Created by gpt-4o-2024-11-20 on 2025-06-10

This image displays a vintage blank form titled "League for Preventive Work — Registry of Feeble-Minded." The form is designed to collect detailed personal and medical information about an individual, potentially for tracking those considered "feeble-minded" within the context of eugenics or social welfare efforts during the early 20th century.

The headings on the form include spaces for:

• Name (surname first), Date and Place of Birth
• Residence
• Name of Husband (or Wife)
• Name of Father and First and Maiden Name of Mother
• When Examined, By Whom, Basis of Diagnosis, and How Long Under Observation and By Whom
• Diagnosis
• Institutional information: Date of Application, Institution, and details on admission and discharge
• Date of Commitment by Court, including the related institution and dates of admission/discharge
• Miscellaneous fields for Remarks and information about the examiner (whether they are a physician or psychologist).

At the bottom, the form includes fields indicating whether the Case is Active (Yes/No), who reported it, and other noted details, such as hospital register status or involvement of social services.

This form reflects the historical practices tied to mental health and societal classifications during the time period it was created.

Created by gpt-4o-2024-08-06 on 2025-06-10

The image is a blank form titled "League for Preventive Work – Registry of Feeble-Minded”. It is intended to record personal and medical information about an individual regarded as "feeble-minded." The form has several labeled lines and sections for filling in information such as:

• Name (surname first), date and place of birth
• Residence
• Name of husband (or wife)
• Name of father
• First and maiden name of mother
• When examined, by whom, basis of diagnosis, and how long under observation and by whom
• Diagnosis
• Date of application, institution, when admitted, when discharged
• Date of commitment by court, institution, when admitted, when discharged
• Remarks
• Reported by
• A section for noting if the examiner is a physician or psychologist
• A section for when hospital registers and noting if known to the social service department
• An indication of case activity with "yes" or "no" options

This form appears to be historical and reflects outdated and now considered inappropriate language and practices regarding mental health.

Created by anthropic.claude-3-haiku-20240307-v1:0 on 2025-06-14

The image appears to be a form or registry from the "League for Preventive Work" related to a "Registry of Feeble-Minded" individuals. The form contains various fields to be filled out, including the person's name, date and place of birth, residence, name of husband or wife, name of parents, diagnosis, dates of application, commitment, admission, and discharge from institutions, as well as remarks and notes for physicians or social service departments. The form does not contain any identifiable human faces or names.

Created by us.anthropic.claude-3-5-sonnet-20241022-v2:0 on 2025-06-14

This is a historical medical form titled "League for Preventive Work - Registry of Feeble-Minded." It appears to be a blank intake or registration form that would have been used to document information about patients. The form includes fields for:

• Name (surname first) and date/place of birth
• Residence and spouse information
• Parents' information
• Examination details including diagnosis and basis
• Dates of application, admission, and discharge from institutions
• Court commitment information
• A remarks section
• Case status (active yes/no checkbox)
• Space to note if the examiner is a physician or psychologist
• A field for hospital registry information

The form reflects historical medical and institutional practices that would now be considered outdated and problematic, particularly in its terminology and approach to mental health and disability. This type of documentation was likely used in the early-to-mid 20th century.

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

The image presents a vintage, yellowed document with a title at the top that reads "LEAGUE FOR PREVENTIVE WORK - REGISTRY OF FEEBLE-MINDED." The document is divided into sections, each containing specific information.

• Name (Surname First)
  • The first section is labeled "Name (Surname First)" and includes fields for the person's name, date and place of birth, and residence.
• Residence
  • The "Residence" section contains fields for the person's name of father, name of mother, when examined by whom, basis of diagnosis, how long under observation and by whom, diagnosis, date of application, date of commitment by court, institution, when admitted, when discharged, remarks, reported by, case active, and notes.
• Reported By
  • The "Reported By" section includes fields for the person who reported the information and the institution where the person was admitted.
• Case Active
  • The "Case Active" section indicates whether the case is active or not.
• Notes
  • The "Notes" section provides additional information about the person, including their occupation and any relevant medical history.

In summary, the image shows a vintage document used to record information about individuals who were considered feeble-minded. The document includes various sections that provide details about the person's background, diagnosis, treatment, and outcome.

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

The image depicts a card with the title "LEAGUE FOR PREVENTIVE WORK - REGISTRY OF FEEBLE-MINDED" at the top. The card is divided into sections, each containing specific information about an individual.

Residence

• Name of Father
• Name of Husband (or Wife)
• First and Maiden Name of Mother

When Examined

• By Whom
• Basis of Diagnosis
• How Long Under Observation and By Whom

Diagnosis

• Date of Application
• Institution
• When Admitted
• When Discharged

Date of Commitment by Court

• Institution
• When Admitted
• When Discharged

Remarks

• Reported By
• Case Active
• Yes/No

The card appears to be a record-keeping tool for tracking individuals with mental health conditions or disabilities. It provides a comprehensive overview of an individual's personal and medical history, including their residence, family information, diagnosis, treatment, and institutionalization. The card also includes space for remarks and notes from healthcare professionals or social workers. Overall, the card serves as a valuable resource for healthcare providers, social workers, and researchers seeking to understand and support individuals with mental health conditions or disabilities.

Created by amazon.nova-lite-v1:0 on 2025-06-10

The image is of a document titled "League for Preventive Work - Registry of Feeble-Minded." This document appears to be a form used for recording detailed information about individuals deemed to have mental disabilities, likely during the early to mid-20th century. The form is divided into several sections, each containing specific fields for data entry.

Key sections of the form include:

1. Personal Information: This section gathers the individual's full name (surname first), date and place of birth, residence, and family details such as the names of the father and mother (including maiden name).

2. Examination and Diagnosis: This part records details about the examination, including the date, the examiner's name and qualifications (whether a physician or psychologist), the basis of diagnosis, and how long the individual was under observation.

3. Medical History: This section captures information about when the individual was admitted to an institution, the date of discharge, and any remarks regarding their condition.

4. Legal and Institutional Details: This part includes the date of application for commitment by court, the institution where the individual was admitted, and the dates of admission and discharge.

5. Additional Notes: There is a note to indicate if the examiner is a physician or psychologist, and another note to record if the hospital registers are known to the social service department.

6. Status Indicators: The form has checkboxes for "Yes" and "No" to indicate whether the case is active and if the individual is reported by the hospital.

The document is printed on a beige-colored paper, and the text is in a clear, legible font. The form appears to be part of a larger registry maintained by the League for Preventive Work, which likely aimed to document and manage cases of mental disability within a specific community or institution.

Created by amazon.nova-pro-v1:0 on 2025-06-10

The image shows a document titled "League for Preventive Work - Registry of Feeble-Minded." The document appears to be a form used for recording information about individuals who were considered "feeble-minded." The form has several sections, including personal information, medical history, and institutional details. The form includes fields for the individual's name, date and place of birth, residence, and name of spouse or parent. There are also sections for medical information, such as the basis of diagnosis, date of application, institution, and when admitted and discharged. The form also includes a section for remarks and a note indicating whether the examiner is a physician or psychologist. The document appears to be a historical record of individuals who were deemed "feeble-minded" and may have been institutionalized or under observation.

Created by gemini-2.0-flash-lite on 2025-05-04

The image displays a printed form titled "LEAGUE FOR PREVENTIVE WORK - REGISTRY OF FEEBLE-MINDED". It appears to be a historical document used for collecting information about individuals considered "feeble-minded."

The form is divided into several sections designed to gather specific data points, including:

• Personal Information: Name (Surname First), Date and Place of Birth, Residence, Name of Husband (or Wife), Name of Father, and First and Maiden Name of Mother.
• Medical and Observation Details: When Examined, By Whom, Basis of Diagnosis, How Long Under Observation and By Whom, and Diagnosis.
• Institutional Records: Date of Application, Institution, When Admitted, and When Discharged (likely referring to institutional placements). There are also sections for Date of Commitment by Court, Institution, When Admitted, and When Discharged, which further suggests the form was used for tracking individuals who were committed or placed in institutions by the court system.
• Remarks: A space for any additional relevant information.
• Reporting and Case Status: Reported By, Case Active (with options for "Yes" and "No").
• Notes: A section to note if the examiner is a physician or psychologist and a note for when hospital registers are used, including information known to the Social Service Department.

The layout is organized with lines and headings, indicating the form's intended use for recording structured information in a methodical manner. The document's tone and terminology reflect historical societal attitudes regarding intellectual disabilities.

Created by gemini-2.0-flash on 2025-05-04

Here's a description of the image:

The image presents a historical document: a registry card titled "LEAGUE FOR PREVENTIVE WORK - REGISTRY OF FEEBLE-MINDED." The card is structured as a form with labeled blank lines for filling in information related to an individual deemed "feeble-minded."

The form includes the following fields:

• Name (Surname First)
• Date and Place of Birth
• Residence
• Name of Husband (or Wife)
• Name of Father
• First and Maiden Name of Mother
• When Examined
• By Whom
• Basis of Diagnosis
• How Long Under Observation and by Whom
• Diagnosis
• Date of Application
• Institution, When Admitted, When Discharged
• Date of Commitment by Court
• Institution, When Admitted, When Discharged
• Remarks
• Reported By
• A section to indicate if the case is active (Yes/No)
• A note to indicate if the examiner is a physician or psychologist
• A note about hospital registers and social service department knowledge

The language used reflects the terminology and attitudes prevalent during the time the card was likely created, a period when eugenics and institutionalization of individuals with intellectual disabilities were more common. The document provides insight into historical perspectives on intellectual disability and societal efforts related to its management.

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

The image is a form titled "League for Preventive Work – Registry of Feeble-Minded." This form appears to be used for recording information about individuals diagnosed with intellectual disabilities. Here is a detailed breakdown of the form:

1. Name (Surname First): Space to write the individual's surname followed by their first name.
2. Date and Place of Birth: Space to record the individual's birth date and location.
3. Residence: Space to note the individual's current address.
4. Name of Husband (or Wife): Space to record the spouse's name if applicable.
5. Name of Father: Space to note the father's name.
6. First and Maiden Name of Mother: Space to record the mother's first and maiden names.
7. When Examined: Space to note the date of the examination.
8. By Whom: Space to record the name of the person who conducted the examination.
9. Basis of Diagnosis: Space to note the criteria or method used for diagnosis.
10. How Long Under Observation and By Whom: Space to record the duration of observation and the observer's name.
11. Diagnosis: Space to note the specific diagnosis.
12. Date of Application: Space to record the date when the application was made.
13. Institution: Space to note the institution's name.
14. When Admitted: Space to record the admission date to the institution.
15. When Discharged: Space to note the discharge date from the institution.
16. Date of Commitment by Court: Space to record the date of court commitment.
17. Institution: Space to note the institution's name.
18. When Admitted: Space to record the admission date to the institution.
19. When Discharged: Space to note the discharge date from the institution.
20. Remarks: Space for additional comments or notes.
21. Reported By: Space to note the name of the person reporting the information.
22. Case Active: Checkboxes to indicate if the case is active (Yes/No).
23. Note if Examiner is a Physician or Psychologist: Instruction to note if the examiner is a physician or psychologist.
24. When Hospital Registers—Note if Known to Social Service Department: Instruction to note if the individual is known to the social service department when hospital registers are reviewed.

The form is designed to capture comprehensive details about individuals diagnosed as feeble-minded, including personal information, examination details, institutional history, and additional remarks.