This article reviews the origin of hospitals and hospital libraries in Japan, Europe, and the United States. A brief history of the development of hospital libraries in Japan presents a picture of uncertainty and struggle regarding the identity of the hospital library. The Kinki Hospital Library Association was founded in 1974 in the Kansai region, and the Japan Hospital Library Association was established in 1976 with 38 members. Then, as now, hospital libraries reflect the institutions within which the librarians operate. The roles of the hospital libraries have been varied and important during the twentieth century. Hospital librarians are beginning to make their mark and will continue to do so. We will discover what the new century brings in the way of health care information delivery.