1917 Cocaine Order Form from a New York Dental Office

Item Details

Not Signed

An original cocaine order form from a New York dental office. The “Order Form for Opium, Etc.” is dated February 12, 1917, and requests thirty units of cocaine hydrochlorate, along with six units of Listerine and four of distilled water, from a New York City dispensary, “for dentist’s use” in an office in Champlain, near the Canadian border. The order form is presented under glass, in a black wooden frame with a two-way hanger to the verso.

Condition

- foxing to paper; wear to edges and corners of paper; warping to paper; minor surface wear to frame; easel has been removed from backing.

Dimensions

- measures frame; visible image measures 6.25"W x 9"H.

Item #

18LEX002-118