COMMENTARY: Bartlett JG, Onderdonk AB, Cisneros RL, Kasper DL. Clindamycin‐Associated Colitis Due to a Toxin‐Producing Species ofClostridiumin Hamsters. J Infect Dis 1977; 136:701.

The 1977 report by my colleagues and me [1], published in The Journal of Infectious Diseases, was the initial report of Clostridium difficile as the etiologic agent of antibioticassociated pseudomembraneous colitis (PMC). The present review includes background to the report, a brief summary of studies that were included in the report, and a postscript on highlights of subsequent developments. Retrospective review, much of which became apparent after publication of the 1977 report, included 3 different lines of relevant investigation: studies dealing with the anatomy and clinical features of PMC, studies of C. difficile, and studies of antibiotic-associated colitis in rodent models. The first report of a pseudomembraneous lesion in the intestine was published in 1893 by Finney [2]. It concerned a 22-year-old patient of William Osler who underwent gastric surgery and postoperatively developed severe diarrhea that subsequently proved to be lethal. The autopsy showed “diphtheritic membranes” in the small bowel (the pathologic sections are still in the Pathology Department at Johns Hopkins Hospital, along with the handwritten clinical notes of William Osler). PMC was a rare condition until the introduction of antibiotics, when it became a relatively common adverse effect of treatment with tetracycline and chloramphenicol. Staphylococcus aureus was the major nosocomial pathogen and was implicated because of its high frequency of recovery in stool [3]. At that time, every textbook of medicine had a section devoted to S.