The Blue People of Kentucky: A Medical Mystery Hidden in Appalachia's Hills

Picture this: You walk into a 1960s Kentucky clinic and meet two siblings with distinctly blue skin. Not pale blue from cold, but deep, unmistakable blue. This was Dr. Madison Cawein's reality when he first encountered descendants of Kentucky's famous "Blue Fugates" — a family whose genetic legacy had painted their skin in impossible shades for more than a century.

The French Orphan's Legacy

This story began in 1820 with Martin Fugate, a French orphan who claimed land along Kentucky's Troublesome Creek near modern-day Hazard. He married Elizabeth Smith, a redheaded American woman, and settled in the remote corner of the Appalachian Mountains to raise a family.

Then something weird happened. Of their seven children, four were born with an extraordinary trait: blue skin.

The geographic isolation meant families often intermarried within small communities. As the Fugates married other local families — the Smiths, Combses, Stacys and Ritchies — the blue trait spread throughout Eastern Kentucky, generation after generation.

A 200-Year Mystery

For nearly two centuries, no one understood what caused the blue coloration. Some believed it was heart disease, others thought it was "an act of the devil."

But here's what's remarkable: The blue Fugates lived surprisingly normal lives despite their unusual appearance. Luna Fugate Stacy, described as the "bluest" of the blue Fugates, had 13 children and lived to age 84. Still, their unique skin led to widespread curiosity about what was happening.

The mystery began unraveling in 1960 when Dr. Madison Cawein, a hematologist at the University of Kentucky, started hearing rumors about the blue hill folks. Cawein was immediately intrigued.

When siblings Rachel and Patrick Ritchie walked into a Hazard clinic, Cawein found his subjects. Through careful research, he discovered the blue Fugates suffered from methemoglobinemia — a rare condition caused by lacking the enzyme diaphorase.

While most people have less than 1% methemoglobin in their blood, the Fugates carried levels of 10-20% — enough to turn their skin blue and their blood chocolatey brown. It turns out, while both Martin and Elizabeth lacked blue skin, they both carried the recessive methemoglobinemia (met-H) gene, greatly increasing the odds of their offspring having the condition.

The Blue Cure

Armed with the knowledge of what caused the blue skin, Cawein set about treating the family. When he administered 100 milligrams of methylene blue to the Ritchie siblings, their skin changed within minutes.

"Within a few minutes, the blue color was gone from their skin. For the first time in their lives, they were pink. They were delighted," Cawein recalled.

As roads connected Eastern Kentucky to the outside world, the Fugate descendants began marrying outside their traditional circles. Benjamin Stacy, born in 1975, was likely the last blue descendant. Today, congenital methemoglobinemia remains extremely rare, with only a few cases documented worldwide.

The Blue Fugates' story reminds us how geographic isolation can concentrate rare genetic traits and how scientific curiosity can solve centuries-old mysteries.

Did This Story Feed Your Curiosity?

Unearthing hidden histories, natural wonders and curiosities takes research, time, and maybe a little caffeine! If you enjoyed this journey and want to help fuel future Feed Your Curiosity stories, consider dropping a tip in the Curiosity Jar below. It's a 'pay what you want' way to support the stories that feed your brain. Every contribution helps keep these fascinating tales coming!