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This essay explores how phobia emerged as a familiar medical diagnostic in the United States and Atlantic world in the eighteenth and nineteenth centuries. Before phobia developed into a variable suffix that could attach to different objects and ideas, its meaning took shape in literature on rabies. Until the late 1800s, the common name for rabies among English speakers was hydrophobia. Transliterated from the Greek, the term was used to designate a dread of liquids, prompted by difficulties in swallowing—a symptom doctors considered the most familiar form the disease took. By the late eighteenth century a diagnostic twist had taken effect: many physicians agreed that one could acquire hydrophobia without being bitten. Doctors called this subspecies "spontaneous hydrophobia." This article argues that phobia's variability as a concept grew in dialogue with case studies documenting the phenomenon of spontaneous rabies.