Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


In the _tertiary stage_ the joint lesions are persistent and
destructive, and result from the formation of gummata, either in the
deeper layers of the synovial membrane or in the adjacent bone or
periosteum.


_Peri-synovial_ and _peri-bursal gummata_ are met with in relation to
the knee-joint of middle-aged adults, especially women. They are usually
multiple, develop slowly, and are rarely sensitive or painful. One or
more of the gummata may break down and give rise to tertiary ulcers. The
co-existence of indolent swellings, ulcers, and depressed scars in the
vicinity of the knee is characteristic of tertiary syphilis.

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