Cussy Mary is also a "Blue" — the last of a line of blue-skinned people, whose skin appears the unusual shade due to a rare genetic disorder.

In 1936 eastern Kentucky, 19-year-old Cussy Mary Carter works for the New Deal–funded Pack Horse Library Project, delivering reading material to the remote hill people of the Appalachian Mountains.

Cussy Mary, sometimes known as Bluet, lives with her coal-miner and labor-organizing father, and feels her work as a librarian honors her long-dead mother, who loved books.

Her "Pa", Elijah, slowly dying from lung disease from working in the mines, is determined to marry his daughter off, at any cost, in order to ensure her future security.

A new patron on her route, Jackson Lovett, piques her romantic and intellectual interest, but she also soon realizes that a relative of Charlie's, an evangelical preacher named Vester Frazier, is stalking her as she traverses her remote trails, and means her harm.

They turn to Doc, a local physician who has long been eager to test and study the Blues, and he helps the Carters steer clear of suspicion in return for access to Cussy Mary.

He takes her to a hospital in Lexington for tests, where she is poorly treated, humiliated, and physically invaded, but he basically means well and also provides Cussy Mary with food, which she shares with the starving school children on her route, many of whom suffer from pellagra and are facing death.

[7] The program was widely popular, and its benefits proven, as school children who enjoyed the service were reported to exhibit markedly higher performance in class.

Scott theorized that the absence of the enzyme diaphorase in the red blood cells prevented the reconversion of methemoglobin to hemoglobin, resulting in the condition known as methemoglobinemia, and that it is caused by a recessive gene.

[9] Cawein treated the family with methylene blue, which temporarily transformed their skin to "normal" hues; however, the treatment only lasted about a day, and involved unpleasant side effects.

[11][12] As the 20th century progressed, improved transportation and communications reduced the isolation of the Fugates in their Appalachian "holler", and the family dispersed, while the new genes introduced to the line made the appearance of methemoglobinemia increasingly rare.

"[19] Philip K. Jason, in the Southern Literary Review's "May Read of the Month" recommendation, predicts that readers would find Book Woman to be "one of the most original and unusual contributions they will encounter in the realm of the current literature of the American South."

He praises how beautifully the relationship between father and daughter is portrayed, as well as the "unexpected poetry" of Cussy Mary's voice and speech patterns, noting that for a bookish young woman, she nevertheless speaks in the hill people's dialect.

In addition to the historical value and Richardson's accomplished "presentation of her protagonist’s challenges and perseverance within a culture hostile to deviation from norms", Jason finds of equal value the "reminder of the priceless necessity, the enduring thrill, of books and reading.

[21] Several readers of advance copies noted significant similarity between the stories, despite the obvious differences, including plot devices that are not part of the historical record of the librarians.

[21][23] Moyes, a British author and native living in England, stated she had a busy schedule[citation needed] and has not commented, but her imprint spokesperson has denied that she or the publisher had any prior knowledge of the existence of Book Woman or its contents.

[citation needed] Richardson, asserting that she could not afford to engage her own counsel to pursue a legal claim in the expensive copyright courts, continued to answer the issue of what she termed "alarming similarities" to the media[citation needed], which several articles attempted to track the timelines of the two books' drafts, submissions and publications — from which no clear picture has yet emerged.