Sotah 8b ~ Sironechi and Strangulation

Measure For Measure

In today's page of Talmud, we are reminded of the principal of "measure for measure", or as the Mishnah teaches: במדה שאדם מודד בה מודדין לו.  Rav Yosef teaches that this principal applies to the offenses that were capital crimes; although court imposed executions are no longer carried out,  במידה לא בטיל - "measure for measure remains in force."

מי שנתחייב סקילה או נופל מן הגג או חיה דורסתו ... מי שנתחייב חניקה או טובע בנהר או מת בסרונכי

One who deserved death by stoning, either falls from a roof or is trampled by a wild animal...one who deserved death by strangulation [one of the four types of biblical capital punishment] either drowns in a river or dies of sironechi (Sotah 8b)

The question that we need to answer is, of course, just what is סרונכי - sironechi ? Rashi explains that it means חולי בגרנו  "he becomes sick in his throat" but as we will see, this rather general explanation became more specific among later commentators. 

Marcus Jastrow's dictionary (published 1886-1903) defines sironechi as "choking" or "suffocation." The origins of the word, Jastrow claims, is from the root סרך meaning to clutch or hold fast.  This seems reasonable, and Jastrow's understanding of this Mishnah would be that a person who would have been liable to judicial execution by strangulation will meet his end by choking or suffocation.

Soncino, Schottenstein and Koren

The English translations of the Talmud are more specific than was Jastrow, and suggest that the condition is due to an infectious disease. The Soncino Talmud translates sironechi as quinsy, and the Schottenstein Talmud does the same.  The Koren Talmud takes a different approach, and translates the condition as diphtheria. In a side note, the Koren Talmud states that sironechi may have a semitic origin, or it may be derived from the Greek sunnakhe "referring to a form of strangulation that results from complications of diphtheria due to the trachea being blocked by pus." So let's understand what each of these conditions is, and how it may mimic execution by strangulation.


Peritonsillar abscess at the back of the mouth.  But even this does not occlude the airway, and breathing is not usually affected.

Peritonsillar abscess at the back of the mouth.  But even this does not occlude the airway, and breathing is not usually affected.

Quincy is an uncommonly used word that refers to an inflammation of the tonsils.  It is a complication of what Americans tend to call Strep throat, and what I grew up in London calling tonsillitis. It is most commonly caused by a bacteria known as Group A beta-hemolytic Streptococcus, and most of you reading this will have had it, or seen it in a family member. Today it is easily treated with antibiotics, but one of its rare complications  is a peri-tonsillar abscess, sometimes called quinsy.  In this condition, an abscess forms at the back of the mouth in the tonsils, which bulge forward.  When this occurs, the treatment is to lance the abscess.  I've treated hundreds of cases of strep throat and many cases of peri-tonsillar abscess, and the condition never causes suffocation - though it could in theory.  This makes it a very unlikely candidate to be the condition known as sironechi. Sorry Soncino. And sorry, Schottenstein.  


Child infected with diphtheria. Photo from the  CDC .

Child infected with diphtheria. Photo from the CDC.

Diphtheria is a disease caused by Corynebacterium diphtheriae. Infection causes weakness and fever, followed by swelling in the throat, which gradually becomes covered in a thick grey membrane.  If that doesn't kill the victim, toxins released by the bacteria may finish him off.  According to the Centers for Disease Control and Prevention, in 1921 there were over 200,000 cases of diphtheria in the US, and over 15,000 deaths. Diphtheria is still found in the developing world, especially in parts of Africa and India, and the World Health Organization estimates that there were over 7,000 cases worldwide in 2014.

Like most physicians in the west, I've never seen a case (or met someone who has seen a case, or met someone who has met someone...) because, thanks to widespread vaccination, the disease here has been almost completely eradicated.  Diphtheria may certainly kill its victim by suffocation, and while there is no other reason to identify this with sironechi, it's a reasonable choice. So one point to Koren.

Classical respiratory diphtheria is characterized by formation of a gray-white pseudomembrane in the throat that is firmly adherent. A swollen, bull-neck appearance caused by inflammation and edema of soft tissues surrounding lymph nodes is associated with severe illness and higher death rates...
— Wagner K. et al. Diphtheria in the Postepidemic period, Europe, 2000-2009. Emerging Infectious Disease. 2012 18 (2):218.



Although none of the English translations suggest epiglottis as a possible translation for sironechi, it is an infection that certainly may fit.  The disease is most commonly caused by Haemophilus influenzae type b, and results in swelling of the epiglottis, which is a flap of tissue that covers the larynx (also known to non-medically trained personnel as the voice box). It is your epiglottis that moves over the voice box every time you swallow, preventing food from entering your trachea and lungs. In acute epiglottitis, that flap of skin, and the surrounding tissues, may become swollen to such a degree that breathing becomes impossible, and the victim suffocates.  Thankfully, this disease is now extremely unusual in developed countries since there is an effective vaccine against it. In fact I can't recall having seen a single case of it. Because of the way in which the disease causes the airway to become occluded, epiglottis is good a candidate for the condition described in the Mishnah as sironechi. It's certainly as likely as quinsy or diphtheria.  

Did George Washington Die of Sironechi?

It is generally agreed that when George Washington died in December 1799, it was from some kind of throat infection, although the precise cause remains unclear. Two of the physicians who treated Washington published an account of the president's last hours. Here's an excerpt:

George Washington was attacked with an inflammatory affection of the upper part of the windpipe, called in technical language, cynanche trachealis. The disease commenced with a violent ague, accompanied with some pain in the upper and fore part of the throat, a sense of stricture in the same part, a cough, and a difficult rather than painful deglutition, which were soon succeeded by fever and a quick and laborious respiration.

Interestingly, each of the three diseases we have reviewed here have been suggested as the one that killed Washington. Writing in The New England Journal of Medicine, David Morens noted that the culprits include "inflammatory quinsy" and the relatively new diagnostic entity called cynanche trachealis ("dog strangulation"), a term likely to include "the modern diagnosis of bacterial epiglottis...[as well as other conditions such as] laryngeal diphtheria and viral croup." Morens acknowledged that historians do not agree on the cause of Washington's death, but he thought that  "the signs and symptoms point to acute bacterial epiglottitis."

Blood Letting for Sironechi, and for the President

There is more to the relationship between Washington's death and sironechi. In Masechet Yoma, the tractate that deals with the laws of Yom Kippur, a treatment for sironechi is mentioned: מקיזין דם לסרונכי בשבת - "one may let blood on shabbat to alleviate sironechi"(84a). We've addressed the issue of blood letting in the Talmud elsewhere, and noted that it was a widely used therapy until the late nineteenth century.  And as George Washington lay dying from an occluded airway, his doctors decided the best therapy was to let his blood. This they did four times, the last just a few hours before Washington died. It would appear that the medical practice to let blood for a patient with sironechi was found not only in the Jews of Babylon, but among the physicians of Washington's home at Mount Vernon too.   

Washington's death by choking was carefully documented and published, but the infectious agent behind it remains uncertain. If a single infectious agent is behind the talmudic condition of sironchi,  it remains similarly unknown. But most likely, sironechi just means choking or suffocation - (as Rashi and Jastrow suggested) a condition that could be caused by any of the diseases we've reviewed - and more besides. To identify one disease as the cause of sironechi is to miss a larger point - that is likely caused by many infections.  Today, vaccinations make many of these diseases so rare that most physicians will never see a case. Like the form of judicial execution that it mimicked, sironechi has become a feature of a past that we are all better without.    

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Yevamot 118b ~ Does Marriage Make You Happier?

(אמר ריש לקיש: טב למיתב טן דו מלמיתב ארמלו. (יבמות דף קיח

Resh Lakish said: It is better for a woman to live as tan du than to live alone
— Yevamot 118b

In a 1975 lecture to the Rabbinical Council of America, Rabbi J.B. ("the Rav") Soloveitchik, quoted this aphorism of Resh Lakish found in today's Daf.  The Rav went on to explain that it was "based not upon sociological factors...[but] is a metaphysical curse rooted in the feminine personality. This is not a psychological fact; it is an existential fact." Wow.  Is this statement of Resh Lakish really an existential fact? To answer this, we need to first answer another question - what do his words actually mean?

One way to understand the aphorism is as follows:  "A widow would rather live in misery than live alone." But that's not the only translation, which depends on the exact meaning of the Aramaic phrase טן דו (tan du).  There are a number of possibilities.


 Let's start with Rashi (and his explanation to the text in .כתובות דף עה).

טן דו - גוף שנים. משל הדיוט הוא, שהנשים אומרות טוב לשבת עם גוף שנים משבת אלמנה

Tan Du: Two bodies. This is a common maxim, for women say that it is better to live as two than to live alone

So according to Rashi, Resh Lakish never mentioned anything about living in misery. He just made the observation that women prefer marriage over a single life.

Jastrow's Dictionary

Not so Marcus Jastrow, whose dictionary (published 1886-1903) became a classic reference text for students of the Talmud. Jastrow translated טן דו as a load of grief, an unhappy married life. This will become very important later, so make note. 

The Soncino Translation

Moving on, the Soncino translation of the Yevamot (first published in 1936) echoes Jastrow's translation "It is preferable to live in grief than to dwell in widowhood." However, a footnote to the text notes that "Levy compares it with the Pers., tandu, two persons." (The reference here is to Jacob Levy's  German Dictionary Chaldisches Worterbuch uber die Targumim - Aramic Dictionary of the Targums and a Large Part of Rabbinic Literature.) Why did Isidore Epstein, editor of the Soncino Talmud, choose to use Jastrow's translation over that of Levy - and that of Rashi? Answering that will take us too far off track, so we will leave it for another time... 

Melamed's Aramaic-Hebrew-English Dictionary

Melamed's Aramaic-Hebrew-English Dictionary (Feldheim: Jerusalem 2005) follows Rashi : "טן דו = two bodies." 

The ArtScroll Translation

The ArtScroll Schottenstein Talmud basis its translation on Rashi, but adds a footnote that brings its meaning closer to that of Jastrow and the Soncino: "I.e a woman prefers even a less than desirable marriage over staying single." 

The Koren Steinsaltz Translation

In his Hebrew translation of the Aramaic text, Rabbi Steinsaltz follows Rashi, and translates  טן דו as "two bodies."A side note points out that the true origin of the phrase is not known, though it likely comes from Persian.

The newer English Koren Talmud follows the same translation: "It is better to sit as two [tan du] than to sit lonely as a widow, i.e., a woman prefers the companionship of any husband over being alone."  The note, (written by Dr. Shai Secunda), is more definitive than the Hebrew note. Tan Du is from middle Persian, meaning together.  It's nothing to do with being miserable.

Teshuvot Hage'onim

I've left perhaps the strongest textual witness for last: how the words Tan Du were understood during the period of the Geonim (c. 589-1038). In 1887 Avraham Harkavy published a collection of responsa from this period that he found in manuscripts held in the great library of St. Petersburg. In this collection is a reference to our mysterious words:

  טן דו בלשון פרסי שני בני אדם. ארמלו יחידות 

טן דו in Persian means two people. ארמלו means alone.

Chronologically, this is our earliest source, and, therefore, perhaps our most compelling. Case closed.


Variations of the Resh Lakish Rule

So far we have the following four versions of what we will now call the Resh Lakish Rule:

It's better for a woman to be...

....married and unhappy than single  (Jastrow)

...in a less desirable marriage than no marriage at all (ArtScroll footnote).

...miserable and married than to be a widow (Soncino).

...with a husband than to be alone (ArtScroll, Koren, Melamed, Rashi, Teshuvot Hage'onim)

What if Tan Du Means Miserable?

It seems that the translation of  טן דו as miserable originated with Jastrow, and that those who translate Resh Lakish as saying "misery is better than being single" are following in the Jastrow tradition. If we were to evaluate the Resh Lakish Rule per Jastrow (and Soncino and an ArtScroll footnote), the question is, what, precisely, constitutes  a "miserable marriage"? One in which the woman feels physically safe but emotionally alone? One in which her husband loves her dearly but is  unable to provide for her financially? Or one in which she has all the money she needs but her husband is an alcoholic? Tolstoy  has taught us that each unhappy family (and presumably each miserable marriage) is unhappy in its own unique way. The point here is not to rank which is worse. 

Today it would be utterly silly (and incredibly rude and insulting) to suggest that a woman is better off miserable than single.  But after our review, that does not appear to be what Resh Lakish ever said.  What he really said was this: a woman would be better off (טב) married than living alone (as a widow). Resh Lakish didn't explain what he meant by better off, so we will have to assume that what he meant was a measure of overall well-being, or what we call... happiness. What we want to know, is how this understanding of Resh Lakish stands up today. Was the Rav correct when he called this "an existential fact"?

Measuring Happiness & Happiness Inequality

Happiness inequality exists and has been well documented. University of Pennsylvania economists Betsy Stevenson and Justin Wolfers, (who live together, but not within the bonds of marriage), note that

“...the rich are typically happier than the poor; the educated are happier than those with less education; whites are happier than blacks; those who are married are happier than those who are not; and women—at least historically—have been happier than men.”

But why is this so? Don't we all oscillate around a set point of happiness, regardless of what life may throw at us? Some psychologists think so.

Lottery Winners & Accident Victims: The Set Point Theory of Happiness

According to the set point theory of happiness, we all revolve around our own, innate happiness point. When we are faced with adversity, we do, to be sure, become sadder. But we eventually bounce back to where we were before, back at our set point. Similarly, when met with some good mazal, we are, for a period, more happy. But then we return to our innate set point for happiness, wherever that was prior to the good fortune. The evidence for this comes from a classic study which found that "lottery winners were not much happier than controls" and that accident victims who were paralyzed "did not appear nearly as unhappy as might have been expected." (The problem is that this study used a tiny sample - there were only 22 lottery winners and 29 paralyzed accident victims - so we need to be very cautious in generalizing from it.) 

Married people are – on average – happier than those who are single, but perhaps this fact does not suggest causation. Some would argue that it's just a correlation. A grumpy person, unable to hold down a job and miserable to be around, is not likely to find another individual willing to marry him. So it’s not that marriage makes you happier –it’s that happier people are more likely to find a partner and get married. According to this set point theory of happiness, the Resh Lakish Rule would not be supported, since the act of marrying would have no overall long-term effect on happiness.


However, evidence from a 15 year longitudinal study of 24,000 people suggests that "marital transitions can be associated with long-lasting changes in satisfaction."  This would support the claim that marriage is causally related to happiness. It's not that you went from being a happy person who was once single to being a similarly happy person who is now married. What actually happened was that the marriage had an effect on just how happy you became.  And data from other large cohort studies show that happiness increases when people marry. Just look at the happiness of women by marital status in the figure below. Was Resh Lakish onto something?

Mean happiness of women by marital status, birth cohort of 1953-1972, from ages 18-19 and 28-29. From Easterlin, RA.  Explaining Happiness .   Proceedings of the National Academy of Sciences   2003. 100 (19): 11176-11183.

Mean happiness of women by marital status, birth cohort of 1953-1972, from ages 18-19 and 28-29. From Easterlin, RA. Explaining Happiness. Proceedings of the National Academy of Sciences 2003. 100 (19): 11176-11183.

Remarriage has the same positive effect on happiness as a first marriage
— Richard Easterlin, Explaining Happiness

All this supports the Resh Lakish Rule that people are happier when they are married. (I say people because all the evidence applies equally to men too.) But we can get even more specific, because Resh Lakish used the word ארמלא, which most likely means widowed (and hence has a secondary meaning of being alone). There is actually data that applies to this more specific Resh Lakish claim about widows, and it comes from The Roper Center at the University of Connecticut. 

From   Economics and Happiness  , ed Bruni L. Oxford University Press 2005.

From Economics and Happiness, ed Bruni L. Oxford University Press 2005.

As shown in the table, 62% of women who are widowed want to be happily married.  (Of course this also means that about 40% of widowed women would rather not be married -  even happily. That’s a huge proportion. Still, the overall finding still supports the Resh Lakish Rule.) The women's perspective is the most important perspective in this conversation, and when women (widows)  were asked, most wanted to be married again. Widows indeed wish to live as two rather than live alone. I don't think this amounts to anything like an existential fact, as claimed by the Rav. But the evidence from the social sciences would certainly support the Resh Lakish Rule.

Free to call the tune, free to say if you’re gonna work or play
You can have the moon but you don’t have to have it night and day

Anyway, on your own with only you to concern yourself
Doesn’t mean you’re lonely, just that you’re free
Live and alone and like it, don’t come down from that tree

That’s the answer for me
That’s the answer for me
— Live Alone and Like It (From Dick Tracy), by Stephen Sondheim


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