Together with the increase in motorisation sudden death at the wheel by natural causes has also gained more importance although this is not a very frequent occurrence. Scattered reports on such cases in the literature are summarized and discussed with regard to recognition, frequency, age and sex distribution, pathological changes and marginal problems, e. g. diagnostic difficulties, risk and prevention. At the top of the list of the causes of sudden natural death at the wheel are disturbances of the cardiovascular circulation and under this heading the ischemical heart diseases with 83%. The frequency peak lies in the sixties age group and in the case of the ischemical diseases generally in the seventies age group which is an indication that driving is particularly a burden for the circulation. The percentage of women (2.6%) is approx. 10 times less than it is in sudden deaths generally, this obviously being due to the fact that women in advanced years do not drive as often as men. In approx. 50% of cases the sudden natural death takes place when the vehicle is stationary. Serious accidents are seldom. Diagnostic difficulties occur when alcohol has been consumed or when in an accident caused by the sickness the victim is fatally injured or when the question of guilt is not clear. Restrictive measures will not completely prevent sudden death when driving; it is most important that a patient with a history of myocardial infarction or of advanced age should be advised of the dangers of driving by the physician treating him.