Intended for healthcare professionals

Cultural Studies

Sri Lankan sanni masks: an ancient classification of disease

BMJ 2006; 333 doi: (Published 21 December 2006) Cite this as: BMJ 2006;333:1327
  1. Mark S Bailey, specialist registrar in infectious diseases and tropical medicine1,
  2. H Janaka de Silva, professor2
  1. 1Army Medical Directorate, Camberley, Surrey GU15 4NP
  2. 2Department of Medicine, University of Kelaniya, Ragama, Sri Lanka
  1. Correspondence to: M S Bailey mark{at}
  • Accepted 21 November 2006

The classification of disease used in Sri Lankan sanni masks is still relevant today

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 called Maha 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,1 2 3 4 5 6 and their roles as a form of behavioural therapy have also been considered.7 However, little has been written about the sanni classification of disease and its representation in the various sanni masks.

Summary points

  • The Sanni Yakuma is the best known exorcism ritual in Sri Lanka

  • Exorcists wear masks depicting the demons thought to be responsible for a person's ailments

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


Fig 1Gulma Sanniya (left), demon of parasitic worms and stomach diseases; Bihiri Sanniya (middle), demon of deafness; Golu Sanniya (right), demon of dumbness


Fig 2Gedi Sanniya (left), demon of boils and skin diseases; Jala Sanniya (middle), demon of cholera and chills; Kora Sanniya (right), demon of lameness and paralysis

classification of disease

View this table:

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, 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 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 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 otherwise its appearance varies considerably (fig D on The demon for boils and skin diseases has skin lesions that look like carbuncles on the face (fig 2, left). It is not surprising that the masks for malaria and high fevers (fig E on and for cholera and chills (fig 2, middle) are similar and have fiery red complexions. The mask for high fevers can usually be distinguished by flames across the forehead, which may be reminiscent of the temperature chart from a febrile patient. The mask for lameness and paralysis always has a unilateral facial deformity that could represent a neurological lesion such as stroke (fig 2, right). The mask for bilious diseases usually has a yellow or orange complexion suggestive of jaundice.

Hence the sanni demons do seem to represent disease syndromes, and their masks show clinical features that are familiar to clinicians today. This classification of disease has considerable merit, especially considering its origin among non-medical practitioners many centuries ago. Sri Lanka has an ancient history of medical achievements, including the first recorded hospitals and a system of Ayurvedic medicine that dates from the 4th century bc. Our observations should further enhance this reputation.

In an era of “faceless” diseases, clinicians may wish to “know their enemy” by being aware of masks relevant to their own specialty. We hope this will lead to cultural enrichment and give the sanni demons the recognition they deserve.


  • Embedded Image
    Five of the sanni masks are on

  • We thank TRG Dela-Bandara, Department of Sinhala and MH Gunatilleke, former professor, Department of Fine Arts, Faculty of Humanities, University of Kelaniya for their valuable comments on the manuscript.

  • Contributors: MSB and HJdeS conceived the study and interpreted the data. MSB undertook the literature review, collected the data, and drafted the manuscript. HJdeS critically revised the manuscript with input from TRG Dela-Bandara and MH Gunatilleke. HJdeS is the guarantor.

  • Competing interests: None declared.


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