Necrotising
fasciitis is a rare, but potentially fatal,
soft-tissue infection. Historical depictions of the disease have been described since classical times and were mainly recorded in wartime reports of battle
injuries. Although several different species of bacteria can cause necrotising
fasciitis, perhaps the most widely known is group A streptococcus (GAS). Infection control, early surgical
debridement, and
antibiotic therapy are now the central tenets of the clinical management of necrotising
fasciitis; these treatment approaches all originate from those used in wars in the past 150 years. We review reports from the 19th century, early 20th century, and mid-20th century onwards to show how the management of necrotising
fasciitis has progressed in parallel with prevailing scientific thought and medical practice. Historically, necrotising
fasciitis has often, but not exclusively, been associated with penetrating
trauma. However, along with a worldwide increase in invasive GAS disease, recent reports have cited cases of necrotising
fasciitis following non-combat-related
injuries or in the absence of antecedent events. We also investigate the specific association between GAS necrotising
fasciitis and
trauma. In the 21st century, molecular biology has improved our understanding of GAS pathogenesis, but has not yet affected attributable mortality.