Two hundred years ago, surgeons were barbers who also pulled teeth, bled you and lanced your boils. They were rough and ready men, trained on the battlefields, and not at medical schools.

Physicians were far above them in the social scale. Called "doctors" and trained in universities, they doled out medicines, were well versed in Latin and Greek, had a high opinion of their own knowledge, and despised the surgeons as tradesmen. We still call surgeons "mister", rather than "doctor" in memory of those days.

Yet the old surgeons were far better at saving lives than the physicians. While they were cutting out diseased parts, such as cancers and infections, they cured more than they killed. We can't say the same for the doctors of those days. It wasn't until the 1940s, with decent antibiotics, that people going to doctors had a better-than-even chance of being helped, rather than made worse, by them.

Obviously anyone with an illness would rather be treated medically than by "the knife". But there are times when there is no alternative, and we will always need good surgeons. And the knife is no longer the main tool of the surgeon's trade. What is astonishing about surgery today is how it is changing and where it is going. The big killers of today are heart attacks and strokes, and cancers.

Take heart attacks, for a start. We all know people who have had a coronary bypass operation or who have had coronary arteries widened by a balloon or a stent (a stent is like a tube of reinforced chicken wire that keeps a narrowed artery open). But what about using the balloon technology to deliver a gene into the damaged wall of a diseased artery, to make it self-repair? That's not science fiction - it has already been successfully used in people whose leg arteries have closed up, and who are in constant pain. It's only a research project at the moment - but it's just the beginning of a completely new approach to disease.

The big advantage of the new surgery is that the operators will be able to deliver substances to any part of the body, so that they work precisely at that site, and nowhere else.

The possibilities of putting the right genes into the right place are awesome. Many cancers happen because the patient possesses a faulty "p53" gene. In the normal person, the p53 gene "switches on" whenever it detects a cell behaving abnormally - as happens when it is beginning to turn cancerous. The "on switch" sends a message to that cell to "commit suicide". It obligingly bursts, its contents are dispersed, and the cancer is prevented.

A faulty p53 fails to detect the cancerous change, and the cancer can then grow and spread. Amazingly, the researchers are close to finding ways to insert normal p53 genes into cancers, so that the cancers can be defeated by the body's normal mechanisms. Imagine curing cancers with a mechanism that is so normal to the body it will not have side effects! Yet the experts predict this will be commonplace by the year 2010.

The genetic researchers aren't just looking at p53. They are finding substances - they are called cytokines - that can reinforce the body's immune system, helping it to cause cancer cells to die off or to be destroyed much like germs are killed off by our white cells and blood plasma in an infection.

None of these projects are in the least far-fetched. Some are already being tried out in cancer research centres, and should be available to most cancer sufferers within the next ten years. And during that time, the distinction between physicians and surgeons will disappear in many hospital centres, as both work together in teams for the common good of patients. I'm looking forward immensely to the 21st century.

Converted for the new archive on 30 June 2000. Some images and formatting may have been lost in the conversion.