Last week I looked back at how medicine has changed over the years, vastly for the better. Now to look forward at advances that are just over the horizon - that may even be in place before 2000.

Some of them may not seem to be such great steps forward, but medicine's like that today. It progresses in lots of little steps - and all together they make a big difference in the end.

Take the work of Dr Bill Jordan, at the Hammersmith Hospital in London. He and his team are studying bone marrow transplants. In particular they are looking at a condition called "graft versus host disease" - what happens when a graft is rejected.

It's caused by the release of chemicals called cytokines, and the Hammersmith team are finding out not only which are the "bad guys" among the cytokines, but how to prevent them from causing rejection.

It's one of the many steps towards ways of transplanting marrow without needing a perfect match between donor and patient. I'm very optimistic that big steps forward in the treatment of leukaemias and other anaemias will come from this work. That's good news for anyone living with leukaemia, and their families.

Another is the news that a particular germ, called mycobacterium paratuberculosis, has been found in over 92 per cent of all cases of Crohn's disease. That's a serious debilitating bowel disease in people aged 15 and 25, affecting around 40,000 people in Britain every year.

It is difficult to treat, and often patients have to go on long-term steroids, with all that means in severe side-effects. Now that John Hermon-Taylor, Professor of Surgery at St George's Medical School in London, has shown that it's almost certainly a mycobacterial infection, we have a combination of antibiotics to treat it.

The London group has an 80 per cent cure rate, and their figures are confirmed by doctors in Florida and Australia. This is a huge step forward, and will prevent and stop a lot of real misery.

Then there's good news about pre-eclampsia, or toxaemia of pregnancy. In this illness pregnant women develop high blood pressure, kidney disease and retention of fluid. It gets worse during pregnancy and with each succeeding pregnancy, and every year between 500 and 600 British babies die from it. Because it is recognised early from the rising blood pressure and routine urine tests, fewer young women die from it today - but it still kills up to ten mothers a year in Britain.

Now the causes of pre-eclampsia are being unravelled by Professor Philip Baker, of Nottingham University. They are discovering the chemicals that promote the abnormality in the womb that leads to the disease. Until now, all that could be done was to save the mother by bringing down her blood pressure with drugs, and to hope that the baby would survive.

Often the pregnancy had to be terminated early to try to save both lives. Now we are only a short time away from using new drugs that cancel out the effects of the toxaemia-inducing chemicals - and from identifying with much more accuracy the women likely to suffer from the disease. Within the next ten years, pre-eclampsia should be consigned, like smallpox, to the dustbin of history.

Probably the most amazing news of the last year, however, has been the use that has been put to one of the most powerful poisons known to man - botulinum toxin. Food infected by botulism kills quickly by paralysing muscles. Past epidemics have been caused by poorly cooked meats, usually in tins, and it kills thousands of scavenging seagulls on rubbish tips each year.

Yet tiny doses of that same poison have been put to good use. They can be injected into over-active muscles to stop them going into cramps and spasms. Research by Dr Peter Moore at the Walton Centre for Neurology and Neurosurgery in Liverpool has shown that it can greatly help children with cerebral palsy, who have suffered brain damage around the time of birth.

It is also used to help people with dystonia, a condition in which the muscles, usually of the face or neck, go into spasm, giving them anything from a twitching eyelid to a wry neck or a stiff back that can't be bent.

These reports are just the tip of a huge iceberg of modern successful medical research. In these days of alternative and complementary medicine, it's good to know that the orthodox medical skills that took us out of the medical middle ages are still winning the fight against disease.

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