The game is afoot!
Since sending out my last update, I have heard back from several folks about what could have caused the muscular atrophy of our mystery patient. Some suggestions include sudden spinal injuries, early undiagnosed polio, or psychological conversion.
As many of you know, my background is in cultural studies from the Gilded Age, particularly concepts of masculinity. Initially I had also thought that our patient might be suffering from a psychological illness, especially as Dr. Leale made reference to “the insane.” Much of my own research has focused around neurasthenia, which had reached “epidemic” proportions in the US in the 1880s. It was discovered by George Beard in 1869 and was what we would consider extreme exhaustion. Men all over the United States were suffering severe, incapacitating physical and mental breakdowns (it was considered so characteristic of Americans that William James, Harvard professor and brother of Henry James, called it ‘Americanitis’). Most historians now believe that there were numerous cultural factors that led to this “epidemic”, but it would not be an exaggeration to say that most prominent Americans at the time deeply feared this mysterious mental and physical weakening of American men (this would in turn, they believed, weaken the country, making it susceptible to invasion, etc.). All this is by way of saying that though doctors did not understand the causes of mental illness at the time, they were certainly aware that it could have physical repercussions. I feel confident that the experts brought in on this particular case would have considered this possibility.
Also, while I do agree that unwanted marriage could have been a trigger for such a psychological reaction, I think in this case we do not know enough about the patient’s background to make a generalization that a marriage would have been formally or informally “arranged.”. The consultation of so many experts from this time suggests to me that 1) this was a relatively wealthy patient, and/or 2) that the patient’s condition was so unusual that it attracted medical attention. This is important because negotiations of marriage at this time depended very much on socio-economic status, class, race, and numerous other factors. Certain groups, what would have been termed “classes,” of people would certainly have been involved in more “arranged” marriages because of family reasons, religion, etc. But we just don’t know in this case.
The other possibility that occurred to me was that marriage might have been prevented because there was no possibility of consummating the marriage or having children. Depending on how the illness was presenting, doctors could have made this diagnosis. I can think of many circumstances where this would have led to the dissolution of an engagement.