Clapp, Jayne and Hughes. The opinion of the court was delivered by Clapp, S.j.a.d.
This is an appeal in a workmen's compensation case. While at work one afternoon, petitioner sustained a coronary infarction, which brought on his present disability. As established by the evidence and the findings of both the County Court and the Division of Workmen's Compensation, he, at the very time of the attack, had been subjected, by the circumstances of his employment, to unusual emotional stress. The principal question presented by these facts is whether the stress was a contributory cause of the infarction. Petitioner recovered a judgment in the Division, but the County Court reversed on the ground that causation had not been established. He now appeals to us.
We will accept the findings below, and the supporting evidence, indicating that petitioner had prior to the attack been suffering from some coronary athero- or arteriosclerosis,
of which he was unaware. We will accept also the finding of the County Court that the infarction was caused by a coronary occlusion and not, as stated by a heart specialist testifying for petitioner, a coronary insufficiency. However, it might be observed, in passing, that the medical opinion, to which the court attached some weight on the theory that it was given by the treating physician, was merely the "admitting diagnosis" -- a notation on the hospital record -- which had been rendered by a doctor when first called into the case. He did not testify. The "final diagnosis," shown on that record, which was made by the same doctor after he had in fact treated petitioner, does not mention an occlusion. Passing that, however, we are brought to a consideration of the County Court's important finding that there was no medical evidence to connect the emotional stress referred to and the immediately ensuing occlusion.
It is true that the two doctors testifying for the employer, Dr. Asher Yaguda and Dr. Arthur M. Masters, stated, one of them very flatly, that an occlusion cannot be caused by emotional tension or by activity or effort. On the other hand petitioner's case is supported by a solid opinion of the heart specialist testifying for him, that the emotional stress here caused the infarction. This specialist testified further, in effect, that autopsies performed on those who have had an infarction as a result of emotional stress, tensions and strain, show that some of them so afflicted have sustained an occlusion; more often, however, they show an insufficiency. In his view the probabilities therefore were that petitioner had suffered, not an occlusion, but a relative insufficiency. He went on to point out however that "only an autopsy would show" with scientific certainty "whether there was an occlusion" or an insufficiency. Snoden v. Watchung Borough , 29 N.J. Super. 41 (App. Div. 1953), affirmed 15 N.J. 376 (1954).
The factual question posed by the decision below -- namely, may an unusual emotional disturbance or an unusual exertion be a contributory cause of a coronary occlusion? -- has been repeatedly threshed out in the courts as well as the [47 NJSuper Page 289] agency. The following cases all have answered the question in the affirmative, allowing recovery to the petitioner. Hentz v. Janssen Dairy Corp. , 122 N.J.L. 494 (E. & A. 1939); Passafiume v. H.T. Hynds, Inc. , 128 N.J.L. 27 (Sup. Ct. 1942); Swift & Co. v. Von Volkum , 131 N.J.L. 83 (Sup. Ct. 1943), affirmed 132 N.J.L. 344 (E. & A. 1945); Lockwood v. Parker , 132 N.J.L. 482 (Sup. Ct. 1945); Breheny v. County of Essex , 132 N.J.L. 584 (Sup. Ct. 1945), affirmed 134 N.J.L. 129 (E. & A. 1946); Dalton v. Consolidated Laundries Corp. , 134 N.J.L. 27, 32 (Sup. Ct. 1946); Prawatchke v. Sheffield Farms Co. Inc. , 134 N.J.L. 92 (Sup. Ct. 1946) (thrombosis); Weisenbach v. New Milford , 134 N.J.L. 506 (Sup. Ct. 1946); Van Ness v. Haledon , 136 N.J.L. 623, 627 (E. & A. 1948); Moleski v. Bohen , 1 N.J. Super. 136 (App. Div. 1948); Carpenter v. Calco Chemical Div., Amer. Cyanamid Co. , 4 N.J. Super. 53 (App. Div. 1949); Gorelick v. Paramount Slipper Co., Inc. , 5 N.J. Super. 406 (App. Div. 1949); Pisciotta v. Mahoney-Troast Construction Co. , 8 N.J. Super. 213 (App. Div. 1950); Amend v. Amend , 12 N.J. Super. 425 (Cty. Ct. 1950); Margolies v. Crawford Clothes , 24 N.J. Super. 598 (App. Div. 1953); Snoden v. Watchung Borough, supra; cf. Todd v. Northeastern Poultry, etc., Inc. , 9 N.J. Super. 348 (Cty. Ct. 1950). Among various cases of the Bureau, which have been reported, see Eisen v. Jacquard Fabrics, Inc. , 19 N.J. Misc. 526 (W.C. Bur. 1941) ("That physical overexertion or effort may be a competent cause in precipitating the development of coronary thrombosis is no longer open to doubt. Like any other diseased condition, arteriosclerosis of the coronary vessels may, under certain circumstances, be aggravated by such trauma, resulting in a final occlusion"). It appears from the reports that the courts and the Bureau have, time and again, rejected the contrary view advanced by doctors brought into the case by the employer. 1 Larson, Workmen's Compensation Law , 566 (1952). Accordingly, compensation was allowed in Dalton v. Consolidated Laundries Corp. , 134 N.J.L. 27, 32 (Sup. Ct. 1946), supra , with this observation:
"The differences in the medical testimony lie in the frankly conceded fact that prosecutor's [employer's] experts share the view of others in their profession, that neither effort nor exertion, nor trauma is causally related to coronary thrombosis, while other experts as those for respondent [employee] entertain a contrary view. The views of prosecutor's experts, as we have had occasion to observe , ignores the construction which we have given to the meaning of a compensable accident under our statute." (Citing cases.) (Italics added.)
Again in Breheny v. County of Essex , 132 N.J.L. 584 (Sup. Ct. 1945), affirmed for the reasons stated, 134 N.J.L. 129 (E. & A. 1946), compensation was awarded. The Supreme Court said:
"Their [the heart specialists called by the employer] conclusions were concededly based on the premise that 'effort and trauma are not causally related to coronary occlusion,' a premise which in their view reflects the opinion of leading authorities on the subject. That premise sounds a familiar but discordant tone."
The opinion of the very doctors, who testified for the employer here, has been rejected in reported cases. Thus Justice Heher, for the former Supreme Court, in Weisenbach v. New Milford , 134 N.J.L. 506 (1946), speaking of Dr. Masters and other medical witnesses for the employer, said:
"These specialists were content to say they entertained the view expounded by a Dr. Masters, that a coronary occlusion cannot result from 'undue exertion or excitement.' Their testimony is not convincing. It is at odds with the strongly preponderant ...