It is the proccupation of MSPs and police officers - parts of Scotland are blighted by a street culture of slashing and slaughter. Nearly 12,000 people were treated for knife wounds last year, a stabbing rate that is 3 times higher than in England and Wales.

Health professionals, who stand on the gory front line, are now beginning to enter the political debate to find solutions to the problem. Traditionally, theirs has been a voice rarely heard, but hospitals are now increasingly collaborating with violence-reduction initiatives.

Alastair Ireland, clinical director of emergency medicine at Glasgow's hospitals, sees awful maiming and waste of life among young men day in, day out, and is helping the authorities in their struggle to tackle the issue.

The A&E department of the Royal Infirmary in Glasgow, where he is lead consultant, sees about 15 victims of stabbings every week. His department is now on the second phase of working with the violence reduction unit of Strathclyde Police so that “hotspots” in the East End and the centre of the city can be identified and targeted.

“We share anonymised data about the type of incident, the location and the motives,” Mr Ireland said. “We co-operate with the violence reduction agenda because we are keen to do whatever we can to prevent injuries occurring. The more conscious people are of what an issue it is, the better.”

Last month, writing in the BMJ, Jonathon Shepherd, Professor of Oral and Maxillofacial Surgery and director of the Violence Research Group at Cardiff University, recommended that every hospital emergency department in the UK should share anonymised information about violent incidents with local crime reduction agencies in order to tackle knife crime.

Professor Shepherd said that the data was effective in that it allowed the police to focus their resources and that a perceived likelihood of being caught was more of a deterrent than the severity of sentence. He claimed that the evidence base for the crime sciences was in its infancy and recommended greater research. He also supported practical measures, including criminalisation of knife carrying, and metal detectors at strategic street and public transport locations.

“I agree wholeheartedly with everything Jonathan Shepherd wrote,” Mr Ireland said. “I think it's important that we as health professionals collaborate with the police. I think we have a social responsibility not just to deal with the individual rushed into resuscitation, but also to try to prevent it happening in any way we can.

“Perhaps the ultimate solution is political and cultural and I think Scotland, and Britain, as a nation needs to have more self-belief. We also need to recognise the human need of young men to expend energy and aggression.

“These are natural emotions and they need outlets other than fighting. Young people need diversions.”

That violence is a form of entertainment in Scotland is tragically reflected in the attitude of the victims. “The average emotion is sometimes one of indifference, acceptance - a matter-of-fact ‘I've been stabbed',” Mr Ireland said. “Sometimes, when they are recommended for (overnight) admission to hospital, they just say, ‘Stitch me up' and leave. If it was me, I would be panicky, but some people seem to accept being stabbed, because many, maybe, come from a culture where it's not too abnormal. I'd say 70 to 80 per cent of them are under the influence of alcohol.”

Stabbings present a big challenge, because health professionals can never underestimate the possiblity of severe injuries from small and innocuous-looking wounds.

Mr Ireland recalled a case of a stabbing with a screw driver, which left a tiny puncture but resulted in the main pulmonary artery being pierced, which required the victim to have his chest opened up to save his life.

Mr Ireland, 46, said: “We tell our trainees there's no such thing as an innocuous stab wound. I recall one night two brothers who had both been stabbed. Both had a 1cm wound below the left nipple: one had a partly collapsed lung, the other was dead.”

A former army doctor and the father of two teenage children, he is extremely reluctant to dwell on the grim reality of stabbings, but admits that on busy nights his department can be something of a bloodbath.

“I remember one particularly busy night, about two years ago, when I was called in ... and taking a deep breath and smelling the blood. In the first bay there was a cardiothoracic team crouched over someone with their chest open and they were not winning; in the next bay there was a patient who had a 3ft sword protruding from his head; and the third patient had been the victim of a multiple machete attack and was covered from head to foot in large wounds.

“All these were separate incidents, and tragically, despite our efforts, all three died. These things stick in your mind.”

Enforcement, Mr Ireland said, was very important to prevent such horrors, but equally so was addressing the culture. In deprived areas gangs could be a replacement for absent fathers; combined with cheap alcohol, cheap drugs and a lack of other activities.

“Some young men naturally want some kind of adrenalin rush. While other people might get it from sport, or work, they don't have access to these things and the territorial culture that exists becomes a substitute.

“I also wonder on a deeper level if there is not enough national pride. I think Scotland needs to stand up and have more to be proud of. If we had more pride in ourselves we might be less likely to foul our own doorsteps.

“I think a lot of people join gangs more out of fear than bravado. There have always been ringleaders but a lot of the footsoldiers are quite fearful. If people are afraid to travel from one block to another, how do they get a job? How do they ever build confidence?

“What we are seeing is the end product of that fear and desperation, and we need to do whatever we can to address the situation.”

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