Until the mid-19th century, there had not been a single resident physician in the Holy Land. However, by the first World War in 1914, 19 hospitals had been established in Jerusalem. The reasons for this unusual phenomenon were religious, political, and sectarian. This does not apply to The Marienstift Kinderhospital, which was unique in 19th century Jerusalem. The hospital was founded and operated by Dr Max Sandreczky, a German pediatric surgeon. The standards of medical and surgical practice in the hospital not only compared favorably with those in western Europe, but, in certain aspects, they were more advanced. The Marienstift Kinderhospital was an "implant" of a western institution in a society that was medieval in character. The response of this society was studied as well as the natural history of this unique institution and its medical director, the pediatric surgeon, Dr Max Sandreczky.