= Solution
\b[Support the acute illness, relieve painful <arthritis>, and repeatedly assess the <heart>; modern treatment also eradicates the antecedent <streptococcal infection> and prevents recurrence.] <Acute rheumatic fever> is an inflammatory consequence of preceding <Group A streptococcal infection>, rather than infection of each painful <anatomical joint> by the organism. The distinction matters because an <antibiotic> and an <anti-inflammatory drug> have different purposes.<Clinical Guidance for Acute Rheumatic Fever by CDC>[Cause, clinical features, treatment and secondary prevention]{ref}
In an 1864 answer, the defensible foundation is rest during the febrile illness, attentive nursing, adequate drinks and food, comfortable support of painful <anatomical joints>, and relief of <pain>. The physician would follow the <temperature>, <pulse>, breathing, ability to drink and <urine> output. Examination with a <stethoscope> should be repeated for a new <heart murmur>, a <pericardial friction rub> or signs of <heart failure>; improvement of the <arthritis> does not prove that the <rheumatic carditis> has ended. Historical alkaline treatment with <potassium bicarbonate> or other alkalis was intended to counter a supposed acid state. <Opium> was used for severe <pain> and sleeplessness, with risks of <constipation> and <respiratory depression>. Neither that acid theory nor abolition of <pain> establishes prevention of damage to the <heart valves>. Contemporary discussion already disputed whether the apparent benefit of alkalis exceeded that of rest and nourishment, and recognised the difficulty of comparing unlike cases.<Treatment of acute rheumatism in the Edinburgh Medical Journal (1862)>[Practice of Medicine, pp. 179–183: alkaline treatment and discussion of case comparisons]{ref}
Current assessment includes an <electrocardiogram> and <echocardiography>, since <valvulitis> may be present without an obvious <heart murmur>. A suitable <penicillin> regimen eradicates residual <Group A streptococcal infection>; subsequent <secondary antibiotic prophylaxis> reduces further attacks. An <anti-inflammatory drug> such as <naproxen> or <ibuprofen> treats the established inflammatory symptoms, with choice and monitoring appropriate to age and illness. These measures should not be described as reversing an already scarred <heart valve>. <Heart failure> from severe <rheumatic carditis> needs specialist management; severe <Sydenham's chorea> may require specific treatment as well as protection, rest and support. Activity is adjusted to the clinical and cardiac findings rather than prescribed as indefinite immobility. <Bloodletting>, deliberately induced <dehydration> and historical <counterirritation> provide no substitute for these measures.<Australian guideline for acute rheumatic fever and rheumatic heart disease (2025)>[Chapter 7, especially Table 7.1: acute manifestations, carditis, chorea and continuing care]{ref}
The treatment outline therefore has two time scales: control the present inflammatory illness and its complications, then prevent another immune-mediated attack. Modern <salicylate> treatment should not be projected backwards as the settled Oxford practice of December 1864.
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