The current medical concepts regarding group A β-hemolytic streptococcal pharyngitis are well documented. This study demonstrates that these concepts can form the basis of rational medical management in rural general practice; that this management is practical in regard to time and money expended; and that private patients willingly cooperate. Of 1,052 patients with proved streptococcal pharyngitis, 1,045 (99%) received ten full days of antibiotic therapy, and 808 (76.6%) returned for follow-up cultures. Of 633 families involved, 503 (79.2%) families had every household contact cultured, and 567 (89.5%) of the families had at least 75% of household contacts cultured. Since adoption of this management, the incidence of rheumatic fever has apparently decreased sharply in the county.