CONGENITAL INDURATION OR TUMOR 
OF THE STERNO-MASTOID. 
BY 
JUSTIN HER0LD/1.M., M.D., 
New York. 
Reprinted from the International Medical Magazine for February, 1893. CONGENITAL INDURATION OR TUMOR OF THE 
STERNO-MASTOID. 
The muscles of the human system, taking into consideration their 
exposed situation, are much less frequently associated with injuries and 
diseases than would be supposed. Their anatomical construction, their 
protection by integument, fat, and fasciae, together with their power of 
resistance to well-known morbid processes, make the muscles a rare seat for 
injuries and diseases. Observation recently of a case of congenital indura- 
tion of the sterno-mastoid muscle has incited me to report the same, together 
with a few facts occurring in the history of this affection, so very often 
overlooked or passed over as insignificant. 
Some months ago I was summoned to treat an infant four weeks old, 
presenting a swelling, as hard as bone, on the right side of the neck. The 
history of its occurrence was supplied me by the mother of the little 
patient, which was her third born in the space of six years. She had been 
attended by a midwife at each confinement. The two first children were 
born in the natural way; the subject of this writing presented by a foot. 
After the mother had been in labor for fully sixteen and a half hours, the 
midwife seized both feet of the child in her hands and pulled with great 
force, until the head of the child became " stuck," as the mother expressed 
it. The midwife then took a short rest, after which she resumed her forceful 
methods, finally relieving the mother of the child, by actually pulling it 
from the point at which the head was engaged in the pelvis; the mother, 
in spite of this harsh treatment, was up and about her household duties on 
the fourth day thereafter; but the infant was not so lucky. After the lapse 
of three weeks the above-mentioned swelling was observed by the mother, 
who at the time ascribed it to the force used by her attendant in delivering 
her of her child. I examined the patient carefully, and found a swelling 
covering the situation of the right sterno-mastoid muscle in its entirety, 
quite as hard as bone; so much so that it appeared, on casual inspection and 
palpation, to be a dislocated clavicle; it produced no inconvenience whatever, 
no deformity, simply appearing as a hard swelling, and disappearing gradu- 
ally in the course of eight weeks upon the daily application, externally, 
of equal parts of glycerin and tincture of iodine. I have observed this 
condition of the sterno-mastoid several times in the last ten years, occurring 
in infants born with a good-sized head and large shoulders, which neces- 
sarily make labor difficult, and assist in causing this affection. 2 
JUSTIN HEROLD, A.M., M.D., ON 
Myosclerosis, or induration of the sterno-mastoid, appears either within a 
few days or a few weeks after birth. Its occurrence is not very frequent, it is 
always unilateral, and may occur on either side, but is more frequent on the 
right. The induration causes a limited swelling, occupying a part or the whole 
of the muscle; the contour of the muscle becomes apparent in this swelling, 
which extends from the clavicle upward to the mastoid process, presenting 
a noticeable condition. An admirable description of this swelling has been 
presented to us by Henoch in his work on " Diseases of Children." He de- 
scribes the swelling " as a hard round, or band-shaped, nodular tumor, on the 
lateral aspect of the neck, corresponding to the anterior part at the sterno- 
mastoid muscle. Its size varies,-oftentimes as large as a pigeon's egg, but 
frequently much larger and elongated, so that I have occasionally found a 
large part of the anterior edge of the muscle hard and nodular, whence band- 
shaped projections ran into the adjacent parts of the muscle. Occasionally 
there are two or three isolated hard spots in the edge of the muscle. As a 
rule the upper half of the muscle is much more frequently affected than 
the lower, but in one case I found almost the entire anterior half of a carti- 
laginous hardness." A greater or lesser degree of pain may be occasioned 
by induration of this muscle, both on pressure and on movement; it may 
be absent or only occur at intervals. Redness and heat of the swelling 
have been conspicuous by their absence in the limited number of cases 
coming under my observation. To my mind the most noticeable features in 
these cases are the abnormal increase in the density and firmness of the 
structures, which become as hard as rock. In the majority of cases slight 
deformity exists; this may be noticed in that the child's head is not held 
straight while prone, but is turned to one side; usually the face is turned 
to the opposite side and the head to the affected side; this position, accord- 
ing to Professor Henoch, is not constant, and the younger the child the less 
frequent is its occurrence. Professor Henoch says that the youngest child 
affected in his experience was three weeks old, and the majority are from 
four to six weeks old; three cases occurring at the ages of three, five, and 
twelve months. As I mentioned at the beginning of this article that I 
observed no deformity in my case, it conforms to the idea of Professor He- 
noch, that the deformity is not constant, and appears more infrequently 
the younger the child. 
What is the cause producing this induration of the sterno-mastoid 
muscle ? It is undoubtedly established during the birth of the child, through 
traction on the head and shoulders. In difficult labors, the head, especially 
if large, may be caught at the superior strait of the pelvis, consequently 
any undue force expending itself on the neck of the child, whether it be 
manual or instrumental, is sufficient to rupture this muscle. Still, indura- 
tion of the sterno-mastoid has been observed in cases in which labor was 
normal and unattended with any difficulty; cases in which neither manual 
nor instrumental aid was employed. Congenital diseases and constitutional 
taint have been advanced as probable causes, but this connection has not CONGENITAL INDURATION OR TUMOR OF THE STERNO-MASTOID. 
3 
been established upon close scrutiny of reported cases. It is evident that 
almost all the children affected presented abnormally at birth, rendering 
manual or instrumental aid through traction necessary; in other cases, by 
far the smaller number, it was found that although the children affected pre- 
sented normally, still labor lasted a long time, necessitating forcible traction. 
In some of the cases a large head and shoulders delayed delivery; in my 
opinion, traction of the head and shoulders does the damage. The effect, 
consequent upon the cause, consists of a partial rupture or tearing of the 
fibres, or of certain fibres of the muscle, hemorrhage into the muscular 
structure, and an inflammation, followed by one of the local effects of in- 
flammation, which is induration. Induration is the process of hardening, 
following inflammation in any structure, from any cause; in a few words, 
it is a chronic inflammation; the enlargement and hardening of the muscle 
being due to an inflammatory exudate. In cases of induration of the sterno- 
mastoid, there is no deposit of morbid structures, or degenerations of struc- 
ture, consequently the composition and structure of the muscle are not 
materially changed. Induration of the sterno-mastoid is nothing more than 
a termination of the process of inflammation; the nutrition of the muscle 
being changed, forming an exudate, which organizes and forms the swelling 
and hardness observed in these cases; although the swelling may be partly 
due to the extravasation of blood and interference with its function, the 
consistency of the muscle is affected, as the result of a local inflammatory 
process. Professor Van Buren described the process very aptly, as "one 
of the characteristic features of chronic inflammation ; especially does indu- 
ration take place where constructive inflammation has been prevented from 
attaining its object in the healing of a breach of continuity; the nutritive 
material brought for the purpose of aiding repair remains unused in the 
form of new tissue-growth, more or less organized, which collects around 
the capillary vessels, furnishing the exudation. It is new tissue formation 
intended for repair, but diverted from its object. This increase in the 
numerical elements of the connective substance immediately surrounding 
the capillary vessels constitutes, as the term first employed by Virchow, 
hyperplasia, or a redundant tissue formation by elements which have been 
turned aside from their purpose. The use of this term serves to distinguish 
an increase in bulk caused by inflammatory induration from hypertrophy, 
which is a purposive overgrowth of an organ generally invoked by its 
increased use, the habitually increased functional activity soliciting con- 
stantly a larger supply of nutritive material. It is proper to notice that 
the new tissue growth which constitutes inflammatory induration is less 
perfectly organized than the more normal growth of cicatricial tissue; hence 
induration may be removed by absorption, by atrophy, or by retrogressive 
changes, such as fatty degeneration. Thus systematic pressure will cause 
the rapid disappearance of the embankment of induration surrounding a 
chronic ulcer of the leg." This description applies very significantly to 
induration of the sterno-mastoid. In the limited number of cases observed 4 
CONGENITAL INDURATION OR TUMOR OF THE STERNO-MASTOID. 
by me I never noticed that suppuration occurred. Neither did I notice 
any permanent deformity resembling torticollis. According to my ex- 
perience, the swelling and hardness constituting the induration disappear 
spontaneously in the course of a few months; the process of restoration of 
function in the muscle being a natural one,-namely, by absorption,-at most 
the tincture of iodine diluted with an equal quantity of glycerin may be 
applied externally, or, as recommended by Dr. Clarendon Rutherford, of 
Chicago, the external use of ungt. sod. iod.; potass, iodid. and vaseline, to 
produce gentle counter-irritation; slight friction may also be employed. International 
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