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"Bold, Skillful Ohio Doctor Saved Douglas; Thus Started Lincoln Toward White House"

"By WALTER MORROW

"... for want of a nail the shoe was lost; for want of a shoe the horse was lost; and jor want of a horse the rider was lost."
—Poor Richard's Alnmanac, 1757.

"If there had not been a Dr. Horace Ackley at Cleveland in 1855, Stephen A. Douglas probably would have lost his voice or died. If Douglas had lost his voice there would have been no Lincoln-Douglas debates in 1 858. If there had been no debates Abraham Lincoln quite probably would have remained an obscure country politician in 1860.

"Without Lincoln the country might have been partitioned, because some of the strongest Abolitionists wanted 1o let "our erring sisters go in peace." But the. nail that saved the shoe and the horse and the rider was ready when needed. A tough, pioneer, whisky-loving surgeon named Ackley, who fought off mobs when he wanted to operate on human beings, was the nail..." https://archive.org/details/lincolndouglasdegenlinc/page/n21

On Douglas's near-fatal attack of bronchitis in 1855, see Robert W. Johannsen, Stephen A. Douglas, pp. 484-5:

"The 'Illinois Platform' was enthusiastically adopted by the crowds at Douglas' remaining speaking engagements. On October 27, the Senator was in Paris, on the state's eastern edge, and was beginning to show the effects of his stumping tour. His voice had become hoarse, and he was physically tired. Following his Paris appearance, a group from Terre Haute, across the boundary, in Indiana, insisted that he gratify local Democrats with a speech, and, although his remaining appointments in Illinois were tightly scheduled, he agreed to accommodate them. Appearing before the assembled crowd, he discovered that his hoarseness had become so aggravated that he could not speak effectively. A severe cold added to his problem, and early the next day he was seized by coughing spasms. He immediately took to bed and placed himself under the care of a local physician. He was suffering from an acute case of bronchitis. His remaining engagements were canceled, and he received strict orders to do no further speaking until his lungs and throat had healed. Recovery, however, did not come as expected, and his condition steadily worsened. Three weeks later, his physician reported no significant change, adding that it was impossible to predict when it would be safe or prudent for Douglas to leave his room. Deep solicitude was expressed throughout the nation, and at one point rumor of his death was circulated.

"Illinois' Democratic leaders made frequent trips to Douglas' Terre Haute sickroom and sent back full reports on his condition, although they found him unable to converse. By December 1, improvement had begun. Thomas L. Harris, who remained with Douglas for much of the period, wrote to Lanphier, 'Judge Douglas is slowly recovering, he now sits most of the day. He is still very hoarse, talks with difficulty, and has much soreness in the chest, and at intervals a hard cough. His attack was very severe. There was a general inflammation of the throat and respiratory organs, so much so, that suppuration has taken place, and the membranes sloughed off.' There was hope, Harris noted, that Douglas might be able to start for Washington by mid-December. The hope proved vain. Although he resumed his correspondence with friends and relatives, he was still unable to return to his normal activities. As a final measure, throat surgery was recommended. In late December, he traveled by easy stages to Cleveland, where a series of operations on his throat was performed by Dr. Horace Ackley, a professor of surgery at the Cleveland Medical College. Early in January, Douglas wrote that his throat 'is now very sore in consequence of the surgical operations recently performed, the last of which was a few days ago to cut off the Uvula or lower pallate. The doctor 'delights in running Probings down the windpipe, and cutting off pallates, & clipping Tonsils, and all such amusements. I confess that I do not enjoy the fun quite as well as he seems to do.' More worrisome than his physical condition was his absence from the Senate. 'I have been shut out from the political world,' he complained. With each day of convalescence his impatience to return to Washington mounted, but it was not until early February that he was back at his home in the capital and even later before he felt strong enough to appear in the Senate. It was not a convenient time to be out of circulation.. ." https://books.google.com/books?id=pCzhaQTh5SEC&pg=PA484

So suppose Douglas dies in 1855--or even that his voice never recovers, which could mean political death for someone as dependent on oratory as Douglas. Lincoln was not quite as unknown before 1858 as Walter Morrow's article suggests (his name was even placed in nomination for the vice-presidency at the 1856 Republican national convention) but it's true that the debates gave him a big boost, and I'll assume that without them he would not have been nominated in 1860. Obviously, having (say) Seward nominated would have big effects, but what Morrow ignores is that the absence of Douglas could have major effects well before the 1860 or even 1858 elections. For example, without Douglas's opposition, the admission of Kansas as a slave state under the Lecompton constitution could well have made it through Congress--certainly some northern Democrats would have rebelled against it, but the question is, would enough have done so to defeat it. Even in OTL, sixty percent of northern Democrats in the House voted for Lecompton! http://inside.sfuhs.org/dept/history/US_History_reader/Chapter5/freehlinglecompton.html
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