I taught Ephraim also to fro, taking them by their alms; but they knew not that I healed them. This picture of God's guiding and guarding care of Ephraim is very touching and tender. It is that of an affectionate parent or tender nurse teaching a child to walk by leading-strings; taking it up in the arms when stumbling or making a false step; and in case it fell curing the wound. Thus, nurse-like, God taught Ephraim, his wayward perverse child, to use his feet (so the original word imports), all the while lending considerate help and seasonable aid. He took them by the hand to guide them, that they might not stray; he took them in his arms to hold them up, that they might not stumble and to help them over any obstacle that might lie in the way; and when, left to themselves during a short season, and in order to test their strength, they did stumble and fall, he healed their hurt. And yet they did not apprehend nor appreciate God's gracious design and dealings with them in thus guiding and guarding them, and in healing their diseases both temporal and spiritual. There is, perhaps, an allusion to Exodus 15:26, "I will put none of these diseases upon thee which I have brought upon the Egyptians: for I am the Lord that healeth thee." This promise, it will be remembered, was vouchsafed immediately after the bitter waters of Marah had been sweetened by the tree which, according to Divine direction, had been cast therein. Thus Kimchi: "And they have not acknowledged that I healed them of every sickness and every affliction, as he said, 'I will put none of these diseases upon thee.'" The reference is rather to all those evidences of his love which God manifested to them during their forty years' wandering in the wilderness; or perhaps to his guidance of them by 'his Law throughout their entire history. Rashi remarks that "they knew it very well, but dissembled [literally, 'trod it down with the heel,' equivalent to 'despised'] and acted, as if they did not know." The word תדגלחי is properly taken both by Kimchi and Gesenius
The word קהם has also occasioned some difficulty and consequent diversity of explanation.