John M. Foley, MD describes his observations: "The circumcision of a newborn boy is a spectacle so appalling and revolting in its cruelty that, on their first encounter with the ordeal, many robust medical students faint. The infant's arms and legs are tied down securely spread-eagled onto a molded Circumstraint Board, with his genitals exposed. The foreskin opening in a newborn is normally very small, to prevent entry of foreign matter. The first stage of circumcision is to grasp the foreskin with forceps and widen this opening. Since the foreskin is attached to the glans by a still developing membrane called the synechia this requires the foreskin and synechia to be torn apart. Naturally this is excruciatingly painful and the infant screams in terror and pain. Next, ignoring the infant's trauma, forceps are used to pull the entire foreskin and much of the penile shaft skin through a clamp, the clamp's screw is tightened and left in place for several minutes for crush to take place. The tissue is then slit and trimmed with a scalpel. From 50% to as much as 80% of the total penile skin is removed. In this country anesthetics are rarely used, they are considered unnecessary. The infant frantically struggles and screams and often vomits and defecates, before lapsing into unconsciousness."