This study adds to the small but growing literature on Black health history--the rise of hospital care and hospital services provided to Blacks from the antebellum era to the integration era, a period of some 150 years. The work examines the political, policy, legal, and philanthropic forces that helped to define the rise, development, and decline of Black hospitals in the United States. Particular discussion is given to the federal Hill-Burton Act of 1946 and the extent to which the legislation impacted Black hospital development. The roles of the Freedman's Bureau, National Medical Association, National Hospital Association, and the U.S. Commission on Civil Rights in the development of Black hospitals is highlighted.