In 1870, several thousand of the 900,000 residents of Manhattan were Masons. Many of these Masons made it a point to lunch at the Knickerbocker Cottage, a restaurant at 426 Sixth Avenue. At a special table on the second floor, a particularly jovial group of Masons used to meet regularly. 

The Masons who gathered at this table were noted for their good humor and wit. They often discussed the idea of a new fraternity for Masons, in which fun and fellowship would be stressed more than ritual. Two of the table regulars, Walter M. Fleming, M.D., and William J. Conlin, an actor with the stage name William J. Florence, took the idea seriously enough to do something about it.

Billy Florence, as known by his friends, was a star and world renowned actor. After becoming the toast of the New York stage, he toured London, Europe and Middle Eastern countries, always playing to capacity audiences. While on tour in Marseilles, France, Florence was invited to a party given by an Arabian diplomat. The entertainment was something in the nature of an elaborately staged musical comedy. At its conclusion, the guests became members of a secret society.

Florence, recalling the conversations at the Knickerbocker Cottage, realized that this might well be the vehicle for the new fraternity. He made copious notes and drawings at that initial viewing and on two other occasions when he attended the ceremony, once in Algiers and again in Cairo. When he returned to New York in 1870 and showed his material to Dr. Fleming, Fleming agreed.

Dr. Walter Millard Fleming was a prominent physician and surgeon. Born in 1838, he obtained a degree in medicine in Albany, New York, in 1862. During the American Civil War, he was a surgeon with the 13th New York Infantry Brigade of the National Guard. He then practiced medicine in Rochester, New York, until 1868, when he moved to New York City and quickly became a leading practitioner.

Fleming was devoted to fraternalism. He became a Mason in Rochester and took some of his Scottish Rite work there, then completed his degrees in New York City. He was coroneted a 33° Scottish Rite Mason on September 19, 1872.

Fleming took the ideas supplied by Florence and converted them into what would become the Ancient Arabic Order of the Nobles of the Mystic Shrine (A.A.O.N.M.S.). While there is some question about the origin of the Fraternity's name, it is probably more than coincidence that its initials, rearranged, spell out the words "A MASON."

The group adopted a Middle Eastern theme and soon established "Temples" meeting in "Mosques" across the continent. Another Masonic group, the Mysterious Order of the Veiled Prophet of the Enchanted Realm (known colloquially as the "Grotto"), adopted a similar theme in 1890. The Middle Eastern theme was popular at the time and alluded to the mystery and ceremony of the Arabian Nights, with its elaborate parties and frolic.

Despite its Arabic theme, the Shrine is in no way connected to Islam. It is a men's fraternity rather than a religion or religious group. Its only religious requirement is indirect: all Shriners must be Masons, and petitioners to Freemasonry must profess a belief in a Supreme Being. In order to further minimize any confusion with religion, the use of the word "Temple" to describe Shriners' buildings has now been replaced by the phrase "Shrine Center."

The Shriners often participate in local parades, sometimes as rather elaborate units: shrines may have one or more whole units of miniature vehicles in themes (all sports cars; all miniature 18-wheeler trucks; all fire engines for instance) of a dozen or two dozen Shriners executing elaborate drills in the mini-vehicles; an "oriental band" dressed in cartoonish versions of Middle Eastern dress; floats, including huge inflatable balloons of Shriners wearing their fezzes -- some local mosques actually have all of the above marching in the same parade.

The Shriners are committed to community service and have been instrumental in countless public projects throughout their domain. They also host the annual East-West Shrine Game which is a college football all-star game. Once a year, the fraternity meets for the Shriners Imperial Conference in a major North American city. It is not uncommon for these conventions to have 20,000 participants or more, which generates significant revenue for the local economy.

The Shrine's charitable arm is the Shriners Hospitals for Children, a network of twenty-two hospitals in the United States, Mexico and Canada. It was formed to treat young victims of polio, but as that disease was controlled, they broadened their scope. They now deal with all pediatric cases, most especially with orthopedic injuries and disease and burns. The Shrine has pioneered new treatments for these conditions.

There is never any charge for treatment at a Shriners Hospital. There is no requirement for religion, race, or relationship to a Freemason. Patients must be under the age of eighteen and treatable. Local Shrine temples most often provide free transportation to the nearest hospital. In 2002, a mascot named Fez Head Fred debuted, primarily to visit their children's hospitals.

In 2005, Shriners Hospitals approved 37,755 new patient applications, attended to the needs of 123,385 patients and provided the following free of charge:

• 228,261 radiology procedures
• 305,455 outpatient, outreach and telemedicine visits
• 67,735 orthotic and prosthetic devices applied 
• 24,627 surgical procedures
• 227,857 occupational therapy treatments

Shriners Hospitals' total budget for 2006 is $649 million, of which $616 million is targeted for operating expenses (including $33 million for research) and $33 million for buildings and equipment expenditures. During the 84-year history of the Shriners Hospitals, approximately $7.6 billion has been spent to operate Shriners Hospitals, and over $1.73 billion has been spent on construction and renovation.