On the 
Frequency of Contracted Pelvis 
Among American Women, 
As Deduced from 2227 Cases of Labor. 
BY 
EDWARD REYNOLDS, M.D., 
BOSTON, MASS. 
REPRINT FROM VOL. XV. 
transactions. 
1890. [Reprinted from the Transactions of the American Gynecological Society, 
September, 1890.] 
ON THE FREQUENCY OF CONTRACTED PELVIS 
AMONG AMERICAN WOMEN, AS DEDUCED 
FROM 2227 CASES OF LABOR. 
By Edward Reynolds, M.D., 
Boston, Mass. 
The widespread incredulity of European obstetricians 
upon the alleged infrequency of contracted pelvis among 
American women, and their expressed opinion that its rarity 
is due to the almost universal neglect of pelvimetry by 
American physicians rather than to any national peculiarities 
of our native women, seems sufficient reason for the publica- 
tion of any clinical observations which may have a bearing 
upon the subject, and the present report of 2227 cases of 
labor is intended as a contribution toward the settlement of 
this question. 
The material upon which the paper is based consists of 100 
cases confined in the wards of the Boston Lying-in Hospital, 
and 2127 delivered since May 1, 1886, in the Out-patient 
Department of the Hospital and the Obstetric Department of 
the Boston Dispensary. 
These 2227 cases have furnished me with thirty instances 
of pelvic deformity, to which I have added nine drawn from 
my private and consulting practice; but since many different 
nationalities are represented among the patients of both 
clinics, it is necessary to classify them by nativity before 
attempting to draw any inferences from the proportion of 
deformity observed. 
The amount and percentage of contracted pelvis, and its 2 
FREQUENCY OF CONTRACTED PELVIS. 
distribution by nationality among the out-patients are shown 
by Table I. 
Table 
I. 
Nationality. 
No. 
of 
Simple 
flat. 
Generally 
contrated 
flat. 
Justo- 
minur. 
Naegele 
oblique. 
Total. 
No. 
Per 
cent. 
No 
Per 
cent. 
No. 
Per 
cent. 
No 
Per 
cent. 
No. 
Per 
cent. 
Jewish1 .... 
768 
4 
0.005 
4 
0.005 
4 
0.005 
1 
0 001 
13 
0 017 
American 
581 
0 
2 
0.004 
2 
0 004 
Irish .... 
475 
1 
0.002 
2 
0.094 
3 
0.006 
6 
0.013 
English .... 
72 
1 
0.014 
1 
0.014 
Scattering or unreported2 
231 
0 
Total . 
2127 
6 
6 
9 
1 
22 
Table I. 
21 of these 22 cases either occurred in my service or were 
seen by me in consultation with my colleague, Dr. C. W. 
Townsend, but to them should be added 2 cases attended by 
Dr. Townsend alone, and 2 delivered by Dr. C. M. Green, in 
each of which the record states that the measurements were 
taken but not preserved, as is shown in 
Table II. 
Nationality. 
Pelvis. 
Reporter. 
American3 .... 
" Justo-niinor." 
Green. 
Jewess 
"Pelvis contracted." 
Green. 
Jewess 
" Contracted pelvis." 
Townsend. 
Irish 
"Contracted pelvis." 
Townsend. 
Table II. 
1 These women are almost without exceptions Russians, Poles or Germans, 
who live together, are clinically indistinguishable, and are therefore grouped 
under one heading. 
2 The unreported cases formed the larger part of this class, and were, almost 
without exception, precipitate labors in which the whole report was incomplete. 
* Included in Table I. REYNOLDS. 
3 
The value to be accorded to these results must depend 
largely upon their agreement, as regards the foreign patients 
at least, with the reports of European institutions; but in 
attempting a comparison we are met at the outset by the 
difficulty that, even in the German-speaking countries, where 
the subject has been most carefully studied, the reported 
results vary so widely (e. g., 1.5 per cent., Hecker; 2.8 
per cent., Winckel; 9.5 per cent., Pfund; 13.1 per cent., 
Michaelis; and 14.9 per cent., Litzmann) as to appear at first 
sight wholly irreconcilable with each other. 
The discrepancy is, however, to be explained by a difference 
in the definition adopted for the limit of normal variation, 
since the authors who obtain the lowest percentages recognize 
as abnormal only those cases in which arrest occurred in 
pelves whose conjugates were less than three and one-half 
inches, while those who find the deformity most frequent 
admit to their tables all pelves whose conjugates are dimin- 
ished by only 0.5 cm. (0.2 inch). It is, therefore, essential in 
reporting any series, to compare its results only with those 
which have been obtained by a somewhat similar rule. That 
which I have used, is that diminution of the conjugate to three 
and one-half inches with ample transverse space, or to four 
inches when accompanied by general contraction, is sufficient 
to constitute an abnormality. 
My percentage among German-speaking patients (1.7 per 
cent.) would, therefore, be expected to correspond somewhat 
closely to those of Michaelis (13.9 per cent.), Litzmann (14.1 
per cent.), or Pfund (9.5 per cent.); and the extreme dis- 
crepancy which in fact exists, is to be explained, partly, at 
least, by the fact that their tables were founded upon routine 
measurement of every case which came under observation, 
while in mine, only the operative cases were measured. It 
is, therefore, necessary, before instituting a comparison, to 
ascertain by computation the probable total percentage which 
which was present among my patients; and if to this end we 
accept the rule of Michaelis and Litzmann, that from 70 to 4 
FREQUENCY OF CONTRACTED PERVIS. 
80 per cent, of pelves classified by such a rule will fail to 
obstruct labor, we must multiply the observed proportion 
(1.7 per cent.) by four, to obtain the probable total percentage, 
6.8 per cent., which is even then much less than that obtained 
by any German authority who admits the lesser grades of 
deformity to his table. , 
A second point of interest in this inquiry is the proportion 
which obtains between the number of generally-contracted 
pelves found and the total amount of deformity observed. 
Here, again, the reports of foreign institutions differ widely 
(e. g., 1.4 per cent., Winckel; 6.4 per cent., Muller; 22.3 
per cent., Gonner; 50.0 per cent., Hugenberger; and 52.8 
per cent., Bidder), but in these tables, also, the results depend 
upon the rule adopted, since the higher percentages are all 
reported by observers whose tables include only the more 
severe cases, while the results (1.4 per cent, and 6.4 per cent.) 
of those who adopt a more comprehensive definition are 
again widely different from my 61.5 per cent. 
A closely similar difference in both respects seems to obtain 
between my results among the Irish and English, and those 
reported from their homes, although the accounts which I 
have been able to obtain from these countries are far less de- 
tailed than those published by the Germans; but if we turn 
to the native-born portion of the clinic, the decreased total 
deformity and the relative increase of general contraction 
become"more striking yet when compared with the reports 
of European institutions; since the 581 American women 
furnished only two observed cases of deformity, and these 
both of the justo-minor type; a number which, by com- 
putation after the rule of Michaelis aud Litzmann, would 
give a total proportion of only 1.6 per cent, of contraction; 
and, small as is the number of cases, the difference in the 
results is so striking as to demand further investigation. 
The variation of the proportions observed among the 
foreign-born portions of the clinic from those of European 
hospitals, and their approximation to those obtained from the EDWARD REYNOLDS. 
5 
natives, is probably due to the fact that a large number of 
these women, though born in Europe, were brought to this 
country during infancy or childhood, underwent the develop- 
mental changes of puberty here, and might, therefore, be 
expected to approach more or less closely to the characteristics 
of the native-born patients, especially as these latter were 
almost without exception of foreign parentage; but if this 
explanation is in reality sufficient to account for the dis- 
crepancy, and if it be true, as this investigation seems to 
suggest, that women of American birth are practically exempt 
from all but the justo-minor deformities, the same results 
should be obtained from the 100 cases observed in the wards, 
whose pelves were all measured; and it should also be found 
that all of the somewhat larger number of American pelves 
seen in consultation were of the same type. 
Table 
III. 
Nationality. 
No. 
Simple 
flat. 
Generally 
contracted 
flat. 
Justo- 
minor. 
Total 
American .... 
5 
1 
1 
Irish 
27 
2 
2 
English 
3 
1 
1 
Negresses1 .... 
8 
1 
1 
Scattering 
5 
Total 
100 
4 
1 
5 
Table III. 
The 57 native in-patients produced, as is seen in Table III., 
only 1 case of deformity, and that a typical justo-minor pelvis 
-the percentage (1.8) being closely similar to that obtained 
1 The occurrence of two flattened pelves [See Table IV.], both probably of 
rhachitic origin, among the small number of negresses delivered, and the absence 
of any well-marked rhachitic influence among the other cases, is in striking 
accordance with the statement of Bradford and Lovett [Orthopedic Surgery, 
chapter xix.], to the effect that severe rickets is seldom or never seen in this 
country, unless among the children of Southern Europeans, or among the 
negresses of the Northern States. 
* 6 
FREQUENCY OF CONTRACTED PELVIS. 
from the out-patients (1.6 per cent.)-while the few foreigners 
yielded 4 examples of flattened pelvis and no justo-minor; 
similarly, of the 4 deformed American pelves seen in private 
practice (Table IV.), 3 were justo-minor, and 1 a rare form 
of transversely contracted pelvis of somewhat similar etio- 
logical significance; but since this preponderance of sym- 
metrical contraction might easily be ascribed to an error of 
observation, it seems best to describe briefly here the method 
by which the differential diagnosis was made. 
Table IV. 
Nationality. 
Simple 
flat. 
Generally 
contracted 
flat. 
JllBtO- 
minor. 
Robert's. 
Total. 
American .... 
3 
1 
4 
Negress 
1 
1 
Irish 
2 
2 
English 
2 
2 
Total 
3 
2 
3 
1 
9 
Table IV. 
The tests by which a simple flat deformity was diagnosed 
were : That the presenting part entered the brim with its long 
diameter transverse, that its contact with the side walls of 
the pelvis was less close than with the symphysis and pro- 
montory, that the half-hand when introduced into the vagina 
for internal palpation, found the transverse space ample, that 
the external bis-iliac diameters were of nearly or quite normal 
length and the external conjugate diminished; but on the 
other hand, if the position was transverse, the degree of con- 
tact equal or nearly equal on all sides, the bis-iliac diameters 
decreased, though to a less extent than the external conjugate, 
the promontory low, the longitudinal curve of the sacrum 
increased, and the axis of the false pelvis, as a whole, short, 
the case was classified as generally contracted flat; while if 
the promontory was high, the sacrum straight and relatively 
long, the symphysis erect, the external diameters syrame- ED WARD REYNOLDS. 
7 
trically decreased, the sacro-iliac notches shallow, and the 
mechanism that of early flexion at the brim, the pelvis was 
considered to be justo-minor; and it may be said here that in 
all but one of the American pelves, these latter characteristics 
were well marked, while in that one case (Case 21), although 
the diagnosis was less clear, the weight of evidence seemed to 
point plainly to the justo-minor type. 
If this classification be accepted as sufficiently exact for 
clinical purposes, I think that, so far as the number of cases 
warrants any deduction, it may be safely concluded that an 
American birth decreases the amount of pelvic deformity 
among the children of foreign parents, that the same result 
may perhaps be attained even by residence in this country 
during the early years of life, and that when such malforma- 
tions occur among American women they are usually, if not 
always, of the justo-minor type. That pure-blooded American 
women are not wholly exempt from this evil is, however, 
shown, if proof be needed, by the fact that two of the con- 
tracted pelves seen in consultation were observed in women 
who were of long American descent, and distinctly of the 
upper classes of society; and, finally, if it is true that flattened 
pelves are the result, as a rule, of insufficient nourishment or 
excessive labor before or during puberty, while the justo- 
minor deformities are due to simple arrest of development at 
that period (that is, to a partial persistence of the infantile 
type), and are, therefore, independent of such conditions, the 
result obtained is perhaps just that which would have been 
expected a priori from the conditions of American life and 
the peculiar characteristics of American women. 8 
FREQUENCY OF CONTRACTED PELVIS. 
No. 
Nationality. 
Pelvis. 
Labor. 
Operator. 
Iliac 
Spines. 
Iliac 
Crests. 
External 
conjugate. 
Diagonal 
conjugate. 
Symphysis. 
Promon- 
tory. 
True con- 
jugate by 
estimation 
Diagnosis 
and 
remarks. 
Inches. 
Inches. 
Inches. 
Inches. 
Inches. 
1 
Jewess, 
9% 
10 
7% 
4% 
4 
General con- 
traction of 
slight degree, 
flat. 
Version; extraction difficult; crani- 
otomy to after-coming head. 
Townsend. 
2 
Jewess, 
8% 
10% 
6% 
4% 
Normal. 
Low. 
3% 
Simple flat. 
Version. 
Reynolds. 
3 
Jewess, 
8% 
10 
8 
4% 
Normal. 
Normal. 
4 
Naegele ob- 
lique. 
Version and easy extraction after 
six hours delay at brim, O. D. P. 
Diagnosis by internal palpation, 
and constant difference of 1 c.m. 
in usual special measurements. 
(Am. Journ. Obstet., July, 1890.) 
Reynolds. 
4 
Jewess, 
8% 
10 
7% 
4% 
Normal but 
erect. 
High. 
3% 
Justo-minor. 
Axis-traction forceps at brim. 
Reynolds. 
5 
Jewess, 
8% 
9% 
6% 
4 
Normal. 
Normal. 
3% 
Simple flat. 
Foetus anencephalic; face presenta- 
tion ; extraction of body difficult. 
Operation by house physician; 
measurements by Reynolds. 
Reynolds. 
6 
Jewess, 
9% 
10% 
7JT 
4/4 
Normal. 
Normal. 
3% 
Generally con- 
tracted, flat. 
Axis-traction forceps. 
Townsend. 
7 
Jewess, 
Taken 
but not preserved. 
4% 
Normal. 
Normal. 
3% 
Simple flat. 
Forceps, axis-traction, failed to ex- 
tract ; version difficult on account 
of bad constriction ring; extrac- 
tion difficult; 10 lb. child. 
Reynolds. 
8 
Jewess, 
9% 
10% 
7 
4 
Normal. 
High. 
3% 
Generally con- 
tracted flat, 
transverse 
space mark- 
edly dimin- 
ished. 
After failure of axis-traction for- 
ceps, Dr. Richardson called in 
consultation, and did version, but 
failed to extract. Craniotomy to 
after-coming head. 
Reynolds. 
9 
Jewess, 
9 
10% 
6% 
4 
2 inches long 
;and very 
erect. 
Very 
high. 
3 
Justo-minor. 
Craniotomy after consultation with 
Dr. C. M. Gteen. Sixty hours in 
labor when first seen. 
Reynolds. 
Table V.-Out-patients. EDWARD REYNOLDS. 
9 
10 
Jewess, 
9 
6X 
4 | Long and 
High. 
35i 
Justo-minor. 
Craniotomy because exhausted by 
Reynolds. 
11 
Jewess, 
9& 
11 
7X 
erect. 
Normal. 
Normal. 
W 
Pelvis shallow 
long labor when first seen. Died 
of fine bronchitis and oedema of 
lungs, probably secondary to long 
etherization. 
Version. 
Reynolds. 
12 
Jewess, 
9J4 
10 
7 
Long and 
High. 
3% 
and transverse 
space some- 
what dimin- 
ished ; flat and 
slight general 
contraction. 
Justo-minor. 
Child 9 lb.; dead when first seen. 
Reynolds. 
13 
Jewess, 
9 
10 
7% 
erect. 
Normal. 
Normal. 
33/ 
Simple flat. 
Version. 
Reynolds. 
14 
Irish, 
Exter 
nal measi 
irements 
4 Normal. 
Normal. 
3% 
Simple flat. 
Version. 
Reynolds. 
15 
Irish, 
W 
lost. 
11 
8 
Short but 
Low. 
3X 
Generally con- 
External measurement much in- 
Reynolds. 
16 
Irish, 
8% 
10 
7tf 
erect. 
Normal. 
Normal. 
tracted flat. 
Generally con- 
creased by great stoutness of pa- 
tient, but transverse space mark- 
edly diminished, by internal pal- 
pation and mechanism. Axis- 
traction forceps failed. Version 
difficult; child stillborn. 
Arrest of O. D. P. at brim, normal 
Reynolds. 
17 
Irish, 
9% 
7X 
4% Bather 
Rather 
4 
tracted flat 
Justo-minor. 
rotation to O. D. A. Axis-traction 
forceps. 
Contraction very slight. Arrest due 
Townsend. 
18 
Irish, 
11 
7% 
erect. 
4% 2 inches. 
high. 
Normal. 
4 
Justo-minor. 
probably to O D.P. position ; foetal 
heart failing. 
Contraction very slight; child 8% 
Townsend. 
19 
Irish, 
9X 
W 
7 
Long and 
High. 
4 
Justo-minor. 
pounds, S. D. A. Forceps, axis- 
traction, to breech at brim. 
Forceps. 
Reynolds. 
20 
English, 
9tf 
10 
73/ 
erect. 
4% Inclined. 
High. 
3K 
Simple flat. 
Version. 
Reynolds. 
21 
American, 
10 
11 
7% 
4% 1 Erect. 
High. 
3X 
Justo minor. 
Axis-traction forceps; 10 lb. child. 
Reynolds 
22 
Jewess, 
'Pelvis contracted." 
Forceps. 
Green. 
23 
American, 
'Justo-minor." 
Forceps. 
Green. 
24 
Jewess, 
'Contracted pelvis." 
Version. 
Townsend. 
25 
Irish, 
'Contracted pelvis." 
Forceps. 
Townsend. 10 
FREQUENCY OF CONTRACTED PELVIS. 
No 
Nationality. 
Pelvis. 
Labor. 
Operator. 
Iliac 
spines. 
Iliac 
crests. 
External 
conjugate. 
Diagonal 
conjugate. 
Symphysis. 
Promon- 
tory. 
True con- 
jugate by 
estimation 
Diagnosis and 
remarks. 
26 
English, 
Inches. 
10% 
Inches. 
10% 
Inches. 
6% 
Inches. 
4% 
Normal. 
Low. 
Inches. 
False pelvis visibly 
flaring; simple flat 
probably rhachitic. 
Normal labor, mechanism of 
a flattened pelvis. 
IT 
Irish, 
10% 
11 
4 
Long. 
Low. 
3% 
Simple flat. 
Normal; position of sagittal 
suture transverse. 
28 
Irish, 
10% 
H% 
7 
4 
Normal. 
Normal. 
3% 
Simple flat; outlet 
flaring. 
Normal; position of sagittal 
suture transverse. 
29 
American, 
8% 
10% 
7 
4% 
Erect. 
High. 
4 
Justo-minor. 
Normal, but mechanism of 
early flexion. 
30 
Negress, 
9 
9% 
7 
4 
Increased 
inclination. 
Very 
low. 
3% 
Transverse space not 
diminished; simple 
flat, possibly rha- 
chitic. 
Normal labor ; head low on 
entrance. 
Table VI.-House Patients. EDWARD REYNOLDS. 
11 
No. 
Nationality. 
Pelvis. 
Labor. 
Operator. 
Iliac 
spines. 
Iliac 
crests. 
External 
conjugate. 
Diagonal 
conjugate. 
Symphysis. 
Promon- 
tory 
True con- 
jugate by 
estimation 
Diagnosis and 
remarks. 
31 
American, 
Inches. 
9 
Inches. 
11 
Inches. 
8 
Inches. 
4% 
Long. 
High. 
Inches. 
3% 
Justo-minor external 
Spontaneous delivery at seven 
32 
Irish, 
English, 
9% 
10% 
7% 
4% 
Normal. 
Normal. 
3% 
measurements in- 
creased by extreme 
stoutness of patient. 
Simple flat. 
months. 
High forceps. 
Reynolds. 
33 
9 
10 
6% 
4 
Normal. 
Normal. 
Elat, with slight gen- 
Version. 
Reynolds. 
34 
Irish, 
10 
12 
8 
4% 
Normal. 
Normal. 
3% 
eral contraction. 
Simple flat; large ex- 
Seen with Drs. F. C. Murphy 
Reynolds. 
35 
English, 
Patient 
moribun 
d when see 
i. Extern 
al measure- 
Low. 
2% 
ternal measurements 
due to fatness of pa- 
tient. 
Transverse space much 
and F. W. Goss. Version 
before my arrival. Crani- 
otomy to after-coming'head. 
Seen with Drs. P, C. Gavin 
Reynolds. 
86 
American, 
9% 
10% 
ments not 
6% 
aken. 
5 
Arch masc 
uline. 
4% 
decreased. Pelvis 
shallow, generally 
contracted, flat. 
Transverse space di- 
and J. P. Reynolds. Breech 
presentation; body extract- 
ed before my arrival. Crani- 
otomy to after-coming head. 
Dwarf (50 in., 90 lb.); subject 
37 
American, 
10 
11% 
8 
4% 
Erect and 
Normal. 
3% 
minished, especially 
at outlet Marked ky- 
phosis. Justo-minor 
with kyphosis added. 
Bones all slender; pa- 
of old and recent dorsal 
Pott's disease. Sent to me 
by Dr. and referred 
to Bost. Lying-in Hosp, ser 
vice of Dr. Richardson, who 
induced labor at 7 months. 
Seen at 7 months with Dr. J. 
38 
39 
American, 
American 
8.4 
10 
10.4 
10% 
6.6 
6% 
4% 
relatively 
long. 
Short and 
Low. 
3% 
tient fat. Justo- 
minor. 
Robert's pelvis. Bos- 
ton Med. and Surg. 
Journ., vol. cxxii. 
No. 17, Apr. 24, '890. 
Pelvis very shallow. 
P. Reynolds. Induction at 
8 months recommended. 
Patient left Boston. 
Seen with Drs. G.Haven and 
A. Coolidge, Jr. Forceps 
failed. Craniotomy. 
Seen with Dr. H. J. Barnes at 
Haven. 
(colored), 
much in- 
clined. 
Simple flat, probably 
rhachitic. 
eight months. Recom- 
mended to wait until term. 
Normal labor. 
Table VII.-Private Patients.