For many years, neural therapy according to Huneke was unjustly forced into an outsider’s role as a fringe method in medicine. Now, more than fifty years after its discovery, the recognition is at last growing among medical practitioners at universities and hospitals that the selective use of local anesthetics can greatly enrich and expand the conventional therapeutic armory, since physicians such as Adler, P Dosch, Gross, Harrer, Kibler, Schoeler, Siegen, and the Viennese team of Bergsmann, Fleischhacker, Hopfer, Kellner, Pischinger, Stacher, and others have shown by their work that the effects of neural therapy can be proved objectively.

For years, more than 50 % of all established practitioners in West Germany have been using neural therapy successfully in their day-to-day practice, for both diagnostic and therapeutic purposes.

In 1928, the brothers Ferdinand and Walter Huneke published a joint paper on ‘Unfamiliar remote effects of local anesthetics’ (Unbekannte Fernwirkungen der Lokalanästhesie). They reported the successful treatment of painful conditions in segmental areas and drew attention to the importance of injecting the correct site. They soon recognized that when procaine is injected, previously unknown reflex-like reactions are produced via Head’s zones. In addition to the purely intravenous injections with which they had begun, they discovered that paravenous and intramuscular injections could also be effective. For this type of treatment Kibler suggested the name of ‘segmental therapy with local anesthetics.’

And then, of course, we are injecting procaine. As long ago as 1906, Spiess noted that anesthesia suppresses any inflammation. We see danger not in the pathogenic agents but in the nerve irritation (depolarization) they cause. But we can reverse this with our anesthetic preparations, using them to stop bacterial and virus attack and proliferation, and thus preventing infection. If we infiltrate procaine around a fresh snakebite, the venom can no longer act on the organism. This is explained first by the fact that the anesthetic breaks the conductivity of the nerve fibers. Thus, the nerves can no longer conduct the irritative stimuli to the nerve centers. But further, procaine is also capable of recharging the cell membranes damaged by the irritation and of restoring their normal electrical potential. By this means, the production of toxic stimuli is blocked, which would otherwise cause the center to respond with panicky, excessive, and therefore dangerous reactions. In tetanus, rabies, poliomyelitis, and many other diseases, we need to imagine similar processes taking place, reminding us of the interference-field theory and of the possibility available to us of eliminating the pathogenic nerve irritation with procaine. The picture is rounded out if in this connection we remember that serum sickness can be stopped by anesthetizing the serum injection site (Muschaweck).

Far more important than all theory, however, is the fact that, whether we like it or not, that is the way it is. Obviously, no one can be prevented from continuing to carry out the traditional, ritual acts of ablution and of disinfecting the patient’s skin before injecting procaine. In certain circumstances, as, for example, before deep injections in the perineal region and near the anus, we also disinfect first. Similarly, for injections into the joints and the subarachnoid space and ventricles, the same sort of asepsis and antiseptic precautions must govern our actions as for major surgery! The same applies to seriously ill patients before parenteral treatment and to patients who are treated with high doses of corticosteroids. As has been stated, in return we need have no misgivings about being somewhat less punctilious in all other cases.

T. C. Dann, in an article published in the Lancet, took the view that the standard few seconds’ routine skin disinfection before an injection is totally useless. At best, no more than ~ 80 % of all bacteria are killed thereby. He and his colleagues had been giving injections for 6 years without prior disinfection, without ever finding any harmful side-effects result. They disinfected the skin only in above-mentioned exceptional cases. But in all such cases the skin is thoroughly cleansed for at least 2 (preferably 5) minutes with iodine, alcohol, or hexachlorophene. In 1978, Felig, in the Lancet, went so far as to describe the business of disinfecting the skin before injections as an “unnecessary ritual act.” In diabetics, where the risk of infection is substantially greater, 1700 injections were given without any prior disinfection of the skin around the injection site; not a single case of local or general infection resulted.

Procaine blocks cholinesterase, inhibits the formation of acetylcholine and the sensitivity to stimuli of the peripheral choline receptors. It suppresses histamine formation. As a β-receptor blocker it eliminates the physiological and pathological reactions caused by stress and sympathicomimetics. It lowers the level of catecholamines in the blood (epinephrine, norepinephrine, dopa-mine).

For procaine and the other anesthetics, several specific pharmacological effects have been proved, all of which are desirable from our point of view. According to these studies:

1. It acts to restore neurovegetative equilibrium, i. e., it can act either as a stimulant, increasing tonicity, or as a relaxant to reduce tonicity, depending on the patient’s initial state.

2. It acts to relieve pain. Here, in addition to its central and peripheral analgesic effect, there is also an anti-pyretic, anti-allergic, and spasmolytic element. As the pain disappears, the reactive inflammation also vanishes. By eliminating pain receptors the pain threshold is raised. When the injections are placed correctly, this effect lasts longer than the anesthetic effect, which indicates a decrease of pathogenic feedback. This suggests that the repolarization of the cell membrane during the anesthesia-hyperpolarization, with subsequent membrane stabilization, has a positive effect on the regulation mechanisms.

3. Its effect on the nervous system is made up of its ability to act simultaneously on the peripheral, the autonomic, and on the central nervous systems. It alters the functional state of the nervous system by reducing its lability, thus making it less sensitive to harmful stimuli. It is thus in a position to eliminate the state of shock of different origins and degrees of severity. If used correctly locally, it blocks pathogenic reflexes and reactivates the previously blocked neurovegetative system with its spontaneous healing capability.

4. It develops a therapeutic effect on all three components of the blood supply, i. e., the heart, the vascular system, and the blood. It has a regulating effect on the blood supply, is anti-allergic and a vasodilator, and reduces the permeability of the vascular walls:

a. Around the heart it inhibits the stimulus formation and conduction, and acts anti-arrhythmically. It has an oxygen-conserving effect on the heart muscle.

b. Microcirculation improves with the opening of arteriovenous anastomoses. Edema can drain and inflammations improve. In animal testing, edema was prevented when paws were treated with procaine before compressing them.

c. Animal testing proved the antihistamine effects of procaine, particularly by affecting the acute serum shock and suppression of the Shwartzman reaction. The stimulation of sensitive fibers causes histamine secretion, which stimulates more receptors. The antidromic reflex causes further histamine secretion. This lasts for a short while because the secretion is limited. Initially, sympathicus stimulation causes a spasm of the arterioles, which turns into pathological vasodilation with edema formation, vascular bleeding, intense pain with limited mobility, and muscle dysfunction. The sealing effect of procaine on the capillary walls begins quickly, reaches its peak after 1 hour, and lasts for up to 4 hours. In animal testing using procaine, the Bezold-Jarisch reflex of the induced collapse (loss of blood pressure, slowing down of pulse and respiration) can be prevented.

5. It also acts on the smooth musculature. So, for example, it sensitizes the uterus with regard to the hormone of the posterior lobe of the pituitary.

6. It has a substantial influence on the formation and secretion of hormones and enzymes.

7. It stimulates diuresis.

8. According to Uri, it also acts “directly on those parts of the brain which are associated with the transformation of stimuli into sensations.”