Forty-two patients were examined with the hysteroscope. Thirty-five cases were so examined in the office; six cases in the hospital. The latter were patients requiring some operation and the hysteroscopy was done as a preliminary procedure. Of the thirty-five office cases the examination was unsuccessful in two cases because of cervical stenosis. Both these patients were sterile. One patient was intolerant to the examination. Local anesthesia was employed in one hospital patient; scopolamine-morphine in another. In three cases the examination was repeated once.In two of the hospital cases and four of the office cases, bleeding due to the introduction of the hysteroscope interfered with satisfactory vision. No further attempt was made in these cases to inspeet the uterine cavity. As the No. 22 French gauge uteroscope was used in them, bleeding might prove disturbing in a much smaller percentage by using the smaller No. 15 French caliber instrument. It was felt that, because of the essential factor of inflation, it was best not to continue when bleeding to any appreciable degree was present. Insufflation as employed for the tubal patency test was used in twelve cases, the syringe in twenty-nine cases. The rubber bulb was substituted in some of the cases as a control and was found to be less practical. With the gas flowing at a uniform rate the pressure was best noted in the carlier cases. The 20 c.c. syringe was found applicable and convenient and has been adopted as a routine.In two instances the amount of gas used was sufficient to induce a subphrenic pneumoperitoneum and was associated with shoulder pains. These were slight and lasted a few minutes as carbon dioxide was used. In five patients water irrigation under negative pressure was a part of the technic. It was abandoned because of its futility. Inflation with the syringe in the nonbleeding uterus proved the best medium of distention and for vision and has been adopted as the regular procedure in the hysteroscopy. The modified McCarthy type cystourethroscope was employed in all cases and was found to be the best adapted for uterine endoscopy.Contraindications.—It goes without saying that uteroscopy will not be employed as an ambulatory procedure in acute or subacute inflammations of the pelvis. Where it may be deemed desirable from the diagnostic point of view to examine the uterus endoscopically in such instances there can be no objection to doing so in hospital patients. Insufflation is, however, absolutely to be forbidden in the presence of inflammation.In certain cases of dysmenorrhea of the so-called obstructive type, uterine endoscopy may prove helpful by noting the behavior of the internal os functionally, or noting obstructing folds of the mucosa at the same point, ball valve-like folds or polypi causing mechanical obstruction to the escape of the menstrual flow without causing pathologic bleeding.In the diagnosis of the uterine cause of genital bleeding, endometroscopy might have an almost routine value since it can reveal such lesions as glandular hyperplasia of the endometrium, polypi, retained products of gestation (chorioepithelioma and carcinoma). The excising uterine endoscope will prove of special value in this field. Under direct vision a portion of the diseased endometrium may be removed for diagnosis. The very small lesion may perhaps be totally removed in this way. It may be possible too, to introduce direct vision fulguration for uterine lesions comparable to vesical lesions.In case of fibroids, uterine endoscopy also has a definite value in view of the modern competitive treatment by x-ray, radium, or surgical removal. It is perhaps the only simple means at our disposal to determine definitely the presence of a submucous myoma alone or amidst multiple fibromyomata in any given uterus. All other factors being equal there is general agreement on the opinion in favor of surgical removal of a uterus known to have a submucous myoma. The direct vision endometroscope affords this means of diagnosis.In studying the cyclical changes of the endometrium in all phases of menstruation. Heineberg4 had suggested “that the macroscopic changes occurring in the mucosa during menstruation might also be observed in favorable cases”. In a limited number of cases of carly pregnancy where for therapeutic purposes interference is contemplated, study can also be made of the carliest stages of ovum implantation, etc., and specimens can be thus obtained that otherwise would be unavailable. Not only is this a convenient method of observing the endometrium but small pieces from specific areas of its surface can be removed for study. It may be possible to check up Hitschmann and Adler's studies by accurate diagnostic excision of the mucosa using a procedure which is less traumatic than curettage.