The Blue Fugates of Kentucky: A Medical Mystery Explained

The Blue Fugates of Kentucky were an Appalachian family known for their blue-tinted skin, a trait caused by a rare genetic condition called hereditary methemoglobinemia. The story begins in 1820 when French orphan Martin Fugate and his American bride Elizabeth Smith settled on Troublesome Creek in Eastern Kentucky. Both carried a recessive gene for the condition, and four of their seven children were born with blue skin. The family intermarried with other local families, spreading the trait through the region. In 1960, hematologist Madison Cawein, with nurse Ruth Pendergrass, identified the condition as an enzyme deficiency (diaphorase) that caused an excess of methemoglobin in the blood, turning it brown and the skin blue. Cawein treated affected individuals with methylene blue, which restored normal skin color. The condition faded as roads and railways brought new marriages, but a descendant, Benjamin Stacy, was born in 1975 with the trait, though his skin later normalized. The Blue Fugates have been featured in books and TV shows, and other cases of blue skin have been reported from external causes like colloidal silver.