A player falls. There is a deadly hush in the stadium. The team doctor, a young physician, fresh out of medical school, tries mouth to mouth and cardiopulmonary resuscitation.

“It was Nov. 12, 1972, 12 minutes past 3 in the afternoon,” recalls the Belgian doctor, Michel d’Hooghe. “I had all the problems in the world to reanimate the player. I will never forget this, or the first time Nico Rijnders opened his eyes at 7 o’clock the next morning.”

Even for a physician, trained to cope with life and death, the paradox of a sportsman suffering heart failure is haunting. Subsequent tests on Rijnders, a Dutch international, showed a congenital heart defect. He never played again. He died four years later of another heart attack. He was 28.

D’Hooghe was new to the game, and giving his services to Club Bruges free of charge. He had no warning of Rijnders’ heart condition, though in 1971 the player had been replaced at half-time after feeling breathless and complaining of tightness in his chest during Ajax Amsterdam’s European Cup final victory over Panathinaikos.

Ajax sold him to Bruges. D’Hooghe subsequently sent him for a checkup at Ghent University Hospital after Rijnders felt unwell.

The doctor has since established his own rehabilitation and sports medicine faculty at Bruges Hospital. He also heads the medical committee of FIFA, soccer’s world governing body. In that capacity he oversees the clinical program for 260 million players globally.

The world has changed since he joined Bruges. There should now be no club of its size that lacks the basic equipment — a defibrillator to jump start the heart and oxygen to prevent brain damage — that D’Hooghe had to work without in those days.

But the Rijnders drama still influences him. So does the sudden death of Marc-Vivien Foé, who collapsed while playing for Cameroon against Colombia in Lyon during FIFA’s Confederations Cup in 2003. The stadium in Lyon was not directly on d’Hooghe’s watch, but the World Cup next year in South Africa will be.

Taking the World Cup to Africa for the first time is FIFA’s greatest challenge. In February, d’Hooghe will hold a workshop in South Africa for the medical officers of the 32 national teams qualified for the World Cup.

“I shall ask every doctor to sign a memorandum to FIFA against doping,” he said. “The doctors have all taken the Hippocratic oath, but we must not be so naïve to presume that athletes obtain forbidden medications without assistance.

“Sometimes, the doctors are guilty. In 1994, I had to expel Diego Maradona from the World Cup, and Argentina’s doctor was very angry with me. There were five substances that should not have been in his system, but they said that it was only tiny amounts. Please, I had to say, you cannot say somebody is only a little bit pregnant!”

No performance-enhancing drugs were found at the autopsies on Rijnders and Foé. But their sudden deaths, 31 years apart, and the fact that top players have dropped dead at an increasing rate in the era of advanced medical science, disturbs anyone who thinks about it.

Top-line players including a Zambian, Chaswe Nsofwa; a Portuguese, Hugo Cunha; a Hungarian, Miklos Feher; a Scot, Phil O’Donnell; two Brazilians, Serginho and Marco Dos Santos; and two Spaniards, Alberto Puerta and Dani Jarque. All died at the peak of their careers — as did many more outside the spotlight.

FIFA, through its Medical Assessment and Research Center in Zurich, is amassing data on cardiac arrest — and on issues such as playing in heat and humidity and at altitude.

“Many of these cases could have been prevented by adequate preventative cardiac examination,” said d’Hooghe, urging more electrocardiograph scans. “It is not expensive. An E.C.G. should be possible in 90 per cent of the world, and if not, if money is the problem, we at FIFA should help through the GOAL funding for every association.”

Where a problem is initially suspected, an echo cardiograph is more expensive, but within the compass of wealthy clubs or associations.