Italian researchers have identified the earliest representation of limb transplant in an ancient altar piece, suggesting that physicians dreamed up such intervention more than 1,500 years ago.

Made by an obscure painter, Matteo di Pacino, the artwork can be found at the North Carolina Art Museum in Raleigh. It dates to the 14th century and depicts, at the base of the altarpiece, a 5th-century tale about the healing of a man suffering from a leg disease.

"Historic sources describe the event as a miracle that occurred in 474 AD," Antonio Perciaccante, at the department of medicine of Gorizia hospital, told Discovery News.

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According to the story, Saints Cosmas and Damian, two physicians converted to Christianity who practiced in a Roman province of Syria, severed the limb of the patient and replaced it with a healthy leg taken from a deceased Ethiopian male. Then they placed the amputated leg inside the Ethiopian's coffin.

Perciaccante and colleagues Frank Rühli, director of the Institute of Evolutionary Medicine (IEM)at the University of Zurich, Francesco Maria Galassi, principal investigator of Italian Paleopathology Project at IEM, and Raffaella Bianucci, senior author and bio-anthropologist in the Legal Medicine section at the University, carefully examined the painting -- a tempera and gold leaf on panel -- and found the leg suffered from a peculiar disease.

"Morphologically, the amputated limb appears to be edematous, soft and putrid, with some skin lesions consistent with wound drainages," the researchers wrote in the Journal of Vascular Surgery.

"Based on these characteristics, we speculate the man had suffered from an infected gangrene of the right leg," they concluded.

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According to an 18th-century book on the life of the Saints, the patient most likely was the sacristan of a church dedicated to Cosmas and Damian.

Whether the "miraculous" healing occurred or not, the 5th-century tale represented in Matteo di Pacino's painting shows that physicians considered amputation the best treatment for infected gangrene at that time. Most importantly, the concept of organ transplant was already rooted in their knowledge.

"Until now, we have though of transplant as a medical concept that developed around 1900. Our research predates it by fifteen centuries," Perciaccante said.

Paleopathographist Raffaella Bianucci speculated that 5th-century physicians and later colleagues may have tried to perform transplants of amputated limbs. However, due to the strict necessity of compatibility between donor and recipient and the occurrence transplant rejection, any attempt would have inevitably failed.

"Indeed the transplant is reported as a legendary act. It not casual the miracle was attributed to Saints Cosmas and Damian, which were two physicians," Bianucci said.

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