A rare Tiemann's oblique cutting scarificator with horn handle. The scarification is primed by pulling the screw at the end of the handle and released by pressing the trigger on the dorsal aspect of the handle. The depth of the cut is altered by the central screw on the body. Marked "G Tiemann & Co New York".  There is a picture of this version on P 99 of "American Surgical Instruments" by James Edmonson and similar earlier instrument is shown in figure 1650 P 115 of Tiemann's American Armemantarium Chirurgicum and on this site.