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 forms of the disease. The feasibility of and justification for rheumatic fever control programmes in developing countries has been often questioned. A co-operative study co-ordinated by the World Health Organization has now demonstrated that systematic prevention of rheumatic fever recurrences not only benefits the patients concerned but also has economic advantages. Primary prevention by systematic penicillin treatment of all streptococcal throat infections is at present beyond the reach of many health care systems, and anti-streptococcal vac cination is still in the research phase. The mainstay of the combat against rheumatic heart disease thus remains 7 RHEUMATIC FEVER secondary prevention - the long-term monthly administ ration of penicillin injections to identified patients. This requires, among other things, that penicillin be available.