Syphilitic rhagades at the anus and entrance of the vagina :

-JAHR Georg Heinrich Gottlieb

These rhagades consist of narrow, elongated ulcers, or cracks in the folds of the anus. They are more or less numerous, scarcely ever show themselves except in cases of unmistakable constitutional syphilis, and may be confounded by inexperienced persons with rhagades, or lacerations caused by the passage of hard excrements, by the introduction of a foreign body, or even by hæmorrhoids. These last-mentioned rhagades, however, are easily distinguished from syphilitic ones, by the fact that they are seldom very numerous, and always exhibit a red (more or less bleeding) surface, and not very elevated borders: whereas, syphilitic rhagades are numerous, rest for the most part upon a rather hard and swollen surface, and have a rather hard and lardaceous base, with red, hard, raised edges. According to some authors, these rhagades, are, in some cases, quite superficial, not very painful, with soft and smooth edges, and secretion of a whitish pus, in which case it would undoubtedly be very difficult to decide whether they are of a syphilitic nature, or not. If I may trust my own experience, I am disposed to assert that rhagades of this description are never syphilitic; I have met with such rhagades when all primary or secondary syphilitic symptoms were entirely wanting, but a disposition to hæmorrhoids or common tetter existed, or where the patient suffered with nothing else than mercurial symptoms. The authors who have stated such anomalous doctrines, in their rage to discover everywhere symptoms of masked syphilis, go so far as to regard the common pruritus of the anus and

Syphillitic ulcers at anus

scrotum as ordinary signs of the syphilitic disease, in all cases. The case is different where these rhagades are deep and painful, with hard and raised edges, and secretion of a bloody, acrid serum, which corrodes the neighboring parts. In such a case, their syphilitic nature can almost always be taken for granted; and a further examination will almost invariably reveal the existence of other secondary symptoms, either upon the skin or on the uneven surfaces
Besides these rhagades, true chancres often are seen on the border of the anus as well as in the rectum, close above the sphincter. These chancres are never secondary, but always primary, caused by direct infection, in conseqence of a criminal attempt a sexual connection, and in all cases one of the most terrible products of the syphilitic virus. If these primary chancres occur at the anus, they frequently occupy the same folds where the rhagades are located but are not as numerous as these, very frequently they constitute a single ulcer, are less in circumference, and distinguished in nothing from primary chancres, either as regards appearance or edges, except by their oblong form, which is owing to the shape of the fold where they have become located. When seated at the entrance of the rectum, they are located higher up than the rhagades, always above the sphincter of the anus, so that externally not the least trace of them can be discovered, except by the oozing, which, however is not always perceptible, and generally passes off with the excrements.