The remote hills of Eastern Kentucky were home to a distinct community for a long time. They had a strikingly blue skin which puzzled them and the neighbors for decades. Known as the Blue Fugates or the blue people of Kentucky, the condition was the result of a rare hereditary blood disorder called methemoglobinemia, which turned their skin a distinctive shade of blue while leaving them otherwise healthy.

The condition was traced back to the recessive gene carried by the founding members of the family.

Origins of the Blue-people of Kentucky

Martin Fugate, a French-born settler, married Elizabeth Smith, a Native American who had normal colored skin, but both were carriers of the recessive gene that causes methemoglobinemia. The Fugates lived near Troublesome Creek and Ball Creek in rural Kentucky. Unaware of this condition, they had seven children of whom four inherited the disorder and had blue skin. The family members lived long and healthy lives except for their unusual skin color. Over time, due to the family’s isolation in the Appalachian region of Kentucky, descendants continued inbreeding which resulted in the recessive gene being carried on and expressed over generations.

What is Methemoglobinemia?

Hemoglobin carries oxygen from lungs to all over the body with the help of ferrous ion (Fe²⁺). But methemoglobin has ferric ion (Fe³⁺), which decreases the amount of oxygen that can be carried effectively, resulting in blue skin. Mild methemoglobinemia, when methemoglobin levels are around 10–20%, is usually not fatal and primarily presents with cyanosis. However, levels beyond 30–40% can cause serious health concerns such as shortness of breath, seizures, or coma, and levels above 70% may be fatal.

In the 1960s, hematologist Dr. Madison Cawein III administered methylene blue to a brother-sister duo who arrived in his clinic for consultation, and he immediately saw positive results. ^[2]

He had learned about a study conducted on hereditary methemoglobinemia among isolated Inuit populations in Alaska, which had a history of marriages within the family. ^[3]

This resulted in further studies, and the community was advised to take methylene blue pills daily which would keep their skin a normal pink hue.

The condition finally subsided when the members of the family started moving out due to better connectivity.

Later Generations

The last documented person born with blue skin in the Fugate lineage was Benjamin Stacy, born in 1975. His skin was blue at birth, but the color subsided after a few months, and it was believed to be inherited from his grandmother Luna Stacey. He would still turn blue during cold months or when agitated. ^[4]

Their story is widely recorded in scientific literature and studied as a rare genetic disorders case study, particularly in the context of Appalachian genetics and how isolation shaped inheritance patterns.

1. Percy, M. J., and Lappin, T. R. J. “Recessive congenital methaemoglobinaemia: Cytochrome b5 reductase deficiency.” British Journal of Haematology 141, no. 3 (2008): 298–308.

2. Cawein, M. M., J. M. Lappat, R. C. Mueller, and L. F. Mahoney. “Hereditary Methemoglobinemia in a Large Appalachian Family.” Archives of Internal Medicine 128, no. 2 (1971): 152–156.

3. Scott, E. M., and E. Griffiths. “Hereditary Methemoglobinemia in Alaska Natives.” American Journal of Human Genetics 13, no. 1 (1961): 80–89.

4. Trost, Cathy. “The Blue People of Troublesome Creek.” Smithsonian Magazine, October 1982.

5. HowStuffWorks. “The True Story of the Blue People of Kentucky.” HowStuffWorks Health, accessed August 3, 2025. https://health.howstuffworks.com/human-body/systems/circulatory/blue-people-kentucky.htm.

6. TheCollector. “Blue Fugates: The True Story of Kentucky’s Blue People.” TheCollector, accessed August 3, 2025. https://www.thecollector.com/blue-fugates-kentucky/.

7. AllThat'sInteresting. “Meet the Fugate Family, the Mysterious Blue People of Kentucky.” AllThat'sInteresting, accessed August 3, 2025. https://allthatsinteresting.com/blue-fugate-family-of-kentucky.

MSM