[Footnote 1:  A detailed report is published in the Berliner Klinische Wochenschrift Aug. 4.]

Dr. Koch commenced by remarking that what was required for the prevention of cholera was a scientific basis.  Many and diverse views as to its mode of diffusion and infection prevailed, but they furnished no safe ground for prophylaxis.  On the one hand, it was held that cholera is a specific disease originating in India; on the other, that it may arise spontaneously in any country, and own no specific cause.  One view regards the infection to be conveyed only by the patient and his surroundings; and the other that it is spread by merchandise, by healthy individuals, and by atmospheric currents.  There is a like discrepancy in the views on the possibility of its diffusion by drinking water, on the influence of conditions of soil, on the question whether the dejecta contain the poison or not, and on the duration of the incubation period.  No progress was possible in combating the disease until these root questions of the etiology of cholera are decided.

Hitherto the advances in knowledge upon the etiology of other infective diseases have done little toward the etiology of cholera.  These advances have been made within the last ten years, during which time no opportunity—­at least not in Europe—­has occurred to pursue researches; and in India, where there is abundant material for such research, no one has undertaken the task.  The opportunity given by the outbreak of cholera in Egypt last year to study the disease before it reached European soil was taken advantage of by various governments, who sent expeditions for the purpose.  He had the honor to take part in one of these, and in accepting it he well knew the difficulties of the task before him, for hardly anything was known about the cholera poison, or where it should be sought; whether it was to be found only in the intestinal canal, or in the blood, or elsewhere.  Nor was it known whether it was of bacterial nature, or fungoid, or an animal parasite—­e.g., an amoeba.  But other difficulties appeared in an unexpected direction.  From the accounts given in text-books he had imagined that the cholera intestine would show very slight changes, and would be filled with a clear “rice-water” fluid.  He had not fully recollected the conditions met with in post-mortem examinations had formerly made, and was therefore at first surprised to meet with quite a different state of things.  For he soon found that in a large majority of cases remarkably severe lesions were present in the intestines.  In other cases the changes were slighter, and eventually he met with some which, to a certain extent, corresponded with the type described in text-books.  But it was some time, and after many inspections, before he was enabled to correctly interpret the varied changes met with.  In spite of a most careful examination of all other organs and of the Mood, nothing was found to establish the presence of an infective material, and attention was finally concentrated on the intestinal conditions.