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The Fugates, a family living in the hills of
Kentucky Kentucky ( , ), officially the Commonwealth of Kentucky, is a state in the Southeastern region of the United States and one of the states of the Upper South. It borders Illinois, Indiana, and Ohio to the north; West Virginia and Virginia ...
starting in the 19th century, were commonly known as the "Blue Fugates" or the "Blue People of Kentucky". They are known for being carriers of a genetic trait that led to the blood disorder methemoglobinemia, causing the skin to appear blue.


Ancestry

Martin Fugate and Elizabeth Smith, ''Science 82'', November, 1982 who had married and settled near
Hazard, Kentucky Hazard is a home rule-class city in, and the county seat of, Perry County, Kentucky, United States. The population was 5,263 at the 2020 Census. History Local landowner Elijah Combs Sr. laid out the town in 1824 as the planned seat of the n ...
in around 1820, were both carriers of the recessive methemoglobinemia (met-H) gene. As a result, four of their seven children exhibited blue skin, and continued reproduction within the limited local gene pool ensured that many descendants of the Fugates were born with met-H. The disorder can cause heart abnormalities and seizures if the amount of methemoglobin in the blood exceeds 20 percent, but at levels between 10 and 20 percent it can cause blue skin without other symptoms. Most of the Fugates lived long and healthy lives. The "bluest" of the blue Fugates, Luna Stacy, had 13 children and lived to age 84. Descendants with the gene continued to live near Troublesome Creek and Ball Creek into the 20th century. They eventually came to the attention of the hematologist Madison Cawein III, who with the assistance of the nurse Ruth Pendergrass made a detailed study of their condition and ancestry. Based on a report published in the ''
Journal of Clinical Investigation The ''Journal of Clinical Investigation'' is a twice-monthly peer-reviewed medical journal covering biomedical research. It was established in 1924 and is published by the American Society for Clinical Investigation. Articles focus on the mechanism ...
'' in 1960 by a public health physician named E. M. Scott, who had studied a similar phenomenon among native Alaskans, Cawain concluded that a deficiency of the
enzyme Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrates, and the enzyme converts the substrates into different molecules known as products ...
diaphorase resulted in an oxygen deficiency in the red blood cells, causing the blood to appear brown, which in turn made the skin of those affected appear blue. He treated the family with methylene blue, which eased their symptoms and reduced the blue coloring of their skin. His findings were published in the ''
Archives of Internal Medicine ''JAMA Internal Medicine'' is a monthly peer-reviewed medical journal published by the American Medical Association. It was established in 1908 as the ''Archives of Internal Medicine'' and obtained its current title in 2013. It covers all aspects ...
'' in 1964. Benjamin Stacy, born in 1975, was the last known descendant of the Fugates to have been born exhibiting the characteristic blue color of the disorder, though he quickly lost his blue skin tone, exhibiting only blue tinges on his lips and fingertips when he became cold or agitated.


In popular culture

In 2019, the novel '' The Book Woman of Troublesome Creek'', by Kim Michele Richardson, described a fictional version of the Fugate family during the Great Depression. In 2021, the novel ''Blue-Skinned Gods'' by S. J. Sindu references a family from Kentucky with methemoglobinemia but doesn't use the surname Fugate. A reference to "the Huntsville subgroup" is made in the American version of television sitcom '' Shameless'' when
Kevin Ball Kevin Ball (born 12 November 1964) is an English former professional association football, footballer who played for Portsmouth F.C., Portsmouth, Sunderland A.F.C., Sunderland, Fulham F.C., Fulham and Burnley F.C., Burnley. Since his retirement, ...
(played by Steve Howey) discovers that he may have ancestors from that group.


See also

*
Family aggregation Family aggregation, also known as familial aggregation, is the clustering of certain traits, behaviours, or disorders within a given family. Family aggregation may arise because of genetic or environmental similarities.Butcher, J., S. Mineka, and ...


References

{{Reflist, 30em American families Blood disorders