Severe Acute Respiratory Syndrome

(SARS) and Coronavirus disease-2019

(COVID-19): From Causes to
Preventions in Hong Kong Siukan Law
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Severe Acute Respiratory Syndrome (SARS) and Coronavirus

disease-2019 (COVID-19): From Causes to Preventions in Hong Kong

Siukan Law, Albert Wingnang Leung, Chuanshan Xu

PII: S1201-9712(20)30192-2
DOI: https://doi.org/10.1016/j.ijid.2020.03.059
Reference: IJID 4065

To appear in: International Journal of Infectious Diseases

Received Date: 17 March 2020

Revised Date: 24 March 2020
Accepted Date: 24 March 2020

Please cite this article as: Law S, Leung AW, Xu C, Severe Acute Respiratory Syndrome
(SARS) and Coronavirus disease-2019 (COVID-19): From Causes to Preventions in Hong
Kong, International Journal of Infectious Diseases (2020),
doi: https://doi.org/10.1016/j.ijid.2020.03.059

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Severe Acute Respiratory Syndrome (SARS) and Coronavirus

disease-2019 (COVID-19): From Causes to Preventions in Hong

Kong

Siukan Law1,2,4, Albert Wingnang Leung3, Chuanshan Xu1*

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1. Key Laboratory of Molecular Target and Clinical Pharmacology, State Key Laboratory of

Respiratory Disease, School of Pharmaceutical Sciences & Fifth Affiliated Hospital, Guangzhou

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Medical University, Guangzhou 511436, China

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2. School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong,

Shatin, Hong Kong

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3. Asia-Pacific Institute of Aging Studies, Lingnan University, Tuen Mun, Hong Kong
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4. Department of Science, School of Science and Technology, The Open University of Hong

Kong, Ho Man Tin, Kowloon, Hong Kong

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*Correspondence to Professor Chuanshan Xu (xcshan@163.com)

Highlights
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 Hong Kong has been attacked by the coronavirus disease-2019 (COVID-19).

 To prevent further outbreak of COVID-19, this article discusses the current understanding
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of COVID-19 and compares with the outbreak of SARS-CoV-2 in 2003 of Hong Kong.

 The cause, transmission, symptoms, diagnosis, treatment and prevention to study for an
applicable measurement to control COVID-19.

Abstract

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 Hong Kong has been recently attacked by the coronavirus disease-2019 (COVID-19). In late

January 2020, it's shown a steadily increasing trend of confirmed cases. There is a 257 in total

infected cases confirmed including 4 deaths until 20th of March 2020. To prevent further

outbreak of COVID-19, this article discusses the current understanding of COVID-19 and

compares with the outbreak of SARS-CoV-2 in 2003 of Hong Kong from the causes,

transmission, symptoms, diagnosis, treatments and preventions to study for an applicable

measurement to control COVID-19.

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Keywords: Severe Acute Respiratory Syndrome (SARS); Coronavirus disease-2019 (COVID-

19); Causes; Transmissions; Symptoms; Diagnosis; Treatments; Preventions; Hong Kong

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Introduction

An outbreak of pneumonia with unknown etiology emerged in Wuhan of Hubei Province,

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China on December in 2019. Chinese scientists confirmed that a new coronavirus named severe

acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of pneumonia outbreak.

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Now, this severe acute respiratory syndrome has been termed as coronavirus disease 2019

(COVID-19) by the World Health of Organization (WHO) [1].

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Coronavirus is a group of viruses categorized into alphacoronavirus and betacoronavirus often

causing cold and other mild upper respiratory tract infections in the human body.
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Alphacoronavirus consists of HCoV-229E and HCoV-NL63; Betacoronavirus consists of HCoV-

OC43 and HCoV-HKU1. Nevertheless, the rare form would be lethal such as SARS, MERS and

COVID-19 [2]. SRAS-CoV, MERS-CoV and SARS-CoV-2 are betacoronavirus [3]. However,

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SARSr-CoVs belong to the subgenus Sarbecovirus (previously lineage B) of genus

Betacoronavirus and occupy a unique phylogenetic position. It's the most lethal [4].

On the 20th of March 2020, 178 countries or territories reported that there are 234073 in the

total confirmed case with 9840 deaths globally; 81300 confirmed cases and 3253 deaths reported

in China [5]; 257 confirmed case with 4 deaths in Hong Kong [6]. In response to the outbreak,

we summarize the current knowledge of COVID-19 and compare it with the previous

experiences of the SARS outbreak in Hong Kong to study for an effective measurement to

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control the COVID-19 epidemic.

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Causes

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SARS was caused by a coronavirus (CoV) and identified in 2003 according to the World
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Health Organization (WHO). Coronavirus (CoV) is an animal virus from bats which infected

human in Guangdong province, China [7-8].

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Hong Kong's SARS index-patient was Dr. LIU Jianlun in February 2003, who came to attend a

family wedding gathering. He was a Provinciale doctor contacting and treating SARS patients
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from Sun Yat-Sen Memorial Hospital in Guangdong [9]. On 21st of February 2003, Dr. LIU and

his wife checked into room 911 on the 9th floor of Metropole Hotel in Kowloon Hong Kong. He
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was a SARS super-spreader infected 23 other hotel guests from 7th to the 9th floor. The hotel

guests traveled to Canada, Singapore, Taiwan and Vietnam transmitting SARS to these locations.
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Dr. LIU was hospitalized in Kwong Wah Hospital of Hong Kong, he never recovered and died in

the Intensive Care Unit on 4th of March, while he caused around 80% of the Hong Kong cases

[10-11].

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 COVID-19 is similar to SARS, also caused by a coronavirus (CoV) that occurred in the

seafood and wet animal wholesale market in Wuhan, Hubei Province, China [12-13].

On 22th of January 2020, the first COVID-19 case was confirmed in Hong Kong and announced

by the Centre of Health Protection (CHP). However, no index patient has been identified at

present. Initially, most of the confirmed cases had a travel history to Mainland China by High-

Speed Rail, especially from Wuhan. Only a confirmed case had no recent travel history on 5th of

February 2020 [14-20]. There was an increase in the largest number of 10 confirmed cases per

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day from 9th of February 2020. In the Chinese lunar new year family gathering with two relatives

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from Guangdong Province, China [21]. 11 of 19 participants were diagnosed with COVID-19

infection. 2 other confirmed cases were the colleagues of the infected participants [22-24].

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Besides, the largest community spreading was reported at Fook Wai Ching She from Maylun
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Apartments in North Point Hong Kong on 4th of March. 18 patients in total were tested with a

positive result of COVID-19 who’s visited the temple or association with the confirmed cases in
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January or February [20]. The accumulated number of cases was raised to 257 with a steadily

increasing number of infected cases in Hong Kong on 20th of March 2020 [6].
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The trend of SARS outbreak

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A total of 1718 infected cases appeared in Hong Kong from 11th of March to 6th of June 2003

[25]. The SARS epidemic had three phases from March to June. First, the outbreak in Prince
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Wales Hospital was in March because of the local infected person admission while the spreading

of SARS infection affected a large number of medical staffs and students; Second outbreak

related to the spread from hospital to the community on 15th of April 2003 which influenced

block E of Amoy Garden with a total 329 estate residents infected cases; Third phase was from

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the early of May to the mid of June 2003, continuous new cases were reported but in a declining

trend. According to the previous studied, SARS induced 253 dead in Hong Kong [26], it was

approximately 15% dead rate ranging from 1% in those aged less than 24 years to over 50% in

those aged over 65 years within this period [27].

The trend of COVID-19 outbreak

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In Hong Kong, there were 257 infected cases from 23th of January to 20th of March 2020. It

consisted of 140 males and 117 females within ten age groups from 0 to 100 years old. The age

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and gender distribution of infected patients were shown in Figure 1 [6].

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The identity of confirmed cases were divided into three categories, 9 (3%) person of unknown

(waiting for confirmation), 10 (4%) of Non-Hong Kong residents and 238 (93%) of Hong Kong
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residents (Figure 2) [6].
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There were only a few infection cases from 23th of January to 8th of February. However, the

infection cases rose quickly on the 9th of February as the Hong Kong boundary control points
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such as Lo Wu, Lok Ma Chau, Lok Ma Chau Spur Line and Macau Ferry Terminal were not

closed at the beginning for reducing the flow of people and traffic [28]. The reported cases were

increased sharply from 23rd of January to 20th of March especially after 17th of March which was
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double per day (Figure 3) possibly because some Hong Kong residents returned to Hong Kong
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from overseas countries with infected COVID-19 [6].

On 12th of February, the first infected person was discharged and the accumulated discharged

persons were 97 at present (Figure 4).

Transmission

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 SARS-CoV is most readily transmitted by respiratory droplets when an infected person coughs

or sneezes within a short distance. The virus could also spread when a person touches a surface

or object contaminated with infectious droplets then touched his/her mouth, nose or eyes [29].

The average incubation period for SARS within human is 4 to 6 days, although rarely it can be as

short as 1 day or as long as 14 days [30]. SARS patients secret the virus excretion in respiratory

and stool during the second week of illness and start to deteriorate. It resulted in more than 8000

persons suffered from Severe Acute Respiratory Syndrome (SARS) and caused 774 person’s

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death in 2002-2003 [31].

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SARS-CoV-2 was indicated as animal-to-human transmission because of the linkage between

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fish and wild animal market based on the early studied [32]. However, there is a rapidly
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increasing incidence of infections by asymptomatic carriers [33-34], therefore, SARS-CoV-2

may have human-to-human transmission through droplets or direct contact [35-36].

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Compared to SARS-CoV, SARS-CoV-2 might be transmitted by respiratory droplets within a

long distance of 2m or by contaminated surfaces leading to infection through contact

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transmission [1]. The average incubation period for COVID-19 expands to 5 days and the period

of quarantine is 14 days from the last date of exposure. It was the longest incubation period for
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similar types of coronaviruses. However, it’s remained argumentative since the longest

incubation period for COVID-19 can be 27 days or above according to the present-day finding
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[37]. Perhaps, respiratory droplets were not the major factor for transmission [38]. Recently,

there is a patient dog infected from its nasal and oral cavity with a low level of COVID-19 virus.

It’s not shown any signs of disease before. This is the first case of human-to-animal transmission

that has been confirmed by the experts from School of Public Health in the Hong Kong

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University, College of Veterinary Medicine & Life Sciences in the City University of Hong

Kong and the World Organization for Animal Health [39].

Symptoms

The symptoms of SARS and COVID-19 are divided into systematic and respiratory disorders

(Table 1). Systematic disorders of SARS and COVID-19 are fever, cough and fatigue. The major

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respiratory disorders of COVID-19 and SARS are rhinorrhea, sneezing, sore throat and

pneumonia but COVID-19 patients have more respiratory symptoms than the patients with

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SARS [29, 34, 40-42]. Leukopenia, lymphopenia and lower platelet count are possibly observed

in the hematology [43-44].

Diagnosis
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Reverse transcription polymerase chain reaction(RT-PCR) is the golden test for the diagnosis of

SARS and COVID-19. Computed Tomography (CT) scan is the auxiliary diagnostic method.
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The images of CT sometimes appear bilateral pulmonary parenchymal ground-glass and

consolidative pulmonary opacities with a rounded morphology and a peripheral lung distribution
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when patients infected with SARS and COVID-19 [45].

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SARS
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RT-PCR is a technique that combines RNA reverse transcription with polymerase chain

amplification (PCR) of cDNA. It’s the rapid and specific diagnostic test for SARS following the

protocols of the World Health Organization (WHO) and commonly used in the SARS outbreak

2003. Respiratory specimen, stool specimen and urine specimen could be used for RT-PCR

testing while respiratory specimens were collected in the SARS epidemic [46]. The peak

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detection period in SARS-CoV after illness: respiratory specimen is week 2; stool and rectal

swab specimens are weeks 2 to 3 and urine specimen is week 4 [21].

COVID-19

Real-time quantitative polymerase chain reaction (RT-qPCR) is the most common and effective

nucleic acid detection technologies for SARS-CoV-2. Meanwhile, high-throughput sequencing

technology has been applied for diagnosis. It’s limited usage because of the high cost. Immune

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identification technologies such as Point-of-care Testing (POCT) of IgM/IgG and enzyme-linked

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immunosorbent assay (ELISA) are other possible diagnostic methods for COVID-19 but remain

to be studied [45].

Treatments -p
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SARS
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The combination regimen of steroids and ribavirin was the treatment protocols for SARS in

Hong Kong [47].

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Corticosteroid is commonly used as an immunomodulatory agent to modulate inflammatory

cytokines to achieve immune homeostasis [48]. Steroid with high dosage was used to treat
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patients with SARS [49].

Ribavirin can suppress the replication of RNA virus. It has been used in treating hepatitis C
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virus, lassa fever virus and severe respiratory syncytial virus infection [50]. However, the usage

of ribavirin did not reduce the intra-tracheal intubation or mortality rates [51]. It has significant

toxicity which may cause hemolytic anemia and electrolyte disturbances [50].

Protease inhibitor for treating human immunodeficiency virus (HIV) infection has also been

considered as a treatment for SARS. Lopinavir-ritonavir coformulation (Kaletra) blocks the virus

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replicase polyprotein and prevents the replication of RNA. This is able to reduce the intubation

and mortality rates especially administered in the early stage with ribavirin and corticosteroid

[52]. Glycyrrhizin that can inhibit viral absorption and penetration has been found to be effective

against SARS-CoV during and after the viral adsorption period [53]. The Interferons are partly

effective against coronaviruses but the efficacy is not accurately tested [54]. Gamma

immunoglobulins are used in SARS but the effectiveness remains to be evaluated [55].

Broad spectrum antibiotics such as fluoroquinolone or beta-lactams and macrolide are also

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utilized to treat nonspecific features and assisted ventilation is commonly used for respiratory

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failure in SARS patients [55].

COVID-19
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Broad spectrum antiviral drugs have been used in treating COVID-19 infection e.g oseltamivir,

lopinavir, ritonavir and ganciclovir regimen; remdesivir and chloroquine regimen [40]. The
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invention of a specific antiviral drug for COVID-19 is still progressing. Potential compounds are

available for further investigation such as EIDD-2801 (isopropyl ester of N4-hydroxycytidine),

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Sofosbuvir, IDX-184, Ribavirin and Remidisvir may be considered as its high therapeutic

potential in treating emerged viral infection [56-57]. Meanwhile, there are not only the antiviral
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drugs needed for an infected patient but also the prophylaxis e.g. vaccine is required for the

uninfected person especially for the healthcare workers. Antibiotics and ventilation support are
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also utilized in COVID19 patients [43].

Sequela

SARS

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 The exercise capacity and health status of SARS recoverees were significantly lower than the

general population. In the early rehabilitation phase, the short and weak breath caused limitations

in physical function because of reduced lung function with patchy changes. A minority of

survivors had a mild decrease in carbon monoxide diffusing capacity [58]. Steroid resulted in

some psycho-behavioral problems such as anxiety and depression, it might be improved

gradually in most of the patients [59]. However, high dose corticosteroid treatment induced

avascular necrosis of the joint and hip which further decreases the health status and mobility

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[60].

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COVID-19

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Some patients recovered have 20-30% decrease of the lung capacity because of the reveal

irreversible fibrosis [61]. This causes lung tissue scarring and stiffening as well as the immune
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system damage. Lung permanent damage may be leading to severe respiratory issues such as
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acute respiratory distress syndrome (ARDS) [62]. Younger patients have a better chance of

recovery but patients within 40 to 50 years old only have little chance and difficulty back to their

pre-illness status.
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Preventions
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To prevent the spread of SARS and COVID-19, measures are based on effective infection
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control and isolation. The relative measures are mainly focused on 4 aspects, confirmed cases,

close contact handling, community prevention as well as protection on healthcare workers.

SARS

(i)Confirmed cases

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 On 12th of March 2003, the Department of Health in Hong Kong alerted Word Health

Organization (WHO) for the first notable suspected infection condition in Prince of Wales

Hospital (PWH) ward 8A for handling the confirmed cases. The department of Food and Health

Secretary started daily press briefings on the latest SARS condition and government measures

for informing the public and increasing the effectiveness of tracing close contact person since

16th of March 2003. In the mid of April 2003, a temperature check was required for a person who

arriving in Hong Kong to detect any suspected case of SARS [63].

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(ii)Close contacted handling

On 31st of March 2003, all close contactors of SARS were mandated to report daily and

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designated medical centers by Department of Health for close contacted handling. Home
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quarantine measure extend to close contactors of a suspected case to minimize the opportunities

of transmission for the virus since 25th of April 2003. Due to the increasing report of a confirmed
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case in block E Amoy Garden, isolation camp was opened for the evacuation of block E Amoy

Gardens residents in April 2003 [64].

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(iii)Community prevention
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On 27th of March 2003, Hong Kong government announced the suspension of classes in all

schools from 29th of March to 6th of April 2003 to prevent clustering. While there was no visiting
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policy extending to all acute ward in HA hospital for preventing further close contact cases. On

2nd of April 2003, the Word Health Organization (WHO) issued a travel advisory recommended

to postpone for all non-essential travel to Hong Kong and Guangdong. Education for the use of

face mask, hand hygiene, disinfection of surfaces for fomites, avoiding contact with SARS

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patients and their body fluids, covering your mouth by tissue when coughing or sneezing and

other simple hygiene measures were provided by the government to prevent further community

outbreak [65].

(iv)Protection on healthcare workers

Healthcare workers were advised to use personal protective equipment (PPE) including N95

masks for an aerosol generated procedure, face shield or goggles, gloves and isolation gowns

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with strict infection control to prevent the droplet and contact transmission. During the SARS

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period, health workers worked in a pair for mutually monitoring the infection control implement,

especially wearing and removing the PPE. When transferring the confirmed patient, advise the

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patient putting on the mask to prevent the spread of droplets with viruses. Daily self-monitoring
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of fever and any other symptoms of SARS were implemented in Hospital Authority for early

detection of SARS infection. The high-risk areas such as A&E, ICU and Isolation ward were
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adequately ventilated with negative pressure to prevent infection of the health workers [66].
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COVID 19

(i)Confirmed cases
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On 8th of January 2020, Centre for Health Protection added “Severe respiratory disease

associated with a new infectious agent” as the notifiable diseases in Hong Kong which gained
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the authority on quarantine for handling the confirmed case. All confirmed cases should stay in

the hospital for isolation and treatment until fully recovered. Suspected cases were also required

to isolate in the hospital until a negative result of SARS-CoV-2 observed. To increase the

effectiveness of detecting high risk cases on admission to the hospital in early February 2020, the

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patient’s travel history was connected from the immigration department and shown in the

hospital authority computer system (Clinical Management System). Temperature check

maintained the routine check for person arriving in Hong Kong. The Health declaration form

should be submitted compulsorily by paper or electronic for all travellers who arrived at Hong

Kong International Airport from 8th of March 2020. Private doctors were allowed to collect a

respiratory specimen for the symptomatic patient to send for viral testing at accredited private

laboratories on 9th of March 2020 [67]. Started from 20th March, 2020, the Hospital Authority

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(HA) established 2 temporary COVID-19 virus test centers at the AsiaWorld-Expo and the North

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Lantau Hospital for people arriving in Hong Kong with upper respiratory symptoms to undergo

viral test and to wait for the laboratory results [68].

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(ii)Close contacted handling

All visitors arrived at Hong Kong who has been to Hubei Province in the past 14 days must be
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transferred to 3 quarantine centers (Chai Wan Lei Yue Mun Park and Holiday Village, Jao

Tsung-I Academy Heritage Lodge, Chun Yeung Estate) [69]. On 19th of March 2020, all people
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arriving in Hong Kong who have been to Iran, Daegu and Gyeongsangbuk-do in Korea, Emilia-

Romagna, Lombardy and Veneto regions in Italy within the past 14 days have to stay in a
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quarantine center for quarantine [70]. Compulsory home or accommodation quarantine for 14

days implemented to people who arrived in Hong Kong from Mainland China (but not include
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Hubei Province) on 8th February 2020 has been extended to people who arrived to Hong Kong

from all any other overseas countries and area except Macau, Hong Kong and Taiwan since 19th

of March 2020 [69]. Home or accommodation quarantine for 14 days, daily body temperature,

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sign and symptoms monitoring are required and electronic wristbands are also worn to monitor

the location of who have been isolated [71].

(iii)Community prevention

In the late of January government gradually declared to close all kindergarten, primary schools,

secondary schools and special schools for community prevention; all amusement parks in Hong

Kong including Hong Kong Disneyland Resort, Ocean Park Hong Kong and Madame Tussauds

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Hong Kong; all facilities of the Leisure and Cultural Services Department (LCSD) including

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public museums, public libraries, sports centers and venue were also closed to prevent clustering.

Home office for working was advised. Special arrangements for the Hong Kong Diploma of

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Secondary Education examination, such as widen seating plan, compulsory use of mask and
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temperature measuring will be implemented to prevent cross infection. On 17th of January 2020,

Hong Kong Government prohibited the entry of non-Hong Kong residents who have visited the
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Hubei Province in the past 14 days since 27th of January 2020 [71]. The High-Speed Rail train

services have been suspended from 29th of January 2020 and the cross border train station has
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been suspended from 4th of February 2020 to prevent close contacted high-risk cases to Hong

Kong. On 17th of March 2020, the Hong Kong Security Bureau extended the red outbound travel
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alert to all overseas countries/territories based on public health concerns [72]. Hospital Authority

(HA) raised the emergency response level to emergency with no visiting, exceptions will be
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made for clinical consideration and suspended volunteer services or clinical attachment in all

public hospitals to prevent further close contact cases on 25th of January [73-74].

(iv)Protection on healthcare workers

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 Every person in a public hospital was required to wear a surgical mask for preventing cross

contamination with the emergency response level. Same to SARS conditions, the hospital

authority advised using personal protective equipment (PPE) as discussed above. A special

allowance as housing allowance (HK$500/day) was provided for the healthcare staff working in

high-risk areas for the purpose of renting accommodation for self-isolation to prevent close

contact with their family so as to prevent from spreading to the community [75].

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Conclusion

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The causes, transmissions, symptoms and preventive measures of SARS and COVID-19 are

reviewed above. However, diagnosis and treatments remain for further study. Polymerase chain

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reaction for confirming the interaction of SARS or COVID-19 sometimes may show a false

negative. There is no specific treatment regimen, only has a broad spectrum of antiviral drugs for
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COVID-19 patients and no vaccine for prevention at present. Nowadays, personal hygiene and
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protection are the most important for preventing the spread of COVID-19 such as

wearing a mask and washing hands as well as reducing social contact including avoiding crowds,
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working in home, so on.

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Funding

The authors received no specific funding for this work.

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Ethical approval

Ethical approval is not required.

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Conflict of interest

All authors declare no competing interests exist.

Conflict of Interest Statement

The authors declare that they have no known competing financial interests or personal
relationships that could have appeared to influence the work reported. This work has not been
published previously and the manuscript is not under consideration for publication elsewhere. The
submission is approved by all authors.

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24
Another random document with
no related content on Scribd:
Cambridge Gulf Tribes, x, 51, 62, 65, 74, 93, 99, 101, 226, 238,
282, 288, 375, 377, 405
camel, ochre drawing of, 329
Campbell, John, 344
camp, clearing a site for, 100;
life, 100-119;
occupations while in, 112, 113;
selection of, 91
camptocnemia, 15
cannibalism, 21, 189
canoes, 160-164;
dug-outs, 164;
housing of, 162;
with outriggers, 164;
with sail, 164
capacity of skull, 37
Cape York, 93, 104
caravan travelling, 1
caries, 31
Carpentaria Gulf, 50, 93, 128, 129, 151, 160, 161, 162, 164,
189, 201, 266, 287, 375
carpentry taught boys, 85
carrying, dogs, 67;
infants, methods of, 66, 67
carved bone, 313;
grave posts, 207, 309-310;
pearl shell, 313;
 trees, 308, 309;
weapons, 310
carvings in rock, 299-308
Cassia, branch used as an emblem of peace, 2;
used for headgear, 280
casus belli, 183
caterpillar, 122;
totemic designs of, 350, 352
Caucasian, 58, 59;
derived from Australoid, 59
cave drawings, 314, 315, 322 et seq.;
of Glenelg River, 333, 343-345;
inspiration given by natural feature, 331, 332
celestial “walk-about,” 296
ceremonial dance, drawing of, 332, 338
ceremony of welcome, 379
character of aboriginal, 227
characteristics of race, 5-17
charcoal drawing, method of, 323;
of ceremonial dance, 338, 332;
of crows, 319, 335, 336;
of buffalo hunter, 325, 337;
of kangaroo hunter, 326, 337
cheek bone, 30
chief of tribe, 226
chignon, 47
child decorations, 84, 85
childhood, 69-90
children, entertainment of, 69, 70, 71;
position of at ceremonials, 84, 85;
playing with sand and mud, 73-75;
running after wind-driven seeds, 76;
taught to sing and dance, 70;
taught to draw and imitate tracks, 71, 72, 73;
tobogganing, 75
chin, 29
Christianity, 257
cicadae and crickets, musical powers envied, 384
cicatrices, 236-238, 250
circle-within-circle designs, 351, 353
circumcision, 239-244;
drastic treatment of shirkers, 243
clubbing the initiate, 242
clubs, 168, 169, 170;
in warfare, 188
club-rule, 222-223
“coal sack,” 332
cockatoo, kept as pet, 89
colour, artificially applied to body when hunting, 142;
of aboriginal’s skin, 40-45;
affected by climate, 45, 49, 59
composition, in aboriginal art, 338
conception, ideas about, 284, 285
conventional designs, 346 et seq.
conventional representation of human figure, 353-358
conversation, actions aiding, 395;
by song, 385
conversationalist, the aboriginal as, 371, 395
Coo-ee, 2. See also “käu,” 142
cooking, methods of, 108
cooleman, 92
Coopers Creek, 50, 83, 92, 102, 114 (Barcoo), 121, 127, 150,
155, 169, 170, 190 (Barcoo), 200, 237, 362, 376
cores, stone, 364
corrobboree, 377
cosmetics, 115
Cossus moth (witchedy), 122, 204
cotton tree (Bombatt malabaricum), 249
council of old men, 225, 226
Crocker Island, 131, 191
Crocodile, carvings of, 331;
ceremony of, 377;
eggs of, 126;
floating log to simulate, 159;
hunting the, 134
cradle, food-carrier taking the place of, 65
“cratch-cradle,” 84
crawfish, 128
cremation, not practised, 204
crossed boomerangs, the symbol of strife, 347, 351
crows, ceremony of, 378, 379;
drawing of, 319, 335, 336
“cutting” the shadow, 175
Cunningham, Professor D. J., 24
Cyperus rotundus (“yelka”), 148
Cyrena, acting as a pigment dish, 319;
used as a scraper, 162

D
“dabba,” stone knife, 367
daggers, 172
Daly River spear types, 196, 197, 198
“damatba” throwing weapon, 170
“dangorra,” the great emu in the sky, 315, 333, 349
Darwin, Charles, 33
dead person’s name not mentioned, 211, 212
death, tracing the cause of a, 208, 209
dental rudiments, 33
de Rougemont, 133
desert surroundings, 1
dialects, variety of, 387, 388
“didjeridoo” drone pipe, 375, 376, 379, 380
Dieri Tribe, xiv, 4, 76, 82, 83, 92, 111, 121, 150, 155, 170, 172,
190, 205, 206, 218, 237, 242, 271, 282, 289, 290, 361, 362,
376, 386, 396, 400
diminutive expressions, 396, 400
“dindula,” hair ornament, 47
dingo, the wild dog of Australia, 119;
hunting the, 141;
mythical dingo or “knullia” people, 342
Diprotodon, 52, 54;
associated with other bones, 119;
carving of spoor, 307
disc throwing, 76
discipline, 85
diseases, the cause of rapid decline of aborigines, xiv
dog, the constant companion of aboriginal, 118, 119
dolichocephaly, 35
dolls, 79, 80
down-decoration of ground, 282, 326
Dravidians, 58
drawings, in sand, 70-73;
of “totem,” 339-343
dress, mode of, 113, 114, 115
drinking, methods of, 98, 99
drone pipe, 375, 376, 379, 380
drought, trying conditions of, 117
Dubois, Professor, 55
Duboisia Hopwoodi, 155
Duckworth, Professor, W. L. H., 33
duels, 165-174;
 boomerang, 168;
chivalry displayed in, 174;
club, 168-170;
damatba, 170;
heavy spear, 172, 173;
kutturu, 165-168;
reed spears, 171;
stone dagger, 172;
shield used in, 173
dugong, hunting the, 134-137;
sung to during initiation, 19
dugout canoes, 164
Durham Downs, 237

E
ear, 29, 30
echidna designs, 336, 346, 347
eggs, of birds, 125, 126;
of reptiles, 126
“Elaija,” a sacred ancestor, 283
“elbola,” bark headgear, 280
“elenba,” wooden hair pins, 47
elopement, 223
emu, in the sky, 315, 332, 333, 334, 349;
carved in boabab, 309, 330;
carving on boomerang, 317;
 ceremony, 274-280, 377, 378;
game, 81, 82;
gum leaves imitating the rustle of, 374;
hunting the, 129-140;
neck in the sky (“Yirrerri”), 334
enemy, corrobboree portraying the slaying of, 383, 384
“engulba,” pitjuri, 155
ensellure, 7
epipteric bone, 36
“Erinnja,” an evil spirit, 294
“erriakutta” (yelka) ceremonial drawing, 282, 327
erythrism, 48
escort of natives, 2
Etheridge, R., x
ethmoid, 25
“Etominja,” sacred ground design, 282, 326
Eucalyptus corymbosa (Bloodwood), 98, 152;
dumosa (water mallee), 98;
miniata (woolly butt), 161;
rostrata (red gum), 147;
tetradonta (stringy bark), 161
Eugenia, leaf poultice applied to breast, 20
evil spirit, 291, 292, 294, 299, 314, 385
exchange of wives, 224
exclamations, 398, 399
external angular process, 25
extremities, length of, 10
eye, 23, 25

F
Face, 22-30
fat of emu and goanna, 115
fatty tissue scant in aboriginal, 5, 6
fatty tumours, 6
feather wig, 50
femur, 14, 15
feet, evolution and use of, 10 et seq.;
“hand-like” form of Berringin tribesman, 11
fibula, 16
fight, corrobboree of, 382
figure contrast between aboriginal and European, 5 et seq.
fire-fly, artificial, 376
fire ceremony (“Ngardaddi”), 261, 263
fire, 108;
shovels, 109, 110;
saw, 111, 202;
sores, 110;
stick, 110, 112;
whisk, 110, 111;
the precursor of civilization, 258, 260;
legend concerning origin on earth, 259, 260
fireless cooking, 80
fire walking, 236
firewood, gathered by women, 107
fish, barriers, 129;
designs, 350;
hooks, 132;
nets, 129, 130, 131;
nooses, 129;
ochre drawings of, 328;
spears, 131, 132
fishing, in parties, 127, 128, 129;
line, 132;
methods, 127, 128;
races, 128
flatfoot, 12
Flinders, Matthew, 117
Flinders Ranges, burial customs in the, 206;
ochre mine, 316;
rock carvings, 299, 303-308
flying fox design, 345, 350
foetal elements (“rattappa”), 287
food-carrier, used as cradle, 64, 65, 66
food restrictions, 250, 251
foot of Tasmanian, 14
footmarks in caves, 322
fourth molar, 32, 33
forehead, 23, 35
Fowler’s Bay, 64, 76, 295, 383
Fraipont’s method, 28, 29
frog, corrobboree of, 379
frog dance of children, 70
frog designs, 335, 346
frontal bone, 35, 36
frontal suture, 34
Frontispiece, 145
funeral chant, 211

G
gagging the initiate, 242, 246
Garner, Professor, 405
Genyornis, carving of track, 308
geological antiquity, 49, 52, 53, 54
gesture language, 388-394
“gibba,” chewed bone, 176
“Gibberi,” circumcision, 242
Gibraltar skull, 23, 32
Ginmu Tribe, 4, 253
girls accompany women instructors, 85
Glenelg River, xi, 159, 288, 312, 333, 344
goanna, 127
Gondwana, 55, 56
Good Spirit, 294, 295
goose hunting, 138, 139
“gorri,” a game played on the Humbert River, 76, 77
gouge, bone, 314
grasshopper, 387
grass tree, cover when emu hunting, 140;
flower stalks used for making spear shafts, 195
grave posts, 207
Great Australian Bight, 66, 141, 169, 192, 199
great emu ceremony, 274 et seq.
Grey, Sir George, xi, 219, 272, 340, 343, 344
Gribble, E. R., 17
Groote Island, 101, 164, 197
ground drawings, 282, 326, 327
grubs, 122-125
gruesome rite, 247, 290
“gummanda,” cicatrices, 238

H
habitations, 101-105
half-castes, 59, 60
hailstone (“Imbodna”), mythical stone, 264
hair, 46, 47;
belts, 116;
cutting of, 117;
pins (wooden), 47
Hakea bark, charcoal used for blackening hair, 285
hammers, stone, 360
hand-ball, 77
hand-like feet, 10-12
hand-prints in caves, 321, 322
hand-mills, 319, 361
hardening the child, 236
hatchets, stone, 362, 363
hawk traps, 137, 138
head-biting during initiation, 244, 245
head-dress, of emu ceremony, 277;
of “tjilba purra” (phallic) ceremony, 287
head-rests, 105
height of aboriginal, 16, 17
Helix perinflata, 121
Hickson, Sydney, 49
hide and seek, 78, 79
Higgin, A. J., 157
hollow trees used as shelters, 102
honey, wild bees’, 145;
drink, 153, 154
honey-ant, 146, 147
Howitt, Dr. A. W., 295
human chain-pattern, 353, 354, 355
human form, pictographic representation of, 353-358
Humbert River, 76, 320, 324, 336, 337, 352, 353, 403
Humboldt, Alexander von, 20
humerus, 16
hunt, objects of the, 121
hunting, 120-147;
buffalo, 144, 145;
crocodile, 134;
dingo, 141;
dugong, 134-137;
emu, 129-140;
geese, 138, 139;
hawks, 137, 138;
kangaroo, 141-144;
opossum, 140, 141;
turtle, 132, 133;
whistling duck, 139;
wallaby, 141;
wombat, 141
hunting instinct, 120, 121
hunting with fire, 126
huts, 102-105
Huxley, Thomas, 24
hypertrichosis, 46

I
“ilbarinam,” tjuringa, xi
“ilja-imbadja,” hand marks in caves, 321
“ilgarukna,” venesection, 275
“illiya tjuringa,” emu ceremony, 274 et seq.
“ilpalinja,” sun worship, 265-267
“Iltdana,” evil spirit, 292
Ilyauarra Tribe, 4, 205
“Imbodna,” a mythical hailstone, 264
“Imboromba,” a spirit father’s mate, 287
imitation, of the plovers’ call, 70, 265, 379, 386;
of the dingo’s howl, 70;
of the jungle fowl’s call, 380;
of the crow’s call, 378;
of the crocodile, 377;
of the emu, 279, 378
“Indorida,” the mate of Rukkutta, 291
infant betrothal, 221
infant, treatment of, 64-68;
rubbing milk and charcoal over body of, 65;
singeing hair of, with fire stick, 65
“ingada,” a chief, 226
Ingada Ladjia Knaninja, leader of yam ceremony, 281
“ingwitega,” munyeroo, 150
inion, 36
initiation, 230-256;
amputation of finger-joints, 253, 254;
of the female, 252, 253;
origin of, 251, 252;
without mutilation, 249
instinct for locating water, 96
interment, 205-207
internal angular process, 25
interrogatives, 403
intitjuma, ceremonies, 274
intoxicating drink, 153, 154
introduction to a tribe, 1-3
iris, 25
“irr,” 171;
expression of disgust, 118
“irriakutta,” yelka, 149

J
“jarrulge,” mulga apple, 152
Jewish features, 26
“jingardti,” a chief, 226
Joyce, Capt. T. A., x
judge of character, 228
“judja,” a chief, 226
jungle fowl, corrobboree of, 380, 381
jus primae noctis, 256
justice, idea of, 227

K
“kadabba,” phallus, 283, 284
Kai Kai, an old medicine man, 180
“kaidi,” tjuringa, 270
kaili (boomerang), used as musical instrument, 383;
miniature, for practice, 82
Kaitidji (Kaitish) Tribe, 4, 92, 364
Kakera, marriage group, 220
Kakatu Tribe, 4, 267
“kaleya pubanye,” the sitting emu (coal sack), 332
“kaloa,” raft, 160;
toy models of, 82
“kalumba,” nardoo, 150
“kalunuinti,” phallus, 288
“kanbanna,” paddles, 159
kangaroo, charcoal drawings of, 321, 326, 336, 337;
conventional representation of, 350;
corrobboree of, 381;
hunt, 141-144;
ochre drawings of, 327, 328;
origin of “arre,” its name, 387;
tjuringa design of, 349, 352
“kapa” or “kadje,” water lily, 151
“kapi wiyinna,” magic water stick, 264
“karru,” milky way, 349
“karwinnunga,” shield, 173
“käu,” vide Coo-ee, 142
“käu-käu,” chewed bone, 176
“kaula,” native pear, 152
Keith, Sir Arthur, x
kidney fat and marrow of dead warriors eaten, 189
Killalpaninna, 290;
“killa wulpanna,” 290, 291
King Sound natives, 50, 82, 88, 132, 151, 159, 283, 309, 311,
330, 358, 363, 396
kitchen-middens, 121, 122
Klaatsch, Professor Hermann, x, 25, 28, 29, 42, 50
“Knaninja,” xi, 265, 271, 274, 280, 281, 282, 285, 327, 341, 352,
353
“Knaninja Arrerreka,” mythical sun creature, 265;
ceremonies of, 274
knives, stone, 364
“knudda” (fat) of witchedy, 342
“Knurriga Tjilba Purra” (phallus), 286;
head of the Kukadja, 285
kobong, xi, 219, 226, 232, 269, 271, 272, 340
Kochia bush, used for making vegetable-down, 276
Kolaia Tribe, 4, 65
“kolldürr,” stone spear-head, 370
Kukadja, 285, 286, 292, 293
Kukata Tribe, 4, 32, 81, 82, 87, 184, 200, 205, 236, 241, 242,
248, 255, 288, 296, 318, 361, 362
“kukerra,” playing stick, 82, 83
Kumara marriage group, 220
Kunapippi, a mythical witch, 271
Kurdaitja, an evil creature, 71, 72
“kurreke tata,” the plover, 70, 265, 386
“kutturu,” fighting stick, practice, 87;
duels, 165-168;
embodied in head-gear, 280
Kuyanni Tribe, 4, 362
“Kwatje,” water, ceremonies, 274
“Kwatje purra,” magic water stick, 264

L
lachrymal bone, 25
lactation, artificial, 20
“ladjia,” or yam tjuringa, 280 et seq., 337;
design of, 347
Lake Eyre, 50
lances, 193
“langa langa,” a shell knife used for “cutting the shadow,” 175
“langu,” native pear, 152
language, xii, 386-405
lanugo, 46, 49
La Perouse, 107
Larrekiya Tribe, 4, 62, 77, 111, 130, 131, 139, 142, 163, 164,
170, 196, 201, 202, 205, 207, 208, 210, 230, 249, 252, 332,
374, 379, 384
legs, 14
Lemuria, 55, 56
lerp manna, 147
leucoderma, 43
licentiousness, 224, 254
“lionila,” a club, 170
lipomas, 6
lips, 31
living skeletons, 21
lizards, 126;
designs of, 334, 335
lobulus, piercing of, 30
log rafts, 158-160
“lorngai,” feather wig, 50
lumbo-sacral curve, 9
“lurra,” a lipoma, 6

M
MacDonnell Ranges, 50, 92, 127, 146, 153, 155, 218, 226, 285,
291, 341, 362, 364, 405
Maiyarra’s conception, 61;
accouchement, 63
Malay bêche-de-mer fishers, 57
manna, 147
mastoid process, 30
“marimba,” wallaby bone used for loosening a tooth, 236
marine molluscs, 121, 122
marital relationships between man and woman, 222, 223
marriage systems, 218, 219, 220, 221;
allotment of infant, 221, 222
“marriwirri,” wooden sword, 170