Created by gemini-2.0-flash-lite on 2025-05-31

This image is a vintage, pre-computer-era form or record, specifically designed for tracking information about Typhoid Fever cases. The form, likely a card or a sheet from a larger register, is laid out in a clear, organized manner with horizontal lines and spaces for handwritten data. The top section lists standard details such as "Location," "Name," "Age," and "Physician's first visit". The form seeks to collect specific information about the patient's living conditions, exposures, and illness progression. Notable sections inquire about potential sources of infection, such as water sources (city, filter, well, spring), milk supply, and the presence of oysters and vegetables in their diet. The bottom of the image contains the text "Library Bureau S3436", and a stamp from the "Health Department, Springfield, Mass." The form's simplicity, use of lined paper, and handwritten elements are indicative of a time when information was recorded and managed manually.

Created by gemini-2.0-flash on 2025-05-31

Here is a description of the image:

The image shows a form titled "Typhoid Fever" on what appears to be a light tan or beige card. The form has various fields for information, including "Location," "Reported By," "Name," "Age," "Physician's first visit," "Physician while ill," "Address for 30 days before attack (Including trips out of town)," "First symptom," "Went to bed," "Health before attack," "Location when taken ill," "Patient's occupation," "Family's occupation," "Previous cases in house," "Other cases in neighborhood," "Sewer connection, cesspool, vault. Plumbing," "Milk," "Milk supply," "Water supply; city, filter, well, spring," "Ice," "Oysters," and "Vegetables." A stamp, diagonally placed, reads "HEALTH DEPARTMENT, Springfield, Mass." The form is printed with horizontal lines in light blue or green. The bottom of the form includes the text "Library Bureau S3436."