In 1857 the Nishikata exclave finally received a vaccination clinic, with Koyama Yōju in charge. Until then, local parents who wanted to have their children vaccinated most likely turned to clinics of other nearby territories such as Sabae, or to country doctors like Koyama and Naitō Dōitsu who were offering illegal vaccinations. The events leading up to the establishment of the Nishikata clinic provide some insight into the relationship between domain rule and the vaccinators’ regional network, as well as on the role of country doctors in vaccinating areas far away from the clinics.

In 1857, Ōno's domain physician Hayashi Unkei visited Kasahara Ryōsaku in Fukui and informed him of the following incident. Some time ago, he and his Ōno colleagues had learned that Koyama Yōju was once again performing vaccinations in Ota village. This time, however, Koyama was acting with official backing. The domain representative (rusuban, probably the rural intendant) had ordered him to vaccinate the local people, “not knowing that we [the vaccinators] had earlier sworn an oath at the domain office [of Fukui].” Hayashi apologized to Kasahara for this oversight, but reassured him that he and his colleagues had already put a stop to Koyama’s activities by contacting the domain representative in question. He also pointed out that the domain representative had since been removed from his post, though it is unclear whether this removal had anything to do with the vaccinations.

This incident shows that Ōno’s domain government, despite its collaboration with the vaccinators, was not fully aware of the doctors' professional network and agreements. The domain representative in Nishikata simply seems to have done what made sense from the government’s point of view: ask a physician of reasonable ability to vaccinate domain subjects within his region to achieve population growth and prosperity in line with the domain's mercantilist agenda. The vaccinators, as we have seen, had different priorities in mind: building public trust in the treatment and preventing greedier competitors from hijacking the technique. Ultimately, however, the two sides were able to resolve their disagreement because they shared the goal of full coverage and because they relied on each other: the physicians on the coercive power of the government and the officials on the physicians’ contacts and expertise.

Officials from the brand-new intendant’s office in Ota might have been forgiven for assuming that Nishikata would fall outside the control of the castle-town-based occupational associations with privileges in the rest of the domain. After all, Nishikata was not part of the territory of Ōno’s beggar boss association, for example, and its village watchmen acted independently from the beggar bosses in the castle town. Nishikata’s sake brewers, too, did not belong to the sake brewers’ guild in Ōno's castle town (Ehlers 2018, 86, 104, 255; Kinoshita Den'emon family archive, docs. 463:307, 464:294, 462:284). 

The vaccinators’ society, however, had separate chapters for each domain, and that meant that exclaves such as Nishikata had to be overseen from the castle town. With Koyama’s operation now terminated, the problem remained of how to achieve coverage in Nishikata. The vaccinators eventually solved this problem by integrating Koyama, this time on their own terms.