Every year I was seeing more and more patients suffering from porphyria variegata. In 1963 I thought it might be a good idea to examine the records of patients who had died at the Provincial Hospital in Port Elizabeth (which at that time treated white patients only) to see if some of the deaths had been due to acute porphyria and that perhaps the correct diagnosis had been missed. There were 40 to 50 deaths at the hospital every year and a few deaths, in retrospect, were indeed attributable to acute porphyria, although the diagnosis had not been made at the time.

I also found four deaths among men who had been admitted to hospital from jail and who had died from injuries that looked suspiciously like assault. One man had been admitted to hospital in 1959 with bruising all over his body. The government doctor (known as a district surgeon) who attended prisoners had, accidentally, left his record. This had been included in the patient's folder and stated ‘Fibrositis – lin.meth.sal’. ‘Lin.meth.sal.’ is oil of wintergreen. Apparently the district surgeon had seen the patient covered in bruises and used the term ‘fibrositis’ to disguise his findings. When he was examined by the doctor on admission to hospital, he realised that the patient was desperately ill and wrote on the patient's record sheet on 17 September 1959, ‘Multiple abrasions, intraperitoneal injury, BP 90/50’. The patient had very low blood pressure, evidence that he was in shock. He was given a blood transfusion and taken to the operating theatre. When his abdomen was opened by the surgeon, it was found that part of his intestine, his duodenum, was ruptured. He died twenty-four hours later. No comment was made about the death at the time; it was not referred to the coroner and there was no inquest.