All 4 Uses

although
in
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Her handwriting was large and lovely, although it ran at a crooked angle down the page.†
Chpt 5

although = even though -- used to connect contrasting ideas
Elizabeth smiles like she's talking to a child, although certainly not her own.†
Chpt 12
I have chosen Anonymous, although Elaine Stein doesn't know this yet.†
Chpt 21
Johnny squeezes her hand, gets her another drink from the bar, her fifth, although he doesn't know this.†
Chpt 25 *

Definitions:

(1) (although)
even though -- used to introduce an idea that contrasts with or makes the main statement surprising

At the start of a sentence, although can play a role similar to words like however, yet, still, even so, on the other hand, or nonetheless—all of which signal contrast. In the middle of a sentence, although can sometimes be used where but or though might also work, but though or but often sound more natural. For example, "She's a great teacher, though not the most popular" is usually smoother than "She's a great teacher, although not the most popular."
(2) (meaning too rare to warrant focus)