Created by gpt-4o-2024-11-20 on 2025-06-09

This image shows a blank data collection form titled "Tuberculosis Mortality of Newark, N.J." at the top. The form appears to be designed for recording details about individuals who died from tuberculosis in Newark, New Jersey. It includes various fields for information, such as:

• Name
• Sex
• Died at
• Age
• Color
• Condition
• Occupation
• Born
• Ancestry
• Doctor
• Home Address
• Died of
• Kind of House
• Floor
• No. of Rooms
• Light or Dark
• Clean or Dirty
• Disinfection
• Previous Cases
• Family History
• How Contracted
• Remarks

Each field is followed by blank spaces or dotted lines for filling in specific information. The form appears to focus on collecting both medical and environmental/social data about the deceased individuals, likely for analytical or public health purposes during the time period it was used.

Created by gpt-4o-2024-08-06 on 2025-06-09

The image is of a form titled "TUBERCULOSIS MORTALITY OF NEWARK, N.J." It appears to be intended for recording details about individuals who have died from tuberculosis in Newark, New Jersey. The form includes various fields to fill out information, such as:

• DIED (date)
• NAME
• SEX
• DIED AT (location)
• COLOR
• CONDITION
• AGE
• OCCUPATION
• BORN
• ANCESTRY
• DOCTOR
• DIED OF
• HOME ADDRESS
• KIND OF HOUSE
• FLOOR
• NO. OF ROOMS
• LIGHT OR DARK (referring to the home environment)
• CLEAN OR DIRTY (referring to the home environment)
• DISINFECTION
• PREVIOUS CASES (of tuberculosis)
• FAMILY HISTORY (related to tuberculosis)
• HOW CONTRACTED (the disease)
• REMARKS

Each line provides a space for written responses, separated by dotted lines, suggesting these were blank fields to be filled in with specific case information. The form likely serves as a record for analyzing tuberculosis mortality data during the time period it was used.

Created by anthropic.claude-3-haiku-20240307-v1:0 on 2025-06-13

The image appears to be a form or record related to tuberculosis mortality in Newark, New Jersey. It contains various fields to be filled out, such as the deceased person's name, sex, age, occupation, ancestry, doctor, cause of death, home address, and details about the type of housing and living conditions. The form seems to be part of an effort to track and study tuberculosis cases and deaths in the local area.

Created by us.anthropic.claude-3-opus-20240229-v1:0 on 2025-06-13

The image shows a form titled "TUBERCULOSIS MORTALITY OF NEWARK, N. J." It appears to be a death record or mortality report related to tuberculosis cases in Newark, New Jersey.

The form has various fields to be filled out, including:

• Name of the deceased person
• Date and location of death
• Sex, color, condition (likely marital status), and age of the deceased
• Occupation and place of birth
• Ancestry and doctor
• Home address where the person died
• Details about the residence such as kind of house, floor, number of rooms
• Indication of light or dark, clean or dirty, and disinfection status
• Fields for previous tuberculosis cases in the family and family history
• How the disease was contracted
• A remarks section

The form provides a structured way to collect key demographic and residential information about individuals who died from tuberculosis in Newark during a certain time period, likely for public health tracking and epidemiological analysis of the disease.

Created by us.anthropic.claude-3-5-sonnet-20241022-v2:0 on 2025-06-13

This image shows a blank historical medical form used to track tuberculosis mortality in Newark, New Jersey. The form appears to be a detailed questionnaire that would have been used to collect data about tuberculosis patients who died. It includes fields for various personal and medical information such as:

• Name and date of death
• Sex
• Color, condition, and age
• Occupation and place of birth
• Ancestry and attending doctor
• Cause of death and home address
• Housing details (kind of house, floor, number of rooms)
• Environmental conditions (light/dark, clean/dirty, disinfection)
• Previous cases
• Family history
• How the disease was contracted
• A space for remarks

This document appears to be from an earlier era when tuberculosis was a major public health concern and cities needed to carefully track mortality data related to the disease.

Created by us.meta.llama3-2-11b-instruct-v1:0 on 2025-06-10

The image depicts a form for recording tuberculosis mortality statistics in Newark, New Jersey. The form is titled "TUBERCULOSIS MORTALITY OF NEWARK, N.J." and features a series of questions that were used to collect data on individuals who died from tuberculosis.

The form includes the following fields:

• DIED
• DIED AT
• COLOR
• OCCUPATION
• ANCESTRY
• DIED OF
• KIND OF HOUSE
• LIGHT OR DARK
• PREVIOUS CASES
• FAMILY HISTORY
• HOW CONTRACTED
• REMARKS

Each field has a blank space for the user to fill in the relevant information. The form is printed on a beige background with black text, and it appears to be a vintage document from the early 20th century. The form is likely used by public health officials or medical professionals to track and analyze tuberculosis cases in Newark, New Jersey.

Created by us.meta.llama3-2-90b-instruct-v1:0 on 2025-06-10

The image is a form titled "TUBERCULOSIS MORTALITY OF NEWARK, N. J." in black text at the top. The form has several lines for filling in information about a deceased person who died of tuberculosis, including:

• Name
• Sex
• Age
• Occupation
• Ancestry
• Doctor
• Home address
• Kind of house
• Number of rooms
• Light or dark
• Clean or dirty
• Disinfection
• Previous cases
• Family history
• How contracted
• Remarks

The form appears to be from the early 20th century, based on the style of the font and the language used. It is likely that this form was used by health officials or medical professionals to collect data on tuberculosis deaths in Newark, New Jersey.

Created by amazon.nova-lite-v1:0 on 2025-06-06

The image is a document titled "TUBERCULOSIS MORTALITY OF NEWARK, N. J." The document appears to be a form used to record information about individuals who died from tuberculosis in Newark, New Jersey. The form is structured with various sections, each containing specific fields to be filled in. The fields include:

• Name
• Sex
• Age
• Color
• Condition
• Occupation
• Born
• Ancestry
• Doctor
• Died of
• Home Address
• Kind of House
• Floor
• Number of Rooms
• Light or Dark
• Clean or Dirty
• Disinfection
• Previous Cases
• Family History
• How Contracted
• Remarks

The document is blank, indicating that it has not been filled out with any data. The form is designed to collect detailed demographic and health-related information about individuals who died from tuberculosis, potentially for statistical analysis or historical research.

Created by amazon.nova-pro-v1:0 on 2025-06-06

The image shows a form that is probably a medical record of a person who died from tuberculosis in Newark, New Jersey. The form has blank spaces for the person's name, sex, age, color, condition, occupation, born, ancestry, doctor, home address, kind of house, floor, no. of rooms, light or dark, clean or dirty, disinfection, previous cases, family history, how contracted, and remarks. The form is titled "Tuberculosis Mortality of Newark, N. J." and is probably used to record the details of a person who died from tuberculosis.

Created by gemini-2.0-flash on 2025-05-25

The image shows a form titled "Tuberculosis Mortality of Newark, N. J." It includes blank spaces to fill in information about individuals who died from tuberculosis, covering aspects like their name, sex, age, birthplace, occupation, ancestry, the doctor who treated them, their home address, the type of house they lived in, the floor they resided on, the number of rooms, the cleanliness and lighting of their residence, previous cases, family history, how the disease was contracted, and any relevant remarks. The form seems designed for collecting detailed data on tuberculosis-related deaths in Newark, N. J., likely for public health analysis and tracking.

Created by gemini-2.0-flash-lite on 2025-05-25

The image is a form titled "Tuberculosis Mortality of Newark, N.J." with various fields to fill out. The form includes the following information categories:

• Personal information: Name, Sex, Age, Born, Color, Condition
• Medical details: Died At, Died Of, Doctor
• Living Conditions: Home Address, Kind of House, Floor, No. of Rooms, Light or Dark, Clean or Dirty, Disinfection
• Other Factors: Occupation, Ancestry, Previous Cases, Family History, How Contracted, and Remarks.

Created by us.mistral.pixtral-large-2502-v1:0 on 2025-06-05

The image shows a historical document titled "Tuberculosis Mortality of Newark, N.J." This document appears to be a form used to record details about individuals who died from tuberculosis in Newark, New Jersey. The form includes several fields for recording various pieces of information about the deceased, such as:

• Died (date of death)
• Name
• Died at (location of death)
• Sex
• Color (likely referring to race or ethnicity)
• Condition (presumably the condition of the body or health status)
• Age
• Occupation
• Born (place of birth)
• Ancestry
• Doctor (attending physician)
• Died of (cause of death)
• Home address
• Kind of house (type of residence)
• Floor (floor of the residence)
• No. of rooms (number of rooms in the residence)
• Light or dark (presumably referring to the lighting conditions in the residence)
• Clean or dirty (hygiene conditions of the residence)
• Disinfection (whether disinfection measures were taken)
• Previous cases (previous instances of tuberculosis in the family or residence)
• Family history (medical history of the family)
• How contracted (how the individual contracted tuberculosis)
• Remarks (additional notes or comments)

This form would have been used to gather detailed information for public health records, likely to track the spread of tuberculosis and to understand the living conditions and other factors that might contribute to the disease's prevalence and mortality rates.