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
Bobby Moore
Unquestionably one of the finest footballers of all time, Moore was a star with his local club West Ham United, whom he captained to victory in the FA Cup in 1964 and the European Cup Winners Cup in 1965; he subsequently captained England to World Cup victory in 1966. His international career lasted until 1973, encompassing 108 caps (still a record for an outfield player), and 90 as captain (a record). The following year he left West Ham for Fulham, and took them all the way to the 1975 FA Cup final, where, alas, they lost 2–0 to his former club. He retired in 1977 after a career totalling a staggering 1000 competitive matches.
Moore was to endure a torrid retirement, however. His marriage to first wife Tina broke up, a number of business ventures failed, and he found no success as a manager, as well as being seemingly shunned by football. Eventually he found some personal happiness with his second wife Stephanie and became a popular summariser on Capital Radio. Moore was diagnosed with bowel cancer aged 49, following symptoms that, in retrospect, started several years earlier. He underwent a colectomy and chemotherapy, but at operation two liver metastases were already evident. He died at home in Putney, London on 24 February 1993, aged just 51.1
Keith Newton
England's right back in the 1970 World Cup started his career at Blackburn Rovers, moving to Everton in 1969 and winning the Championship in his first season. In 1972 he moved to Burnley where he played for six seasons prior to retiring in 1978. He later worked in the motor trade. Newton died from lung cancer on 16 June 1998,2 aged 56.
Jeff Astle
Astle had a successful club career with his local team West Bromwich Albion, with whom he won the League Cup in 1966 and the FA Cup in 1968. He scored the only goal of the match against Everton in the final of the latter competition. Famed for being an excellent header of the ball, he scored 174 goals in 359 matches. His international career was less successful; he won five caps and is remembered for an awful miss against Brazil in the 1970 World Cup, when he shot wide of an open goal after coming on as a substitute. After retiring in 1974 he ran a window cleaning business, and stayed in the public eye with appearances on comedians Frank Skinner and David Baddiel's ‘Fantasy Football’ show. In retrospect his eccentric and disinhibited displays on the programme may have been early signs of dementia, which was established by 1997; subsequent cerebral CT scans demonstrated frontal lobe shrinkage. His condition worsened rapidly, and on 19 January 2002 he collapsed and died while visiting his daughter.
In a landmark case, the South Staffordshire coroner Andrew Haigh concluded that Astle's brain condition was caused by repeated heading of the ball; it was effectively death by industrial injury (the first recorded for a footballer), likened by Mr Haigh to the brain injuries noted in boxers.3
Emlyn Hughes
Hughes, a combative defender or midfielder, made his professional debut for Blackpool before transferring to Liverpool in 1967. He made his international debut in 1969, and although he won 62 caps over the next 11 years, he never played in a major tournament: in 1970 he was strictly a reserve.
If his international career was disappointing, considerable consolation came in the form of one of the most successful club careers ever. With Liverpool he won the Championship four times and the FA Cup once; moreover, they became unquestionably the best team in Europe, winning the UEFA Cup in 1973 and 1976 and the European Cup in 1977 and 1978, with Hughes captain for each triumph. Leaving for Wolves in 1979, he enjoyed one last hurrah, winning the League Cup in 1980.
In retirement Hughes worked mainly in the media, becoming a popular presence on ‘A Question of Sport’. In 2003 he was diagnosed with a brain tumour, but despite surgery his condition deteriorated and he died on 9 November 2004.4
Brian Labone
An Everton fan who became a one-club man with his boyhood team, central defender Labone made his debut in 1958. He won the Championship in 1963 and 1970, as well as the FA Cup in 1966 and was club captain for the last two triumphs. An ankle injury in 1971 ended his career, but he continued to work with the club as an administrator as well as conducting corporate hospitality. Labone collapsed suddenly and died from a myocardial infarction at his home on 24 April 2006.5
Peter Osgood
One of the most charismatic players of the genre, the tall, handsome Osgood embodied the glamorous and successful Chelsea team of the early 1970s. A prolific scorer and maker of goals, he won the FA Cup in 1970 and the European Cup Winner's Cup a year later, while leading a famously carefree life off the pitch. Indeed it was lifestyle issues rather than any question marks over ability that made him unpopular with England's conservative manager Sir Alf Ramsey, and he won only four caps, although two were substitute appearances during the 1970 World Cup. A similar fallout with Chelsea manager Dave Sexton led to his leaving the club for Southampton in 1974, but he had further success there when the Second Division team improbably won the FA Cup in 1976. He retired in 1979 after a brief, unsuccessful return to Chelsea.
His life became chaotic in retirement, with the failure of a pub business, a second divorce, problems with drink, and an argument with former Chelsea chairman Ken Bates which led to his being banned from the club, to the disgust of many fans.6 With the Abramovich regime he was reinstated as a popular corporate host at the club. However, on 1 March 2006, while attending an uncle's funeral, Osgood himself died suddenly from a myocardial infarction, aged 59.7
Alan Ball
Ball sealed his reputation when he delivered the best individual performance of the 1966 World Cup final. Although the youngest member of the winning team at 21, he had been a regular for Blackpool since he was 17. He joined Everton after that World Cup and won the Championship with them in 1970 before leaving for Arsenal a year later. He won no further domestic honours, despite productive spells with Southampton and Bristol Rovers, before he retired aged 37. He then managed several clubs with moderate success.
Ball published his autobiography in 2004, detailing his private struggle when his wife and one of his daughters both had cancer; his wife died from ovarian cancer that year.8 On 25 April 2007, while attempting to extinguish a fire in his back garden, Ball died suddenly from a myocardial infarction.9
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.
