The problem of prevention of recurrent attacks of rheumatic fever has always presented a great challenge to the responsible physician. Prior to the advent of chemotherapeutic and antibiotic agents, the avoidance of streptococcic disease and the general symptomatic care of the patient proved fruitless in attempting to prevent progressive cardiac damage in the patient who had had rheumatic fever. Tonsillectomy has not prevented recurrences of the disease, and now it is usually felt that patients with histories of rheumatic fever have the same indications for removal of the tonsils as do those who have not been afflicted with the disease. The strongest evidence for a direct relationship between rheumatic activity and antecedent streptococcic infection has been presented by prophylactic programs.
The sulfonamides were used in the first direct approach to the prevention of recurrences by attempting to keep the throat free of beta hemolytic streptococci of Lancefield group A. Because