Friday, May 20, 2016

Derifil - Nose Plugs in a Bottle

Before the advent of air conditioning and ventilation systems, hospitals were a virtual cafeteria of disgusting olfactory stimulation. The various offensive smells would just hang in the halls of the hospitals. Often times you could tell which ward you were on just by the character of the different smells. I think the worst was probably the detox ward. Combine the pungent stink of paraldehyde with every effluent a body could expel and you get the picture.

I remember a job interview where the meticulously attired supervisor asked me what my priorities would be if hired. The response popped into my head and I spouted out without much thought, "The ward smells just terrible. I would do something to mitigate the stink." The boss looked somewhat bemused, but offered me the job.

Traditional odor control involved opening as many windows as possible, using fans, dumping soiled linen as quickly as possible, and cover-ups like Airwick sticks positioned on door transoms. These odor camouflaging sticks looked like large green candles and did manage to add another olfactory flavor to the mix. I hated the smell of these green monsters as much as the scent from expelled lactulose enemas. I know it sounds paradoxical but those Airwick sticks had the nastiest "clean" smell that I have ever inhaled.

There was a revolutionary pharmaceutical product that was introduced at our hospital in the early 1980's. It was called Derifil and the product insert with this drug made some spectacular claims that had nurses enthralled.

This stuff was a chlorophyll derived medication administered orally in a beautifully colored greenish/black pill. We were totally fascinated by this pills color. Some said that it was the greenest black color they had ever seen and others insisted that it was blackest green color. Anyhow, it was very unique.

The medication was touted as an internal deodorant that actually quashed odors within the patients body before the stink could be expelled. It was said to quench the odor of stool, emesis, and even wounds draining purulent goo. I never figured out how a patient with vomiting could retain an oral dose, but the product insert did indeed specify that Derifil would destink an emeisis. We thought the hospital should obtain candy dishes to dispense this miracle drug. Just fill the dish to the brim and pass out the green/black miracle pills to every patient in sight with double doses on the detox ward especially prior to administering Lactulose enemas.

The Derifil era at our hospital only lasted for a couple of years and was quickly forgotten. This stuff was definitely effective at mitigating the odor of stool and doctors would order it for some patients that were squeamish about their new  colostomies and were preoccupied with the odor.

Derifil was introduced before pharmaceutical companies were clever enough to medicalize and come up with a pathological sounding name for the disorder and physicians did not recognize odor control as a serious medical issue. Maybe if the drug companies marketed Derifil to combat OOD (offensive odor disorder) the odor control game could have been propelled to a new paradigm. Without clever marketing, Derifil came to be regarded as a lifestyle drug before anyone even heard of lifestyle drugs. Physicians and patients alike failed to see odor control as a significant medical problem.

I also think that lack of  compliance with the odor control regimen may have been an issue. Who wants to acknowledge that they stink so bad they have to take a pill? People have evolved through the years an ability to tolerate their own body smells no matter how bad. I have been in attendance at many code browns (a great new term I picked up from you whippersnapperrns) where the nurses and aides are gagging and resisting the urge to run away while the patient lies there without batting an eyelash. People are basically immune to their own bad smells and not keen on taking a drug like Derifil.

Derifil seemed like a good idea at the time, but it quickly fell out of favor. I wonder, with new pharmaceutical marketing techniques this medication could be resurrected and become a commercial success.


  1. We always kept a communal jar of Vicks Vap-O-Rub at the nurses station. Especially handy for dealing with Code Browns!!

  2. That is a new one on me, I never even knew there was a pill for something like that! Thanks for the education!!!

  3. Ah I remember those Airwick sticks from my youth!

    But, I can't decide which is worse; those putrid green sticks or the small "odor neutralizer" sprays we had on our unit to use after changing a patient with c diff or foul stool. They did nothing to neutralize the odors but rather added the lovely scent of 'Grandma's Roses' to the air. Or, "poop roses" as we so affectionately called it.

  4. We were fond of Renuzit stick-ons (you can fit a lot of them on the headboard where no one can see) and kitty litter in wash pans tucked discretely underneath the bed.

  5. I guess it's part of my age induced foolishness, but I get a real kick out of these old school odor control modalities. I just remembered another ancient odor control device. We used to have these grey box devices about the size of a boot box mounted up near the ceiling. About once every 2 weeks they had to be wound up with a crank that resembled a Victrola crank. These spring loaded devices then sprayed an aerosol mist (no electricity needed) that smelled like flowers at preset timed intervals. It was a big mistake to be near one of these gizmos when the spray started.

    The advanced HVAC systems of modern hospitals are a significant advance in healthcare.

  6. There is currently no system, OTC solution, or other that can help with the pungent smell of necrotic and gangrenous bowel - we advance with technology, but some things never change.

  7. You got that right, sister! I've been absent from the trenches for many moons but just thinking about certain smells shivers my timbers. Old OR nurses used to swear by putting a gob of Vick's vapo rub inside your mask, but when I tried that trick I smelled the stink as well as the Vicks.

    Necrotic bowel is indeed bad. Anaerobic septic processes always have that characteristic skunk like nose burning property. Enough said.