Official Prescription Forms for Medicinal Liquor- USA 1931
as scanned by James Stewart Campbell, MD. 2013
From 1920 to 1933, the production and sale of alcohol was illegal in the USA. One of the few exceptions to this prohibition was the use of alcohol for medicinal purposes under a doctor's prescription. Doctors could not write the order on a regular prescription pad, however. They had to use a special Rx form designed and distributed by the US Treasury Department's "Bureau of Industrial Alcohol." Early versions of this form were graphically simple, and thus easy to forge (see the mystery link for an example). By 1931 the forms had fine engraving similar to currency notes to reduce the chance of forgery. These forms were supplied in a collated pad. Carbon paper was used to generate the duplicate copy.
These Alcohol Rx forms were designed to be very complicated and strict. Oddly, only one line was provided to write in the kind of liquor, the quantity, and the directions for use. The other seven lines were for full identification and address of the patient, the prescriber, and the dispensing druggist. Note that both the doctor and the druggist were assumed to be male. Also, the prescription was only good for three days after it was written (thought that could be extended to six days by the doctor). Clearly these federal forms reflect the dead seriousness surrounding alcohol prohibition. They seem designed to discourage people from going to their doctor for access to alcohol, and, because the original prescription was to be forwarded to the "Supervisor of Permits," they drove a huge wedge between doctor and patient by completely ignoring the privacy of the doctor-patient relationship.
I obtained these forms in 1976 when I took over the practice of Dr. Leon Staton, MD. of Hayesville, NC. I found the forms in his miscellaneous papers and saved them through the years.
These are low-resolution copies of the documents. Click on the scan to download a high-resolution JPG version of the form (1 to 3 MB each).
Rx Form 1403 for Medicinal Liquor during Prohibition - USA 1931 - Original Front :
Rx Form 1403 for Medicinal Liquor during Prohibition - USA 1931 - Original Back:
Rx Form 1403 for Medicinal Liquor during Prohibition - USA 1931 - Duplicate Front:
Rx Form 1403 for Medicinal Liquor during Prohibition - USA 1931 - Duplicate Back:
