The domain-run clinic opened on 10/25 in Shimo-Edomachi in a former administrative building of the domain. With a size of over 100 tatami mats, the new clinic was much larger than its predecessor and employed a greater number of physicians. To be sure, most actual vaccinations were still being performed by town doctors from the chapter and domain physicians appeared primarily in supervisory roles. The status difference between domain and town doctors continued to impede collaboration, and many domain physicians did not yet see the benefits of receiving training in in the new technique. But Hakuō now began to train domain doctors as well upon orders from the government. Interest in the procedure slowly expanded.

The new clinic opened right in time for the vaccination boom of the winter of 1852/53. In the fall of 1852, smallpox spread in the castle town, and only vaccinated children appeared to be safe from infection. Townspeople and villagers near the castle town scrambled to take their children to the clinic and threatened to overwhelm the capacities of the new facility. Hakuō reported long lines in front of the clinic gate. Between 100 and 200 people seem to have lined up on each vaccination day, and on 1/23, 1853, the clinic had to turn 130 children away after vaccinating 230.