JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 90
Cf2 Staffs as walking aids in ancient Egypt and Palestine
W Y Loebl MD FRCP1 J F Nunn MD FRCA2
J R Soc Med 1997;90:450-454
Simple sticks have been used by man since time
immemorial. Primitive man used a stick to protect himself,
to hunt and to fight. Later, the cane became a symbol of
power and of aristocracyl. Since man adopted an erect
posture he would have required a stick or crutch as a
walking aid to relieve the handicaps of disease, trauma and
deformity2. But despite their widespread and diverse use,
the history and early development of sticks as walking aids
and crutches have not been much studied. This paper
C0 presents and discusses the evidence for the employment of
om
staffs as walking aids during the Pharaonic and Greek eras in
Egypt and in neighbouring Palestine, which was under
Egyptian domination during part of the Biblical period.
Sticks and staves were among the objects most
OE-O commonly and constantly portrayed in use in ancient
Egypt3. They took a great variety of forms and were
employed in many different ways-including ritual
placement in the deceased's coffin4. Egyptians with
disabilities affecting their walking would surely have used
sticks as crutches or walking aids. This application has
received scant attention in the various detailed reviews
about staffs in ancient Egypt4'5. Nevertheless, Derry
presented skeletal evidence for the use of a staff as a
walking aid (see below)6.
The lack of previous discussion of staffs as walking aids
in Egypt is mainly attributable to the strict artistic
conventions that were prevalent in ancient Egypt7. The
figures of men and women were depicted in accordance
with a rigid representational canon and, with very rare
exceptions, they were shown in perfect physique and
health. Only their servants could be realistically portrayed
with their physical imperfections8. As a result, while men
were frequently portrayed holding staffs, examples of their
use by the disabled are extremely rare, as are the depictions
of women holding staffs.
WALKING STICKS
The earliest tool-making hominids would probably have
used sticks as walking aids as well as for hunting and
fighting. However, ancient Egyptian walking sticks are
'32 St Ronans Crescent, Woodford Green, Essex IG8 9DG, England, 2The
Stocks, 3 Russell Road, Moor Park, Northwood, Middlesex HA6 2L, England
450 Correspondence to: Dr Loebi
August 1997
invariably shown as long straight staffs. Even when the
worker carries a heavy load (Figure la), the staff that helps
to distribute the weight and to secure his balance has no
handle. Nothing like the modem 75 cm walking stick is
known from ancient Egypt. (The short staff in Epstein's
unreferenced Figure 2 must surely be Greek2.) The Greeks
already portrayed on their vases men leaning on crutches
with a top cross-bar, or on sticks with curved handles, some
150 years before the end of Pharaonic rule (Figure 2)9.
Greeks were resident at Naucratis in the Nile Delta from
the 7th century BC, and so these improved Greek walking
aids must have been known to the Egyptians. But they were
not depicted by them, probably because of their strong
artistic and cultural conservatism.
The association of the staff with sandals for walking has
been found inscribed on a sarcophagus, as well as in texts
such as certain spells in the Book of the Dead4, and in the Tale
of the Two Brothers10. The Bible mentions walking sticks on a
number of occasions. Jacob describes how he crossed the
Jordan with nothing but the staff in his hand (Genesis 32, x).
Moses instructs the Israelites to have their belt fastened,
their sandals on their feet and their staff in their hand in
readiness for the Exodus (Exodus 12, xi). Jesus instructs the
twelve disciples to take nothing for the journey beyond a
stick-but they might wear sandals (Mark 6, viii; but
compare Matthew 10, x [no shoes, no stick] and Luke 9, iii
[no stick]). The Talmud prohibits entry to the Temple courts
in Jerusalem with one's staff or with one's sandals on11. It
mentions walking sticks with some reluctance as possibly
having a concealed hollow-for smuggling jewellery, or to
enable beggars to steal oil or wine12.
THE STAFF OF AUTHORITY
In her comprehensive study of decoration in Egyptian tombs
of the Old Kingdom, Harpur has discussed and classified
some of the postures of men holding the long medu staff13.
In the commonest position (Figure lb) the man holds his
staff almost vertically in front, more often in his right hand,
with the arm slightly flexed at the elbow. He stands with
one foot forward or is seated. In his other hand, he holds an
aba sceptre. This posture is also depicted by many statues.
The Gardiner hieroglyphic sign A2 1 defines the same
posture, when the man is not holding a sceptre14.
 JOURNAL OF THE ROYAL SOCIETY OF MEDICINE
(a) (b)
Figure 1 (a) Servant using a staff to help him in carrying a heavy
load. From the tomb of Meres-ankh in Giza, 4th Dynasty, c2550 BC (b)
Man holding medu staff and aba sceptre, as symbols of authority
(Harpur 6.2.1), closely resembling the hieroglyph A22 in
Gardiner's list. From the tomb of Ra-khaef-ankh in Giza, 5th Dynasty,
c 2400 BC
The staff in this posture is undoubtedly an emblem of
authority, analogous to the royal sceptre. Whether or not
some holders of the medu staff used it for walking, that was
not its primary purpose. The formal purpose of the staff in
this posture is confirmed by the use of A2 1 as the
hieroglyphic determinative in Egyptian words for 'official',
'noble', 'magnate', and 'courtier'14.
The most famous Biblical parallels for the staff of
authority are the staffs used by Moses and by Aaron-
mainly in Egypt, but also subsequently in the wilderness
(Exodus and Numbers). A staff of the medu type was probably
also used by the angel who ignited the offering brought by
Gideon (judges 6, xxi) and by Jonathan when he culled
honey from the hive (I Samuel 14, xxvii). Other staffs
mentioned in the Bible were, by their contexts, probably
shorter and more like batons: Judah gave his staff as a
pledge to his daughter-in-law, who was disguised as a
prostitute, and he was able to recognize it again later
(Genesis 38, xviii). Elisha dispatched his staff ahead with his
Figure 2 Men holding sticks with curved handles, and leaning on
a crutch with a cross-piece. On a Greek vase depicting a scene from
Homer's Iliad, c 480 BC
Volume 90 August 1997
assistant when he went to revive the dead boy (II Kings 4,
xxix). And Jeremiah talks of breaking the commander's
staff, his baton of honour (Jeremiah 48, xvii).
THE STAFF IN THE PRESUMED POSTURE OF
LEISURE
Distinct from the postures of the staff of authority, there is
another major group of staff-holding postures. They have
been described as showing the person slouching against his
staffl5. The staff is held more obliquely, usually with both
hands. One hand grasps the top of the staff, and the other
hand rests against it at the level of the thigh, but
occasionally it is raised. One leg is in front, and there are
two major variations in the position of the foot. In the first
type the forward leg is slightly bent at the knee with the
heel clear of the ground (Figure 3a). The second type shows
both legs straight and the feet flat on the ground (Figure
3b). This group of postures is regarded as depicting a
position of leisure devoid of any indication that there may
be a problem of locomotion (Roth AM, personal
communication). On the contrary, persons portrayed in
this pose are sometimes shown elsewhere in their tombs
engaged in vigorous physical activities.
Nevertheless, the first type of this posture, with the
knee flexed and the heel off the ground, is of special interest
to us because it is compatible with the possibility that this
stance compensates for a painful condition of the hip, the
knee or even the heel. There are portraits in this group
where the staff may have actually been used for support
rather than as an emblem of status. Thus the stela of Intef
(Figure 3c) shows the tomb owner just holding his staff, but
with signs of apparent wasting of his forward leg8.
Unfortunately, there is no corroborative information on
Intef's physical state. The posture of Intef accords very
closely with Derry's account of the probable mode of use of
the stick by the man with hydrocephalus, discussed below.
Epstein also described an example of this posture from the
tomb of Harkuf2. He too wondered whether the flexed
knee indicated an injury. But Epstein mistook a crack in the
surface of the relief for an axillary horizontal piece at the
top of the staff, defining it erroneously as the earliest
recorded crutch.
Another of several such portraits is in the tomb of
Menna, a scribe of the eighteenth dynasty. An elderly
balding white-haired man (Figure 4a) is overseeing
agricultural activities13. When a farm labourer grew old
and developed osteoarthritis he could no longer work in the
fields, and it is reasonable to suppose that, if he had been
industrious and trustworthy, a wise owner might well
continue to employ him as an overseer. The canons of
proportion and style would not have been so strictly
implemented when it was a servant, and not the tomb 451
 JOURNAL OF THE ROYAL SOCIETY OF MEDICINE
(a) (b) (c)
Figure 3 (a) So-called position of leisure with one heel off ground
(Harpur 6.2.2-1). From the east wall of tomb of Ra-khaef-ankhu in Giza,
4th Dynasty, c 2550 BC (b) Alternative so-called position of leisure
with both heels on the ground (Harpur 6.2.2-2). From the tomb of
Mer-ibi in Giza, 4th-5th Dynasty, c2500 BC. (c) Although his position
resembles that shown in (a) this man is not actually leaning on his
stick and his forward leg appears to be wasted. Stela of Intef, 12th
Dynasty, c 1900 BC: British Museum EA 562
owner, who was depicted in this posture. Therefore, the
possibility of a realistic depiction of an elderly man with
fixed flexion deformity of a lower limb joint cannot be
entirely excluded in such cases.
In the Bible, there are laws regarding the convalescent
victim of an assault, who is leaning on a stick when walking
out of doors (Exodus 21, xix). And Jacob is described as
leaning on the top of his staff (Hebrews 11, xxi). In this
particular posture, the risk of injury to the palm of the hand
which grasps the upper end of the staff is vividly described.
Twice, Egypt's unreliable support for the kingdom of Judah
is compared to a splintered cane, that will run into a man's
hand and pierce it if he leans on it (II Kings 18, xxi; and
Isaiah 36, vi).
(a) (b)
Figure 4 (a) A servant, balding and apparently aged, overseeing
agricultural activities while resting on his staff. From the tomb of
Menna, Theban tomb TT 69 at Sheikh Abd el-Qurna. 18th Dynasty,
c 1400 BC. (b) Tomb owner leaning on his staff which is tucked into
his axilla (Harpur 6.2.2-3). From the tomb of Nefer in Saqqara. 5th
452 Dynasty, c 2400 BC
Volume 90 August 1 997
THE STAFF IN THE AXILLA
A major variation on the posture of leisure portrays the staff
being used in a manner that bears the closest resemblance to
a crutch-and it therefore provides the greatest medical
interest. In this stance, the top of the staff is apparently
tucked into the armpit, with the arm on the same side
loosely supporting it at thigh level. The other hand does not
touch the staff (Figure 4b). In this posture, both legs are
usually straight and the feet are flat on the ground. Rarely,
the forward leg is bent at the knee with the heel clear of the
ground.
A unique variation of this last stance is represented on
the limestone portrait of an unidentified prince (Figure 5)
thought to be Smenkhkaral6'17. His anterior leg is flexed
and the foot is curled around the back of his straight leg.
Judging by the tilt of his body, he is leaning heavily on his
staff. There is considerable uncertainty about Smenkhkara,
who died when he was about 20 years old, after he had
ruled for only three years17. Smenkhkara came to maturity
soon after the end of the Amarna period, with its greater
artistic freedom and apparent realism. Therefore the
possibility cannot be ruled out that the prince's portrait
displays some genuine impairment of mobility, although
there is no medical information about him.
The Bible also mentions the placement of a stick in the
axilla when it describes the risk from the unprotected upper
end of the staff. Ezekiel, like Isaiah, ridiculed the reliability
of Egypt's support for the kingdom of Judah: it was no
better than a reed, which splintered in the hand when
grasped and which tore their armpits (Ezekiel 29, vi-vii).
THE STAFF OF OLD AGE
For an elderly person, a walking stick may be helpful in
general age-related disabilities18. In articular diseases of the
lower limbs, the stick provides support and reduces
pressure on affected joints. In cases of impaired
coordination, diminished postural reflexes, or loss of
muscular power, a stick will improve stability and aid
balance. A stick can also compensate for reduced visual
acuity.
The hieroglyphic ideogram or determinative for
seniority (A20 in the sign list of Gardiner) provides a
remarkable example of the realistic depiction of a stick
employed as a walking aid14. It shows a thin stooped balding
man leaning on a stick (Figure 6). The old man portrayed in
the hieroglyph is accurately shown with osteoarthritic
nodular joint enlargements in their typical distribution:
acromioclavicular, metacarpophalangeals of the right hand,
and a bunion of the first metatarsophalangeal joint of his
front foot. The stick is forked at its lower end, perhaps to
prevent it sinking into soft ground. A similar ideogram, but
with no fork in the stick, is listed by Gardiner as Al 9, and
 JOURNAL OF THE
Figure 5 Carved and painted limestone from the late Amarna
Period, thought to portray Smenkhkara. Slab said to be from Tell el-
Amarna, 18th Dynasty, c 1340 BC: Berlin Agyptisches Museum, 15000
refers specifically to old age. But the fork in the stick is
absent as often as it is present and seems to have no
particular significance5.ix
The stoop of the old man shown in this hieroglyph may
result from various causes. Among the commonest is
anterior wedging of vertebral bodies in the thoracolumbar/
spine from osteoporotic trabecular fractures, trauma or
infection. It may also result from an alteration of spinal
posture such as lumbar flexion to compensate for a fixed
flexion deformity of an arthritic hip or knee, or the
increased thoracic kyphosis which can occur in parkinsonism
and in ankylosing spondylitis.
Some staffs appear to have been produced specifically
for an old person. Hassan describes two sticks of the New
Kingdom period that each bear an inscription wherein the
deceased owner is addressing his staff saying, 'Come my
staff, I lean on you '.In one of them, 'when I have
grown old is added. In his Maxims the vizier Ptahhotep
said, 'May this servant be ordered to make a Staff of OldI
Age'l 9. The Bible also mentions old men and old women .. .
each leaning on a stick because of their great age (Zechariah
8, iv).
CASES OF UNEQUIVOCAL WALKING DISABILITY
Derry was the first to consider the evidence for the use in
antiquity of a stick as a walking aid6. His findings have been
discussed recently by Nunn8. Derry described the skeleton
of a man of at least 30 years of age, found in an Egyptian
cemetery of the Roman period. He had evidence of
ROYAL SOCIETY OF MEDICINE Volume 90 August 1997
hydrocephalus with a skull circumference of 660 mm and an
estimated volume of 2901 mL. The long bones showed
evidence of left sided weakness and over-development of
the right arm. On the basis of hypertrophy of certain muscle
insertions in the bones, Derry proposed that he used a stick
as a walking aid:
It is suggested that this man supported himself by the use of a long
staff placed across the body so as to reach the ground on the left side,
and grasped high up by the right hand, the left perhaps giving some
assistance. In this manner he could support his body momentarily
while bringing the right foot forward.
Derry's deductions are in quite remarkable agreement
with the characteristic portrayal of the use of a stick in
one of the artistic conventions which we considered above
(see Figure 3c).
To our knowledge, the only convincing portrayal of a
disabled man who must have used his staff as a walking aid is
in the funerary stele of Roma (Figure 7), a doorkeeper of
the eighteenth or nineteenth Dynasty, with a grossly wasted
:;..,
8 ,
#
- 7/
';
;
t
;
^r.
Figure 6 The hieroglyphic ideogram of old age. The tomb owner
is requesting I... a goodly old age (iawet nefer)'. From the stela of
Iry, 4th Dynasty, c2550 Bc: British Museum EA 1168 453
 IJOURNAL OF THE ROYAL SOCIETY OF MEDICINE
iIN
-I..
Figure 7 Roma, a door-keeper of the 18th or 19th Dynasty, c 1300
BC. From his stela in the Carlsberg Glyptotek Museum, Copenhagen AIN
134
and shortened leg and an equinus deformity2'8. Some favour
the view that this is due to poliomyelitis contracted in
childhood, with failure of bone growth and compensatory
equinus deformity. Others have proposed that the equinus
was a primary variety of club foot, with secondary wasting
and shortening of the leg. Unfortunately, we cannot rely on
the artist to provide an accurate portrayal. Roma is not
depicted using his staff as a walking aid in the usual way,
because both his hands are occupied in making offerings.
Instead, he is gripping his staff between his chest and upper
arm, which might still have afforded him some support.
This portrayal is unique to our knowledge.
So far as we are aware, these are the only examples of
the depiction of staffs in relation to definite or possible
impairment of locomotion in ancient Egypt. We would
welcome further reports from readers.
454
Volume 90 Au g u st 1 99 7
Acknowledgments We are indebted to the following for
their helpful advice: Ms Carol Andrews, Dr Esti Dvorjetski,
Dr Ralph P j Jackson, Mrs Rosalind M Janssen, Dr P
Lacovara, Professor Graham P Mulley and Dr Ann Macy
Roth. The drawings and the photograph are by W Y L.
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Neuen Reiches. Miinchen-Berlin: Deutscher Kunstverlag, 1976:114-99
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6 Derry DE. A case of hydrocephalus in an Egyptian of the Roman
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