It has become commonplace to say that the decline of rheu matic fever in Europe and North America has little, if any thing, to do with medicine; but to conclude that efforts to control the disease are futile would be an error leading to what could be termed public health malpractice. The need for adequate treatment of patients suffering from acute rheu matic fever or chronic rheumatic valvular heart disease is obvious; but control also means prevention, and here, too, the need is obvious, if only to lighten the burden on health care, due especially to the treatment of patients with advanced...