Partly-printed form headed "Original Prescription Form for Medicinal Liquor," one page, 5.5 x 4.5, October 6, 1933. Issued under the authority of the National Prohibition Act, a prescription form filled out for "Alcohol," with directions to take a "Teaspoonful every hour." Issued by a pharmacist in Kansas City, Missouri. In fine condition, with a light vertical bend.