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The writers reminded that a consensus on Classification of veinous diseases, necessary to build up homogeneous samples, was being set up. Now, they are introducing a thermal nosology that is as useful. Next, the history of spas, the characteristics of Thermal Springs and thermal practices as well as their results are described. The writers present a standardization of the observation and control parameters of the therapeutic effects. The rigorous and scientific process was defined by an interdisciplinary scientific process was defined by an interdisciplinary scientific Council and it is based on the creation of a Computerized Laboratory of Research and a Thermal University. It has become an example in the field of thermalism. According to the results and the modern indications, the water cure has to be prescribed at an early stage. The practitioner must think about it and insert the water cure in the arsenal of veinous diseases. According to the hydrogeologists' estimates, BARBOTAN les thermes, the first European spa with about 22,000 patients is thought to possess enough water to allow from 40,000 to 60,000 people to be treated yearly. A thermal environment is the ideal place for an efficient vascular rehabilitation and functional re-education. In phlebology, more than one million people should benefit from a water cure yearly ... Only 70,000 follow this treatment. Everyone has to wonder about this situation, which, to those who do not benefit from a thermal cure in phlebology, is as astonishing as prejudicial.

The follow-up of women treated for varicose veins before pregnancy(ies) has shown the superiority of this approach over that consisting of treating varicose veins only after pregnancies. Prior treatment avoids the further development of varicosities during the pregnancy. It ensures greater comfort. The few recurrences which develop can be easily dealt with by sclerosing injections after delivery. All young women who are candidates for pregnancy should undergo careful phlebological evaluation and appropriate treatment of varicose veins.

There is little objective evidence available when prescribing aids and appliances such as elastic supports for the leg. Doctors are generally ill-informed about effectiveness, fitting and costs of these garments. The claims of competing suppliers cannot be applied to clinical situations because the garments are tested in vitro on rigid forms. Elastic support for the lower limb is required in the treatment of varicose veins and gravitational disease and has been found effective in prevention of deep venous thrombosis. This study examined the in vivo effectiveness of four commercially purchased garments for these two purposes. The legs of 40 patients with varicose veins, 12 with gravitational disease and 20 patients admitted for elective operations were studied. Pressure exerted by the garment was detected by partly fluid filled bags between garment and limb. The results in patients with varicose veins and gravitational disease were similar. Only two garments exerted effective pressure and of these two the combination of a roller bandage and tapered tubigrip is recommended on grounds of least expense and ease of application. Of the four anti-embolism supports only the roller bandage plus tapered tubigrip produced effective compression: two garments produced reversed flow gradients in the majority of tests. Elastic supports should be double tested, firstly by the manufacturer for basic stretch and regain characteristics and secondly in vivo by clinicians to provide objective evidence of cost effectiveness.

Lymph oedema have to be treated in the same way that complications of chronic venous deficiency of the lower limbs are usually treated. Isolated or linked, these two pathological conditions call for the same therapeutic method: reduction; if lymphostatic phenomena persist, it is then necessary to have recourse to lymphatic drainage and/or to compression; surgical treatment must continue to be regarded as exceptional.

In the first section, the authors describe some epidemiological features and give an account of the capillary structure and the structure of different veins. They describe the venous physiology and its modulations, in order to be able to give a precise description of different venous affections: venous senescence, chronic venous insufficiency, thrombophlebitis. The particular features of these three pathologies and their action mechanisms enable the authors to envisage appropriate phleboactive therapy, and to evaluate it in advance. As far as the actual notion of evaluating these venous therapies is concerned, the authors make clear that there is no difference between thermal therapies and phleboactive allopathic therapies. They concentrate on describing a unique methodology in two stages considering the thermal establishment as a pharmaceutic laboratory and as an out-patient hospital for follow-up treatment. This therapeutic evaluation comprises two sections: preparation at the laboratory (pharmaco-clinical stage, animal experimentation) and the second stage of therapeutic clinical tests on humans. The authors define a rigorous, quantified methodology based on homogeneous samples in the framework of a computerised medical file consisting of a base and polyvalent satellites. Satellite 3, assembling the elements of the therapeutic form, deals, for example, with phlebotonics, vascular protectors and thermal cures. A detailed list of different phleboactive therapies is drawn up, making it possible to analyse their specific respective effects, and therefore to give specific prescriptions. The patient can hope for preventive measures and a cure with fewer after-effects in the context of a general, well-conducted sanitary education. The authors conclude that patients, doctors and the organizations concerned will benefit greatly from this.