For the first two years, Kasahara Hakuō performed vaccinations at a clinic in his own house in Hamamachi, in the townspeople's section of the castle town of Fukui. The struggles of this early period illustrate the importance of scale and the pressure on vaccinators to exercise control over the bodies of patients, to a degree that eventually required the intervention of domain authorities. 
 
This first clinic was extremely small--only 25 tatami mats, seven of which were used for vaccinations, four for examinations, and 14.5 mats as a waiting area for children. The number of patients matched the size of the clinic. Although the clinic was conveniently located in a town of about 33,000 people, initial recruitment of patients was sluggish. In 1850, for example, rumors were spreading in the castle town...add text... 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, Hakuō noted that 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].

Although Fukui's domain government supported Hakuō's initiative, domain physicians initially refused to learn the new treatment and did not actively participate. Therefore, the early clinic was run entirely by Hakuō himself and a number of other town doctors who had joined his newly founded association of vaccinators [provide link]. 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 his private funds, which were dwindling as his income from his original job as a town doctor had dropped. In 1851, Hakuō rang the alarm bells and 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 town children 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.