Who holds pears like that?!

[Koen G]

Thanks, Marco! This must indeed be the leper with the clapper. The nymph holding the corresponding object certainly doesn't look like a paragon of good health, but this might be a relative thing among Voynich nymphs.

Regarding the "goiter", I assume that this is about the small humpbacked person in the image on top. Since he stores all his nutrients in this hump, he remains small.