At the dinner for Mr Chamberlain, the Earl of Grantham is suddenly taken ill, and is diagnosed with a perforated ulcer. This condition would, however, rarely present with major bleeding as shown here, but rather with intense abdominal pain. He is taken to the local, very small hospital and operated on. In a telephone call to Mr Carson, the Earl is said to have undergone a gastrectomy (removal of all or part of the stomach). This is a major surgical operation, taking in excess of 1-2 hours, which would require resources far beyond those of this hospital, and would also not be indicated for these symptoms. The preferred procedure in a perforated ulcer case under these circumstances would be to close the perforation, which is a much smaller and less dangerous operation.