In this episode, the minister of Health from Westminster, Neville Chamberlain, who would later become the prime minister, 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.
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. 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.
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, 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 discovers that Denker had insulted Dr. Clarkson in the public streets. She 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!"
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 very bad legal ramifications for Spratt. Under pressure, he goes and his words spare Denker from being sacked. However, the ingrate is not even grateful for his help. As such she still troubles the butler.
At the abbey, Chamberlain arrives, and again, Violet holds forth about how the merger of the hospitals would not be beneficial (what she wanted really was to maintain power in Downton, which was fast slipping away), but 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 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 let the merger stand, as it would be best for and benefit both hospitals), and then they argue about Violet's keeping the identity of Marigold's situation secret.
Mary overhears this and realizes that Marigold is Edith's daughter, and that the rest of the family knew and she didn't. She gets infuriated about this, which leads up to the later confrontation between the sisters later in the season.