More dangerous than we knew

Around 3pm on Tuesday, November 25, 2014, Dr Peter Brukner left a meeting in downtown Melbourne. He checked his phone, which had been set to silent. A message from his son in New York: "What's happened to Phil Hughes? Doesn't sound good." Alarmed, Brukner flicked over to Twitter and thumbed through his timeline. One phrase leapt out at him from the many he saw: "Mouth-to-mouth resuscitation".

Brukner swore to himself. Then he drove to the airport. On the way he called his employers, Cricket Australia, and asked them to book him on the next flight to Sydney. A little over two hours later, he arrived at St Vincent's Hospital in Darlinghurst, where Hughes was in the operating theatre, undergoing emergency surgery to relieve the swelling on his brain.

Brukner has worked in Aussie Rules, and with Australian national teams in athletics, swimming, hockey and football, and been head of sports medicine at Liverpool FC. In all that time, in all those sports, he had never lost an athlete or player to an on-field injury - but at lunchtime the next day, the hospital staff told him there was nothing more they could do. Brukner's training helped him push his shock aside. When Hughes's team-mates started to arrive, he organised their trips to his bedside, two-by-two. Hughes was unconscious, covered in tubes, wires, and bandages. Brukner saw how hard it hit the players. "A lot of them had never been in the intensive unit of a hospital before, had never seen anyone dying, or brain dead, let alone their own mate."

On Thursday afternoon, Brukner took part in CA's press conference. He was keen to talk. He wanted to explain what had happened, in layman's terms. The ball had hit Hughes's vertebral artery, which had split, flooding his brain with blood, and causing a subarachnoid haemorrhage. The specialists at St Vincent's had known similar wounds to be caused by car crashes and street fights, but never by a blow on a cricket field. And this was the point Brukner wanted to make to the watching world. "I wanted to emphasise how freakish it was, because I was worried people would be too terrified to play cricket.

I wanted to reassure everyone that they, their sons and daughters were not at risk of dying the next time they picked up a bat and ball. I felt that was really important." After the press conference, Brukner's memories get blurry. Everyone went to the SCG, where the bar was opened. "All the cricket family were there having a drink." One of the Australian Test players told him: "Doc, look, you've got to keep telling us this is rare, that it's not going to happen to us, otherwise we can't go out there." As team doctor, Brukner's duty now was to the other players, to try to help them cope. And so this became his message, repeated over and over in the next few days. Even then, he could see how they struggled in the run-up to the First Test against India, which had been postponed until December 9 in Adelaide. In the nets, "some of them went in for three balls and walked out again. They just couldn't face it, couldn't do it, it was just so raw." Brukner thought there was no way they would be ready for the Test.

It was only later, once the game was over and Australia had won, that Brukner began to think again about what had happened. "Maybe cricket lost its innocence," he says. "I suppose we're better able to cope with [Aussie Rules] footballers dying in collisions and things like that, but cricketers, they're not supposed to die." But they do. Two days after Hughes's death there was another, when Hillel Awasker, an umpire, was struck on the jaw by a ball during a league match in Israel, and died of a suspected heart attack.

Around the world, there have been at least a dozen deaths from injuries sustained while playing cricket in the last decade, and most likely more. It is impossible to be sure: while cricket keeps assiduous records of all manner of trivial statistics, there is no list of fatalities. The records are piecemeal, and have to be pulled together from internet searches, newspaper archives and reference books. Even so, a pattern quickly emerges. In 1967, Patrick Turpie, 17, died in Sydney after being hit on the heart while batting. The coroner said it was "a million-to-one chance". In 1975, Martin Bedkober, 22, died in Brisbane in similar circumstances; the doctor called it a "freak accident". In 1991, Daniel Brown, 13, was killed in Norfolk by a short ball that hit him on the neck. This time the coroner said it was "a million-to-one fluke".

Given how many games are played each day, in gardens, streets, fields, grounds and stadia around the world, deaths obviously are rare. But how many times can they be described as "a million to one" before we question whether those odds are wrong? If we don't know exactly how many deaths there have been, how can we quantify the risk? And, if we don't know what caused them, how can we try to stop them from happening again?

Brukner decided to put together a database recording the fatalities - a simple idea, which, it soon became apparent, would be complicated to realise. Brukner worked with Tom Gara, an amateur cricketer, professional historian and expert researcher. Gara started by combing through local newspaper archives in England and Australia. A major problem was that - for complex copyright reasons - there are few digital newspaper archives for periods later than the mid-1950s, oddly making it easier to collect information for the first half of the 20th century than the second. Nor did Gara have access to equivalent archives in other countries, such as India, Pakistan, Bangladesh and Sri Lanka.

Brukner, whose work is being supported by Cricket Australia, is still investigating deaths since 1950, and is also hoping to find research partners in other countries. Still, thanks to Gara's hard work, Brukner was able to compile a list of deaths that had occurred in England, Australia and New Zealand between 1850 and 1950. The headline finding is that cricket is - or certainly was - a more dangerous game than many believe. In that 100-year period, there were at least 358 cricket-related deaths in Great Britain and Ireland, 131 in Australia, and 17 in New Zealand. That's a total of 506, and an average of around five a year, though the frequency has ebbed and flowed.

There is a noticeable spike in the mid-1930s, for instance, possibly because bowlers were trying their hand at Bodyline: there were 18 deaths in England in 1933-35, eight of them firmly identified as being caused by batsmen being hit on the head or heart by short balls. Many of the 358 known deaths in Britain and Ireland, it should be said, came about in ways which needn't cause so much concern today. A large number were from sepsis or tetanus, as wounds and cuts suffered while playing became infected and went untreated. A smaller number died in less conventional circumstances. In 1921, two gunmen attacked a match between the Gentlemen of Ireland and the Military of Ireland at Trinity College in Dublin. The men, IRA members, fired shots through the railings on Nassau Street. While the players, "realising what was happening, threw themselves flat on the field", the spectators were not so quick to duck. Kathleen Wright, 21, was hit in the back, and died on the way to hospital.

In 1943 nine boys were killed during a match at Downside School in Somerset, when a Hawker Hurricane fighter making a low pass over the ground clipped a tree and nosedived into the outfield. The debris flew into the crowd on a grass embankment. A year earlier, a corporal in the Royal Army Medical Corps, C. J. Harris, was killed when nine German aeroplanes made a surprise attack on a match between the local police and an Army XI on the south-east coast. Harris was apparently "killed while fielding the ball", as he "ran straight into the path of a falling bomb, which hit the ground only a few yards from the pitch".

Bombs and bullets aside, there are a surprising variety of hazards at your average ground. At least seven children were killed in accidents involving pitch rollers. At least six men were struck by lightning. Four were killed trying to retrieve balls, three climbing high fences, the other hit by a train as he ran across the tracks. Two died fighting fellow players, who hit them with their bats. In both cases, the assailants were tried for manslaughter - and acquitted.

And, in 1881, a spectator named Clements died after a replacement stump was thrown on to the field and pierced his skull. Gara and Brukner decided not to include the case of an umpire who, in 1904, died after he tripped down a staircase while sneaking into the cellar beneath the pavilion to fetch a beer at lunch.

The vast majority of deaths were caused by balls bowled, thrown, or struck, in a match or at practice, the victims a mix of batsmen, bowlers, fielders, umpires, spectators, and passers-by. From Albert Judd (1894), hit on the back of the neck after a fielder threw the ball up in celebration of a catch; through Seward Biffen (1914), struck on the head while stooping to tie his shoelaces during batting practice; to George Dodman (1919), who was hit on the chest while keeping wicket, went home sick, then returned to take part in a 500-yard walking race. He collapsed and died at the finish line.

As diverse as the circumstances were, the causes of death tended to be one of three: a blow to the head, causing delayed death in the hours or days after the match; a blow to the neck, causing a brain haemorrhage; or a blow to the heart, triggering a condition known as commotio cordis. This last seems almost impossible to guard against. "It is all about being hit over the heart at a particular moment in the cycle of the heartbeat," Brukner explains. "If you get hit in that thousandth of a second, you can go into cardiac arrest." Research done in baseball has shown that chest protection doesn't necessarily prevent it. Brukner estimates that "it probably happens once a year around the world somewhere in cricket". The data concerning deaths from 1950 onwards is incomplete, but Brukner says: "Before the introduction of helmets the vast majority were from head injuries. After helmets, head injuries became relatively rare, and there were probably more deaths from vertebral artery injuries than we realised. Now you would probably argue that the hit over the heart is the most common cause of death."

Of the 358 deaths in Britain and Ireland between 1850 and 1950, around 20 are likely to have been caused by vertebral artery dissection, the injury which killed Hughes. There have certainly been more cases in the years since, though it's unclear exactly how many. Brukner hopes and believes these deaths will become rarer in the future, now that helmet manufacturers have started providing stem guards to protect the back of the neck. "It amazes me that everyone isn't using them already," he says.

The former Australian opener Chris Rogers was one of the first players to make the transition. Then, in the Lord's Test last summer, he was hit by a short ball from Jimmy Anderson. He turned and ducked, and was caught just behind his right ear - flush on the stem guard. "He was one of the few players at the time wearing it," Brukner says, "and we both said to each other afterwards, if he hadn't been wearing it, who knows what would have happened?"

What we do now know is that the risks involved in cricket are greater than we imagined, and have tended to be underplayed. In 2015, there were more fatalities. Bavalan Pathmanathan, 24, died after being struck on the heart while batting in a club match in Surrey. Vamshi Krishna, aged only six, died after being hit on the chest while fielding close in during a playground game in Hyderabad. Soon after, also in Hyderabad, 31-year-old Saba Tasleem was killed by a ball that hit her on the temple as she was drying clothes at her home near a gully game. Surprise no longer seems the appropriate emotion. Better, instead, to follow Brukner's lead, and start figuring what more can be done.