I feel like that is a potential tension from the word go. Thackery and Cornelia were on the same page about the accident so his whole 'my circus' construct is not so sacrosanct as much as he is a realist/pragmatist and not at all subtle about it.
Both Thackery and Edwards are loosely based on real people. Haven't checked on the real inspirations but I imagine Algernon's European background took from that real black doctor of the period.
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