1793 Philadelphia yellow fever epidemic with slaves, arrived from Cap Français, Saint-Domingue. The 2,000 immigrants were fleeing the slave revolution in the north of the island. They crowded the port of Philadelphia, where the first yellow fever epidemic in 30 years began in the city in August. It is likely that the refugees and ships carried the yellow fever virus and mosquitoes. It is transmitted during mosquito bites. The mosquitoes easily breed in small amounts of standing water. The medical community and others in 1793 did not understand the role of mosquitoes in the transmission of yellow fever and other diseases. Physicians and other survivors
Yellow fever probably transferred to North and South America with the importation of slaves from Africa, part of the Columbian Exchange following European exploration and colonization. The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados. An outbreak was recorded by Spanish colonists in 1648 in the Yucatán Peninsula, where the indigenous Mayan people called the illness "xekik" ("blood vomit"). In 1685, Brazil suffered its first epidemic, in Recife. The first mention of the disease by the name "yellow fever" occurred in 1744. McNeill argues that the environmental and ecological disruption caused by