN PUETT holds a BA degree in history and education from Duke University. After a career in teaching and addiction counseling, she is now an Independent Scholar who has published in history and poetry. With a focus on art and science in the Renaissance, Susan has co-led Honors students from the University of Georgia to Florence, Italy.  Her research has resulted in the publication of Renaissance Art & Science @ Florence, a book she co-authored with J. David Puett.

J. DAVID PUETT has a BS and MS degrees in physics and a PhD in biochemistry. With faculty appointments at the Vanderbilt University School of Medicine, the University of Miami School of Medicine, the University of Georgia, and the University of North Carolina School of Medicine, he has published extensively in science (cancer biology and reproductive biochemistry) and is currently writing both science and history. Teaching Honors Seminars on Renaissance Florence and co-leading university students to Florence fostered his interest in Florentine Renaissance art, and with Susan Brunn Puett he co-authored Renaissance Art & Science @ Florence.


Summer 2018  |  Sections  |  Art Essays

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