An intensive multidiscipline investigation of 200 fatal pedestrian accidents indicated that the pedestrian, in most cases, bore much of the responsibility for the accident in which he was killed. Alcohol was found in a minimum of 43% of the accident victims, and more than 80% had been violating some pedestrian traffic regulation. Since most injuries were produced by blunt trauma, it was rarely possible to identify the specific feature of the automobile design which caused the injury. Although multiple injuries were common, many serious lesions were not recognized before death and were discovered only at autopsy. Common correlations of these occult injuries with more easily recognized lesions are presented, and the importance of certain diagnostic signs is stressed.