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received: 2022-06-30                 DOI 10.19233/ASHS.2022.32
INSIDE AND OUTSIDE THE HABSBURG PUBLIC HEALTH SYSTEM.
MANAGING COMPLEXITY WITHIN THE AUSTRIAN LITTORAL (1849–1880s)
Francesco TONCICH
University of Ljubljana, Faculty of Arts, Aškerčeva 2, 1000 Ljubljana, Slovenia
e-mail: toncichf@ff.uni-lj.si
ABSTRACT
The aim of this essay is to understand the development of the public health system within the Austrian Empire 
between 1849 and the end of the 1880s. After a contextualisation of the legal and administrative rules of Austrian 
citizenship and the welfare organisation system, the text provides some examples from documents in the archival 
collection of the Littoral’s Lieutenancy. The essay focuses on the problematic relationship between the new laws for 
inclusion in Austrian citizenship and the right of indigent persons to be cared for. Health, legal, bureaucratic and 
socio-economic factors were so intertwined that they form a complicated Gordian knot.
Keywords: Habsburg public health, Heimatrecht/Pertinency, indigent people, Austrian Littoral, hospital’s costs, 
provincial funds
DENTRO E FUORI IL SISTEMA SANITARIO PUBBLICO ASBURGICO.
GESTIRE LA COMPLESSITÀ NEL LITORALE AUSTRIACO (1849–1880)
SINTESI
Il presente lavoro si propone di comprendere lo sviluppo delle strutture sanitarie pubbliche nella Monarchia 
Asburgica tra il 1849 e la fine degli anni Ottanta del XIX secolo. Dopo una breve contestualizzazione della 
struttura legale e amministrativa di inclusione nella cittadinanza austriaca e nell’organizzazione assistenziale 
pubblica, il testo mostra alcuni esempi illustrativi tratti da documenti del fondo archivistico della Luogotenenza 
del Litorale. Il saggio si concentra sul rapporto problematico tra la nuova forma giuridica di inclusione nella 
cittadinanza austriaca e il diritto delle persone indigenti a essere assistite gratuitamente. Aspetti sanitari, legali, 
burocratici e socioeconomici si intersecano in modo così stretto da formare un complicato nodo gordiano.
Parole chiave: sanità pubblica asburgica, Heimatrecht/pertinenza, persone indigenti, Litorale austriaco, 
costi degli ospedali, fondi provinciali
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INTRODUCTION
This article offers some insights into the evolution of 
public health in the Habsburg Monarchy, in particular 
in the crownland Littoral/Küstenland1, after the revolu-
tionary year 1848/49. Examining documents from the 
archival collections of the Littoral’s Lieutenancy, the 
analysis spans from the late 1840s until the late 1880s. 
The evolution of public health since the 19th century 
has been one of the central topics in the larger processes 
of state building and modernisation of European civil 
societies (Berridge, Gorsky & Mold, 2011, 23–73). An 
analysis of the structures of public health is not only a 
matter of medical history, but also a particularly strategic 
and dense interdisciplinary point of study: it allows us 
to observe a wide range of themes and problems, which 
could otherwise easily remain unnoticed or would be 
taken into consideration individually. This also concerns 
the evolution of the Habsburg Monarchy, during one of 
the most formative phases of its own history, when the 
complex relationship between the imperial state and 
civil societies underwent a period of great change and 
upheaval.
Principally, this study raises two important questions 
after 1848/49: 1) the relationship between state and so-
ciety through the creation and development of modern 
administrative structures and institutions for welfare; 2) 
the new forms of inclusion into (and exclusion from) the 
first concept of modern Austrian citizenship.
HEIMATRECHT AND THE “SUPPLY OF POOR 
PEOPLE”: A NEW FORM OF INCLUSION, A NEW 
FORM OF SOCIETY?
The crisis of 1848/49 led to some important social 
and economic issues, particularly closely linked to the 
increasingly urgent question of the political and social 
participation of new, important forces such as the rising 
bourgeoisie and the working class. The restored imperial 
power had to take social demands much more seriously 
into account (Judson, 2016, 218–221). In the dynamic 
context after the “March Revolution”, the implementa-
tion of citizenship and welfare state structures played a 
crucial role in restoring and re-ordering imperial power 
– together with the abolition of the lASTs remains of the 
feudal system (Bruckmüller, 1999). As early as 1849, the 
Viennese government aimed to reshape the state’s rela-
1 Since there are usually two (sometimes even more) cultural designations for placenames in the Littoral, I try to reflect this diversity in 
the text. Only for Trieste/Trst/Triest and Gorizia/Gorica/Görz, which have more than two names, is only the first variant reproduced for 
practical reasons.
2 Dominique Kirchner Reill uses to translate Heimatrecht with the English term “Pertinency” (Kirchner Reill, 2021).
3 This is confirmed in research on the immigration of Slovenian speakers from Carniola, Carinthia and southern Styria into the Triestine 
emporium in the late 18th and early 19th century, who, despite the “national crystallisation” of the 1860s, maintained a strong localistic 
self-identification and relationship with their places of origin (Verginella, 2001). Moreover, recent studies have shown how this complex 
Habsburg system of strong legal ties between individuals and their native “small homelands” had important consequences and continui-
ties in the post-1918 transition period, above all in the process of redefining and renegotiating their national and territorial affiliation and 
right of citizenship in the post-Habsburg successor states (more in Hametz, 2019; Kirchner Reill, 2021). 
tionships with civil society through the creation of new 
forms of social inclusion and protection, particularly 
towards needy individuals. 
On 17 March 1849, the “Provisional Municipal Law” 
(Provisorisches Gemeindegesetz) modified the centuries-
old legal institution of Heimatrecht (Right of Residency 
or Pertinency2) by using it as the basis for the first model 
of a modern Austrian citizenship, in addition to updat-
ing fiscal and conscription rules (Reichsgesetzblatt, 
1849, n. 170). Heimatrecht had existed for centuries, 
at least since the middle of the 16th century, and was 
mainly intended to control and manage the unstable 
masses of poor people living and moving within the 
Empire’s territory (Wendelin, 2000, 181–191). This act 
introduced a new form of Heimatrecht, which was then 
completed by the Heimatrechtsgesetz (Residency/Perti-
nency Act) of 3 December 1863, during the first phase 
of the “Constitutional era” (Reichsgesetzblatt, 1863, n. 
105). The new form of Heimatrecht continued to be 
based on the principle of territorial affiliation, but also 
started to progressively guarantee inalienable social and 
civil rights to subjects. Heimatrecht, in the law subsec-
tion called “Armenversorgung” (supply of poor people) 
(Reichsgesetzblatt, 1863, n. 105, 372–373), defined the 
legal and administrative means for managing and reap-
portioning risk and misfortune. 
With regards to the development of a modern public 
health system, the reforms of the Heimatrecht in 1849 and 
1863 determined that the cost of emergency treatment 
in public hospitals should be charged to the municipal-
ity where the individual was legally registered – either 
the individual’s or their parents’ birthplace –, not where 
they actually lived. The Habsburg system discouraged 
individuals from changing their Heimatrecht: it was 
practically impossible to obtain a change of pertinency 
(Wendelin, 2000, 195–216). This structure of inclusion 
into Austrian citizenship bound individuals even more 
closely to their “small homelands” (Ivetic, 2014, 222), 
and, in doing so, legally consolidated centuries-old, pre-
nationalised forms of local self-identification.3
Based on the principles of Heimatrechtsgesetz, 
the Reichssanitätsgesetz (Imperial Sanitary Act) was 
instituted in 1870: this law established the grounds for 
a more standardised, unique and efficient public health 
organisation in the Austrian half of the Monarchy (Re-
ichsgesetzblatt, 1870, n. 68). The Habsburg public health 
system had the characteristics of a pre-“solidaristic wel-
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fare state” (Baldwin, 1990, 55–65): Reichssanitätsgesetz 
developed new regulations from the traditional “poor 
policies”, albeit it through a pivotal systematisation and 
professionalisation of medical facilities and working 
staff, as well as its bureaucratic structure (Obentraut, 
1881, 449–529). 
This legislation led to a paradox: in order to receive 
social protection, medical care and a minimum of fi-
nancial support in case of illness, needy individuals had 
to be legally demonstrated their municipality of birth or 
residence, even if they were living in a different district. 
However, the new legislation was issued at a time of 
increasing mobility due to socioeconomic changes, the 
end of the feudal system, technical innovation and the 
construction of new infrASTsructures (Coons, 1975). 
Moreover, during the 1850s and 60s the Habsburg 
Monarchy followed the general European trend towards 
the free circulation of people and goods, so that the 
Passport Ordinance (Paßverordnung) of 1857 abolished 
the passport requirement for movement within the 
Monarchy, while in 1865 the abolition of the require-
ment for passport checks when leaving Austria was 
also completed (Burger, 2000, 23–25). In such a fluid 
situation, the Austrian system of Heimatrecht and public 
health automatically led to bureaucratic problems, 
misunderstandings and illegalities, even on the part of 
the authorities.
This general problem mostly affected complex 
crownlands, such as the Austrian Littoral, which 
presented a composite administrative unit – embrac-
ing three provinces with three local parliaments 
(Dorsi, 1994, 233–245) –, a strong cultural-linguistic 
differentiation, and tremendous socioeconomic differ-
ences – first of all between industrial and commercial 
port cities and the rural countryside (Verginella, 2008). 
Moreover, the Austrian Littoral represented one of the 
most mobile crownlands of the Empire, primarily for 
working reasons. Trieste was the major focus of impe-
rial and international migration, but there were also 
significant parallel internal migration trajectories within 
and among the three provinces of the Littoral (Steidl, 
2021, 42–43). In addition to the important international 
immigration, the labour market of Trieste functioned 
due to the consistent and constant internal migration 
from rural, mostly economically depressed provinces 
and crownlands around Trieste4, such as the County of 
Gorizia and Gradisca, Istria, Carniola, South Carinthia, 
South Styria, and Veneto (Breschi, Kalc & Navarra, 2001; 
Verginella, 2001; Cattaruzza, 2012; Kalc, 2013; Ton-
cich, 2021, 281–298). Among them, Istria represented 
4 Trieste followed the evolution of other large Habsburg centres, first and foremost Vienna, which were already established by, and 
functioned thanks to, large masses of immigrant workers from other economically depressed provinces of the empire, in particular 
from low skilled and cheap labour or groups of specialised artisans (Hahn, 2000). Based on these centuries-old exchanges be-
tween rural and urban spaces, the highest rate of socioeconomic and linguistic-cultural diversity and hybridity within and around 
the Littoral’s centres was established (Csáky, 2002).
5 In some documents, one reads the Italian term “nazionale”. It has no national meaning, rather it is one of the Italian terms used to indicate 
pertinency, together with “incolato”, “indigenato” and “pertinenza”.
the most important province of emigration to Trieste – 
particularly starting from the 1860s, as a result of the 
outbreak of cholera and malaria epidemics, as well as 
of the plant insect phylloxera and plant disease downy 
mildew, that caused a dramatic crisis for its population 
and agricultural economy.
WHO PAYS FOR WHOM? BUREAUCRATISING THE 
HABSBURG PUBLIC HEALTH SYSTEM
Asymmetries and inequalities in the functioning 
of the public health system can be easily seen in the 
documents of the Lieutenancy concerning the refund of 
medical and hospital costs (“Verpflegskosten”) for indi-
gent individuals with different pertinencies. The central 
question was whether this system was easy to adminis-
ter, or whether its complexity often led to irregularities 
and inaccuracies between the various public offices and 
institutions. This question depended heavily on the high 
migration of labour towards the more industrial cities of 
the Littoral, primarily Trieste; the high number of agen-
cies involved; and the interdependent but often asym-
metrical imperial administrative structure. Not every 
municipal and provincial institution involved had the 
same resources to sustain their own pertinent people, 
who were living abroad, so that a small rural centre in 
Istria or Carniola certainly could not compete with the 
resources available to the richest productive centres of 
the Littoral.
The legal requirements of Heimatrecht often clashed 
with the pragmatic needs of the working classes in the 
Littoral, especially those who lived in the unhygienic 
suburbs and working districts of Trieste (De Rosa, 1981; 
Cigui, 2008). Most of them were originally from another 
province or even crownland and were legally pertinent 
to another municipality of the Monarchy. The legal ex-
traneousness of a sick indigent individual did not imply 
their ineligibility to receive free health care. In May 
1865, the Municipality and the Direction of the Civic 
Hospital of Trieste made clear their pivotal tasks: 
The Municipality of Trieste, and in particular the 
Direction of the Hospital, welcome with solicitude 
all the sick who show up at the municipal hospital, 
whether or not their pertinency has been verified 
at the time. When the condition of the sick person 
necessitates it, in accordance with the norms in 
force, research is required in order to establish 
their pertinency [nazionale]5, and, if the person in 
question is not a member of this Municipality, a 
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copy of the minutes is sent to the political or muni-
cipal authority in charge, so that it may confirm the 
pertinency or make any possible objections. (ASTs, 
IR LL, AG 1, 368, 8332)
The quotation demonstrates, how the principles of 
inalienable rights to access public health care were 
influencing the medical-administrative mentality. It 
shows at the same time, how the public health system 
was not just a matter of medical assistance: in ad-
dition to the medical and nursing working staff, an 
administrative and legal bureaucratic department was 
operating, which, starting from the mid-1860s, was 
becoming an essential part of the medicalisation. The 
main task of the administrative bureaucracy in the 
hospital was to certify the pertinence of the hospital-
ised people, that is, to discover which institution was 
going to pay for their public health care. 
Examining the hospitalisation procedure of the 
main Civic Hospital of Trieste, the hospital’s ad-
ministrative staff was responsible for inquiring into 
their personal data and legal status. In determining 
a patient’s eligibility for free care in a hospital of the 
Empire, it was not enough merely to determine the 
pertinency. The hospital’s medical and bureaucratic 
staff had to verify by means of the admission form and 
interview: 1) the origin/pertinency of the person, 2) the 
type of illness, that is, the reason for their admission 
to the hospital, 3) the “wretchedness” (“miserabilità”), 
that is, the state of indigence (ASTs, IR LL, AG 1, 368, 
6252). This took place through an oral interview 
based on a standard form, which was carried out in 
the hospital ward by the attending physicians. After 
this, the administrative and legal departments of the 
hospital opened the patient’s file. Without involving 
the Municipality or the Lieutenancy of the Littoral, 
the hospital offices sent the request to the provincial 
authority of the municipality verbally indicated by the 
patient or by their documents as the pertinent one. 
Firstly, this action attempted to verify the truthfulness 
of the legal affiliation; secondly, it would automati-
cally request reimbursement of hospital expenses to 
the pertinent “Provincial Fund”. 
This procedure did not only have a humanitarian 
purpose. A “Civic Office of Control and Accounting” 
(Ufficio civico di controllo e contabilità) of the Triestine 
municipality had the main task of studying the status 
of the patients, in order to make simplifications in the 
financial management of the hospital (ASTs, IR LL, AG 
1, 368, 12227, 13242, 12731). This office, together with 
the administration and legal office of the civic hospital, 
was the link between the hospital and the paying institu-
tion such as the competent provincial fund. 
6 Istria was consistently the province most indebted to the city of Trieste for hospital costs. For instance, in 1862, out of the total annual 
credit of 88,031.57 florins for all expenses incurred by the city of Trieste paid in advance for indigent patients pertinent in other crown-
lands, the province of Istria owed as much as 52,517.12 (ASTs, IR LL, AG 1, 368, 2983).
In a city of high immigration such as Trieste, this 
implied that the hospital and the municipality were 
significantly financially “exposed” to third parties, be 
they provinces and municipalities of the same Littoral or 
lieutenancies and district headquarters of other crown-
lands. This very often led to bitter and prolonged legal 
disputes between different offices in different districts 
and regions over requests for payment of health and 
hospital costs for indigent individuals who were not 
pertinent to Trieste or other main cities of the Littoral. 
The most difficult controversies happened with Istria 
and Carniola, which were the provinces most indebted 
to Trieste’s public hospital.6
TOO OLD OR TOO CRAZY TO BE CURED: A 
CONDITIONAL PUBLIC HEALTH SYSTEM
During these disputes between hospitals, lieutenan-
cies and provincial districts, legal third parties who 
had to reimburse costs often used strategies to avoid 
paying and ease the burden on their own provincial 
funds. One strategy was to deliberately allow as much 
time as possible to elapse, so that the paperwork to 
establish the pertinency would stall of its own accord 
in the maze of this complicated system, as the Triestine 
municipality claimed in 1865: “These delays hamper 
the smooth running of affairs, and often make it very 
difficult and even impossible to resolve any doubts that 
may arise concerning the patients’ pertinency and the 
obligation to reimburse the respective costs of care and 
hospitalisation, thus multiplying the number of letters 
and correspondence out of all proportion” (ASTs, IR LL, 
AG 1, 368, 12227).
Most of the problems stemmed from the principles 
of a decree issued by the Ministry of Home Affairs (4 
December 1856, n. 26641; Haemmerle, 1869, 32–56.), 
which had initially regulated the admission procedure in 
the hospitals of the whole Empire. This decree enshrined 
two principles that remained in the administration of 
public health in the following decades: 1) a sick person 
could only be admitted to hospital care after it had been 
established that there was a real need for treatment; 
2) free hospitalisation could only take place for short 
stays, at least not exceeding three months. These two 
points became the bone of contention in disputes over 
claims for reimbursement of medical costs between 
lieutenancies and provincial district capitals, since, 
before hospitalising such a patient, the hospital had to 
inform the pertinent provincial and municipal authority 
and agree on a hospital stay longer than three months. 
However, due to the medical urgency and lack of clarity 
about the pertinency itself, this was not always possible 
and the hospital proceeded in any case, informing the 
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relevant provinces only months later. From this ministe-
rial order, the Austrian Littoral adopted an ad hoc law in 
June 1869, which standardised the procedures for the 
untreatable and/or in need of long and special treatment 
(Notificazione, 1869). 
The mentally and chronically ill or overly elderly 
patients represented an excessive outlay for the pro-
vincial funds due to the length of their stay and the 
lack of security for their care. The acceptance of an 
“incurable” patient would have put the provincial 
fund where the sick person was hospitalised in 
severe financial difficulties, without any guarantee 
that the costs would be reimbursed by the pertinent 
municipality. For these kinds of patients, other facili-
ties, such as hospices or psychiatric hospitals, were 
available, where the costs were amortised. However, 
their transportation from the hospital to these facilities 
was not always possible. This often led the provin-
cial authority responsible for those patients living in 
Trieste to accuse the Triestine hospital of exceeding 
their administrative authority, by taking care of non-
eligible persons without first seeking the provincial 
fund’s opinion (cf. ASTs, IR LL, AG 1, 368, 6252)
In July 1883, a dispute over the non-payment of 
hospital fees broke out between Trieste, Carniola and 
Vienna. Maria Zadnikar was one of thousands of im-
migrants from Carniola living in Trieste for decades 
(Cattaruzza, 1979). Between September 1880 and July 
1881, for almost ten months – in total about 300 days 
–, she was hospitalised at the Civic Hospital in Trieste 
due to severe bronchitis. At that time, she was around 
75 years old and came originally from Šujica, a tiny 
rural village near Dobrova in Upper Carniola (ASTs, 
IR LL, AG 1, 363, 18492). For almost two years, the 
Municipal Hospital of Trieste continually demanded 
reimbursement for the costs of this long and costly 
hospital stay, totalling no less than 272.16 florins. In 
the first moment, the administration of the hospital was 
acting independently through its internal administra-
tion in directly asking the Carniolan Lieutenancy for 
payment of the costs, without having to go through 
the Trieste municipality or the Littoral’s Lieutenancy. 
The Carniolan Lieutenancy had only paid a small part 
of the costs, just for the first three months, leaving 
233 days unpaid (ASTs, IR LL, AG 1, 363, 14654). 
The authorities in Ljubljana pointed out the fact that 
the patient, although pertinent in Carniola, was too 
old to receive such long and expensive treatment, as 
her illness was caused by chronic “senile marasmus” 
(“marasma senile”). 
The hospital in Trieste justified its actions by proving 
that Maria Zadnikar was suffering from severe bronchitis 
that was curable, but she could not be transported to 
7 Dr. Illuminato Zadro, originally from one of the most important families of Rovigno/Rovinj, is listed as a counsellor of the Lieutenancy, 
president of the Provincial Sanitary Council, director of the Obstetrical Institute, provincial health spokesman for the Lieutenancy and 
the Viennese government in 1878 (Almanacco, 1878, 38).
8 Regarding the presence of a proto-physician in the Trieste Civic Hospital at the end of the 19th century, cf. De Rosa (1981, 28).
a “nursing house”, where the costs would have been 
significantly lower. Only after the partial payment from 
Ljubljana, did the administration of the Triestine hospital 
turn to the Lieutenancy of the Littoral, which in turn 
called in the Ministry of Home Affairs in Vienna. The 
latter, however, found shortcomings and irregularities in 
the work of the hospital in Trieste – it had not immedi-
ately informed the Carniolan provincial fund about the 
long hospital stay – and ruled in favour of the Carniolan 
counterpart on the legal basis of the Heimatrechtsgesetz 
of 1863:
[...] the Ministry of the Interior has recently 
noticed that the Trieste Public Hospital not only 
accepts incurable sick persons into hospital care, 
but also does not hand over such sick persons, if 
they are fit for transport, to the Trieste Municipal 
Magistrate for further treatment in the sense of 
§28 of the Heimatrechtsgesetz of 3 December 
1863 – Imperial Law Gazette No. 105 – but re-
stricts itself to merely sending such sick persons 
to the respective provincial authorities. Since this 
procedure […] gives rise to unpleasant recrimi-
nations as well as to protracted negotiations, the 
Governor’s Office is requested […] to take strict 
care that the existing regulations are observed 
punctually on the part of the Trieste Hospital. 
(ASTs, IR LL, AG 1, 363, 108)
The documents on the Zadnikar case provide further 
interesting information about the medical-legal man-
agement of patients with mismatched Heimatrecht: the 
civic Hospital of Trieste had, in addition to the normal 
medical staff, a so-called “provincial proto-physician”, 
who was commissioned by the Ministry of Home Affairs 
to visit only the patients pertinent in Carniola, who were 
living in Trieste and hospitalised in its Civic Hospital, 
and to report on them to Vienna:
[...] the Council implicitly agreed to the 
further hospitalisation of the sick person; 
[...] the hospitalisation became an unavoi-
dable necessity and this is proven not only 
by the declarations of the hospital’s doctors 
in charge but also by those of the provincial 
proto-physician Cav. Dr. Zadro7, who was 
charged with examining the Carniolan pa-
tients [carniolini degenti] in this charitable 
institution and reporting to the High Ministry 
of Home Affairs in Vienna, and who was also 
convinced that Zadnikar, among others, was 
unfit for transport at the end of December 
1880; [...] (ASTs, IR LL, AG 1, 363, 14654)8
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Among the most frequent cases of difficult and 
controversial admission for free treatment and conse-
quent refusal of reimbursement were cases of mental 
illness. Elisabetta/Elisa CASTsullovich-Missetich/
Missetić, originally from Dalmatia (from Pietro della 
Brazza/Supetar), moved with her husband (from Se-
benico/Šibenik) to Trieste ten years before, where she 
was practicing as midwife. When the dispute arose 
in 1867, she was already a widow and lived in the 
Trieste suburb Rozzol (ASTs, IR LL, AG 1, 368, 7231). 
The reason for her hospitalisation was “ebetudine”, 
an unspecified state of psychic confusion, thus falling 
under the classification of special cases identifiable 
as “untreatable” by the decree of 1856. The dispute 
with the Dalmatian provincial fund resulted from their 
refusal to reimburse the expenses, which covered a 
nine-year confinement. The reason for this was the 
failure of the medical facilities in Trieste to inform the 
provincial headquarters in Zara/Zadar in advance, 
and the related request for acceptance of such a spe-
cial case. The latter replied in May 1867 as follows:
The reason for this refusal is based on the fact 
that in opposition to the explicit provisions of 
Ministerial Decree No. 26641 of 4 December 
1856, the homeland authority of the patient 
Missetić was not informed about her stay of 
more than three months, on which omission 
the not insignificant increase in treatment 
costs for the duration of more than nine years 
depended. (ASTs, IR LL, AG 1, 368, 7231)
(IN)DEPENDENT WOMEN? PUBLIC HEALTH, 
HEIMATRECHT AND GENDER
In this lASTs case study, the issue of the inclusion 
and protection of women in welfare policies emerges 
with great importance. The pertinency of a woman, who 
was doing a skilled job and therefore could have been 
socially and professionally independent, still depended 
on a male figure in her own family. Consequently, the 
access to free medical assistance, in case of poverty, 
depended on the man, whether father, brother or hus-
band, who guaranteed eligibility for the woman. In the 
above case, the woman was a widow, which meant that 
her residence depended automatically on that of her 
deceased husband, as indicated by the Heimatrechtsge-
setz of 1863. However, what happened if a woman was 
unmarried and could not show a clear Heimatrecht?
Among the flow of independent female workers to 
Trieste, an important category of specialised and essen-
tial professionals was represented by midwives, some of 
whom were provided as a free service by the Triestine 
municipality for the assistance of indigent classes (De 
Rosa, 2020, 77–136). A constant in the cases of mid-
wives was their professional and social importance, 
even their independence. Among the papers of the 
Lieutenancy on the reimbursement of hospital costs, one 
finds a few cases of midwives treated in Trieste, although 
with different pertinences. 
Of greater interest is the case of the Istrian Maria 
Depangher, a “certified midwife” (“geprüfte He-
bamme”), who is reported to have lived and worked in 
Trieste alone, not following any man (ASTs, IR LL, AG 1, 
368, 1334). She was hospitalised in Trieste, where she 
passed away in September 1865, probably without hav-
ing been able to indicate her pertinency. Among her pri-
vate belongings, a passport for internal travel within the 
Monarchy issued by the authority of Capodistria/Koper 
in 1851 (that is, in the period before the abolition of 
internal passports in 1857) was found. Although through 
research her birth and baptism records were found in the 
parish office of the same town, doubts were still raised as 
to her pertinency. The point was that Maria Depangher 
was a single woman, so before her legal status could be 
established, it had to be fully corroborated by matching 
and comparing it with that of the male figures in her fam-
ily, namely her father and brothers. The father had died 
in Pisino/Pazin in 1845, when Maria was around twenty 
years old and was living there with her parents. After the 
father’s death, she returned to Capodistria/Koper with 
her mother and siblings, and later she moved to Trieste 
to work as midwife. The doubt was therefore between 
different Istrian municipalities due to her father’s work 
and changes of domicile as a k.k. officer in Pinguente/
Buzet and Pisino/Pazin (ASTs, IR LL, AG 1, 368, 1641). 
Eventually, what removed any doubt was a cross-check 
with all the documents concerning her pertinency and 
the legal status of the two brothers, that is, through the 
registration for military service of one of them:
[...] any doubts as to the legal pertinency of this 
family to Capodistria are removed by the witness 
of Domenico Depangher, another of Maria’s 
brothers, who was enrolled in military service 
in Capodistria on behalf of that municipality in 
the Royal Navy on 28 February 1853, after the 
family’s repatriation, and to this end he was 
expressly sent from Montona, where he was at 
the time. (ASTs, IR LL, AG 1, 368, 7252)
1866, THE LONG POST-WAR PERIOD: CHANGING 
BORDERS, REDEFINING PERTINENCES THROUGH 
PUBLIC HEALTH
Faced with the increasing importance of cheap mi-
grant labour – seasonal or fixed – from the 1850s, the 
Austrian government provided bilateral agreements for 
the mutual support of indigent individuals and payment 
of their care and health costs. For instance, the Eisenach 
Convention with the states of the German Confederation 
in 1853 (Reichsgesetzblatt, 1854, n. I/6), the Declaration 
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with some Swiss cantons in 1857, the agreements with 
the Italian Kingdom in 1859 and 1866 (ASTs, IR LL, AG 
1, 368, 4685).9 In addition, these international agree-
ments covered all kinds of illnesses, except for mental 
and/or chronic illnesses.
The public health of the Littoral, particularly the 
coASTsal area, was peculiar, since it was far more 
exposed to international labour migration and transfor-
mations of the international geopolitical order, first of 
all the reorganisation of borders and citizenships of the 
neighbouring Lombardy-Venetia. In October 1868, the 
Triestine mayor, Carlo Porenta, declared, that, since “the 
condition of Trieste [was like] a seaport open to every-
body”, the regulation of hospital costs for foreign workers 
in Austria was “a vital and urgent matter”, especially after 
1866. This happened precisely during the period of the 
beginning of the works for the enlargement of the port 
infrASTsructure (Millo, 2002, 191): Porenta’s main preoc-
cupation was that “such major works preferably attract 
workers from the neighbouring Italian provinces, who 
resort to this hospital when they fall ill”. From his point 
of view, it was a fatal mistake for the Triestine provin-
cial fund to enter into agreements with the Kingdom of 
Italy through diplomatic channels only after the start of 
construction works on the new port, which would have 
brought in masses of poor manual labourers from Veneto 
and other parts of Italy “without the municipality being 
able to legally claim reimbursement for the considerable 
expenses involved” (ASTs, IR LL, AG 1, 368, 5416).
The war of 1866 and the long post-war period 
represented a crucial watershed for the management of 
public health in the Littoral and for the related issue of 
citizenship and costs for indigent people. The shift of 
the Empire’s borders implied a reconsideration about 
pertinency and the right to free care and protection 
for indigent workers coming from Veneto but living in 
the Littoral. During the peace conference in Vienna in 
the autumn of 1866, the Italian and Austrian diplomats 
and ministries negotiated an agreement about the legal 
status of reciprocal subjects/citizens living in both coun-
ties, also concerning the eligibility for public health 
care. The peace treaty of Vienna in 1866 recalled the 
previous treaty of Zurich in 1859 between Piedmont 
and Austria, and the right of Lombard subjects to decide 
their citizenship: the same principle was extended to the 
Venetian provinces seven years later (ASTs, IR LL, AG 1, 
368, 13572). This led to a difficult question concerning 
the pertinency of the Venetians and their eligibility for 
public health care in the Littoral.
In July 1871, Maria Lavezzo, originally from Veneto, 
was hospitalised in Trieste as an indigent woman, though 
without a clear right of pertinency. She was the widow 
of the Venetian Luigi Lavezzo, who, during the war of 
9 Besides these agreements, the regulations with further foreign states (e.g., Great Britain, France, USA, Russia, Spain, Turkey etc.) re-
mained unclear and resulted in the fact that the costs for indigents patients from these countries often remained at the shoulders of the 
treating hospital, with no possibility of requesting payment back.
1866, was himself hospitalised in Padua as a soldier of 
the Austrian Army. During his convalescence, he had the 
option to choose his – and consequently also his wife’s 
– citizenship, either to maintain their previous Austrian 
citizenship or to take Italian citizenship. He remained 
loyal to the Austrian Empire, so he was transferred and 
hospitalised in Leoben, in South of Styria, where he re-
ceived his new Heimatrecht. After his death, his widow 
Maria left Leoben and moved to several cities in order 
to obtain financial substance. In Trieste, she became ill 
and the Triestine hospital was struggling to ascertain 
her pertinency so that, six years after the change of her 
husband’s Heimatrecht, she was still considered to be 
“homeless” (“heimatlos”) (ASTs, IR LL, AG 1, 340, 8646). 
After complicated research, a year later, in August 1872, 
she was declared pertinent to the Styrian crownland, on 
the base of the Residency Act of 1863:
According to new information received from 
Maria Lavezzo, her late husband Luigi Lavezzo, 
who at the time of the cession of Veneto had 
already been admitted to the Invalids’ Hospice 
in Padua, was questioned by the former Army 
Headquarters in Veneto as to whether he 
intended to retain his Austrian citizenship in 
accordance with Article XIV of the Peace Treaty 
of 1866, and declared himself to be an Austrian 
subject, as a result of which he was transferred 
to the Invalids’ Hospice in Leoben. According to 
§2 of the Austrian Residency Act of 1863, every 
Austrian subject must belong to a municipality, 
and consequently Lavezzo also had to belong 
to an Austrian municipality, which had to be 
Leoben. In the case of changes in the right of 
domicile, the wife follows her husband or retains 
the right of domicile as a widow in the municipa-
lity in which her husband had it at the time of his 
death (§11 of the Act). Maria Lavezzo, widow, 
belonged and should still belong to Leoben, and 
even if she were to be regarded as lacking the 
right of domicile in accordance with §10 No. 2 
of the above-mentioned Act of 1863, she should 
also be assigned to Leoben, where she remained 
for a long period before the question of her 
husband’s entitlement arose. (ASTs, IR LL, AG 1, 
340, 10571)
The sources concerning this case study reveal a more 
general fact: the post-war period after 1866 signified a 
long and difficult transition for the Austrian Littoral. It 
put the administration of the crownland, in particular 
the structure of inclusion and provision of welfare and 
citizenship, under stress for the next decade. 
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It also highlighted the Austrian Littoral’s character 
as a maritime “borderland”. Maritime Istria was par-
ticularly affected by the events of 1866, that is, the ex-
Venetian Istria until 1797, which continued to maintain 
close economic, professional, and familial relationships 
with Venice and Veneto until the end of the Monarchy 
(Toncich, 2021, 192–200).10 The daily interdependence 
between maritime Istria and the Venetian shore emerged 
in the more general debate of mutual free health care 
assurances for indigent individuals with different perti-
nencies (in this case now with different citizenship). In 
September 1867, the head of the Parenzo/Poreč district 
declared to the Triestine Lieutenancy that “it is of great 
interest to the writer, regarding Istria’s close relations with 
Italy and especially with Veneto, to clarify this emerg-
ing doubt as soon as possible [...]” (ASTs, IR LL, AG 1, 
368, 12373). Venetians, who only a year before were 
compatriots but now were to be considered “aliens”, 
continued to reside and work in Istria, and vice versa 
Istrians in Venetia. Maritime Istria, far more than Trieste, 
was particularly affected by this international change 
and the issue of the illness of indigent (new) “aliens”. 
Public health became a pivotal legal tool for re-defining 
new political borders and “otherness”, even regarding 
categories which until that moment were included in 
the very same system.
CROSSING INTERNAL BORDERS: INEFFICIENCIES OF 
THE LOCAL BUREAUCRATIC SYSTEM
Looking back at the internal situation in the Aus-
trian Littoral, the frequent and continuous changes 
of domicile of workers often caused problems. In 
addition to the economic issue of reimbursement of 
hospital expenses, the systemic inefficiency of the 
local administrative offices often emerged. With the 
reforms of the 1840s and 1850s, the focus of the legal 
inclusion of citizens was increasingly shifted to the 
more local centres. However, the professional skills 
of local municipal bureaucrats often clearly left a lot 
to be desired, and it affected the issue of conferring 
Heimatrecht. 
Questions about public health and managing costs 
could intertwine with questions of cultural/ethnic 
categorisation and the territorial affiliation of the 
patients. Problems arose when the residency of sick 
individuals was no longer clear and clashed with “par-
ticular” cultural categories or mobile individuals. This 
was the case of an unlucky Istrian Roma-Sinti family 
(Poropat-Levacovich), who was arrested in Rovigno/
Rovinj in June 1885 for occupying a house without 
permission. While in prison, some members of this 
family fell seriously ill with malaria. From interroga-
10 An example of this still high contact between the two Adriatic shores is the Istrian doctor and professor Lodovico Brunetti, born in 
Rovigno/Rovinj in 1813, who graduated in surgery at the University of Padua, where he became one of the most renowned professors 
and luminaries. He continued to maintain close ties with his “homeland”, so much so that he returned there frequently to perform 
special operations (Brunetti, 1876) or as a cholera doctor (Toncich, 2021, 244).
tions and research, it emerged that these people did 
not have a valid Heimatrecht, as the districts in Istria 
they indicated as their original municipalities did not 
have any document concerning them. To this end, the 
couple Marco Poropat and Elena Levacovich could 
not show valid proof of their marriage because the 
marriage certificate could not be found at the parish 
they indicated in Visignano/Višnjan. This meant that 
the children, even young babies, were illegitimate 
(ASTs, IR LL, AG 1, 363, 9711). 
The discussion about who had to pay for their treat-
ment was fiercely contested: a long dispute between the 
Lieutenancy of Trieste and the municipal authorities of 
Rovigno/Rovinj, Grisignana/Grožnjan, Lussinpiccolo/
Mali Lošinj, Veglia/Krk took place from June to Septem-
ber 1885, as no municipality wanted to cover the costs. 
Meanwhile, the health of the family deteriorated, so 
that the costs increased (ASTs, IR LL, AG 1, 363, 2335). 
Eventually, an official of the municipality of Rovigno/
Rovinj intervened in the dispute and verified the illegal-
ity of this situation. The municipality appealed directly 
to the Ministry of Home Affairs due to a lack of accord-
ance with the Heimatrecht as well as the individual 
rights from the Austrian Constitutional Law of 1867, and 
demanded the release of “these poor Gypsies who are 
suffering unjustly”:
The nine gypsies may not, as they are without 
fault, remain further locked up in civic detention 
until the final fulfilment of the legal procedures 
for the verification of their pertinency. This is 
against the §8 of the State’s constitutional law; 
and precisely in order to prevent such prolonged 
illegal detentions, the current law of pertinency 
in §18 stipulates that, as it is not possible at the 
moment to verify the pertinency of a person, that 
person must be assigned to a municipality. (ASTs, 
IR LL, AG 1, 363, 2242)
 Illegality was not self-inflicted, but was the product 
of the municipal authorities themselves. These people 
had been arbitrarily excluded from the legality of the 
Heimatrecht, following a generalised practise of exclu-
sion of Roma-Sinti individuals – considered as a feared 
“in-between diversity” (Zăloagă, 2013) – from the legal 
body of communities in Western and Central Europe 
since the modern era (Fasanelli, 2010; Zahra, 2017). 
The complaint of the municipality of Rovigno/Rovinj 
against this double illegality seemed to be successful, 
as already in September 1885 the nine people received 
the Heimatrecht from their competent municipality of 
Dubašnica/Dobasnizza on the Isle of Veglia/Krk (ASTs, 
IR LL, AG 1, 363, 16864). 
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However, this lack of clarity regarding the Heimatre-
cht was not just an exception concerning a stigmatised 
and excluded cultural minority: it could also happen 
to individuals, mostly needy workers, who transferred 
from one municipality to another, even within the same 
province (Kalc, 2013). This was the case of Anton Pahor, 
who, in March 1883, was declared “geistesschwach” 
(“mentally deficient”) by the medical authorities of 
Gorizia. Pahor needed to be hospitalised, but the ques-
tion of costs emerged: the political authorities of Gorizia 
were unable to establish to which district Anton Pahor 
belonged. He was born in 1834 and grew up in Merna/
Miren (in the County of Gorizia and Gradisca, in the 
district of Gorizia), yet in 1855 he moved with his family 
to Pieris (in the same County, but under the jurisdiction 
of Gradisca). However, in the Volkszählungslisten (lists 
of censuses) he was found neither in one nor the other 
district (ASTs, IR LL, AG 1, 363, 4064). 
This case highlights a common problem with these 
Lieutenancy documents: the municipal authorities often 
turned out to be inefficient in their vital task of confer-
ring Heimatrecht. Yet as these situations of illegality 
emerged, they were corrected on an ad hoc basis in 
times of necessity for medical reasons. 
CONCLUSION: CURING THE BODY, CORRECTING 
THE LEGAL STATUS
The Habsburg public health system, which was 
affected by the post-1849 reforms of the Heimatrecht, 
was shaped by the conservative exigencies of the 
imperial power, however it responded to the social 
and economic requirements of civil society. During 
the administrative and legal re-ordering after 1848/49, 
the more the empire shifted the focus of administra-
tive action to local institutions (i.e., municipalities and 
their civic hospitals), the more administrative-political 
structures of the Empire became interconnected. The 
interconnection was between municipalities within 
the same region, although, in a period of increased 
mobility, also among different crownlands and even 
with other countries. The complex imperial system 
of social and civic inclusion and welfare functioned 
through this combination of localism and interregional 
interconnection. However, it was based on strong 
economic inequalities and asymmetries, what led to 
recurrent administrative problems in the functioning of 
the public health system.
Within these intricate bureaucratic interconnections, 
multiple and complex forms of inclusion and exclusion 
of needy people emerged. These individuals found 
themselves suspended between complicated social and 
familial relationships, gender hierarchies, localisms, 
border changes, and exclusion as persecuted ethnic 
groups. In addition to all this, the vital issue was per-
sonal and public health. 
From the perspective of the Austrian State, public 
health served as a key weapon to control poor and 
unstable parts of the population, and make this control 
widespread even in rural areas far from urban centres. 
More importantly, public health became a means to 
measure the acceptance of post-1849 reforms and to 
correct possible irregularities. Public health policies 
served to penetrate deep into local societies, even 
into pockets of poverty far distant from the “eye of 
power” (Foucault, 1977). The management of public 
health and citizenship represented a pivotal moment 
of encounter between individuals, who often lived on 
the edge of legality – sometimes even outside – and the 
state bureaucracy. The concern about spending public 
resources allowed these irregularities to emerge for the 
first time: the hospital became not only a space for cur-
ing the body of the patients, but also for correcting their 
legal/bureaucratic position.
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VKLJUČENOST IN IZKLJUČENOST IZ HABSBURŠKEGA JAVNEGA ZDRAVSTVENEGA 
SISTEMA. UPRAVLJANJE KOMPLEKSNOSTI V AVSTRIJSKEM PRIMORJU (1849–1880)
Francesco TONCICH
Univerza v Ljubljani, Filozofska fakulteta, Aškerčeva 2, 1000 Ljubljana, Slovenija
e-mail: toncichf@ff.uni-lj.si
POVZETEK
Po krizi v letih 1848/49 je imelo uvajanje državljanstva in struktur države blaginje ključno vlogo pri 
obnovi in ponovni ureditvi imperialne moči. Reforma Heimatrecht, ki je stopila v veljavo 17. marca 1849, 
je spremenila način vključitve v avstrijsko državljanstvo in določila novo fazo dostopa do brezplačne javne 
zdravstvene pomoči za revne ljudi. Ta zakon je določal, da se stroški nujnega zdravljenja v javnih bolnišni-
cah zaračunajo občini, v kateri je bil posameznik uradno registriran – bodisi v rojstnem kraju posameznika 
ali njegovih staršev –, in ne v občini, kjer je dejansko bival. Na podlagi zakona Heimatrecht je bil leta 
1870 uveden Zakon o uredbi javne zdravstvene službe za celotno cesarstvo. Ta zakonodaja je privedla 
do paradoksa: da bi bili pomoči potrebni posamezniki deležni socialne zaščite, zdravstvene oskrbe in 
minimalne finančne podpore v primeru bolezni, so morali uradno dokazati svoj kraj rojstva ali prebivališča, 
tudi če so v času neprestanih selitev zaradi dela živeli drugje. Ta splošni problem je najbolj prizadel kom-
pleksna območja monarhije, kot je bilo Avstrijsko Primorje, ki je bilo zaznamovano s sestavljeno upravno 
enoto, velikimi kulturno-jezikovnimi in socialno-ekonomskimi razlikami – predvsem med industrijskimi in 
trgovskimi pristaniškimi mesti ter podeželjem – in močnimi migracijskimi tokovi. Asimetrije in neenakosti 
v delovanju javnega zdravstva je mogoče zlahka razbrati iz dokumentov deželnega glavarstva o povračilu 
zdravstvenih in bolnišničnih stroškov (Verpflegskosten) za revne posameznike z različnimi pripadnostmi v 
tržaški civilni bolnišnici.
Ključne besede: Habsburško javno zdravstvo, Heimatrecht/pertinentnost, revno prebivalstvo, Avstrijsko primorje, 
stroški bolnišnic, deželna sredstva
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