[Article I]
Bell-Ans (Pa-Pay-Ans Bell)[K]
Bell-ans, for years advertised only in medical journals under the name “Pa-pay-ans (Bell),” is now advertised in newspapers as a remedy that “Absolutely Removes Indigestion.” As it is still being advertised to physicians, we propose to analyze the claims made for it with as much care as would be exercised in the discussion of the newest discovery in medicine, because we believe that it is desirable to show the trend of exploitation of a certain type of preparation in the medical press.
In the New York Medical Journal the following advertisement recently appeared on the front cover:
Acute Indigestion
Yesterday a great soldier and today the head of a big trust succumbed to an attack of Acute Indigestion; and every day we hear from some physician of some case he has saved with BELL-ANS by giving SIX (6) tablets dissolved in a glass of hot water and repeating if necessary. Can any doctor who reads this fail to provide himself with the free supply of BELL-ANS which we gladly send for his emergency case?
Typical of Bell-ans advertisements as appearing in medical journals.
A recently purchased package of Bell-ans contained a circular in which it was stated that Bell-ans removes flatulence, vertigo, weakness and other symptoms of indigestion quickly and pleasantly; that it aids the digestion of food and tends to restore the digestive tract to a normal condition; that it relieves vomiting in pregnancy, alcoholism, seasickness and cholera morbus, besides being pleasant, harmless and effective for colic, sour stomach, feverishness, and wakefulness of infants and children. The circular contained paragraphs purporting to be taken from various medical journals, including the New York Medical Journal, Wisconsin Medical Recorder, the Lancet Clinic, International Journal of Surgery, and Massachusetts Medical Journal. No exact references were given to permit verification or to determine whether or not the quotations were from “reading notices” (advertisements) or from the scientific part of the journals in question. To quote one of the statements given:
“The results from the use of Bell-ans (Pa-Pay-ans Bell) in the treatment of indigestion are so prompt and so generally good—and the evidence of this fact is accumulating so rapidly and from such reliable sources—that we venture to suggest to our readers who have not tried this remedy that they prescribe one original sealed package of Bell-ans (Pa-pay-ans Bell) and that they carefully note the results from its use.
“We suggest an original sealed package because the preparation is widely and badly imitated, and unless such a package is specified an imitation of little value may be substituted and the experiment be thus rendered useless.”
It is possible that Bell-ans has been imitated, but it is not true that it is widely imitated, for no such imitation has ever been called to our attention, and we strongly suspect that the main reason for desiring that an original package be dispensed is that the patient may see for himself the name BELL-ANS plainly blown in the glass.
The circular in question states that there is no derangement of the digestive organs on which the proper dose of Bell-ans will not act quickly and pleasantly! These are samples of the claims made for Bell-ans. Let us inquire into the nature of the conditions for which the preparation is recommended and the treatment advised by well known clinicians.
The subject of indigestion is discussed by Robert Hutchison and Robert Saundby under the general title of dyspepsia in the “Index of Treatment by Various Writers,” Edition 6, 1912, pp. 260–265. Hutchison says: “In the first place it must be remembered that in many patients who complain of ‘indigestion’ the seat of the trouble is not in the stomach at all.”
Newspaper advertisement of Bell-ans, capitalizing the statements of physicians.
The general principles to be observed in the treatment of functional dyspepsia, as given by Hutchison, are: (1) to remove the cause; (2) to adapt the diet to the impaired functional power of the stomach; (3) to administer such drugs as are calculated to stimulate or correct the particular function or functions which happen to be impaired, or disordered. Proper diet, proper mastication of food, hygiene of the mouth, and constipation are enumerated as deserving attention. Careful attention to securing a proper diet is essential. The choice of drugs depends, of course, on the conditions that give rise to indigestion, and he calls attention to the necessity of avoiding all routine treatment and compiling one’s prescription with an eye to the special disorder or disorders of function, whether secretory, motor or sensory, believed to be present. Hutchison gives the following typical prescriptions to illustrate the use of drugs in the different disorders of function:
FOR HYPERSECRETION (HYPERCHLORHYDRIA, ACID DYSPEPSIA, ETC.)
| Sodium bromid | 10 | grains |
| Bismuth subcarbonate | 15 | grains |
| Chloroform water | 1⁄2 | ounce |
This mixture to be taken before meals.
Sodium bicarbonate.
Bismuth subcarbonate.
Heavy magnesium carbonate, of each equal parts.
A small teaspoonful of the powder to be taken mixed with a little water or milk about two hours after meals.
FOR DEFICIENT SECRETION (HYPOCHYLIA, ACHYLIA, GASTRITIS, ETC.)
| Sodium bicarbonate | 10 | grains |
| Tincture of nux vomica | 10 | minims |
| Spirit of chloroform | 8 | minims |
| Compound infusion of gentian | 1⁄2 | ounce |
This mixture to be taken before meals.
Dilute hydrochloric acid and glycerin, of each 15 minims with enough water to make half an ounce, to be taken about twenty minutes after meals.
FOR DEFECTIVE MOTILITY (ATONIC DYSPEPSIA, GASTROPTOSIS, ETC.)
Hutchison recommends the use of 10 minims of tincture of nux vomica in an aromatic vehicle, such as infusion of quassia and compound tincture of cardamom; but another aromatic bitter, such as the compound tincture of gentian, will serve quite as well, of course. This is to be taken before each meal, and for the flatulence that often accompanies this trouble he gives menthol, aromatic spirit of ammonia and spirit of chloroform, as may be needed.
FOR ACID DYSPEPSIA
Robert Saundby recommends the following to be used before each meal for the relief of acid dyspepsia: sodium bicarbonate, bismuth subcarbonate, magnesium carbonate, of each 10 grains; mucilage of tragacanth 15 minims, and enough peppermint water to make an ounce.
These are only a few of the conditions that are discussed by Hutchison and Saundby, but they serve to show that the treatment of indigestion by a single prescription or combination is wholly irrational.
Bell-ans, both under its present name and under its older name, “Pa-pay-ans (Bell),” has always been alleged by its manufacturers to contain papain or to be a preparation of the digestive juice from the fruit of Carica papaya (papaw) with other substances. Various chemists have attempted to find papain present and to determine the digestive power of the tablets, but without success. For this reason The Journal suggested that the change of name from “Pa-pay-ans (Bell)” to “Bell-ans” was probably not made entirely for euphonious reasons, as alleged, especially when one considers that the name of a nostrum is its most valuable asset. It is much more likely that as analyses indicated there was not and probably never had been any papain present in the product, the name was changed for fear that some day the misleading term “Pa-pay-ans” might bring the preparation in conflict with the federal Food and Drugs Act.
Pa-pay-ans (Bell) was examined for the Council on Pharmacy and Chemistry in 1909 and the tablets were found to consist of charcoal, sodium bicarbonate, ginger, saccharin and oil of gaultheria. No digestive ferment could be detected in the tablets. Sodium bicarbonate is antacid and serves to dissolve mucus; ginger, if in sufficient amount, causes the expulsion of flatus, and charcoal, while an absorbent in the dry state, is probably useless for any therapeutic purpose whatever after it becomes saturated with gastric juice. Bell-ans, then, has all of the virtues, which are few, and all of the limitations, which are many, of a tablet of sodium bicarbonate and ginger. Its value in the treatment of acute indigestion would be limited to the value of a tablet of such a composition. It is absurd to suppose that it could have the slightest value in the far more serious conditions attended with intestinal indigestion, with the toxemia and autointoxication to which they give rise.
Bell-ans is now advertised directly to the public—but it is no less valuable on that account. True, it is a “patent medicine” in the commonly accepted sense of the term, but it is no more a “patent medicine” today than it was fifteen years ago when it reached the public, not through the direct medium of the newspapers but the more indirect route of the medical journals and undiscriminating physicians. It is true that, in view of the serious nature of many conditions which are loosely spoken of by the public as “indigestion,” its present method of exploitation is likely to make it just that much more dangerous because of the larger publicity that will be given. The point to be borne in mind is that Bell-ans is now in fact what it has always been in essence, a “patent medicine.”
Typical of Bell-ans advertisements as appearing in newspapers.
Again we ask the question: How do you wish to be classified, Doctor—among those who follow blindly the lead of a firm of nostrum makers, or among the intelligent members of the profession who study their cases carefully and prescribe intelligently? The manufacturers of Bell-ans claim that 100,000 American physicians now prescribe Bell-ans, and that 600,000,000 of the tablets are sold annually. If this is even approximately true it is a serious reflection on the medical profession, for the Council examined Bell-ans and reported its findings nearly eight years ago (J. A. M. A. 53:569 [Aug. 14] 1909), and the statements made in that report are as incontrovertible today as they were then.—(From The Journal A. M. A., Nov. 24, 1917.)