In 1869 the General Assembly of the Commonwealth of Virginia passed legislation that established the first asylum in the United States to care exclusively for African-American patients. Then known as Central Lunatic Asylum for the Colored Insane and located in Richmond, Virginia, the asylum began to admit patients in 1870. This thesis explores three aspects of Central State Hospital's history during the nineteenth century: attitudes physicians held toward their patients, the involuntary commitment of patients, and life inside the asylum. Chapter One explores the nineteenth-century belief held by southern white physicians, including those at Central State Hospital, that freed people were mentally, emotionally, and physically unfit for freedom. Chapter Two explains the involuntary commitment of African Americans to Central State Hospital in 1874. Chapter Three considers patient life at the asylum by contrasting the expectation of “Moral Management” care with the reality of daily life and treatment.