1793 Philadelphia yellow fever epidemic Philadelphia forced evacuation of certain neighborhoods and placed refugees in supervised camps. After the epidemic, the city inspected all houses and destroyed those it deemed unhealthy. American doctors did not identify the vector of yellow fever until the late nineteenth century. In 1881 Carlos Finlay, a Cuban doctor, argued that mosquito bites caused yellow fever; he credited Rush's published account of the 1793 epidemic for giving him the idea. He said that Rush had written: "Mosquitoes (the usual attendants of a sickly autumn) were uncommonly numerous..." In the late 1880s, Finlay's theories were confirmed in Cuba by experiments of the
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