= Solution
\b[<Jaundice> results from accumulation of <bilirubin>; its reversibility depends on the cause, not on the yellow colour alone.] In 1864, obstruction of bile flow and disease of the <liver> were important practical distinctions. Modern physiology also separates excess production from impaired uptake, conjugation and excretion.
Excess breakdown of <red blood cells> can overwhelm the usual handling of <bilirubin>, producing predominantly unconjugated hyperbilirubinaemia. Impaired hepatic uptake or conjugation supplies another non-obstructive mechanism. Hepatocellular injury, as in <hepatitis> or advanced <cirrhosis>, impairs processing and secretion. Intrahepatic <cholestasis> and extrahepatic obstruction prevent normal disposal through <bile>. Obstruction can result from a <gallstone>, a duct stricture, inflammation or compression/invasion by a <tumour>.<Jaundice by Merck Manual Professional Edition>[Pathophysiology and mechanisms: increased production, impaired handling and intrahepatic or extrahepatic cholestasis]{ref}
Conjugated <bilirubin> can enter the <urine>, making it dark; predominantly unconjugated <bilirubin>, which is strongly protein-bound, does not ordinarily produce bilirubinuria. Marked interruption of bile delivery can make stools pale. These findings help locate the problem but do not by themselves distinguish a stone from a stricture or <cancer>. Modern fractionated <bilirubin> tests, liver enzymes and <ultrasonography> supplement the clinical pattern.<Bilirubin in Urine by MedlinePlus>[Urine bilirubin, liver disease and bile duct obstruction; relation to dark urine and pale stool]{ref}
Recovery “by nature” is possible when an obstruction is temporary, a small <gallstone> passes, a reversible inflammatory process settles, or the cause of increased pigment production ceases. An episode of jaundice can clear as <liver> function recovers. It is nevertheless unsafe to infer a harmless or self-limiting cause merely because the jaundice fluctuates; partial malignant obstruction can also fluctuate.
Recovery “by art,” in modern terms, includes treating a reversible underlying illness and relieving a remediable obstruction. A persistent common-duct stone can be removed endoscopically or surgically; an obstructed duct may require drainage. Selected strictures and tumours can be treated, but established extensive hepatic destruction or disseminated malignancy may prevent full recovery even if bile drainage is improved.<Gallstone disease: diagnosis and management by NICE>[Recommendations on common bile duct stones and bile duct clearance]{ref} These are present capabilities, not a claim that modern endoscopy was available to the 1864 examiner.
The period question therefore calls for a conditional prognosis: a movable obstruction or reversible disturbance offers a better prospect than irreversible tissue destruction or an untreatable growing obstruction. \b[A disappearing colour is not, by itself, proof that the underlying disease has been cured.]
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