This post has been edited to try and be more accurate:
That’s right, it is really all about delivering current! I think where I get fixed on potential (as do most of the articles about Midi such as the sparkfun one I linked to earlier) is that when you look at the diagram on the Midi spec page, they show you how to achieve 0ma and 5ma using specific resistors with a 5volt source plus a buffer capable of pushing the line close to 5 volts and pulling it close to 0 (since Ohm's law requires us to know potential and impedance in order for an exact current draw).

https://www.midi.org/specifications/item/midi … l-specification
Based on the Midi reference circuit, there are 3 220ohm resistors (660ohm series impedance) plus some amount of impedance for the LED in the opto-coupler (Edit: a trivial amount actually). With a forward voltage around 1.1 volts on the LED in the opto-coupler (assuming a Sharp PC-900) we can calculate remaining voltage over the resistors as 5v - 1.1v = 3.9v. Then applying Ohm’s law (i=v/r) the circuit draws (3.9volts/660ohms) = 5.9ma when closed (ie. very close to spec, and likely closer if Tx does not fully go to 0volts when low).
After downloading the Midi spec:, There is freedom to choose a different opto-coupler as long as the resistance on the Midi In part of the loop compensates for it. This means that the transmitter side could likely use different potentials and resistances than shown in the spec if the resistor value and the LED forward voltage in the Midi In part of the loop are known. Considering that the Midi In is a black box on any connection you haven't made yourself, I would say that sticking to the spec helps to guarantee that it will work.
So I guess the designer of the post uart transmitter electronics (which is us in this case) needs be fully aware of what voltage we are supplying to DIN pin 4 and what voltage Tx swings between when high and low. We can then add the appropriate resistors to the transmitter side of the loop to ensure we only pull 5ma at Tx low (assuming we know what they used for an opto-coupler and resistor for Midi In, otherwise there are still no guarantees it will work). If we don't know anything about the Midi In side of the current loop and/or the soundcard manufacturer won’t provide us the specs on the Tx gameport pin, then it really comes down to pure luck as to whether it will be reliable, or even work, if we don't use a buffer and just throw some resistors on the pins. I guess I’m lucky that my Audigy works so well without a buffer given that I know nothing about the electrical characteristics of the Tx pin and just put in 220ohm resistors on pins 4 and 5.
Many thanks again for your help here!!
PS – I see Bob and Doug as your avatar, so I want to wish you a happy belated Canada Day!