After the retransmission of 1850, Ōno’s vaccinators were determined not to let the vaccine go extinct a second time. In 1851, Tsuchida Ryūwan, Hayashi Unkei, and Nakamura Taisuke built a vaccination clinic in the Ichibanmachi neighborhood in the castle town, using money granted for that purpose by the lord. Until that point they had conducted vaccinations at their homes, taking turns on a monthly basis ["Ryūin Kiji," Ōno shishi, Shiryō sōkatsu-hen]. Little is known about the internal workings of that clinic, but it did create a hub for the vaccination program and facilitated visits at least for children in the castle town and its immediate vicinity.
Compare with the vaccination clinic in the castle town of Fukui.
Yet the number of volunteers remained low, and towards the end of 1851 the supply was once again on the verge of extinction. The domain government reacted by issuing another edict to advertise Motodo’s case and announce a survey of all unvaccinated children in the domain. As the edict stated, “[t]he lord’s intention is to prevent extinction by making it so that in case the vaccine seems to be going extinct, the three doctors can summon people by name and administer the treatment.” Similar systems of vaccination by appointment were developed in other Echizen castle towns such as Fukui and Sabae to perpetuate the vaccine through times of low interest, based on surveys through village or town officials [Yanagisawa 2019, 2020]. The edict also reassured poor parents that the lord had ordered the physicians to vaccinate their children free of charge [“Shutō shōrei ni tsuki furegaki,” 1851, in Fukui kenshi, Shiryō-hen 7, 458–59].
In subsequent years, the domain increasingly relied on coercion to mobilize sufficient numbers of children. In 1852, after a consultation with his doctors, lord Toshitada decided to make vaccinations compulsory for castle town residents. Doctors were to vaccinate all eligible children from every block association (chō; the basic administrative unit in Japanese towns of the Tokugawa period), and chō officials were asked to facilitate the process by applying pressure on reluctant parents [Town elders' journal of 1852.4.28; House journal of the Nojiri family of 1852, fourth month, both in Ōno shishi, vol. 9: Yōdome-hen, 734–735]. By 1855, parents of unvaccinated children were being punished with house arrest if their offspring was found out to have contracted the disease, and chō officials faced punishment if parents within their block neglected to report for vaccinations. The government also disciplined town children who vandalized the sign in front of the vaccination clinic [Town elders' journal of 1855.4.11, 8.8, in Ōno shishi, vol. 9: Yōdome-hen, 782–783; 1856.9.16, 10.21, in Ōno shishi, vol. 9: Yōdome-hen, 792–793; Iwaji, Ōno-han no yōgaku, 69].
In late 1857, the lord moved beyond smallpox vaccinations and announced the establishment of a hospital—referred to as byōin (the emerging modern Japanese term for "hospital") or Saiseikan ("House of Revitalization")—in Ichibanmachi, one of the central town neighborhoods (see it depicted on the town map at the top of this page). The new facility offered medical treatment to domain subjects of all social backgrounds, including the poor, whom it treated free of charge. One purpose of the hospital was to serve as a training site to improve the skills of local doctors, who were no longer allowed to operate on domain territory without the hospital's approval. The domain also ordered townspeople and villagers to report all cases of cholera and smallpox to the hospital so that sufferers of infectious disease could receive proper instruction. The hospital thus became the centerpiece of the domain's emerging public health care system and an important part of its mercantilist reform. But it took subjects considerable time to embrace this coercive program. As late as 1859, the domain government complained about ungrateful and ignorant subjects, who refused to understand the lord's benevolent intentions behind the vaccinations and the clinic. At the same time, even subjects of other domains seem to have visited Ōno's clinic to obtain vaccinations by 1860 [Ehlers, Give and Take, 257-259].