Blue People of Kentucky

Painting representing the Blue Fugates of Eastern Kentucky by Walt Spitzmiller

From around 1820 through the mid 1900s there were some very unusual-looking people living in an isolated area of Eastern Kentucky. What made them unusual was the color of their skin – it was blue. They were varying shades of blue: Some were pale blue, others a deeper blue, and still others just had blue tinges to their fingernails and lips.

While it wasn’t unusual to see Blues, as they were called, in this isolated Kentucky hollow, not everyone there was blue. Out of a family with eight children, perhaps four or five of them might be born blue, with the others having ‘normal’ Caucasian skin. It wasn’t until the 1960s that these people came to the attention of the medical community, and it was discovered that they carried a rare blood disorder. But what caused this condition and why was it so prevalent in this specific area?

The Blue Fugates

The story of the blue-skinned Kentucky people began in 1820 when Martin Fugate, a French orphan, settled in the wilds of Eastern Kentucky to claim a land grant near Troublesome Creek. Although there is no mention of his skin color in the earliest records, it’s certain that he carried the gene for a condition now known as methemoglobinemia, a rare blood disorder.

Martin settled near Troublesome Creek and married a red-headed, fair-skinned American woman named Elizabeth Smith. Unbeknownst to them, Elizabeth also carried the recessive gene for this rare blue-skin condition. In order for it to be passed to children, both parents must have the gene. Martin and Elizabeth Fugate had seven children, and four of them were blue.

Spread by Intermarriage

At the time, this area of Eastern Kentucky was wild. There were no roads and only a few other families lived near the Fugates. In this isolation, the families didn’t have much choice when it came time for their children to marry. So when one of the Fugate sons married one of the Smith daughters (Elizabeth’s family) it again created the situation where both parents carried the gene and more blue children were born. The gene for methemoglobinemia spread through the local families living in the cabins dotted along the hollows. They later became known as the Blue Fugates.

A typical isolated Appalachian log cabin – Image source

They were generally healthy people living into their 80s and 90s, so they didn’t often see doctors. And living in an isolated area, their condition went unnoticed by the outside world. But as roads and railroads were built through these wild areas, they became exposed to others. When outsiders would see them for the first time, they would be shocked by their blue color and often frightened. The Blues suffered prejudice and persecution because of their unusual appearance.

Cause Discovered

Then in 1960, Madison Cawein, a haematologist working at the University of Kentucky medical clinic in Lexington heard about the blue people. He was immediately intrigued and decided to find out what caused the condition. He teamed up with nurse Ruth Pendergrass, and they began talking to the Blues, taking blood samples, and asking about their family histories.

After identifying the condition, Cawein treated the patients with methylene blue which added oxygen to the blood and temporarily returned their skin to its natural color. However, the drug had to be taken regularly, or the blue color would return.

As their world opened up and the families began to marry with others outside their immediate area, the instances of the disease lessened, and now it is rarely seen. But it does occasionally pop up. The last known person to be born exhibiting the symptoms of this disease was a little boy born in 1975. His skin was blue at birth but was a normal color within a few weeks.

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The Book Woman of Troublesome Creek

I recently read The Book Woman of Troublesome Creek: A Novel by Kim Michele Richardson. It’s a historical fiction novel about a Blue woman who works as a pack-horse librarian in Eastern Kentucky during the Great Depression. It chronicles the loneliness and dangers of being ‘the last’ of the Blue Fugates. I found this book so interesting and well-written that I couldn’t put it down.

Pack Horse librarians in Hindman, Kentucky 1938

Pack Horse Librarians

Between 1935 and 1943 the US government sponsored the Pack Horse Library Project designed to get books into isolated areas of the Appalachian Mountains. The librarians were mostly women who rode horses or mules across the often-treacherous terrain to deliver books to the mountain folk. In The Book Woman of Troublesome Creek, Cussy Mary Carter is a pack horse librarian as well as being a Blue, so the author combines two very interesting historical subjects.

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The Giver of Stars

Another great book about the pack-horse librarians is The Giver of Stars by Jojo Moyes. It shows more of the spirit of these ‘book women’ and how dedicated they were to their mission of distributing books.

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Margo Lestz


  1. Wow—what interesting stories about the Blue people! I had never heard of them before. Margo, you always have a treasure trove of marvelous stories! Thanks for sharing another great one.

    1. Thanks, Paul. I found this very interesting too. Blue isn’t a colour that you often associate with skin – unless it’s cold. 🙂

  2. I loved your post, Margo! Very interesting!
    I had never heard of the Blue People. How divisive would that be to have blue skin?!
    I actually read the Giver of Stars last year. Eleanor Roosevelt’s idea to educate the isolated mountain people with books. She was a powerful influence in providing books to read through the librarians on horseback.

    1. Thanks, Rose. I loved The Giver of Stars as well. Those ladies were so dedicated to their patrons and really endured hardships to deliver their books. In The Book Woman of Troublesome Creek, she is a pack horse librarian and Blue. People didn’t know what to make of the Blues – some thought they were devils… What a terrible thing to endure.

  3. Dear Margo:

    Thanks for another fascinating story, this time of the biological blue bloods, the usual ones being of noble or “aristocratic” birth. 4WIW, as regards the origin of the usual meaning: “‘Blue blood’ is a literal translation of the Spanish ‘sangre azul’. This was the designation attributed to some of the oldest and proudest families of Castile, who claimed never to have intermarried with Moors, Jews, or other races. The expression probably originated in the blueness of the veins of people of fair complexion as compared with those of dark skin.”

    Stay true blue (not necessarily supporting, in the reported English understanding of, the British Conservative Party), if you can! : )

    Thanks again!

    Best regards,

    1. Thanks, Bill. What is interesting is that their blood was actually brown rather than red – so they weren’t blue-bloods after all. 🙂

    1. Thanks, Paula, I think you would enjoy the book. It portrays a very particular part of America and American history.

  4. What an intriguing piece of history…the Blue Fugates and the pack horse women both. Great post.

    1. Thank you! I loved the way the author wove together these two unusual bits of history into a great story.

  5. I was delighted to read your review of The Book Woman of Troublesome Creek. My father’s family was born and raised along the Troublesome. Some chose to remain there, still living in places with names such as Clayhole and Lost Creek. My father never saw a Blue, but my grandfather, “Pap” would occasionally see them when they left their isolation in the “hollers.” Perhaps they were visiting Pap’s general store to purchase staples. Pap was known to be a kind and fair man. I like to think the Blues could approach him without fear.
    I have purchased 8 books for friends and family. I was careful to use your email to order through Amazon. I hope you receive your commission!

    1. Hi Linda, It’s so nice to hear from you. It’s interesting to hear from someone with some connection to the area. Sorry I’m a bit late in answering as I’ve been moving house – always a lot of fun. 🙂
      I just love those descriptive Kentucky places names. 🙂 Thank you so much for ordering from Amazon through my website. That’s very kind of you. I hope you and your family and friends will find the book interesting. I really enjoyed it. Thanks again.
      All the best, -Margo

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