At the time, he had his first confrontation with Spanish authorities, since Betances gave last priority of medical treatment to those Spanish-born military rank and officers who were affected by the disease (they demanded preferential and immediate treatment, and he openly despised them for it). For his hard work to save many Puerto Ricans from the ravages of the cholera epidemic of 1856, Betances was commended by the city's government. However, when the central government established a Chief Surgeon post for the city, Betances (who was the acting chief surgeon) was passed over, in favor of a Spanish newcomer.