Narcotic Order Forms and Holder

Object/Artifact

-

Marvin Samson Museum for the History of Pharmacy

Name/Title

Narcotic Order Forms and Holder

Entry/Object ID

PCP.1999.25.197

Description

Paper narcotic order forms printed with a bouquet of flowers in the upper left corner followed by the text "ORDER FORM FOR OPIUM, ECT.," a decorative border framing the words "United States Internal Revenue" at the bottom of the sheet, and spaces for (from left to right, top to bottom): district, state, registry number, purchaser name, date, recipient name, substance and quantity, signature, business or profession, and address. The forms have two hole punches at the top through which they are spooled onto a support consisting of two spiraling metal rods mounted to a wooden backboard. All the forms are filled out by Philadelphia pharmacists or physicians.

Acquisition

Accession

PCP.1999.25

Made/Created

Manufacturer

United States Internal Revenue

Date made

1915 - 1916

Time Period

Early 20th century

Place

City

Philadelphia

State/Province

Pennsylvania

Continent

North America

Dimensions

Dimension Description

Overall

Height

3 in

Width

6-3/4 in

Length

12-1/2 in