1793 Philadelphia yellow fever epidemic immune to the fever. Many of the slaves in Charleston in 1742 could have gained immunity before having been transported from Africa, by having been exposed to yellow fever in a mild case. People who survived one attack gained immunity. A total of 240 blacks died, in proportion to their population at the same rate as whites. Given the limited resources and knowledge of the times, the city's response was credible. The medical community did not know the natural history of yellow fever, a viral infection spread by the "Aedes aegypti" mosquito. Efforts to clean the city did not defeat
Yellow fever titer (compared to an earlier sample) can confirm yellow fever. Together with clinical symptoms, the detection of IgM or a four-fold increase in IgG titer is considered sufficient indication for yellow fever. Since these tests can cross-react with other flaviviruses, such as dengue virus, these indirect methods cannot conclusively prove yellow fever infection. Liver biopsy can verify inflammation and necrosis of hepatocytes and detect viral antigens. Because of the bleeding tendency of yellow fever patients, a biopsy is only advisable "post mortem" to confirm the cause of death. In a differential diagnosis, infections with yellow fever must be distinguished from