The Spanish influenza reached Rochester in September 1918. Rochester General and other area hospitals were caught shorthanded with many of the graduate nurses working in American Red Cross military hospitals outside the area. Hospital nursing and medical staffs had been reduced to student nurses and interns. Exposure to patients stricken by the disease further reduced the remaining staff.
The operating rooms were closed "on account of the danger of contamination." The fifth floor was converted into an influenza ward along with one of the medical annexes in the rear of the hospital. Beds were set up in every available space to handle the increased patient load. Before the end of the epidemic some five months later, over 870 patients would be treated including 80 students. Some 160 patients died from the flu or pneumonia related causes. Miss Keith reported at the height if the epidemic that there were, "310 patients in the Hospital . . . 25 more than ever before. Out of this number 120 have influenza or pneumonia, 40 men in one ward, nine deaths in twelve hours."
Volunteers from the Twigs and Women's Board filled in where needed; in the laundry, the kitchens, registering patients, acted as secretaries, or helping with the ambulance work. They sat night duty in the influenza ward, volunteered for both day and night duty five days a week for five months in the men’s and women's wards. These volunteer aids became the nucleus of today's Volunteer Service.