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1. The incidence of haemolytic streptococci in the patients of a Hospital School for rheumatic children was determined over a period of 1 year.  2. In the total of 1644 throat and 1644 nasal swabs, group A strains were isolated from 20 throat and two nasal swabs. Eighty-seven strains of Lancefield's groups C and G and 54 strains of groups other than A, C, or G were isolated  3. There was no evidence of cross-infection.  4. Factors contributing to the low incidence of group A strains and the absence of cross-infection are discussed.  5. The carriage of groups C and G strains did not appreciably affect the erythrocyte sedimentation rate.  6. Although no direct evidence is available, the experience of the present study suggests that the incidence of streptococci in an institution for rheumatic children may be reduced by: ( a ) bacteriological screening before admission; ( b ) regular swabbing and Lancefield's grouping of streptococci isolated for the early detection of group A strains; and ( c ) administration of penicillin or sulphadiazine prophylactically to even a limited number of children.  We thank Prof. R. S. Illingworth for his advice in the writing of this paper, Dr J. L. Emery for laboratory facilities, Dr R. E. O. Williams for his advice in the planning of the investigation, and the matron and sisters of Ash House Hospital School, Sheffield, for their assistance.  The expenses of the investigation were defrayed by a grant from the Medical Research Council.

Incidence and importance of streptococci in an institution for rheumatic children