The etiology of scarlet fever is so clear that it is difficult for us to realize the confusion and controversy involving some of the most prominent names in medical history that swirled about the tangled relationships between diphtheria, erysipelas, scarlet fever, and streptococcal sore throat at the turn of the century. The poststreptococcal complications of dropsy and arthritis only served to confound people more. After Loeffler1 described streptococci in cultures from patients with "diphtheria" complicated by scarlet fever (which were probably not diphtheria at all), most people accepted the idea that streptococci had something to do with scarlet fever but it was an elusive something. Were these organisms the primary cause of disease or merely secondary invaders? Why did some patients with streptococcal infection have a scarlatinal rash and others not?
Not everyone was confused. In a remarkable publication in 1893 entitled "Sur La Pathogénie de la Scarlatine,"2 André Bérgé