In 1857, Koyama Yōju finally received a legitimate transmission. He had been working toward this goal at least since his vaccine theft of 1853. As Kasahara Hakuō noted in his journal in 1857 (click here for a translation), Yōju had also received vaccines from Fuchū’s society at one point, and vaccinators from Fuchū (a town close to Nishikata) once asked Hakuō whether they were allowed to share vaccines with Yōju. At that time, Hakuō still rejected this transfer between neighbors, arguing that Yōju was neither from Fuchū nor represented a “separate clinic” within Ōno domain. In other words, he deemed the transfer incompatible with the institutional framework he was hoping to build for vaccinations in Echizen province. It seems that Hakuō was eager to have each vaccinators’ society overlap with a domain territory, and if the vaccine ever went extinct, he wanted domain governments to send a formal request for retransmission to their counterpart in Fukui. Perhaps Hakuō believed that with such a high hurdle for retransmission, physicians would try harder to keep the vaccine alive. It is possible that he saw this principle endangered by Yōju’s request.

In 1857, Hakuō and his colleagues in Ōno came up with a workaround to authorize Yōju’s operation without damaging their institutional framework. They probably felt pressured to act after domain officials had tried to appoint an unauthorized vaccinator for Nishikata. First, Ōno’s physicians invited Yōju and “carefully instructed him in Ōno on the assessment of pocks and other things.” They transmitted the vaccine to him, then “went to his place and imposed on him rules about all kinds of things on the basis of an inspection.” This initiation turned Yōju into a legitimate vaccinator who could be trusted to act in a responsible manner.

Second, Yōju's operation received the status of a “separate clinic” (bekkan) of Ōno domain. As Hakuō explained to his Ōno colleagues, this status would allow Yōju to receive retransmissions from Sabae and Fuchū in case he lost his chain of supply. He cautioned that if Yōju requested a retransmission without such status, he could not receive one “without Ōno’s domain leadership sending a correspondence to the leading officials at the domain office in Fukui.” This was an outcome Hakuō was hoping to avoid because he felt it would taint the achievement of Ōno’s vaccinators, who “had not let the vaccine go extinct even once.” Clearly, Hakuō was hoping to maintain domain-based retransmission as a lever to discipline and motivate vaccinators within each domain. At the same time, he acknowledged that clinics in rural exclaves like Nishikata might require retransmissions from neighboring territories to remain feasible. When Ōno’s vaccinators notified Hakuō that they intended to follow his recommendation and open a “separate clinic” in Nishikata, Hakuō sent a letter to the chapters in Fuchū and Sabae to inform them of that fact (click here for a translation of the letter).

In this manner, the perpetuation of vaccinations in Echizen province depended on the authority of domain rule, yet was impeded by its fragmentation. It took the abolition of domain rule in 1871 to bring the territorial geography in line with the vaccinators’ need for stronger and more centralized governmental control. But even centralization did not result in full coverage right away. In the second half of the 1880s, the vaccination rate in Fukui prefecture finally crossed the eighty-percent mark [Yanagisawa, 2018, p. 59].