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Philoctetes is cited in the famous Catalogue of Ships of the II book of Homer's Iliad. The hero, noble and experienced archer, partecipated to the military expedition against tha ancient town of Troy with seven ships. In the tenth year of war, he was absent from tha Achaean camp, because left on the island of Lemnos, where he suffered for a painful wound, provoked by a bite of a snake (vv. 716-725). In Odyssey Nestor tells Telemachus, a Odysseus son, that Philoctetes, son of Poeas, had come back to his native land (III, 190) and Odysseus says Philoctetes to be an archer better than himself (VIII, 219). In the Sophoclean tragedy Philoctetes it is possible to find other details of the disease. The lesion of Philoctetes was an ulcer (v. 690) of his foot (vv. 7, 291, 697, 824), painful (vv. 9-11), malodorous (vv. 520, 876, 890-891, 1032), and discharging a disgusting, sanguinous material (vv. 695, 782-784). Philoctetes' disease began with a trauma provoked by a viper bite. The snake was venomous, however, the hero did not die, but contracted a chronic disease, that after 10 years continued to affect him. To explain how a trauma could become a chronic affliction, it is necessary to consider a second pathological event, indeed very frequent in cases like that: a chronic infection. Chronic infections affecting the lower extremities, possibly related to previous trauma and whose cusative agents are present in wild and woody regions, include maduromycosis (mycetoma, Madura foot), chromoblastomycosis (chromomycosis, verrucous dermatitis) and botryomycosis (actinophytosis, bacterial pseudomycosis). Maduromycosis is a chronic, suppurative infection of the subcutaneous tissue and contiguous bones, caused by various Actinomycetes and true fungi (Eumycetes) from soil and plants. Chromoblastomycosis is a chronic mycosis of the skin and subcutaneous tissues, caused by several different fungi, recovered from soil and vegetables. Botryomycosis is a chronic suppurative and granulomatous bacterial disease, clinically resembling a fungal infection, caused by pathogens of low virulence: usually Staphilococcus aureus in association with other forms as Pseudomonas aeruginosa, Escherichia coli, Proteus etc. No one of such disease, however, presents the peculiar association of pain with foul odor of Philoctetes' disease. Maduromycosis and chromoblastomycosis may sometimes present pain, but not foul odor; botryomycosis may present foul odor, but not pain. Therefore, a third pathologic event has to be considered: a subsequent bacterial infection. In this event, botryomycosis can be excluded because it is properly a bacterial infection. A secondary infection may occur in patients with maduromycosis and chromoblastomycosis and it is difficult to establish with which of them Philoctetes' disease can be identified, because clinical features of the two diseases are similar. Maduromycosis, however, can be considered as less probable, because does not present malodorous lesions and mostly because it frequently involves bones, muscles, nerves and tendons, causing in time a severe and permanent damage; this fact would be in contrast with the complete and relatively rapid recovery obtained by Philoctetes, once arrived in the Greek camp. chromoblastomycosis superinfected by bacterial agents can show lesions at the same time painful and malodorous, and seems to be the disease that most probably can be identified with the ancient disease which affected the hero Philoctetes thirty-two centuries ago.

(from C. Urso, V. Farella, An Inquiry on Philoctetes' disease, Am. J. Dermatopathol. 18: 326-329, 1996)

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