The essay focuses on a 14th-Century fresco, still partially extant in the church of San Michele at Serravalle Pistoiese, representing St. Blaise healing a child. The first section of the article is dedicated to the stylistic analysis of the composition, which can be dated around the 1320s: the work fits into the context of local painting of that period, influenced by Giotto’s lesson, but marked by a strong emotional charge, and shows strong similarities to the style of the anonymous author of a few later frescoes in the church of San Domenico in Pistoia. The second part of the essay addresses the peculiar iconography of the painting and examines the diffusion of the cult of St. Blaise in the medieval age to identify the reasons for the choice of such subject. Most likely, the fragment didn’t belong to a wider cycle dedicated to the saint, but was rather an isolated votive image, expression of popular devotion. The persistence of such devotion is testified by the subsequent events of transformation of the internal spaces of the church, deductible from the archival documentation.