The opinion of the court was delivered by
■Case, J.
The question is whether, in this compensation case, there is evidence to support a finding that the workman sustained an accident arising out of and in the course of his employment. He was employed by respondent as a utility man or car loader. In the course of his regular duties, at about noon, he was unloading car seat frames, each weighing about 10 or 15 pounds, from a freight car. He was standing on a pile of frames in the car and was pulling the frames off one at a time and handing them down, in like order, to a fellow worker who was on the floor of the car. As he pulled a frame from the pile he felt a pain in his back. He was doing the same type of work he had been doing for six or seven months prior thereto, and in the same way. The only unusual incident on this occasion was that he experienced the pain. Immediately following the occurrence he went to the first aid dispensary and said, “I don’t see how I could have hurt my back because these frames are not heavy”; and at the hearing on his petition for compensation he testified:
“Q. The only thing unusual about this one was that you got a pain in your back as you pulled it? A. That is right, yes.
Q. As far as the operation itself, pulling it, or whatever you were doing, it was nothing different from what you had done for a [588]*588long while, ycm had done it for many months? A. Ever since I went there.”
Claim was filed for a sacroiliac sprain, and compensation was allowed. On successive appeals the Middlesex County Court, Law Division, and the Superior Court, Appellate Division, affirmed. The case comes before us on our certification, granted on the workman’s petition.
From the inception of the workmen’s compensation statute, by the wording of the law and by the construction given' by our courts, liability for injury was grounded in accident. The classic definition of the essential incidents to recovery were:
“(a) an accident, (b) arising out of, and (e) in the course of, his (the workman’s) employment. Even though the injury arose out of and in the course of the employment, if it be not an ‘accident,’ within the purview of the act, there can be no recovery. » * * an ‘accident’ is an unlooked-for mishap or untoward event which is not expected or designed.” Bryant, Adm’x. v. Fissell, 84 N. J. L. 72 (Sup. Ct. 1913).
The criteria of an accident have varied, but it has remained of the essence that there should be an accident.
The workman’s contention is, in substance, that except in heart cases an injury imputes accident. The contention reduces to an exception a requirement which the statute makes general. The language of the statute is: “Compensation for personal injuries * * * by accident arising out of and in the course of * * * employment.” N. J. S. A. 34:15-7. The suggested construction. would, obviously, strike out the effect of the words “by accident,” whereas it is a cardinal rule of statutory construction that statutes are to be so construed that, if possible, full force and effect shall be given to every sentence, clause and word thereof. Bogert v. Hackensack Water co., 101 N. J. L. 518 (E. & A. 1925).
The incident of an unusual strain producing injury or death either directly or by being superimposed upon an ailing bodily condition has from the early days of the statute been [589]*589recognized as an accident in the statutory sense. This is true not only of heart cases but of cases involving other bodily organs and parts, as: pressure on parts weakened by cancer, Voorhees v. Smith Schoonmaker Co., 86 N. J. L. 500 (Sup. Ct. 1914); affecting a weakened heart, Winter v. Atkinson-Frizelle Co., 88 N. J. L. 401 (E. & A. 1915); aggravating a duodenal ulcer, Holzwarth v. Hedden, &c., Co., 1 N. J. Misc. 381 (Essex Com. Pleas 1923, not officially reported); an extraordinary strain activating tuberculosis, Graves v. Burns, Lane & Richardson, 10 N. J. Misc. 667 (Sup. Ct. 1932, not officially reported), affirmed on the opinion below, 110 N. J. L. 607 (E. & A. 1933); a severe or twisting sprain aggravating a spinal condition, George T. Newell, Jr., Inc., v. Workmen’s Compensation Bureau, 10 N. J. Misc. 405 (Sup. Ct. 1932, not officially reported), affirmed on the opinion below, 110 N. J. L. 25 (E. & A. 1933); unusual physical exer.tion dilating the heart, Fire Commissioners, &c., v. Morris, 12 N. J. Misc. 153 (Sup. Ct. 1934, not officially reported); prolonged exertion in pulling out great weeds and bushes, lighting up an old arthritic condition, Van Meter v. E. R. Morehouse, Inc., 13 N. J. Misc. 558 (Sup. Ct. 1935, not officially reported); a sprain “because of some unusual effort” aggravating a prior sprain, Marotta v. Fabi, 13 N. J. Misc. 690 (Sup. Ct. 1935, not officially reported); “work of an unusual character” and from it “an unusual exertion” aggravating a heart condition and so causing death, Bernstein Furniture Co. v. Kelly, 114 N. J. L. 500 (Sup. Ct. 1935), affirmed 115 N. J. L. 500 (E. & A. 1935); “if extraordinary strain * * * was the causative agent of the strangulation (hernia) the fatality was the consequence of an accidental injury,” Furferi v. Pennsylvania Railroad Co., 117 N. J. L. 508 (E. & A. 1937); lifting “a heavy weight,” causing tubercular hemorrhage, held, following Bernstein v. Kelly, supra, an accident, Rekoon v. General Lead Batteries Co., 119 N. J. L. 296 (Sup. Ct. 1938); “unusual exertion” imposed on pre-existing heart condition, causing death, Schneider v. F. & C. Haerter, 119 N. J. L. 548 (Sup. Ct. [590]*5901938); “unusual effort” aggravating pre-existing heart condition, causing death, Rother v. Merchants Refrigerating Co., 122 N. J. L. 347 (Sup. Ct. 1939). Our cases for nearly 30 years based recovery upon the extraordinary causation. The requirement was implicit.
In Hentz v. Janssen Dairy Corporation, 121 N. J. L. 160 (1938), the Supreme Court held, factually, that the employee was the driver of a milk truck making retail deliveries at the houses of customers, that his regular duties were exacting and laborious and that although the road was icy and the slope of it steep there was nothing unusual about the work or about the conditions on the day when he was stricken with coronary thrombosis. Consistently with what we conceive to have been the holdings of our cases, the court decided that on those facts the happening was not an accident within the application of the Workmen’s Compensation Act. On appeal the Court of Errors and Appeals, 122 N. J. L. 494 (1939), determined that the employment from which the strain resulted was “unusually hard on [that] day,” expressed inability to distinguish the case from Voorhees v. Smith Schoonmaker Co., Graves v. Burns, and other cases cited supra, and reversed. Taking the facts as resolved by the Court of Errors and Appeals, namely, that the conditions on the occasion of the heart attack were unusual, there was no distinction to be made from the earlier decisions and the reversal was consistent with them.
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The opinion of the court was delivered by
■Case, J.
The question is whether, in this compensation case, there is evidence to support a finding that the workman sustained an accident arising out of and in the course of his employment. He was employed by respondent as a utility man or car loader. In the course of his regular duties, at about noon, he was unloading car seat frames, each weighing about 10 or 15 pounds, from a freight car. He was standing on a pile of frames in the car and was pulling the frames off one at a time and handing them down, in like order, to a fellow worker who was on the floor of the car. As he pulled a frame from the pile he felt a pain in his back. He was doing the same type of work he had been doing for six or seven months prior thereto, and in the same way. The only unusual incident on this occasion was that he experienced the pain. Immediately following the occurrence he went to the first aid dispensary and said, “I don’t see how I could have hurt my back because these frames are not heavy”; and at the hearing on his petition for compensation he testified:
“Q. The only thing unusual about this one was that you got a pain in your back as you pulled it? A. That is right, yes.
Q. As far as the operation itself, pulling it, or whatever you were doing, it was nothing different from what you had done for a [588]*588long while, ycm had done it for many months? A. Ever since I went there.”
Claim was filed for a sacroiliac sprain, and compensation was allowed. On successive appeals the Middlesex County Court, Law Division, and the Superior Court, Appellate Division, affirmed. The case comes before us on our certification, granted on the workman’s petition.
From the inception of the workmen’s compensation statute, by the wording of the law and by the construction given' by our courts, liability for injury was grounded in accident. The classic definition of the essential incidents to recovery were:
“(a) an accident, (b) arising out of, and (e) in the course of, his (the workman’s) employment. Even though the injury arose out of and in the course of the employment, if it be not an ‘accident,’ within the purview of the act, there can be no recovery. » * * an ‘accident’ is an unlooked-for mishap or untoward event which is not expected or designed.” Bryant, Adm’x. v. Fissell, 84 N. J. L. 72 (Sup. Ct. 1913).
The criteria of an accident have varied, but it has remained of the essence that there should be an accident.
The workman’s contention is, in substance, that except in heart cases an injury imputes accident. The contention reduces to an exception a requirement which the statute makes general. The language of the statute is: “Compensation for personal injuries * * * by accident arising out of and in the course of * * * employment.” N. J. S. A. 34:15-7. The suggested construction. would, obviously, strike out the effect of the words “by accident,” whereas it is a cardinal rule of statutory construction that statutes are to be so construed that, if possible, full force and effect shall be given to every sentence, clause and word thereof. Bogert v. Hackensack Water co., 101 N. J. L. 518 (E. & A. 1925).
The incident of an unusual strain producing injury or death either directly or by being superimposed upon an ailing bodily condition has from the early days of the statute been [589]*589recognized as an accident in the statutory sense. This is true not only of heart cases but of cases involving other bodily organs and parts, as: pressure on parts weakened by cancer, Voorhees v. Smith Schoonmaker Co., 86 N. J. L. 500 (Sup. Ct. 1914); affecting a weakened heart, Winter v. Atkinson-Frizelle Co., 88 N. J. L. 401 (E. & A. 1915); aggravating a duodenal ulcer, Holzwarth v. Hedden, &c., Co., 1 N. J. Misc. 381 (Essex Com. Pleas 1923, not officially reported); an extraordinary strain activating tuberculosis, Graves v. Burns, Lane & Richardson, 10 N. J. Misc. 667 (Sup. Ct. 1932, not officially reported), affirmed on the opinion below, 110 N. J. L. 607 (E. & A. 1933); a severe or twisting sprain aggravating a spinal condition, George T. Newell, Jr., Inc., v. Workmen’s Compensation Bureau, 10 N. J. Misc. 405 (Sup. Ct. 1932, not officially reported), affirmed on the opinion below, 110 N. J. L. 25 (E. & A. 1933); unusual physical exer.tion dilating the heart, Fire Commissioners, &c., v. Morris, 12 N. J. Misc. 153 (Sup. Ct. 1934, not officially reported); prolonged exertion in pulling out great weeds and bushes, lighting up an old arthritic condition, Van Meter v. E. R. Morehouse, Inc., 13 N. J. Misc. 558 (Sup. Ct. 1935, not officially reported); a sprain “because of some unusual effort” aggravating a prior sprain, Marotta v. Fabi, 13 N. J. Misc. 690 (Sup. Ct. 1935, not officially reported); “work of an unusual character” and from it “an unusual exertion” aggravating a heart condition and so causing death, Bernstein Furniture Co. v. Kelly, 114 N. J. L. 500 (Sup. Ct. 1935), affirmed 115 N. J. L. 500 (E. & A. 1935); “if extraordinary strain * * * was the causative agent of the strangulation (hernia) the fatality was the consequence of an accidental injury,” Furferi v. Pennsylvania Railroad Co., 117 N. J. L. 508 (E. & A. 1937); lifting “a heavy weight,” causing tubercular hemorrhage, held, following Bernstein v. Kelly, supra, an accident, Rekoon v. General Lead Batteries Co., 119 N. J. L. 296 (Sup. Ct. 1938); “unusual exertion” imposed on pre-existing heart condition, causing death, Schneider v. F. & C. Haerter, 119 N. J. L. 548 (Sup. Ct. [590]*5901938); “unusual effort” aggravating pre-existing heart condition, causing death, Rother v. Merchants Refrigerating Co., 122 N. J. L. 347 (Sup. Ct. 1939). Our cases for nearly 30 years based recovery upon the extraordinary causation. The requirement was implicit.
In Hentz v. Janssen Dairy Corporation, 121 N. J. L. 160 (1938), the Supreme Court held, factually, that the employee was the driver of a milk truck making retail deliveries at the houses of customers, that his regular duties were exacting and laborious and that although the road was icy and the slope of it steep there was nothing unusual about the work or about the conditions on the day when he was stricken with coronary thrombosis. Consistently with what we conceive to have been the holdings of our cases, the court decided that on those facts the happening was not an accident within the application of the Workmen’s Compensation Act. On appeal the Court of Errors and Appeals, 122 N. J. L. 494 (1939), determined that the employment from which the strain resulted was “unusually hard on [that] day,” expressed inability to distinguish the case from Voorhees v. Smith Schoonmaker Co., Graves v. Burns, and other cases cited supra, and reversed. Taking the facts as resolved by the Court of Errors and Appeals, namely, that the conditions on the occasion of the heart attack were unusual, there was no distinction to be made from the earlier decisions and the reversal was consistent with them. On that basis there was no occasion for a new pronouncement of law; but the opinion, in making the point, not relevant in the instant case, that if there be an accident the superimposing of that accident upon a weakened organ does not defeat recovery, incorporated the following quotation from Lord Loreburn’s statement in Clover, Clayton & Co. v. Hughes, 3 B. W. C. C. 284:
“I do not think we should attach any importance to the fact that there was no strain or exertion out of the ordinary. * * * An accident arises out of the employment when the required exertion producing the accident is too great for the man undertaking the work, whatever the degree of exertion or the condition of health.”
[591]*591That statement did not go to the question of what constitutes an unusual effort or an unusual condition and it did not bear upon the effect of an occupational accident upon a body impaired by disease, the matters with which the Hentz opinion was concerned. We discover no original expression in the Hentz opinion incorporating Lord Loreburn’s view, but if the trend of the opinion is to be considered as supporting the doctrine then the opinion, to that extent, is dictum.
Concurrently with the handing down of the Hentz opinion, the Court of Errors and Appeals also decided the case of Bollinger v. Wagaraw Building Supply Co., 133 N. J. L. 512 (1939), wherein it said that
“We think that the requirement that the injury or death arise by accident, under our statute, is satisfied if the claimant discharges the burden of proving that the condition complained of, i. e., the injury or death, .is related to or affected by the employment, that is to say, if but for the employment it would not have occurred.”
Although the opinion propounded that view, it clearly held that an injury had occurred at a fixed time, that there was “an unexpected occurrence,” consisting of “the impinging of the sand” on a mole on the" workman’s foot, “resulting in injury” on the named day, that the impinging of the sand on the mole was the producing cause of cancer, that the irritation so started caused the melanomic change. Thus the opinion marshalled its facts to constitute an unlooked-for mishap or untoward event not expected or designed—an accident within the definition of Bryant v. Fissell, supra. We consider that the quoted paragraph was unnecessary to the decision. Nevertheless it became a lever upon which broad statements were rested by the Court of Errors and Appeals in Ciocca v. National Sugar Refining Co., 124 N. J. L. 329, 334 (1939), and upon which turned the decision by the Supreme Court in Molnar v. American Smelting and Refining Co., 127 N. J. L. 118, 130, although the Court of Errors and Appeals in affirming the latter ease, 128 N. J. L. 11 (1941), was careful to note that “there was an extra heavy strain [592]*592placed upon the man in the work he was doing shortly before he collapsed”; and out of these inter-related decisions came Cavanaugh v. Murphy Varnish Co., 130 N. J. L. 107 (Sup. Ct. 1943), affirmed on the opinion below, 131 N. J. L. 163 (E. & A. 1944). It did not, however, pass unnoticed that their diversion from the established law had arisen from what was said obiter by the Court of Errors and Appeals in the Bollinger case (see Di Maria v. Curtiss-Wright Corp., 134 N. J. L. 524 (Sup. Ct. 1946), affirmed on the opinion below, 135 N. J. L. 470 (E. & A. 1947)), and in the Hentz and Molnar cases .(see Lohndorf v. Peper Bros. Paint Co., infra, at p. 161).
The focal question in the Ciocca case varied from the one presented in physical exertion injury cases in that it arose from a heat prostration and was whether or not a greater exposure was needed than that to which persons generally in the particular locality were exposed. The statutory construction theretofore established by Kauffeld v. G. F. Pfund & Sons, 97 N. J. L. 335 (E. & A. 1922), and restated in Richter v. Du Pont, 118 N. J. L. 404 (Sup. Ct. 1937), affirmed on the opinion below, 119 N. J. L. 427 (E. & A. 1938), had been that when the employment brings a greater exposure than that to .which persons generally in that locality are exposed, injury or death resulting therefrom arises out of the employment, the “unusualness” (cf. Larke v. John Hancock Mut. Life Ins. Co., 97 A. 320 (Conn. Sup. Ct. of Errors 1916), upon which the Kaufeld decision was rested) being there predicated upon the comparative exposure of the employee and of persons generally in the locality. The Ciocca decision, following the lead of the Hentz and the Bollinger cases, held that the requirement as to an accident is satisfied if it is shown that but for the employment the injury would not have occurred. O.ur determination in the instant ease is primarily concerned with physical exertion injuries and we presently address ourselves thereto. The Ciocca opinion undertook to state a general principle which in its generality we find to be unsound, but we refrain from [593]*593passing upon the correctness or incorrectness of the specific application to cases arising from exposure to the elements.
It is not to be denied that for some years following the Hentz and Bollinger decisions there was confusion as to the significance of the words “by accident.” But the doubts were dissipated by the clear and pertinent language in Lohndorf v. Peper Bros. Paint Co., 134 N. J. L. 156 (Sup. Ct. 1946), affirmed on the opinion below, 135 N. J. L. 352 (E. & A. 1946). It was there held that:
“An accident is ‘an unlooked for mishap or untoward event which is not expected or designed.’ Geltman v. Reliable Linen and Supply Co., 128 N. J. L. 443; ‘an unintended or unexpected occurrence,’ Bollinger v. Wagaraw Building and Supply Co., 122 Id. 512; it is an event happening . at a specific time or occasion. Liondale Bleach Works v. Riker, 85 Id. 426. The words ‘accident’ and ‘employment’ are not synonymous. . To render an injury compensable there must be an event or happening, beyond the mere employment itself, which brings about the final result or contributes thereto, and without which the injury or death would not have resulted. Because an individual continues his occupation when rest is indicated or work ecmfra-indicated and because by continuing the employment he becomes sick or disabled does not of itself form ■ a basis for compensation. To hold otherwise is to constitute an employer an insurer of the health and life of his employees.”
It was thus said with distinctness that there must be an accident, that the accident must be an event beyond the mere employment and that the injury is the result of the accident and is not itself the accident. Although the matter sued upon was death from a coronary occlusion, the principle stated had to do generally with compensable injuries, the need for and the definition of an accident, and the negation of the contention that an injury arising out of and in the course of the employment, with nothing inore, was compensable. Mills v. Monte Christi Corp., 10 N. J. Super. 162 (App. Div. 1950), certif. denied 6 N. J. 315 (1951), and Fox v. Plainfield, 10 N. J. Super. 464 (App. Div. 1950), are cited by respondent as contra. To the extent that these decisions are in opposition to the stated principle, -they are overruled.
[594]*594The language of the Lohndorf opinion was approved, and in part quoted, by us in Seiken v. Todd Dry Dock, Inc., 2 N. J. 469 (1949). Among the numerous decisions following the Lohndorf decision and consistent therewith in requiring unusual efforts or conditions to justify the finding of an accident under the statute are: Joseph Dixon Crucible Co. v. Law, 135 N. J. L. 528 (Sup. Ct. 1947); Lagerveld v. Nathan Doblin Corp., 137 N. J. L. 335 (Sup. Ct. 1948); Ames v. Sheffield Farms Co., Inc., 137 N. J. L. 336 (Sup. Ct. 1948), affirmed 1 N. J. 11 (1948); Moleski v. Bohen, 1 N. J. Super. 136 (App. Div. 1948); Gaudette v. Miller, 1 N. J. Super. 145 (App. Div. 1948); Temple v. Storch Trucking Co., 2 N. J. Super. 146 (App. Div. 1949), affirmed 3 N. J. 42 (1949); Irons v. New Jersey Department of Institutions & Agencies, 3 N. J. Super. 216 (App. Div. 1949); Carpenter v. Calco Chemical Div., Amer. Cyanamid Co., 4 N. J. Super. 53 (App. Div. 1949); Bilyou v. George M. Brewster & Son, Inc., 4 N. J. Super. 59 (App. Div. 1949). These, including Seiken v. Todd Dry Dock, Inc., were heart cases, but we do not distinguish in this respect between heart cases and other cases involving physical exertion injuries.
We conclude that it was necessary for the claimant to prove an unusual strain or an unusual exertion or some condition unusual in the employment in order to show an accident within the meaning of the Workmen’s Compensation law. Pie did not so prove. The question posed at the beginning of the opinion is answered in the negative.
The judgment below will be reversed. No costs.