At the end of the 15th century, the part of Trastevere towards the port of Ripa Grande was almost uninhabited and almost entirely planted with vegetable gardens (see section L'Orto ). One day, perhaps in 1488, "finding himself a devout person in incurable infirmity and having seen an image of the Immaculate Virgin Mary in a very old wall inside a garden ... he vowed that if he healed from said infirmity, he would hold a perpetual lamp lit in front of the aforementioned figure " (Camillo Fanucci, 1601).

The person - who other chronicles say was the same gardener - recovered and kept his promise: others, following his example, wanted to contribute to the public cult of the image by gathering in the Confraternity, approved in 1492 by   Pope Alexander VI and later elevated by Sixtus V , in 1588, to the rank of Archconfraternity, with various spiritual privileges and the faculty to ask for the release of a person condemned to death every year. A chapel was erected around the icon and construction of the current church began almost immediately. From the same period are the news regarding the small hospital of the Confraternity, already functioning and set up at the same time as the association was formed.

Over time, thirteen universities (corporations) of arts and crafts joined the Archconfraternity, competing with each other to embellish and adorn the church, lavishing large sums into it to ensure the work of distinguished artists: in fact, decorations of fruit and vegetables appear everywhere signs of the Universities of Ortolani and Fruttaroli, mills and small scales in memory of the Molinari and Pizzicaroli . An imposing eighteenth century wooden turkey is a gift from the Pollaroli family: about 80 cm tall. and with a wingspan of 150 cm, admirably carved in a single block of wood, it is currently kept in the Sacristy.

The statute received by us in the 1842 edition lists nine universities but tradition has it that there are twelve: University of the Merchants and Sensals of Ripa and Ripetta; University of Molinari and Garzoni dei Molinari; University of Pizzicagnoli or Pizzicaroli and Young of Pizzicaroli; University of Ortolani and Garzoni degli Ortolani; University of Fruttaroli and Limonari; University of Vermicellari that is artisans and retailers of pasta and Lavoranti Garzoni dei Vermicellari ; University of Pollaroli ; University of Scarpinelli or Ciabattini; to which the University of Mosciarellari (sellers of dried chestnuts) are traditionally added; the University of Vignaroli ; the University of Barilari di Ripa. But over time many other universities appeared and soon disappeared, such as those of the Barilari (porters who unloaded the barrels of wine in the nearby port), the Capovaccari, the Legnaroli and Fascinari di Marmorata, the Marinari del Regno, the Misuratori di Grano and the Canepari .

In a time when the church and faith were the fulcrum of all human activity (craft, trade, art, social relations, health, mutual aid), the activity of the Confraternity almost immediately assumed the dual function of civil aggregation within it ( Universities had their own statutes and regulated access to the profession) and spiritual meeting place for industrious men who recognize themselves in the one faith and therefore entrust devotional and charitable life to a company of greater importance than the single corporation. Therefore, all together militated in the Confraternity and wore its liturgical vestment on the established occasions. We recall that the Confraternities (whose first historical experiences date back to the VI-VII century) are the only lay aggregations to which the Church recognizes the right and duty to wear their own habit, according to a communication code that the centuries have made complex.

In our case the robe is a blue robe, in honor of the mantle of the Blessed Virgin which traditional iconography refers to the color of the highest skies, a sign of that divine Grace with which Mary was clothed ab aeterno . On the chest, at the height of the heart, the traditional image of the Madonna dell'Orto. At the sides there is a girdle, also blue, a sign of humility and penance like the habit itself; it must have knots, in a variable number depending on whether we want to remember the shedding of blood in the life of Jesus (seven), or the wounds suffered on the cross (five) or the falls on the way to Calvary (three). When the Eucharist is received, the hanging part of the girdle must be placed on the right shoulder or around the neck, as a sign of filial submission. Finally, a white face - similar to that of the magistrates - surrounds the neck and falls on the chest, a symbol of obedience to the Church, its magisterium and the statute of the Brotherhood.

The hospital, with an adjoining apothecary or pharmacy - active since around 1494 - reaches its full activity by providing health care to the members of the various guilds that are committed to its maintenance. At the end of 1600, with the enlargement of the association, the growth of the corporations and the increase of the population led to an adaptation of the structures.

In fact, the hospital was enlarged to which a building almost equal in size to the original building was added. For the same reasons, the apothecary was also rebuilt, at the expense of the University of Ortolani. These reconstruction works were accompanied by as many decorative interventions by the church on the initiative of the individual corporations. At the end of 1700 the difficulties of the Archconfraternity began also because of the historical events of the time that gave a bad blow to the activity of the association.

Due to the looting and devastation suffered at the time of the so-called "Jacobin Republic" imposed by Napoleon (1798-99), the hospital's activity ceased and despite repeated attempts it could no longer be reopened due to lack of suitable resources. His precious work had lasted exactly four centuries.

The situation worsened further when in 1801-02 Pope Pius VII decided to suppress the guilds and professional universities. The association of S. Maria dell'Orto, once one of the richest in Rome for bequests and property rents, although deprived of many possessions, still managed to restore the church (1825). In 1852, however, the building of the former hospital - empty for fifty years now - was requisitioned by the papal government in order to install laboratories for the manufacture of tobaccos, waiting for the imposing building that still dominates the square to be completed. Mastai, who incorporated a large part of the area previously reserved for the hospital and the small adjoining cemetery. Later, however, after many changes of ownership, the surviving part of the former hospital (including the apothecary) never returned to the availability of the Archconfraternity and the building was used as a civil residence.

After 1870 some modest properties could still be preserved but for a short time: the Savoyard persecutory laws of the Church were also extended to the city of Rome, so that after various events the law n. 6972 of 17 July 1890, also known as the "Crispi law". The provision pretended to equate the assets owned by the Church and those of the Confraternities, which instead all originated from purchases made on their own or from donations from the same associates: a considerable patrimony that was tempting to the exhausted state coffers.

As a result of the Crispi law, only the brotherhoods of pure worship remained intact, while those considered as pious works, or equivalent to public charitable institutions, were subjected to the provisions of civil law. Many Confraternities, deprived of the means of support, had to stop the activity: the historian of the sector Luigi Huetter estimated that in all of Italy there were over 11,700 forcibly extinguished associations.