Prophylaxis of rheumatic fever.

G ROUP A streptococcal infection initiates acute rheumatic fever; rheumatic valvular heart disease is a sequela that develops during or subsequent to the acute rheumatic episode. The mechanism by which the preceding streptococcal infection produces the arthritic and constitutional symptoms and valvular heart disease is unknown. Regardless of the mechanism involved, there is little doubt that prevention of the streptococcal infection eliminates acute rheumatic fever and presumably rheumatic heart disease in any population group. This fact has guided the management of a selected group of individuals, namely those patients who have already had 1 attack of rheumatic fever. The continuous prophylactic administration of a sulfonamide drug or penicillin is a widely practised measure for ensuring freedom from streptococcal infections and rheumatic recurrences. The establishment of the relationship of the streptococcal infection to acute rheumatic fever led to the development of other methods for the control of rheumatic fever, since it was logical to believe that successful treatment of the original streptococcal respiratory disease might alter the attack rate of this nonsuppurative complication. Treatment with sulfonamides failed to prevent rheumatic fever" 2 in spite of the favorable influence it exerted on the natural course of the acute respiratory illness. Subsequently, penicillin was employed by Massell, Dow, and Jones3 for the therapy of streptococcal infections in patients who had experienced 1 or more rheumatic episodes and recurrent attacks of rheumatic fever were