It was a long, long time ago, but there’s a pretty good chance Alexander the Great — a king of the ancient Greek kingdom of Macedon and conqueror of Persia and Egypt, whose reign some historians call a major turning point in European and Asian history — was felled not by a sword, dagger or arrow, but by Salmonella typhi enteritis.
At least, that’s the case made by “A Mysterious Death,” a June 1998 article in the New England Journal of Medicine. Written by doctors from the University of Maryland, including Dr. David Oldach, the story uses historical references to piece together a diagnosis.
“A 32-year-old man presented with fever and pain in the right upper quadrant,” the article began. “The patient had been well until the day after a night of heavy alcohol consumption (12 pints of wine), when fatigue and generalized aches developed. The following evening, he consumed a similar quantity of wine and had sharp pain in the right upper quadrant of such severity that he cried out. The pain resolved quickly, but the area remained tender to palpation. He later had chills, sweats and fever, which continued into the next day.”
After continuing to present the case, Oldach eventually reveals that the patient is in fact Alexander the Great, and that his cause of death could have been food poisoning. A casual review of Wikipedia revealed several theories for his 323 B.C. death, such as run-of-the-mill assassination poisoning, malaria, meningitis and more.
Whether it’s true or not, it’s a good reminder that foodborne illness has been around, well, forever. There are other historical accounts of food poisoning potentially changing history: There’s a theory that composer Wolfgang Amadeus Mozart died from trichinosis and another that the fall of the Roman Empire was because of lead-laced wine, which was discussed in Morton Satin’s “Death in the Pot: The Impact of Food Poisoning on History.”
Eventually, the concern over the safety and purity of food spurred leaders into some action. The Assize of Bread and Ale (turn to page 25 for a timeline of food safety events) regulated the price, weight and quality of bread and beer manufactured and sold in 13th-century England. In 1646, colonists in Massachusetts enacted their own Assize of Bread. In 1785, the state of Massachusetts passed An Act Against Selling Unwholesome Provisions, which made it possible to punish someone who knowingly sold “diseased, corrupted, contagious or unwholesome provisions.” The act is believed to be the first food safety law in the United States.
The 1800s saw several food safety-related events. On July 9, 1850, President Zachary Taylor died of an unknown digestive ailment potentially caused by eating raw fruit and drinking iced milk at a July 4 event. Twelve years later, President Abraham Lincoln formed the Department of Agriculture (USDA), and its Department of Chemistry eventually became the Food and Drug Administration (FDA). In 1897, the National Association of State Dairy and Food Departments, which eventually became the Association of Food and Drug Officials (AFDO), was founded. This eventually ushered in the idea of an Integrated Food Safety System (IFSS), the concept of a national collaborative and cooperative network of federal, state, local, tribal and territorial feed and food protection agencies working in concert to protect the U.S. human and animal food supply.
But it wasn’t until Upton Sinclair’s 1906 book “The Jungle” that the public began to take notice of and voice concerns over food safety.
“Upton Sinclair was writing a book about the labor problems in the Chicago stockyards, but what freaked everybody out was how meat was actually being made and whether sausage had sawdust or whatever in it,” said Bill Marler, foodborne illness attorney and managing partner at Marler Clark, The Food Safety Law Firm.
The public outrage also partly paved the way for passage of the Pure Food and Drugs Act in 1906, which FDA now calls “the culmination of about 100 bills over a quarter-century that aimed to rein in long-standing, serious abuses in the consumer product marketplace.”
It was later revised in 1938 and amended in 1958. The mid-1900s saw more regulations for consumer protection, and in 1970, the Centers for Disease Control and Prevention (CDC) began keeping records on foodborne illnesses.
In 1973, the first major food recall hit the U.S. when more than 75 million cans of mushrooms were removed from store shelves after a nationwide outbreak of botulism.
But all of the positive momentum, regulations and more up to the tail end of the century wasn’t enough to stop the burden of foodborne illness, as evidenced by the 1993 Jack in the Box E. coli outbreak, which caused illness in 732 people, resulting in 178 hospitalizations and the deaths of four children.
“This outbreak impacted far more than the lives and families in its wake,” said Darin Detwiler, an author, professor and food safety advocate whose 17-month-old son Riley was one of the four deaths. “News of the toddlers’ deaths, including that of my son, shook the nation. Never before had the topic of pathogens in food — especially something as American as fast food — gained so much attention in the media.”
What gained far less attention were two separate E. coli outbreaks 11 years earlier, in 1982, that were traced back to hamburger patties from a different fast-food chain.
“Acknowledgement and public discussion of the 1982 outbreaks may even have prevented the 1993 Jack in the Box outbreak,” said Steven Sklare, president of the Food Safety Academy and co-editor of “Food Fraud: A Global Threat with Public Health and Economic Consequences.”
A flurry of activity followed the Jack in the Box outbreak, including USDA officially declaring raw ground beef contaminated with E. coli O157:H7 to be adulterated and mandating food safe handling labels on all packages of raw meat and poultry in 1994.
In 1996, the Pathogen Reduction/HACCP Systems Rule was issued. Then, in 2000, the Global Food Safety Initiative was founded. In 2011, FDA’s Food Safety Modernization Act (FSMA) was signed into law by President Barack Obama, and throughout the following decade, many of its rules were finalized.
While food safety has come a long way, it’s never really finished. As the world has learned with the COVID-19 pandemic, bacteria, viruses and pathogens aren’t always predictable. Even now, new efforts, such as FDA’s Blueprint for a New Era of Smarter Food Safety, hope to reduce foodborne illness or lessen its burden. And with the continued awareness on public health and safety, consumers are more armed with knowledge about the issues than they ever have been.
“While my crystal ball is currently out of service, one thing is for certain: we should look back in order to get ahead,” said Jason Bashura, a food protection professional and adjunct professor at Michigan State University. “Think about it — what has happened in the past is a good indicator for what might happen in the future.”
Bashura also said that in the future, as the food and beverage industry continues to leverage partnerships with trade associations and non-governmental organizations (NGOs), these collaborative efforts can help foster relationships and the development — and sharing — of best practices and lessons learned.
“The ability of an NGO to share non-attributable, industry-based information with government entities to address common challenges across the global food and agriculture system can and will only benefit consumers and ultimately the public’s health and well-being,” he said. “The future of food safety is in the DNA of those relationships.”