In 1854, Kasahara Hakuō made a first attempt to take the vaccine to the countryside. As explained at the previous station, he did not do so to prevent extinction. On the contrary, he regarded rural vaccinations as too risky for “connecting” the vaccine and supported them only after the operation in the castle town had stabilized thanks to the founding of the domain-run hospital, increased training of domain doctors, and a boost in popularity after the smallpox epidemic of 1852/53. These developments had for the first time created a basis for vaccinating people with the sole purpose of saving lives, rather than warding off the threat of extinction.

In the countryside, there had been considerable demand for vaccinations, but as Hakuō noted, most villagers who came to the clinic lived within 2 or 3 ri (between 8 and 12 kilometers) of the castle town. Even within that radius, poorer villagers could not easily afford to travel to the castle town two times in a row. In a proposal submitted to a high-ranking domain official in 1853--while the area was in the middle of a smallpox epidemic--, Hakuō argued that expeditions to the countryside would help shorten lines at the clinic and prevent avoidable deaths from smallpox.

Yet, village vaccinations posed a serious logistical challenge. Because there were no trained vaccinators in the countryside and population density was low, it was difficult to “connect” the vaccine over time. Both vaccinators and vaccine-supplying children had to be brought in from town at exactly the right moment. To minimize the problem of distance, Hakuō devised the so-called “village relay” (muratsugi) method, which looked convenient on paper, but in practice relied heavily on governmental pressure. Village relay was also quite expensive because of the amount of traveling involved, and Hakuō proposed defraying some of the cost by asking parents for donations. One problem with donations was that the vaccinators needed to guard against the perception of profit-making and thus had to keep donations strictly voluntary. A second, related, problem was that the government could not apply too much coercion to a program largely funded by volunteers. Village vaccinations thus highlighted the need for more overall governmental involvement in preventative healthcare.

Discussions and planning for rural vaccinations continued through 1853, and in 1854 the domain leadership finally approved an experimental tour to a number of coastal villages. During the preparations, Hakuō coordinated closely with the district governor in the district office (gun’yakusho), as well as with the censor (metsuke) who had been put in charge of the domain-run vaccination clinic. Hakuō and the district governor, Okada Kihachirō, were deeply committed to making the rural tour a success and cutting cost as much as possible to set a precedent for similar tours in the future.