The treatment of active rheumatic fever has changed little over the course of years; bed rest is believed to be necessary for the lessening of residua although there is only slight evidence for this belief. The virtues of salicylates in high and low dosage and of similar compounds, of corticotropin, cortisone and its analogues continue to be discussed but chiefly now in the light of those studies that are well designed and include adequate control observations. There is still some hope that a drug in the steroid or salicylate class might be found that would make suppression worth while. What is really wanted is something that will inhibit the consequences of streptococcal infection at the stage of rheumatic fever in a more basic way. Achieving this goal depends upon knowing more about the etiologic mechanisms involved.