Historian questions paleopathological diagnosis in a work of art

Abstract

The holy physicians Cosmas and Damian (3rd century ce), on whom there is an extensive bibliography, featured in accounts of miracles written above all in Greek in the East between Late Antiquity and the Middle Ages. Although not all of these accounts were translated into Latin, the so-called miracle of the black leg was initially drafted in this language—seemingly for the first time in Jacobus da Varagine's Golden Legend, the well-known collection of lives of saints compiled in the second half of the 13th century. Our miracle tale is backdated to the time of Pope Felix, who according to Jacobus “did do make a noble church at Rome of the saints Cosmas and Damian” (probably Felix IV, Pope between 526 and 530). Therefore, as the text was written much more recently than the events chronicled, it cannot be said to reflect a late antique mentality. This is an important philologic consideration for the purposes of evaluating the medieval iconography on the subject. Curiously, this iconography is explained in the article using a much later 19th century text, a muddled juxtaposition of accounts that even erroneously attributes the miracle to the year 474, a mistake repeated uncritically in the article. Indeed, the Pope was Simplicius in that year. Performed post mortem by the saints appearing to the invalid in a dream, the miracle was widely used in pictorial portrayals from the 14th century onward. Unfortunately, the article makes no mention of the currently available bibliography on the subject.1Jacquet J.D. Le miracle de la jambe noire.in: Gelis J. Redon O. Les miracles miroir des corps. Presses et Publications de l’Université de Paris VIII, Paris1983: 23-52Google Scholar The diagnosis of gangrene made by the authors of the article on the basis of pictorial depiction—which is hazardous in any case as medieval images are not always an accurate portrayal of reality—is unnecessary, as Jacopo explains the complaint affecting the patient forthwith, writing that cancer (understood as gangrene)2Demaitre L. Medieval notions of cancer: malignancy and metaphor.Bull Hist Med. 1998; 72: 609-637Google Scholar had consumed the man's whole leg (iam cancer unum crus totum consumpserat).3Jacopo da VarazzeLegenda aurea. vol. 2. SISMEL, Florence1998Google Scholar Moreover, our philologic reflections rule out the possibility that the thaumaturgical practices of the saints reflect late antique surgical procedures in the West (the 5th century is mentioned by the authors). At the same time, it cannot be affirmed either that the miracle symbolizes the fact that organ transplantation was rooted in surgeons' knowledge from the 13th century onward, the period when the Golden Legend was drafted. On the one hand, historians are fully aware that accounts of miracles should not be seen as factual reality but rather texts that always need to be interpreted.4Vauchez A. La sainteté en Occident aux derniers siècles du Moyen Âge d’après les procès de canonisation et le documents hagiographiques. École française de Rome, Rome1981Google Scholar On the other hand, although medieval medical and surgical texts explicitly state that the gangrenous part has to be removed using various means, even to the point of amputating the limb, the possibility of a transplant is never contemplated.5Foscati A. Ignis sacer. Una storia culturale del ‘fuoco sacro’ dall’antichità al Settecento. SISMEL, Florence2013Google Scholar The miracle in question must therefore be examined within the confines of its narrative topos. The intriguing —if fanciful—conclusions reached by the article are not supported by the methodologic rigor of iconographic research, which requires a pictorial work to be interpreted in its original historical and cultural context, reconstructed by analyzing the appropriate textual sources. Gangrene, amputation, and allogeneic transplantation in the fifth century ad: A pictorial representationJournal of Vascular SurgeryVol. 64Issue 3PreviewWet or infected gangrene is necrosis of skin and soft tissue due to a broad category of saprogenic microorganisms (bacteria and fungi).1 It may be characterized clinically by edema, erythema, wound drainage, vesicles or bullae, necrosis, purulent secretions, fever, or pain and shows a rapid progression.2 The treatment is based on antibiotic or antifungal therapy, surgical débridement, and, when needed, amputation. The main risk factors include trauma, diabetes mellitus, malnutrition, obesity, immune depressive states, and postsurgical infections. Full-Text PDF Open ArchiveReplyJournal of Vascular SurgeryVol. 70Issue 2PreviewThe multidisciplinary reassessment of diseases of the past offers paleopathologists and historians the possibility of shedding light on the antiquity of pathological conditions.1 Although a full discussion of this specific topic would require a different venue and a lengthier format, we appreciate input and suggestions from both the scientific and literary milieux. Regarding the chronology of the miracle, we agree that it occurred after ad 526 to 530, which corresponds to the foundation of Cosmas and Damian's church in Rome. Full-Text PDF Open Archive