In this episode, the minister of Health from Westminster, Neville Chamberlain, who would later become prime minister during the first few months of WWII (and would become infamous as the one who would appease the Nazis in Germany), comes to Downton to discuss the possible merger between the Downton Hospital and the Royal York Hospital, only to have to deal with a medical crisis, when Robert Crawley has an ulcer burst and is admitted to Downton Hospital.
There is excitement in the abbey, and turmoil as the battle becomes more pronounced with the hospital merger issue. At Charles Carson's and Elsie Hughes's wedding, Dr. Clarkson (David Robb) joins the side of Isobel Crawley Grey; her paramour, Lord Merton and Cora Crawley in seeing the merits of a merger between the Royal York Hospital in York and Downton Cottage Hospital. He finally realizes that this is for the best interests of the comunity. Also on Cora's side is her sister in-law, Lady Rosamund Painswick.
Meanwhile, Violet Crawley is still dead-set against the merger, and belives that the community would be better suited without the merger. She decides to bring in the heavy weight. The minister of health, Neville Chamberlain, would be brought to Downton, to discuss the merger and (hopefully, for Violet) have the idea stopped. She believes that if Westminster stops it, the idea would be dead.
She hopes to use her pull with Chamberlain (his wife, Anne Devere Cole, was the goddaughter of Violet and her late husband) to get her way in this.
An even bigger problem is stewing, though, at the Dower house, where Violet lives. Her lady's maid, Gladys Denker is infuriated that Dr. Clarkson has turned against Violet in the hospital issue. As such, she cuts him down and berates him in the public streets when their paths cross. This infuriates Dr. Clarkson and he warns the nasty Denker that she hadn't heard the last of it. This doesn't faze Denker in the slightest.
Meanwhile, Mr. Carson and Mrs. Hughes (in the previous episode, they agreed to be known as Mr. Carson and Mrs. Hughes, in much the same manner as John and Anna Bates are still called Bates and Anna) are slowly getting used to their new lives as man and wife, and away from the routine of Downton Abbey.
Carson, who still fears change of any kind, wants things to be up to standards at the abbey, while Elsie doesn't see that as a major issue. She brings a hamper of food from Mrs. Beryl Patmore containing some food from upstairs' dinner. Mrs. Hughes starts to wonder if marriage is helpful, as she has to deal with Carson's demands.
Meanwhile, Violet and Isobel, who was with her, discovers that Denker had insulted Dr. Clarkson in the public streets. The Dowager Countess calls for her lady's maid and berates her for what she did. This also leads Denker to be fired. She is ordered to leave the house "forthwith!" However, due to Denker's loyalty, she is given a tepid character, which would allow her to find work elsewhere.
A delighted Septimus Spratt is pleased to hear that his arch-enemy is being given the sack. However, his delight is changed into fear when the wicked Denker threatens him his job if he doesn't prevent her being sacked.
She uses the fact that he had hidden his nephew in the potting shed, and that could have had very bad legal ramifications for Spratt. Under pressure of blackmail, he goes and his words spare Denker from being sacked, saying that what she had done to Dr. Clarkson was done out of misplaced loyalty. However, the ingrate is not even grateful for his help. As such she would still trouble the butler.
Meanwhile, Robert and Cora are entertaining their grandchildren at tea time, (as Lady Mary and Tom, George's mother and Sybbie's father, respectively, are out on estate business; and Edith is in London) and they show them some books of where they had traveled and some of the artifacts they have acquired over the years.
A worried Sybbie asks if the Dowager Countess (whom she calls Granny Violet) is Red Indian. When Robert asks why she would ask such a question, George, showing he has the same wit as his great-grandmother, pipes up, "Nanny says she's on the warpath!" to their grandparents' amusement. Little Marigold, Edith's daughter, didn't understand what was going on, as she was interested in a shell she was looking at.
Robert then tells Sybbie about the Sphinx. He tells her that "she is a creature of secrets, that she never reveals". Cora smiles and tells her granddaughter, "Rather like Granny Violet."
There were a lot of Egyptian references during the course of the series as the real life Earl of Carnarvon's family (in real life, Highclere Castle is their ancestral home) was involved in the finding of King Tutankhamen's tomb. This also explains the naming of Robert's dogs as Pharaoh and Isis (and later, after Isis dies, the new puppy named Tiaa).
At the abbey, Chamberlain arrives, and Violet holds forth about how the merger of the hospitals would not be beneficial (what she really wanted was to maintain her power in Downton, which was fast slipping away). Her behavior at the dinner table becomes so abominable that Isobel scolds her about how her enthusiasm is getting the better of her manners.
Robert is tired of the rowing, and wants quiet, but later he coughs up BLOOD! A stomach ulcer he had burst, and he was coughing and spewing blood all over the place!
The table is in a panic (although Isobel takes charge, thanks to her medical training) and they get the ambulance. He is taken to the Cottage hospital. The family is worried, and both upstairs and downstairs wait to hear what happened. Robert has a gastrectomy and he pulls through during the night. Cora, Mary and Edith all go to be with Robert in this time of need.
Cora and Violet have a brief argument about the merger once more (Cora tells Chamberlain to just let the merger go through, as the pro-merger faction think it would be best for and benefit both hospitals), and then they argue about Violet's keeping the identity of Marigold's situation secret.
Meanwhile, Tom, as everyone leaves, finds out that Violet had blackmailed Minister Chamberlain to come to the dinner. The minister reveals to Tom that as a young man, he and his eventual brother in-law, disguised themselves as street workers and dug a trench which disrupted traffic all over the west end. Tom never reveals to anyone what happened.
Mary overhears the argument between her mother and her grandmother and realizes that Marigold is Edith's daughter, and that the rest of the family knew and she didn't (although most of them had figured it out themselves). She gets infuriated about this, which leads up to the later confrontation between the sisters later in the season.
On the other hand, Mary and Tom have a tete-a-tete and realize that it is time that they take over full responsibility of Downton and the estate. While they would include Robert on the major decisions, they have to begin taking over day-to-day responsibility for the running of the estate. Mary tells Tom that it is the stress of running the estate which caused her father to have an ulcer, and the added stress of the hospital fight burst said ulcer.