To address potential historical and contemporary shortcomings in the diagnosis and management of functional neurologic disorders through review of a historical case of a patient treated with electrotherapy for presumed hysterical paralysis in early 20th century Philadelphia.

Case of a previously healthy 19-year-old woman who presented to the Hospital of the University of Pennsylvania in April 1913 for evaluation and treatment of variable left hemiparesis, allodynia, Lhermitte’s phenomenon, and gait dysfunction which had been present following a back injury in 1911. After thorough review of the patient’s presenting history, physical examination, and unremarkable XR imaging of the spine and hips, the presence of organic neurologic injury was excluded to the satisfaction of her treating team (including pioneering neurologist William G Spiller and neurosurgeon Charles H Frazier) and patient was recommended “daily static electrical treatments” to treat and support the diagnosis of “hysteria”. She received daily electrotherapy for 3 weeks with some improvements in gait, though her pain and sensory symptoms persisted. Her treatment was deemed successful, and she was discharged May 1913 as cured with a diagnosis of hysteria.

Bound, archived treatment records from the Neurological Dispensary at the Hospital of the University of Pennsylvania dating from 1877-1916 were reviewed. Cases labeled with diagnoses of hysteria, hysterical paralysis, neuroses, neurasthenia, spells, and paralysis were selected for individual review. Here, a single case is reviewed given the completeness of the record and that this patient’s diagnostic and treatment course is representative of the contemporary approach to functional neurologic disorders in the late 19^th and early 20^th centuries.

Despite advances in neurodiagnostics and psychotherapy since the 19^th century,  functional neurologic disorders continue to be a common, debilitating, and stigmatized neurologic condition for which our diagnosis and management remains suboptimal.