Managing Space and Time Inside the Clinic
A floor plan of the new clinic in Shimo-Edomachi was discovered among the materials of a domain doctor of Hikone domain [Umihara]. When read in combination with a manual on vaccination procedures (Koshi no mae shū jotōkan tetsuzukisho) from the same archive, this plan reveals that the rooms in the clinic were laid out to support the sequence of treatments [Yanagisawa]. The vaccinators also kept meticulous records on every child to convey information to other teams of vaccinators who worked in different rooms of the clinic or on different days. Anxious to avoid mistakes that could damage the vaccine’s fragile reputation, they inscribed the biological rhythm of the vaccine both into their books and into the floor plan of their clinic. (Hover over the image to explore the floor plan.)
Incoming children were all registered upon arrival and divided into three groups: those to be vaccinated; those vaccinated seven days ago who could serve as "pox bases"; and those vaccinated ten or more days ago, who reappeared for examination and if necessary revaccination. Every child was first sent to the collective waiting room (the so-called sō-damari), but was then classified by group and sent along a different sequence of rooms. The first group, for example, received a yellow sash and went to the upper examination room marked by a yellow flag, and from there on back to the waiting room to wait for vaccination. The second group received a red sash and was sent to the middle room before going back to the waiting room. Guards were posted on the doors of the waiting rooms to keep the children and their caregivers in place. For vaccination, helpers summoned unvaccinated children and "pox bases" in groups of ten each to the vaccination room, where . At every step of the way, secretaries
The third group went to the lower examination room. After vaccination, parents received a paper ticket indicating the date of their child's follow-up visit, as well as an instruction sheet for aftercare at home [Umihara, Yanagisawa].
Even after the smallpox epidemic of 1852/53, which had boosted the popularity of vaccinations, the mobilization of children for vaccinations required a certain degree of persuasion and coercion. Upon Kasahara Ryōsaku's urging, the town governor of Fukui ordered each town section to keep twelve unvaccinated children at hand for times of storm, fire, mid-summer and mid-winter as well as year’s end to help vaccinators “connect” the vaccine while public interest was low. Physicians regularly surveyed the clinic's records to identify children who had failed to show up for their second appointment. At the clinic, guards prevented anyone without an exit pass from leaving the building to make sure that children designated as "pox bases" would not go home before accomplishing their purpose [Umihara, Ban].
Also note how the status distinction between town and domain physicians manifested itself in the floor plan of the clinic.