Miss. Code § 97-31-39
No sale of pure alcohol for medicinal purposes shall be made except upon the written prescription of a licensed and practicing physician of this state, who, before writing such prescription shall have made an actual examination of the patient for whom the prescription is issued, which prescription shall be dated and signed by the physician and shall be in substantially the following form:
"State of Mississippi, ____________________ County, I ____________________ a regularly licensed and practicing physician under the laws of this state, do hereby certify that I have examined ____________________ a patient in my charge, and hereby prescribe for the use of said patient ____________________ of pure alcohol, and I certify that the use thereof is necessary to alleviate or cure the illness or disease from which such patient is suffering. Dated ____________________"
____________________, M. D.
No prescription shall be filled hereunder except upon the day upon which it is issued or the following day, and no more than half a pint of alcohol shall be furnished on any one prescription, and when such prescription is filled it shall not be refilled, but shall be delivered to the druggist filling the same, and at the end of the month in which the same is filed shall be filed by such druggist in the office of the circuit clerk of the county. In towns having a population of 1,000 or more the physician's prescription shall not be filled at any drug store of which he is the proprietor, or in which he has a financial interest, either as partner, stockholder, or otherwise.
Any person purchasing alcohol for any purpose set out in this section, for which a prescription is not required herein, shall first sign a written or printed statement properly dated and deliver the same to the druggist, stating his name, residence and occupation, and the purpose for which he intends to use said alcohol.
Miss. Code § 97-31-39