For the first two years, Kasahara Hakuō performed vaccinations at a clinic in his own house in Hamamachi, in the townspeople section of the castle town. He served there together with the other town doctors from his chapter (shachū). But this first clinic was extremely small--only 25 tatami mats, 7 of which were used for vaccinations, 4 for examinations, and 14.5 mats as a waiting area for children. The number of patients matched the size of the clinic. The vaccinators struggled to find children, and rumors were spreading in 1850...add text... Another problem was that public interest waxed and waned throughout the year. The middle of the summer and winter and around year’s end turned out to be the most difficult times for recruiting children. Moreover, as Hakuō noted, even children who did appear at the clinic often failed to come back after seven days for examination, transfer, or revaccination [this whole part: Yanagisawa, p. 52].

Kasahara Hakuō kept petitioning for a bigger, domain-run clinic, but received only lukewarm responses from domain officials and physicians. Though the domain had granted some funding and official status to the clinic, Hakuō could not run the facility without injecting from private funds, but these were dwindling as his income from his original job as a town doctor had dropped. In 1851, Hakuō rang the alarm bells. He warned domain officials that the vaccine was in danger of going extinct. As Hakuō argued, he had finished vaccinating the children of vassals and now needed town children to keep the vaccine alive. But he could not gain access to them without a more serious commitment from the domain.

This time, Hakuō's words had the desired effect. Perhaps Fukui's officials had begun to worry about the consequences of their inaction. After all, the domain had imported the vaccine after requesting formal permission from the shogunate, and Lord Yoshinaga had recently married and was expected to father a child in the near future. A loss of the vaccine might have been considered a major embarrassment under these circumstances [Yanagisawa].

research by Yanagisawa Fumiko and Ban Isoshirō.