Stone referred to the state that sister Anjali was in as coma vigil and subsultus tendinum(typhoid state) but states also that he does not know much of "medical matters" he is a surgeon. Coma vigil means that the victim has a lesion that disconnects the cerebral hemispheres from all areas lower than the oculomotor nucleus in the brain stem(sourve). Subsultus tendinum (muscle twitches) are a twitching of tendons also common in fever. This is a social determinant for him because with more knowledge he may have been better able to diagnose and treat sister Anjali. Another social determinant is that many of the passengers on board were not used to life on a ship. Their bodies and immunes systems not equipped to withstand diseases and viruses in which they face. If only they were equipped back then with simply just that of knowledge of the diseases could have maybe helped prevent such outbreak. I think the biggest social determinants were knowledge and lack of equipment in this particular place in the novel. Medicine now also has so much advance that could have saved lives in this