Primitive humans performed early forms of surgery using sharpened stone tools as early as 20,000 years ago, as evidenced by a Cro-Magnon cave painting depicting a "witch doctor" dressed in animal skins. While tools were rudimentary, primitive humans displayed technical proficiency in surgeries like amputations. Common primitive surgical procedures included mutilating operations such as circumcision and castration, as well as trephining of the skull, though the purpose of trephining is unclear.