The True Story of Kentucky’s Blue People

The idea of someone turning a different color is somewhat preposterous in modern society. When one considers a blue person, it’s often thought of as fantasy, such as James Cameron’s Avatar, with its world of blue people. Many can’t fathom that genetic mutations can often turn fantasy into reality, as is the case with the Fugate family of Eastern Kentucky’s hill country. In 1820, Martin Fugate claimed a land grant in Eastern Kentucky on the banks of Troublesome Creek. A few families settled in the surrounding valleys, including Fugate, who met and married Elizabeth Smith, and they ended up having 7 children. Three children came out white, while the other 4 were born blue. Throughout the ages, the Fugates married other Fugates while occasionally co-mingling with Smiths, Combses, Stacys, or Ritchies. When a family lives in isolation, it doesn’t make sense to constantly leave to marry. This is how the blue people spread throughout Eastern Kentucky. For nearly 200 years, no one knew what caused the blue people to turn blue. Then, in 1960, a young hematologist named Madison Cawein began hearing rumors about the blue hill folks who inhabited the Cumberland Plateau. Cawein, along with Ruth Pendergrass, a nurse from the American Heart Association clinic in Hazard, scoured the hollers for blue people. 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. 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 1% methemoglobin in their blood, the Fugates carried a level of about 10% to 20% — 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. Martin and Elizabeth both carried the gene by chance, and they passed it down until the 1960s when Cawein discovered the cause. 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 to the doctor, and he injected Patrick and Rachel with 100mg each. Within minutes, the pair’s skin began to turn pink. By the end of the process, the Ritchies were fair skinned for the first time in their lives. Thus, the descendants of the original Fugate clan began losing their blue color.