The number of motor vehicle accidents and deaths from this cause are steadily increasing each year. The surgical significance of these injuries is obviously increasing also, and for this reason the experience of a large accident room service with one phase of the problem, namely, non-penetrating abdominal injury, was reviewed. This study includes 200 consecutive cases, 100 patients dead on arrival and 100 patients who were alive at the time of admission. The majority of patients (83.5 per cent) were injured in motor vehicle accidents. The remaining patients were injured by blows, train accidents, falls and crushing accidents. Serious extra-abdominal injuries were present in 167 patients. The injury was limited to the abdomen in only thirty-three patients. Multiple diffuse injury to the body was present in ninety-seven of the patients who were dead on arrival, and similar injuries were present in seventy of the patients admitted alive. Treatment was possible in eighty patients. The injury was localized to the abdomen in thirty cases, and in the remaining cases the abdominal injury was associated with injuries to the cerebrum, spine, thorax, long bones and pelvis. Although all abdominal organs were involved in this group of cases, the liver and spleen were involved in sixty patients. Therapy consisted of that employed for massive trauma. Priority of treatment depended upon the vital function disturbed. Cardiorespiratory function was restored, and then hemorrhage was controlled by abdominal operation. The treatment of fractures and craniocerebral injuries was deferred until after abdominal operation in most cases. Of the eighty patients submitted to the full therapeutic facilities of the hospital, sixty-seven (84 per cent) recovered. Survival in this group was dependent upon the presence of associated injuries; for example, survival occurred in thirty-nine (78 per cent) of the fifty patients with associated injuries and twenty-eight (93 per cent) of the thirty with injury limited to the abdomen. Death in the treated patients was due to a severely lacerated liver in one, renal failure in one, peritonitis in one, and complications arising from extra-abdominal injuries in ten. Treatment in these patients was administered by a competent staff experienced in the daily management of trauma, and although the survival rate in this series was greater than in similar series reported elsewhere, the mortality rate in general is extremely high for diffuse blunt injury. The fact that the majority of patients with these injuries die before admission and since a critical review of the deaths after admission reveals only a small chance of increasing survival by improved care, the greatest opportunity of saving life from blunt trauma lies in prevention. Although this lies within the legal and sociologic fields, certain observations obtained in the care of these patients indicate that better law enforcement and improved engineering of automobiles may significantly reduce both the number and severity of these injuries.