66756-1920-Amendment-of-the-Cremation-Regulations — Page 2

THE HONGKONG GOVERNMENT GAZETTE, SEPTEMBER 10, 1920.

6. Did you attend the deceased during his or

her last illness? If so, for how long?

7. When did you last see the deceased alive? (Say how many days or hours before death.)

8. How soon after death did you see the body, and what examination of it did you make?

9. What was the cause of death?

f Primary. 1 Secondary.

(Specify the disease, injury, etc., and if possible distinguish the primary from the secondary cause as in the Death Certifi- cate.)

What was its duration in years, months, or

days?

10. What was the mode of death? (Say whether syncope, coma, exhaustion, convulsions, etc.)

What was its duration in days, hours, or

minutes?

11. State how far the answers to the last two questions are the result of your own observations, or are based on statements made by others. If on statements made by others, say by whom.

12. Did the deceased undergo any operation during the final illness or within a year before death. If so, what was its nature, and who performed it?

13. By whom was the deceased nursed during his or her last illness? (Give names, and say whether professional nurse, relative, etc. If the illness was a long one, this question should be answered. with reference to the period of four weeks before the death.)

14. Who were the persons (if any) present at

the moment of death?

15. In view of the knowledge of the deceased's

habits and constitution, do you feel

any doubt whatever as to the character of the disease or the cause of death?

16. Do you know, or have you any reason to suspect, that the death of the deceased was due, directly or indirectly, to

(a) violence;

(b) poison;

(c) privation or neglect?

17. Have you any reason whatever to suppose a further examination of the body to be desirable?

18. Have you given the certificate required for

the registration of death?

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I hereby certify that the answers given above are true and accurate to the best of my knowledge and belief, and that there is no circumstance known to me which can