Tom Wolfe, The Right Stuff, 1979, pages 77-78
“You could see a poor sunken hookwormy sharecropper in bib overalls trying to push a rusty plow through some eroded ground that was more gully than topsoil, aided by a mule with all his ribs showing, while off to one side the man’s sallow hollow-socketed pellagra-ravaged wife with a swollen eight-month belly covered by a dress made from a fertilizer sack leans up against their shack to catch her breath or else to prop up the side wall.”
pellagra |pəˈlagrə; -ˈlāgrə; -ˈlägrə|nouna deficiency disease caused by a lack of nicotinic acid or its precursor tryptophan in the diet. It is characterized by dermatitis, diarrhea, and mental disturbance, and is often linked to overdependence on corn as a staple food.
ORIGIN early 19th cent.: from Italian, from pelle ‘skin,’ on the pattern of podagra.