Sri Lankan sanni masks: an ancient classification of disease.

Sri Lanka has a rich culture of theatre called kolam and exorcism called tovil, which make use of actors, exorcists, masks,music, and dance. The Sanni Yakuma is the best known exorcism ritual, in which numerous sanni (disease) demons are portrayed by exorcists wearing elaborate masks. Occasionally the full complement of 18 possible disease demons is represented in the Daha Ata Sanniya (18 diseases) ritual, but usually a smaller number are used according to which demons are thought to be causing a person’s affliction. The exorcism ends with the appearance of an exorcist wearing the mask of the chief demon calledMaha Kola (the terrific or all encompassing one), which usually incorporates miniature representations of the other 18 demons. Detailed accounts of these rituals and associated beliefs have been documented by anthropologists, and their roles as a form of behavioural therapy have also been considered. However, little has been written about the sanni classification of disease and its representation in the various sanni masks. Information on sanni demons, their associated diseases, and masks was obtained from a literature review and visits to the National Museum of Sri Lanka and the Ambalangoda Mask Museum in south west Sri Lanka. Photographs and observations were made of the masks at these museums and specialist mask sellers in Colombo and Ambalangoda. Considerable variation exists in the identities of the sanni demons, their associated diseases, and masks. All sources agree that there should be 18 demons in total, but our search revealed more than 30 possible names. Nevertheless, the 18 most commonly described forms in authoritative texts are fairly consistent. The table lists these demons and their associated conditions. Figures 1 and 2 show some masks that merited further consideration (others are on bmj.com). Stomach diseases associated with vomiting are distinguished from those associated with parasitic worms. The mask that represents vomiting diseases usually has a green complexion and a protruding tongue (fig A on bmj.com), whereas that representing parasitic worms usually has a pale complexion that could reflect hookworm anaemia (fig 1, left). The complexity of psychiatric illnesses is reflected in the variety of masks that represent insanity, which may be temporary or permanent and related to spirits or not (fig B on bmj.com). The demons for deafness, dumbness, and blindness are perhaps the most consistent finding in all the various listings. The mask for deafness usually includes a cobra (traditionally considered to be a deaf animal) that may extend from the nose to cover one side of the face (fig 1, middle). The mask for dumbness often has a wide open mouth with no teeth or tongue (fig 1, right) and that for blindness usually has its eyes missing (fig C on bmj.com). The name of the demon for epidemics means “divine,” presumably because disease on such a large scale was thought to have a divine origin. This mask is distinguished by having a head dress, but Sanni classification of disease