Rabies, historically known as hydrophobia due to the terrifying symptom of water aversion in infected individuals, has long been one of the most feared diseases known to humankind. Before the advent of the rabies vaccine, a bite or even mere exposure to an infected animal’s saliva was often a death sentence. A chilling letter published in The New York Times in 1874 illustrates the horror of rabies before any effective treatment existed.
The Tragic Cases of Hydrophobia in 1874
Dr. J.W. Pinkham of Montclair, New Jersey, recounted two rabies cases in his community of 3,000 people in a letter to the editor of the New York Times. The first was a healthy Irishman in his sixties who had been bitten on the hand by a neighbor’s dog. While the wound was cauterized, no further intervention was possible at the time, and the event was soon forgotten. Two months later, the man exhibited increasing nervousness, followed by convulsions when attempting to swallow. Recognizing these symptoms, Dr. Pinkham concluded that he was dealing with a case of hydrophobia. The unfortunate patient suffered excruciating agony before succumbing within forty-eight hours.
The second case involved a young German mason in his twenties. Unlike the first victim, no clear history of a bite could be found. Only later did the patient’s family recall an incident where he had killed a suspicious-looking dog with a club while his brother held it down. The theory emerged that infected saliva had come into contact with an open wound or abrasion, leading to the onset of rabies. His symptoms followed the same grim trajectory, and his fate was similarly sealed.
Dr. Pinkham’s observations underscored the stealth of rabies—how its symptoms could take weeks or months to appear, and how even seemingly minor exposures could be deadly. He advised extreme caution around potentially infected animals, recognizing the limited options available to prevent the disease from progressing once symptoms set in.
The Letter in Full
"To the Editor of the New York Times:
While the attention of the public is so generally directed to the subject of hydrophobia it seems a favorable opportunity to relate my experience with this dreaded disease. Within a period of six years in a town numbering 3,000 inhabitants, I have met with two cases of hydrophobia, both of which manifested all the symptoms of the disease in its most terrible form, and terminated fatally.
The first was that of a healthy, well-to-do Irishman about sixty years of age. He was bitten slightly on the hand, while caressing a neighbor's dog, with which he was on good terms, and which had not manifested any symptoms of disease. The dog was killed, the wound thoroughly cauterized, and the circumstance nearly, if not quite, forgotten.
About two months after this, I was first called to see the patient, not being aware of the incidents above related, being informed only that the man was nervous and required some soothing medicine. I noticed at once that his nervousness was of a peculiar variety, and remaining awhile to watch him, I observed a convulsive movement when he attempted to swallow. My suspicions being thus excited, I remained for some time, and became convinced before making further inquiries that I had to deal with & case of hydrophobia. The patient grew rapidly worse, and in spite of all efforts at alleviation died in the course of forty-eight hours, having suffered indescribable agony.
My second case was that of a young German, a mason, about twenty years of age, in whom I noticed the same symptoms as those related above. When I was well convinced by careful observation that the case was one of hydrophobia. I made inquiries, but could obtain no history of a bite of any description. It was only after some member several hours that it occurred to some member of the family that a dog whose behavior had excited the suspicions of a neighbor bad been killed and buried by the patient. It was remembered particularly that the dog looked wild and drooled. The manner of killing was also remembered: a brother held up the dog while the patient struck its head with a club. There is little doubt that the saliva from the dog's mouth came in contact with the hands of the patient, and found its way into his circulation through some abrasion.
These cases are instructive, inasmuch as they establish the fact that hydrophobia in the dog may exist with symptoms so slightly pronounced as to escape the notice of a casual observer; and also as they show the importance of using care in disposing of dogs whose symptoms excite suspicion.
Since witnessing these two cases, I have always deemed it important to make the distance between my hands and the nose of any approaching dog as great as possible, especially as I have observed that nearly all of those who have died of hydrophobia have been bitten on the hands.
In passing through clothing, the teeth usually are deprived of the saliva that covers them, and the bite in this way becomes harmless.
J. W. PINKHAM, M. D. MONTCLAIR, N. J., Thursday, July 2, 1871"
A Death Sentence—Until Science Intervened
For centuries, hydrophobia was known to be universally fatal. The understanding of the disease and its transmission was rudimentary at best. The belief that biting through clothing might reduce the severity of an infection because saliva would be wiped off was, while somewhat logical, an unreliable safeguard against a virus that could infiltrate through the tiniest break in the skin.
It wasn’t until 1885—just over a decade after Dr. Pinkham’s account—that the world saw the first glimmer of hope. Louis Pasteur, the legendary French microbiologist, developed the first rabies vaccine. He successfully tested it on a nine-year-old boy named Joseph Meister, who had been bitten by a rabid dog. The treatment saved the child’s life, and Pasteur’s breakthrough paved the way for a new era in disease prevention.
The Rabies Vaccine: A Triumph of Medicine
Pasteur’s post-exposure prophylaxis (PEP) regimen revolutionized rabies treatment. Unlike vaccines for diseases like measles or polio, which provide immunity before exposure, the rabies vaccine works after potential infection but before symptoms appear. This is possible because rabies has a long incubation period, allowing time for the immune system to mount a defense if vaccinated quickly enough.
Today, rabies vaccines save thousands of lives every year. In developed countries, routine vaccination of domestic animals, along with accessible post-exposure prophylaxis, has made human rabies deaths exceedingly rare. However, in regions where access to medical care is limited, rabies still claims lives. According to the World Health Organization, rabies kills an estimated 59,000 people annually, with the vast majority of cases occurring in Asia and Africa.
Lessons from the Past, Hope for the Future
The 1874 cases described by Dr. Pinkham serve as a haunting reminder of what life was like before vaccines. Rabies was not just a disease; it was a death sentence wrapped in horror and suffering. The advent of the rabies vaccine stands as one of the greatest triumphs of medical science, turning a disease once synonymous with inevitable death into one that is almost entirely preventable.
Yet, despite this success, rabies remains a global health challenge. Continued efforts in vaccination, education, and improved access to post-exposure treatment are vital to eradicating this ancient killer once and for all. The ghosts of hydrophobia past remind us of a time when medicine had no answers—but today, thanks to scientific progress, we do.