leap, he did not intend to leap so as to suffer the injury which caused his death.

12

Injuries inflicted by another person upon the insured, or those self-inflicted when insane,10 are considered to be accidents. injuries due to mistakes in taking medicine,11 to the inhaling of gas,1 and to coming in contact with poisonous substances unintentionally, considered accidental injuries. In Omberg v. United States Mut. Acc. Ass'n,1 the Kentucky Supreme Court held that the bite of an insect, inflicted upon the toe of the insured, which caused blood poisoning to set in and the consequent death of the victim, was an accident for which the insurer should be held liable. In a New York case, under somewhat similar facts, the contrary conclusion was reached.1 In Texas it was held by the Court of Civil Appeals 15 that death due to intestinal inflammation set up by the eating of unsound oysters was an accidental injury; but upon appeal the Supreme Court reversed the decision of the lower court, principally, however, upon the ground that the eating of the oysters brought the injury, if it was accidental, under the terms of an exception in the policy.

Again, death by choking consequent upon an attempt to swallow a piece of beefsteak has been held to be death by accident.16 But it is well settled that death by sunstroke,1 though unusual, is not to be

The fact that the blow struck by the other party was designed makes the injury to the victim none the less accidental if he had no reason to expect it in the natural course of events. American Acc. Co. v. Carson, 99 Ky. 441, 36 S. W. 169, 34 L. R. A. 301, 59 Am. St. Rep. 473.

10 ACCIDENT INS. CO. v. CRANDAL, 120 U. S. 527, 7 Sup. Ct. 685, 30 L. Ed. 740.

11 Carnes v. Association, 106 Iowa, 281, 76 N. W. 683, 68 Am. St. Rep. 306. Here it was said that if the insured died because he took more morphine than he intended, the death was accidental, but it would be otherwise if he had taken only as much as he had intended, not knowing that such a dose would be fatal. But see Dezell v. Fidelity & Casualty Co., 176 Mo. 253, 75 S. W. 1102.

12 United States Mut. Acc. Ass'n v. Newman, 84 Va. 52, 3 S. E. 805. 18 101 Ky. 303, 40 S. W. 909, 72 Am. St. Rep. 413.

14 Bacon v. Association, 123 N. Y. 304, 25 N. E. 399, 9 L. R. A. 617, 20 Am. St. Rep. 748. In this case some putrid animal matter came in contact with an abrasion on the insured's lip, causing infection and the formation of a malignant pustule, which proved fatal. The court held that death was due to disease merely.

15 Maryland Casualty Co. v. Hudgins (Civ. App.) 72 S. W. 1047, reversed in Supreme Court, 76 S. W. 745, 64 L. R. A. 349.

16 American Acc. Co. v. Reigart, 94 Ky. 547, 23 S. W. 191, 21 L. R. A. 651, 42 Am. St. Rep. 374.

17 SINCLAIR v. ASSURANCE CO., 3 E. & E. 478; Dozier v. Fidelity & Casualty Co. of New York (C. C.) 46 Fed. 446, 13 L. R. A. 114. In Railway Offcials' & Employés' Acc. Ass'n v. Johnson, 109 Ky. 261, 58 S. W. 694, 52 L. R. A. 401, 95 Am. St. Rep. 370, often cited as contra, the policy in terms ex

regarded as accidental; nor is the mere rupture of a blood vessel to be regarded as an accident, unless it was induced by some sort of violent accidental occurrence.18 So, when the insured, while stooping over to put on his socks, suffered such a disarrangement of the intestines that death ensued, his fatal injury was held not to be accidental.19 External, Violent, and Accidental Causes.

The terms "external" and "violent" have been added by the insurer for the purpose of restricting the sense of the term "accidental," with which they are coupled, but their presence has had little, if any, influence upon the construction given to the term "accidental cause or injury." The term "external" applies to the force, and not to the injury.20 Thus, poison taken into the system, and operating entirely internally, is nevertheless an external cause, as is the water which causes death by drowning, and gas which causes asphyxiation. Likewise, the term "violent," as applied to causes of accidental injury, means merely that the cause is efficient in producing a harmful result. It is not necessary that it shall be violent in the sense of breaking tissues or otherwise physically and visibly affecting the body.21 Thus, where the insured was injured by his straining efforts to stop his horse that was running away, it was held that the cause of the injury was both external and violent, although the result was entirely internal, being probably a rupture of a blood vessel near the heart.22 And so it is generally held that where an injury is received in attempting to lift a heavy weight, or from any other kind of over-exertion, the result may be attributed to an external and violent accidental cause. 28

pressly recognized sunstroke as one of the risks assumed, subject to conditions.

18 See Standard Life & Accident Ins. Co. v. Schmaltz, 66 Ark. 588, 53 S. W. 49, 74 Am. St. Rep. 112. Here the rupture was caused by a sudden and violent wrenching of the body in an effort to remove a cylinder head from an engine. A similar rupture caused by an effort to close a shutter was held not to be accidental. Feder v. Association, 107 Iowa, 538, 78 N. W. 252, 43 L. R. A. 693, 70 Am. St. Rep. 212.

19 Clidero v. Insurance Co., 29 Scot. L. R. 303. See, also, Southard v. Assurance Co., 34 Conn. 574, Fed. Cas. No. 13,182.

20 American Acc. Co. v. Reigart, 94 Ky. 547, 23 S. W. 191, 21 L. R. A. 651, 42 Am. St. Rep. 374.

21 See the excellent discussion of this matter in Paul v. Insurance Co., 112 N. Y. 472, 20 N. E. 347, 3 L. R. A. 443, 8 Am. St. Rep. 758.

22 McGLINCHEY v. FIDELITY & CASUALTY CO., 80 Me. 251, 14 Atl. 13, 6 Am. St. Rep. 190, Woodruff, Ins. Cas. 277.

23 Standard Life & Accident Co. v. Schmaltz, 66 Ark. 588, 53 S. W. 49, 74 Am. St. Rep. 112; RUSTIN v. INSURANCE CO., 58 Neb. 792, 79 N. W. 712. 46 L. R. A. 253, 76 Am. St. Rep. 136, Woodruff, Ins. Cas. 294.

DISEASE INDUCED BY ACCIDENT-PROXIMATE CAUSE.

233. It frequently occurs that the death of the person insured under an accident policy is caused by some disease induced by an accidental injury. If the circumstances are such as to make the accident, and not the disease, the proximate cause of the death, the insurer is liable as for an accidental injury.

The distinction of proximate from remote causes, always difficult to make, often becomes peculiarly difficult in deciding questions arising under accident policies. The insurer, under an accident policy, is not liable for death by mere disease, even in the absence of the usual clause expressly excluding disease from among the risks assumed. But it frequently happens that, while the immediate cause of death is a disease, that disease is directly attributable to some accident that has previously happened. If the causal connection between the disease and accident is direct and clear, the death will be considered as due to the accident as proximate cause, and not to the disease. Thus, where the insured's toe was bruised and rubbed by a new shoe, which injury caused blood poisoning from which he died, it was held that the cause of his death was the accidental injury to his toe.24 So, in a case decided by the Massachusetts Supreme Court, where the insured had died of peritonitis that was induced by a heavy fall, the court held that, although the insured had once before been afflicted with this disease, and was therefore evidently peculiarly liable to contract it, the proximate cause of his death was the accidental fall, so that the insurer was liable for his death.25 In connection with the facts of this case, the court makes this clear statement of the doctrine of proximate cause, as applicable to such cases: "The law does not consider the cause of causes beyond seeking the efficient predominant cause, which, following it no farther than those consequences that might have been anticipated as not unlikely to result from it, has produced the effect. An injury which might naturally produce death in a person of a certain temperament or state of health is the cause of his death, if he dies by reason of it, even if he would not have died if his temperament or previous health had been different; and this is so, as well when death comes through the medium of a disease directly induced by the injury, as when the injury immediately interrupts the vital processes."

24 WESTERN COMMERCIAL TRAVELERS' ASS'N v. SMITH, 85 Fed. 401, 56 U. S. App. 393, 29 C. C. A. 223, 40 L. R. A. 653.

25 FREEMAN v. ASSOCIATION, 156 Mass. 351, 30 N. E. 1013, 17 L. R. A. 753. So, it has been held that an accidental fall, causing a rupture of a kidney and consequent death, was the proximate cause of the death, though the cancerous condition of the kidney made the rupture possible. Fetter v. Fidelity & Casualty Co., 174 Mo. 256, 73 S. W. 592, 61 L. R. A. 459.

In another case an insurer was held liable for the death of the insured, caused by peritoneal inflammation which was induced by a blow received from the handle of a pitchfork which accidentally slipped from his grasp while being used in pitching hay.28 So, an accident insurance company was held liable for a death caused directly by inflammation of the intestines which had been weakened by disease, the inflammation being caused by the presence of hard food substances that had been swallowed by the insured, who had no knowledge of the weakened condition of his digestive organs.27

Another and different phase of the question of proximate and remote cause appears in the leading English case of Lawrence v. Accidental Ins. Co.28 In that case the insured was standing near a railway track upon which a locomotive was approaching. He was suddenly seized with a fit of illness which caused him to fall forward helpless upon the track, where he was almost immediately crushed to death under the wheels of the locomotive. The defendant claimed that it was not liable under an accident policy for the death of the deceased, on the ground that the proximate cause of his death was his fit of illness, while the plaintiff claimed that the predominant cause was his being run over by the locomotive, which was accidental. The policy provided that the insurance company should be liable only when the accidental injury “was the sole and direct cause of death to insured." The court held that the efficient cause of the death of the insured was the locomotive, which happened accidentally to be present at that time, while the fit was merely the cause of his being upon the track in a place of danger, and therefore remote.

EXTERNAL AND VISIBLE SIGNS OF INJURY.

234. The usual term of the accident policy, providing that the insurer will be liable only for those injuries of which there shall be some external and visible sign, does not require that the injury itself shall be external and visible, but merely that the evidences of accidental injury shall be external and visible.

In the course of their efforts to avoid liability for injuries and deaths due to merely natural causes, and for feigned internal injuries, difficult

26 North American Life & Accident Co. v. Burroughs, 69 Pa. 43, 8 Am. Rep. 212.

27 Miller v. Fidelity & Casualty Co. (C. C.) 97 Fed. 836. So, in Travelers' Ins. Co. v. Hunter, 30 Tex. Civ. App. 489, 70 S. W. 798, the insurer was held liable for a fatal attack of rheumatism caused by an accident.

28 7 Q. B. Div. 216, Richards, Ins. Cas. 522. A similar case is Winspear v. Insurance Co., 6 Q. B. Div. 42, in which the insured, while crossing a river, was seized with a fit, which caused him to fall into the water and drown. The death was considered to be accidental.

to disprove, all accident insurers now insert in their policies a provision to the effect that they will not be liable for any bodily injuries that shall be suffered by the insured, unless there are found some external and visible signs of such injuries. The courts have; however, largely done away with any restrictive effects of this provision, by giving to it such a construction as seldom defeats recovery in a case in which the plaintiff would succeed in its absence. It has been held that the provision has no application whatever to injuries that result in death,29 but only temporary nonfatal injuries. And when the provision is so worded as to make it clearly apply to fatal injuries, the courts have found little difficulty in discovering the requisite external and visible signs.

We must first note that the signs of injury ordinarily required need not be on the body itself, although such was the probably intended meaning of the insurers when the term was incorporated in the policy. Any sign at all indicating the occurrence of an injury that is visible to the eye, or otherwise capable of sense perception, is held to satisfy the requirements of this clause. Thus, froth on the mouth of a person who has died from asphyxiation through inhaling gas is a visible. sign of the cause of his death.30 It has even been held that where artificial respiration was resorted to in the case of the asphyxiated person, and the odor of inhaled gas could be detected, that was a sufficient sign of his fatal injury by inhaling gas.31 Discoloration of the skin is a sufficient external evidence of an internal injury, and the unnatural redness of one lobe of the brain discovered by autopsy has been also regarded as an external visible sign of an accident.33 Even an unusual color of the skin is sufficient; 34 and the court may take into consideration as evidence other external circumstances, not immediately connected with the body, but which would show the cause and probable presence of an accident, as the odor of gas in the room in which a dead body is found. 35

32

In another case, where the injury for which it was sought to hold

29 MCGLINCHEY v. FIDELITY & CASUALTY CO., 80 Me. 251, 14 Atl. 13, 6 Am. St. Rep. 190. In this case the court said: "There are reasons for the condition applying to a surviving claimant. He has unusual chance for feigning an internal injury, if disposed to defraud the insurers. But no such protection is required where the accident causes death. The dead body is external and visible sign enough that the injury was received."

30 United States Mut. Acc. Ass'n v. Newman, 84 Va. 52, 3 S. E. 805. 31 Menneily v. Assurance Corp., 148 N. Y. 596, 43 N. E. 54, 31 L. R. A. 686, 51 Am. St. Rep. 716.

32 Thayer v. Insurance Co., 68 N. H. 577, 41 Atl. 182.

83 Union Casualty & Surety Co. v. Mondy (Colo. App.) 71 Pac. 677.

34 Horsfall v. Insurance Co., 32 Wash. 132, 72 Pac. 1028. 63 L. R. A. 425.

85 See Menneily v. Assurance Corp., 148 N. Y. 596, 43 N. E. 54. 31 L. R. A. 686, 51 Am. St. Rep. 716.