The lymph nodes of the groin or, less commonly, of the armpit or neck, suddenly become painful and swollen. The pulse rate and respiration rate are increased, and the victim becomes exhausted and apathetic. The buboes swell until they approximate a chicken egg in size. In nonfatal cases, the temperature begins to fall in about five days, and approaches normal in about two weeks. In fatal cases, death results in about four days.
Death occurs in most cases two or three days after the first appearance of symptoms.
In primary septicemic plague, the victim has a sudden onset of high fever and turns deep purple in several hours, often dying within the same day that symptoms first develop. Many preventive measures, such as sanitation, killing of rats, and prevention of the transport of rats in ships arriving from ports in which the disease is endemic, are effective in reducing the incidence of plague. Famine, which reduces resistance to the disease, results in spread of plague. Individuals who have contracted the disease are isolated, put to bed, and fed fluids and easily digestible foods. Sedatives are used to reduce pain and to quiet delirium.