During the second World War, and even almost a decade later at the conclusion of the Korean Conflict during the 1950s, infections caused by the Group A beta hemolytic streptococcus and their nonsuppurative sequelae were major problems for practicing physicians as well as for public health authorities. Epidemics of scarlet fever were ever present; quarantine signs could be seen prominently displayed in the windows of the homes of schoolchildren. Many schoolchildren had at least one schoolmate who was homebound and bedridden for months with rheumatic fever. The perceived threat of Group A streptococcal infections was of concern to the lay public, especially to parents of schoolchildren. For the medical community the presence of rheumatic fever hospitals in many cities, institutions like the Harriet Lane Home in Baltimore, the Irvington House in New York, the House of the Good Samaritan in Boston, and La Rabida Hospital in Chicago, served to reinforce the need for increasing the understanding and control of these infections. If those facts about Group A streptococci and children were not sufficiently impressive, the large numbers of individual cases and even outbreaks occurring in military troops during the second World War and during the Korean Conflict further emphasized the issue.
In fact, before the second World War, relatively little was understood about the epidemiology and pathogenesis of these infections and their sequelae. The laboratory studies of Rebecca Lancefield and others, which allowed more precise identification and characterization of Group A streptococci, and the accompanying clinical observations provided the foundation for early control measures.