England's 1970 World Cup Squad

INTRODUCTION

Like many an avid football fan, I was saddened by the recent and untimely death of Alan Ball. The flame-haired midfielder was inextricably linked with England's solitary World Cup triumph in 1966, and was the second member of the team to pass away after Bobby Moore. What startled me, however, was the realisation that he also became the seventh member of England's 1970 World Cup squad to die. I decided to research the fate of these seven deceased players to detect any common threads. I propose no definite answers, but perhaps some food for thought.

BACKGROUND

In June 1970 England's 22-man squad set off to Mexico to defend the World Cup that had been won so memorably at Wembley 4 years earlier. Comfortable, if uninspiring, 1–0 wins over Rumania and Czechoslovakia sandwiched a defeat to the eventual champions Brazil by the same score in a classic match widely regarded as one of the technically finest soccer matches ever played. The points gained ensured passage to a quarter-final against West Germany where, improbably, the team blew a 2–0 lead and contrived to lose 3–2 after extra time.

At the time and since, that last match gained legendary status as an inexplicable, Greek-like tragedy. Journalists ranked England as favourites to retain the World Cup, although I suspect this reflects the hyperbole and unrealistic expectations that have always followed the national team. A place in the final would have been realistic, but even had this happened I think Brazil would have prevailed: with the likes of Gerson, Jairzinho, Rivelino and the incomparable Pelé, they were, by common consent, the finest team of all time. They indeed became worthy winners, defeating Italy 4–1 in a final that capped an excellent tournament.

The far greater human tragedy than one lost football match has been the subsequent demise of so many players. The idea that, in a cohort of some of the country's finest athletes one-third would die in middle age, would have been unthinkable at the time. By contrast, all but one of the said Brazilian squad are still alive, the exception being left-back Everaldo, killed in a car crash in 1974 aged 30 years. The following section gives brief biographies of the players and the circumstances of their death.

THE PLAYERS

REFLECTIONS

I attempted to analyse what is known about the players' backgrounds, personal circumstances, lifestyle, and habits to see whether any clues about their illnesses emerged.

By modern standards the players formed a remarkably homogenous cohort. All were born into the traditional working class, long before that moniker became open to several interpretations. All were white — it would be over a decade before the sons of West Indian immigrants became a regular presence in the team. They hailed from different parts of the country, although these were predictably the game's traditional strongholds. They included one Londoner (Moore), one from just outside the capital (Windsor-born Osgood), one Midlander (Astle), and four from the North-West (Newton, Hughes, Labone and Ball). Interestingly, at the time of the said World Cup, all played for clubs in the region of their birth — footballers were mobile then, but much less so than in the globalised modern game.

The better health of married men in comparison to the single, and certainly the divorced, has long been noted,10 so an analysis of their marital histories is illuminating. At the time of the World Cup six were married, though on his own admission Osgood was in name only, and his lifestyle, as noted, was that of a confirmed bachelor. The one unmarried player, Hughes, had already started dating his future wife. In the subsequent years, Osgood (twice), Moore, and Labone would endure divorce, with the first two remarrying. Ball, of course, died a widower. This quartet, which includes the three players who suffered sudden cardiac death in the absence of any preceding history, appears to have suffered a disproportionate amount of personal trauma, a recognised association with death in middle-aged men.11

What of their fitness and lifestyles? The 1970 squad faced daunting conditions in Mexico, the searing heat and altitude forming an environment the diametric opposite of what they were used to at home. The preparations were meticulously overseen by the team's GP, the Welshman Dr Neil Phillips. However, beyond the constraints of the tournament, it is clear that attitudes to fitness and lifestyle were far more liberal.

As the cult of celebrity was far less evolved then and the press less intrusive than today, some facts are necessarily sketchy. I know only one member of the entire squad who smoked — Bobby Charlton, who gave up the habit in retirement. As a habit it did not seem to loom large with footballers even then, nor for that matter did illicit drugs.

By contrast, alcohol was an almost essential part of the male bonding in this team sport, and to a lesser extent still is. It is unlikely that any members of the squad, whether dead or alive today, were teetotal and many may have exceeded the recommended limits by a very considerable amount. Bobby Moore was always candid about his capacity and desire for drink,1 but he was also a phenomenal trainer and this never affected his game; it was also unlikely to have been a factor in his final illness. By contrast, Osgood had a more profound drink problem as well as other personal problems in retirement, and this may have been a contributory factor.6 Indeed, football and other sports were littered with legendary imbibers during that era. However, envied as their lifestyles may have been during their heyday, their health outcomes make extremely grim reading. The early deaths of George Best (59 years; liver cirrhosis), Jim Baxter (61 years; pancreatic cancer), James Hunt (45 years; myocardial infarction) and Barry Sheene (52 years; pharyngeal cancer) were almost certainly due to alcohol excess; the last three also smoked heavily and had illnesses for which this is a major risk factor. Today, if it is unthinkable that Roger Federer or Tiger Woods would hold court in the clubhouse bar the night before their next triumph, it must also be acknowledged that the ‘super athlete’ is a relatively recent phenomenon.

Astle's death was unique in this cohort for having been deemed directly due to football, and Mr Haigh was certainly confident that the correlation was legally beyond reasonable doubt. Doubts have subsequently been cast about heading the ball as a risk factor for dementia.12 The controversy highlights two of those eternal uncertainties we in the medical profession contend with, the fact that all risk factors are relative not absolute, and the reality that almost all illness is multi-factorial. Though Astle's skill and bravery as a header are acknowledged, this was also the case for many top players of that era not thus affected, including Denis Law, Geoff Hurst, and Jack Charlton.

In the same vein, while we as frontline physicians will continue to extol the virtues of exercise to our patients, the sad fate of so many former professional athletes reminds us that generalisations cannot be extrapolated to any individual.