Hazard was a spectacularly isolated place. In the 19th century the only routes to get to and from the township were along the 45 miles of the Kentucky River’s North Fork or by undertaking a two-week hike across the mountains. It wasn’t until 1912 that the railroad reached town.
Consequently, this remoteness encouraged local folk to intermarry. The chances of meeting outsiders if you lived in Hazard were few and far between, so you can hardly blame the townsfolk for courting and marrying other locals. For many of them, their neighbors were the only realistic options as partners.
It was this intermarriage and the subsequent children such unions produced that exacerbated the condition of the blue people. The skin hue was caused by rare genes combined with interbreeding. Moreover, the genes were continually being passed on by the good people of Hazard to each other. And the condition can be traced all the way back to Fugate and his bride, the red-headed Elizabeth.