In recent years various surgical procedures have been attempted to improve the cerebral function of mentally retarded or cerebral palsied children. One of these is the anastomosis of the carotid artery and jugular vein in an effort to improve the cerebral blood flow. This has been reported to have some degree of success, but the results are of questionable value because of the necessary lack of suitable controls. In this paper are presented the case histories of such an operation on identical twins, one operated and the second serving as a perfect control.

The family history of the twins was significant in that there was a strong history of mental disease on the father's side. Several members of his family had been confined to mental institutions. No clinical diagnoses are known but at least one was known to be a sexual pervert. The father had been in a mental institution before and after the birth of the twins and had received electric shock therapy, with no demonstrable improvement. He also was a sexual pervert. The parents were divorced when the twins were twenty months old. Before and after the divorce the twins and their mother were subjected to physical violence by the father. The twins were said to be extremely fearful of the father. There were no other children, and no other pregnancies.

Pregnancy was uneventful. Delivery was at term following a five day labor. Donald, the twin who was subsequently operated, was born first with a birth weight of six pounds, seven ounces. David, born a few minutes later, weighed six pounds, eight ounces.