In the late 1880s it became apparent in Louisiana that leprosy was endemic in the southern part of the state. Initially, the intention was to establish a leprosy hospital in the city of New Orleans, close to medical facilities, and where the bulk of the patients were to be found. The establishment, instead, of an isolated leper colony at the run-down plantation at Carville, 85 miles up-river, was the result of community indifference, misunderstanding of the nature of the disease, and expected depreciation of property values. Fear of the disease was a secondary matter. The practice of locating residential facilities for the chronically ill at long distances from the centers of physician practice and medical research continues to this day. Interestingly, the arguments that permit this to happen have not changed appreciably from those of a century ago.