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One of the many Freak Show characters to have been inspired by a real person, Pepper (and her husband, Salty) was inspired by Schlitze Surtees. Known as Schlitzie the Pinhead, he was an early 1900s sideshow performer with microcephaly, a neurodevelopmental disorder that causes an unusually small brain and skull. He had the cognizance of a 3-year-old and could only speak in single-syllable words. He is mostly known now because of his part in the 1932 film Freaks.
Source: FX Networks, MGM