For the first two years, Kasahara Ryōsaku 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 in perpetuating the vaccine, as measured in the number of accessible bodies that were suitable for vaccinations. They also show the extent to which vaccinators felt pushed to exercise control over the bodies of patients, eventually requiring 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 or 15 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, negative rumors about vaccinations were spreading in the castle town, and public interest waxed and waned throughout the year. The middle of summer and winter and the time around year’s end turned out to be the most difficult times for recruiting children. Kasahara also noted that even children who did appear at the clinic often failed to come back after seven days for examination, transfer, or revaccination.
Although Fukui's domain government supported Kasahara's initiative, domain physicians initially refused to learn the new treatment and did not actively participate. Therefore, the early clinic was run entirely by Kasahara himself and a number of other town doctors who had joined his newly founded association of vaccinators. Kasahara 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, Kasahara could not run the facility without injecting his private funds, which were dwindling as he no longer had much time to practice as a town doctor. In 1851, Kasahara rang the alarm bells and warned domain officials that the vaccine was in danger of going extinct. As Kasahara 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 (Ban 1985, 163-67; Yanagisawa 2019, 52).
This time, Kasahara'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 2019, 52-53).