In the small museum attached to the church of Covarrubias in northern Spain, amongst the gilded Virgins and plaster Crucifixions, I saw a strange painting. It showed a man undergoing a leg transplant. His new leg is black. Apparently the surgeons were Saints Cosme and Damian, to whom the church is dedicated. In the cathedral of nearby Burgos I saw a second painting of the same incident. And back in London I came across another at the Wellcome Museum.
History relates that Saints Cosme and Damian were twin doctors in third century Syria. It is said that they and their three brothers were tortured and beheaded by the Roman emperor Diocletian for their Christian beliefs. For the next few hundred years they feature in the art of both the Western and the Orthodox Church, carrying pots of ointment and triangular shoulder bags. They were termed anargyroi — the silverless — because they did not charge their patients.
In the Middle Ages, they start appearing as the heroes of a miracle. Justinian, a church deacon in Rome, was suffering from cancer of the leg. He dreamed that Cosme and Damian came to him and replaced his diseased leg with one from an Ethiopian Moor who had died the previous day. When Justinian awoke and saw he had a new healthy leg—although black, he knew his prayers had been answered.
In the depictions there is nothing realistic about the transplant. The brothers just slide the replacement limb into position. No blood, no instruments, only the pot of ointment. Sometimes the right leg is being transplanted, sometimes the left, apparently depending on the artistic needs of the composition. Sometimes it is an above-knee amputation, in others below-knee, and in one picture it is clear that both the severed and the new lower leg have only one bone.
In medieval times illness was seen as the punishment for sin, and only God could grant absolution and healing. The paintings were a reminder to sinful mortals that they needed the saints to speak to God for them. For two hundred years representations appear in Spain and Italy, Germany and the low countries, to impress the message on the congregation.
In 1517 Martin Luther pinned his protest at the sale of indulgencies to the door of the church in Wittenberg. The new Protestantism had no truck with devotion to the saints or relics. The Catholic church’s response, the counter-reformation, was to clean up its act. The Council of Trent decreed that religious imagery should be restrained; art should not portray superstition. The twins and their miracle went out of fashion. In one of their few later appearances they are shown carrying out the transplant with a full set of surgical instruments and a lot of blood. But this is not simple realism. It is an advertisement: the engraving was commissioned by the Guild of Surgeons of Antwerp.
The twins’ story reached Britain. A Greek Orthodox church in Camden, north London, is dedicated to them. Apparently a figure on Salisbury Cathedral carrying an ointment pot is Cosme, or is it Damian? And Damian, or is it Cosme, supports the arms of the British Dental Association. The twins remain busy today. They are said to be the patron saints of surgeons, physicians, pharmacists, dentists and day-care centres. As medics performing miracles and providing health care free at the point of delivery, should not Cosme and Damien be recruited as the patron saints of NHS GPs?
First Published in The Sessional GP magazine 2009
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…