Dickens is describing a scene in the Swiss Alps, and mentions "an idiot sunning his goiter". From the location, the youth was a cretin, a victim of iodine deficiency in utero, because the tiny amounts of iodine needed have been leached out of Alpine soils long ago.
From the Internet:
Endemic goiter and cretinism associated with iodine deficiency have been depicted in paintings and statues since earliest times (55). Only during the past decade, however, have iodine deficiency disorders (IDD) been recognized as the leading cause worldwide of intellectual impairment (36, 69). Development of the central nervous system for normal intellectual functioning depends on an adequate supply of thyroid hormones which require iodine for biosynthesis (21).

Endemic cretinism is the most severe manifestation of the lack of maternal and fetal thyroid hormone arising from severe dietary iodine deficiency (63).

Hallmarks include mental retardation, pyramidal neurological signs in an upper limb distribution, extrapyramidal signs, and a characteristic gait related to the neurological disorder, as well as joint laxity and deformity.

What of the gait? What is there? And what is this use of 'pyramidal'?

And what are great sources of iodine other than iodized salt and sea kelp?

Dear WW: pyramidal here refers to appearance of cross section of the spinal cord. I think it is the areas where right and left motor nerves are located. Neuroanatomy was a hellish course with just too much to learn in the time alloted to it. I'll see I I can find anything on Internet.

All the pictures I could find were in some oddball format my computer could not read. But here's a paragraph. Just a sample to give you an idea of the mumbo-jumbo that was so hard to learn, because there were hundreds of pages of it.

"Complete lesions of the pyramidal or lateral corticospinal tract produce upper motor neuron findings of spastic paralysis and hy-peractive deep tendon reflexes. Lesions to the motor tracts can be further localized by determining whether the motor deficit is on the same side of the body as the lesion. Brain lesions (eg, stroke) cause a contralateral deficit, while spinal cord lesions (eg, hemisection of the cord) cause upper motor neuron signs on the same side of the body."

some soils are naturally richer in iodine, especially soils near a sea coast the occationaly get 'sea spray', and the iodine is 'picked up by the vegetable grown in such soil--salt water fish, and sea food (fresh, or salted or dried), (and cod liver oil) provide some too, the human body need very little..

carregeen, (a sea weed that i thing we have mentioned once before) called 'irish moss' also provide some..

carreggen is use in many food and 'food like products (toothpaste, ie) is is a thickener.. (check out your yogurt, ice cream, puddings, -- carreggeen is a very pale white sea weed, and almost tasteless. it is commonly used with dairy products to thicken them.. you might some some carreggeen in foods in your house right now (oh yeah, check the egg nog!)

(anyone remember the giant blanc monge from monty python? blanc monge's (and bavarian creams) were commonly made with carreggeen, too)