[Rheumatic fever, the idea of progress and the circularity of time]

Rheumatic fever, once virtually "gone" from the western world, has made a come-back in the mid nineteen-eighties. This is disturbing because the control of rheumatic fever was a source of pride to the medical community. Changes in medical practice, such as a less compulsive attitude vis-a-vis streptococcal infections, and social changes, such as "house starvation", probably conspired to bring about the come-back. It's likely that the emergence of more virulent and more rheumatogenic streptococcal strains was facilitated by these changes. Physicians should once again be alert to the streptococcal threat, and accurately diagnose and effectively treat streptococcal pharyngitis.