In 1820, a French orphan named Martin Fugate brought his American bride, Elizabeth Smith, to the isolated banks of Troublesome Creek in eastern Kentucky. Neither could have predicted that their union would launch a medical mystery spanning nearly two centuries. Both carried an extremely rare recessive genetic mutation that turned the blood of four of their seven children a dark chocolate brown, making their skin appear blue. Known to locals as the Blue Fugates, generations of this Appalachian clan lived with skin the color of deep indigo.
The Origin of the Fugates at Troublesome Creek
The peculiar story of the Fugate family begins with a French orphan named Martin Fugate. In 1820, Fugate claimed a land grant in Eastern Kentucky on the banks of Troublesome Creek. The creek, which runs through Knott County, was so named because of its nearly impassable game trail. Even experienced hunters could not weave their way through the valley, as large trees, creeping vines, and misshapen stones guarded the creek’s pathways.
A few families settled in the surrounding valleys, including Martin Fugate, who met and married Elizabeth Smith, a redheaded American woman. The Fugates settled in the remote valleys surrounding Troublesome and Ball creeks and had seven children. Three children came out white. Pale, they said, like their mother’s skin, which was “as pale as the mountain laurel that blooms every spring around the creek hollows.” The four other children were not white. They were beyond the conceptual understanding of skin color in America at the time. Four of the Fugate children were born blue.
If legend is to be believed, Martin Fugate himself was of an indigo tint. Eastern Kentucky, like much of Appalachia, relies heavily on the tradition of oral storytelling. Many in the region were born and raised illiterate, so passing down stories relied on the narrative of mothers, fathers, grandparents, and friends. This is how the story of Martin Fugate was passed through the hill country gossip mill.
Living in an isolated area, the Fugates married other Fugates while occasionally co-mingling with Smiths, Combses, Stacys, or Ritchies. This is how the blue people spread throughout Eastern Kentucky. But no one knew why they were blue. Some thought it was heart disease or lung disorder, while others described it as a disease where the blood got “too close to the skin.”
In addition to being the subject of gossip, the blue Fugates were also the target of superstition. Appalachia is a place of isolation, with unique customs and traditions. Many hill people believed that the blue skin of the Fugates was an act of the devil or that it was a racial issue. Some just thought they looked funny. For this reason, the Fugates and their blue descendants never really left their hollers and continued to intermarry.
Understanding Hereditary Methemoglobinemia and Blue Blood
In 1960, a young hematologist named Madison Cawein began hearing rumors at the University of Kentucky. People spoke about the blue hill folks of the Cumberland Plateau. There were blue Stacys, Combses, Smiths, and Fugates at that time as a result of inbreeding and the small gene pool from which many of Eastern Kentucky’s families came.
Cawein was an accomplished doctor. He helped isolate the antidote for cholera and helped create a drug for Parkinson’s Disease. He was, however, a hematologist at heart. Cawein said that “blood cells always looked beautiful to me,” so when he began hearing about the blue people, his interest was piqued.
Cawein, along with Ruth Pendergrass, a nurse from the American Heart Association clinic in Hazard, scoured the hollers for blue people. Pendergrass was fascinated with the blue people since she gave a blood test to a woman who identified herself as a blue Combs from Ball Creek. Cawein and Pendergrass went on daily missions to find blue people until they were frustrated and near giving up. After all, Cawein was forced to drive eight hours one way, from Lexington to Hazard, when he wanted to go on a search. Then a pair of siblings, Rachel and Patrick Ritchie, walked into the heart clinic in Hazard. They were blue, and Cawein had found his white (or blue) whale.
Cawein began charting the family’s history and found no evidence of heart disease. He suspected from the start a rare condition called methemoglobinemia, a rare but toxic form of anemia that can occur due to abnormal hemoglobin in the blood. However, when Cawein tested the pair for abnormal hemoglobin, the test returned negative.
Cawein turned to medical literature, where he found a case of Native Alaskans who seemed to resemble Kentucky’s blue people. The researcher who treated the blue Alaskans found that they had methemoglobinemia based on an enzyme deficiency and that this condition can be passed down through recessive traits.
The blue Kentuckians were found to lack the enzyme diaphorase, which helps process hemoglobin and keeps the blood from producing too much methemoglobin. While most people have less than one percent methemoglobin in their blood, the Fugates likely carried a level of about 10 to 20 percent; not enough to be harmful, but too much to have a standard skin color. This abundance of blue methemoglobin overpowered the ability of the red hemoglobin to transport oxygen to the blood, thus turning the Ritchies and their ancestors blue and their blood a chocolatey brown.
It seems that the enzyme deficiency began with Martin and Elizabeth Fugate, over 150 years before Cawein’s time, and had trickled down through many hill folks due to inbreeding. Martin and Elizabeth both carried the gene by chance, and they passed it down until the 1960s when Cawein discovered the cause.
The Later Life of the Blue Fugates and Their Descendants
The blue people of Troublesome and Ball Creeks were not happy to be blue. Even when Dr. Cawein examined the Ritchie siblings, he could tell they were embarrassed by his questions. Patrick and Rachel were hunched, almost likely to hide their color with their body language. Dr. Cawein remembered, “You could tell how much it bothered them to be blue.” This embarrassment likely stemmed from the maltreatment from their mountain neighbors.
Cawein was eager to find a solution to their situation, and he did so quite quickly. To get the body to begin turning methemoglobin back to normal, an “electron donor” had to be introduced into the body. This substance would kickstart a color change in the patient, from blue to pink, by replicating the processes of a normal level of diaphorase. Methylene Blue was the obvious solution, as it had been used successfully and safely in the past. Many of the blue folks thought Dr. Cawein was crazy; after all, how could something blue fix the blue in their skin?
Cawein went ahead with the Methylene Blue injection, traveling to the Ritchie siblings’ cabin in the former mining town of Hardburly. He injected Patrick and Rachel with 100 milligrams each of the faux enzymes, and within minutes, the pair’s skin began to turn. By the end of the process, the Ritchies were fair-skinned for the first time in their lives. Cawein gave the siblings methylene blue in tablet form to take daily to maintain their skin tone.
Cawein also wanted to chart the families’ progression with the recessive gene, beginning with Martin Fugate. The recessive blueness did seem to fade throughout the family tree as modern advancements like the railway and modern roads were laid in Eastern Kentucky. However, this did not begin until the 1910s, gaining traction by the 1930s. With the roads came the eventual migration of the Fugate descendants, who moved into neighboring towns and began marrying people outside of their traditional circles.
Thus, the descendants of the original Fugate clan began losing their blue color until Benjamin Stacy was born in 1975 at the University of Kentucky Medical Center. Benjamin, or “Benjy,” was born purple. While doctors wanted to perform a blood transfusion, Benjy’s grandmother remarked that the baby’s great-grandmother, Luna Fugate, was known for having a similar coloring.
It turns out that Benjy’s father, Alva Stacy, was a direct descendant of Martin Fugate. Stacy’s family tree showed that he was, in his words, “kin to himself.” One of Martin and Elizabeth’s blue sons, Zachariah, married his maternal aunt. One of Zachariah’s sons, Levy, married a girl from the Ritchie family, and they had eight children. Luna, one of Levy and the Ritchie girl’s daughters, was blue. She married John E. Stacy, Benjy’s great-grandfather. Benjy’s skin eventually faded to a normal color, though rumor says that his lips and fingernails still turned blue when he was angry or cold.
The Blue Fugates in Popular Culture & Modern Society
According to an ABC News article from 2012, it is unknown if Benjy is still alive or whether there are other blue descendants of the Fugate clan around today. Their relatives are spread across the country, and some of the descendants are likely like Benjy, who owes his non-blue skin color to only carrying one gene for methemoglobinemia.
Not much is known about the Blue Fugates outside of the work accomplished by Dr. Cawein, but others do carry the blue gene or have been turned blue by outside factors like exposure and ingestion of anesthetics like benzocaine or xylocaine, meat additives like benzene, and certain nitrates, or antibiotics like dapsone or chloroquine. In one case, a man named Paul Karason turned his skin blue by consuming and rubbing his skin with colloidal silver compounds to self-treat various skin conditions.
In popular culture, the blue-skinned mountain people of Kentucky are featured most prominently in two books: The Book Woman of Troublesome Creek by Kim Michele Richardson and Blue-Skinned Gods by S.J. Sindu. Both are fictionalized accounts of the Fugate lineage that don’t use the Fugate name. They’ve also been featured as stories on several TV shows focusing on strange history.
