Recovery

RECOVERY, literally should denote complete restoration (restitutio) of the previous healthy state that preceded the development of a given disease. Subjectively, this is indeed the case, for example, in inflammation and in acute infectious diseases. Objectively, however, in such cases the question of recovery is not resolved so simply: most diseases, both general and local, even in so-called complete recovery, which presupposes restitutio ad integrum, represent a conditionally reversible process in a fictional-anatomical and physicochemical sense. This conditionality is expressed mainly in that the same subject to some extent loses the ability to react as before, not only to the same irritation (or invasion), but also to others completely different from it. This change in reactivity after an illness, acquired in the process of recovery, can become a factor of health, i.e., positive (for example, acquired immunity), or conversely, become a negative factor, since the organism acquires a new ability to develop new diseases in itself or the ability for a less favorable course of the same disease (for example, hyperergic inflammation—see Inflammation, as well as Allergy). In the majority of diseases, only so-called incomplete recovery is achieved, expressed in functional restoration without a complete return to normal in an anatomical sense; this includes, for example, healing of wounds with the help of scars, processes of encapsulation of pathological foci, processes of compensatory hypertrophy of organs (see Vicarious processes), etc. The concept of incomplete recovery is close to the concept of the transition of a disease into a pathological condition—pathos, i.e., into some status, which is customarily opposed to the dynamic concept of disease (see)—nogos. Recovery is achieved mainly thanks to the body's ability to reactive responses, the ability to regenerate and to compensatory functions; more specifically, recovery is carried out in such a way that the pathogenic factor is removed from the body by its various excretory systems (such as the gastrointestinal tract, kidneys, skin) or is destroyed intracellularly (theory of phagocytosis) and extracellularly, in the body's juices, with the help of enzymes; some toxic products, mainly of endogenous origin, in addition to excretion and destruction, can also be converted into harmless states; the pathological process itself, after the removal, destruction or neutralization of the cause that caused it, subsides and resolves, and pathological products (exudates, infiltrates, etc.) are resorbed, the defect formed in the tissues is closed by regeneration (see). The totality of all these restorative processes, designated individually as resolutio (dissolution), reparatio (removal + absorption) and completed by regeneration (rebirth), constitutes what has been called since the time of Hippocrates as vis medicatrix naturae, i.e., the healing forces of nature. In any, especially general, diseases, it is necessary to distinguish between clinical-biological and morphological recovery. The former consists of subjective sensations and objectively verifiable functional signs of the onset of health; the latter (morphological) does not always coincide with the former and often somewhat lags behind. In general, recovery represents a certain process, sometimes very extended in time, which begins already during the period of illness and continues beyond the presumed date—so-called clinical recovery; an exact date of recovery cannot be given at the current level of knowledge. This has the practical significance that the very recognition of recovery can be erroneous. Apparent recovery is observed in many hereditary constitutional diseases, in which it is generally not possible to speak of recovery as such, complete or incomplete, since neither the disappearance of one or another at least most important symptom (for example, glycosuria in a diabetic on a rational diet), nor remissions in the full sense of the word (for example, in pernicious anemia, light periods in mental diseases) denote recovery. In socio-economic terms, the concept of recovery appears even more conditional; since the criterion of recovery here is not so much clinical and morphological prerequisites as the practical solution of the question of working capacity after an illness; the term "practically healthy" rather emphasizes than excludes the pathological process, and even more so the pathological condition (see Working capacity).