To determine the modes of transmission of cholera in the regency of Pidie, Indonesia, and to consider strategies for its control, we set up a laboratory to identify Vibrio cholerae 01 from patients with severe diarrhea in all government clinics in the regency and questioned culture-positive cases and neighborhood controls about possible exposures to V. cholerae 01. Between 12 July and 15 August 1982, 63 of 138 suspected cholera cases were confirmed by the laboratory; 53 of these patients were seen and followed up. We were unable to identify a single, indisputable mode of transmission for cholera which was amenable to immediate control. Nonetheless, a number of factors, including exposure to water from the Tiro-Sigli River and consumption of ice, were associated with disease. Other findings bring into question the value of current practices of chlorinating dugwells and disinfecting homes with Lysol® during a cholera outbreak. The case-control approach to investigating the mode of transmision of cholera has distinct limitations when applied in endemic setting where there may not be a single predominant vehicle of transmission, or where the vehicle such as river water is used by all and is only periodically contaminated.