Historical BackgroundStreptococcal infections were recognized by Greek physicians by the 3rd century B.C. A description of erysipelas is recorded in Epidemicus and attributed to Hippocrates. In the Middle Ages, scarlet fever, or "scarlatina," as it was called in Italy, was an eye-catching and notable disease. Sydenham's description in 1676 clearly differentiated this disease from measles and other rashes, but it was not until 1924 that G.F. and G.H. Dick showed conclusively that streptococci were the causative agents. Until the advent of penicillin, childbed fever, or puerperal sepsis, remained one of the most frequent causes of death among otherwise healthy young women. The classic works of Holmes, in 1858, and Semmelweis, in 1861, described the transmission of this disease and provided guidelines for effective preventive measures that are still applicable today. Rheumatic fever was first described by Wells in 1812, and Bouillaud described the association of acute rheumatism and heart disease in 1835. In 1836, Bright published his account of "renal disease accompanied with secretion of albuminous urine."(l) Osler provided detailed descriptions of "malignant scarlet fever," which remained common until the advent of antibiotics (see Fig. 1). Severe invasive disease, including necrotizing 673 A. S. Evans et al. (eds.