5fir 
ACUTE  CRAW-CRAW 
BY 
R.  H.  KENNAN,  M.D.,  D.T.M., 
SENIOR  MEDICAL  OFFICER,  WEST  AFRICAN  MEDICAL  STAFF,  SIERRA  LEONE 
{Received  for  publicaiion  7  F ebruary,  1910) 
1  he  term  ‘  Craw-Craw  ’  is  applied  extensively  in  West  Africa  to 
describe  pathological  conditions  of  the  skin,  which  are  mainly 
characterised  by  the  presence  of  a  papulo-vesicular  eruption, 
accompanied  by  more  or  less  itching. 
Generally,  this  rash  is  most  marked  about  the  buttocks, 
perineum,  genitals,  and  groins  ;  and  is  most  commonly  seen  in  a 
condition  which  seems  to  indicate  chronicity,  viz.,  scale  formation, 
and  hypertrophy. 
But  in  certain  cases  1  have  seen  the  rash  become  almost 
universal  with  great  rapidity,  the  outbreak  being  associated  with 
fever  and  malaise,  and  under  these  conditions  mistaken  for  variola 
and  varicella. 
Both  at  Accra,  on  the  Gold  Coast,  and  at  Freetown,  Sierra 
Leone,  the  affection  in  this  form  is  not  very  uncommon. 
The  rash  may  be  practically  universal  and  is  vesicular  in  the 
very  early  stage.  The  vesicles  have  very  little,  if  any,  papular 
foundation,  and  always  lack  the  well-defined  base  of  a  typical 
variola  spot,  and,  moreover,  the  spot  is  vesicular  at  the  earliest 
period.  Pricking  the  vesicle  in  the  early  stage  allows  exit  of  a 
sticky,  pellucid  fluid,  and  the  vesicle  can  be  entirely  emptied  by 
slight  pressuie  without  further  rupture  of  its  walls,  leaving  the 
latter  collapsed.  In  the  early  stage  of  the  case  the  great  majority 
of  the  spots  show  an  almost  equal  degree  of  development,  but 
careful  search  will  usually  reveal  some  dried  up,  scaly  spots.  The 
centre  of  each  of  the.se  old  spots  is  generally  of  a  lighter  colour,  and 
lound  the  centre  iris-hke  rings  of  epidermic  scales,  attached  by  their 
outer  borders  are  seen.  1  hese  represent  a  late  stage  of  the 
