I have never reviewed a book published posthumously. I believe it places the reviewer in a special position in relation to the author; hence, I've chosen to write it as an engagement with a text that could have been rather than an exhaustive treatment of the text that remains. As the exceptional note before the table of contents alerts readers, Dr Sherry Sayed Gadelrab died of kidney failure in the summer of 2013 in Egypt, but only after defending her PhD dissertation at the University of Exeter in 2012. She had had two kidney transplants during her teen years. I never met the author, but I could feel her presence on every page. Indeed as the foreword notes, her legacy – one I imagine in which life's value and fragility were never taken for granted – lives on in this work.

Medicine and Morality in Egypt: Gender and Sexuality in the Nineteenth and Early Twentieth Centuries strives to capture a fundamental truth of life: that its living is always shot through with historical formations of knowledge that are not simply ours to control even as we are their creators. The swirling eddies of knowledge in which we are caught up and which bind each of us to the other can enrich or impoverish life, make it secure or vulnerable, render it unbreakable or very fragile, depending on what we do with all that knowledge from one moment to the next. This is the subtle lesson of “discursivity” that is often missed by less able interpreters of Michel Foucault. Following in the latter's footsteps, in her work, Gadelrab struggled to demonstrate how this lesson applies to life's most essential and ostensibly least discursive function – sex – in the specific contexts of Islamic and Middle Eastern history.

Acknowledging that the field has been well ploughed though not exhausted by scholars before her, Gadelrab draws extensively from and builds on previous work in two ways. First, she offers a broad overview of what we have learned so far from ancient Greek approaches to the sexed and gendered body, through medieval Islamic developments in medicine, to modern and colonial scientific deployments of gender and sexuality. Second, seemingly conscious of the contemporary entanglements of the body with repressive regimes of truth and power that had their origins in colonialism, she opts for a connected history of modern discursive formations of gender and sexuality. Here, her intimacy with the Egyptian social and cultural context is made vividly clear in the way she is able to navigate between the extremes of blaming colonialism for all the ills of modern Egypt and completely effacing its role in shaping modern life globally.

To that end, chapters 2 to 5 are organized around themes that became salient globally in the nineteenth century as states took more solid shape in and through the targetting of populations for improvement and better management. And in turn, representatives emerged from the latter to make claims of various kinds about the life of the body – social, political, religious, etc. She tracks first the “professional medical discourse on sex and sexuality” over a century extending from 1827 to 1928.

The start date was pegged to Mehmed Ali's establishment of Egypt's first medical school at Abu Za'bal under the direction of the Frenchman Clot Bey. The reason for choosing to end with 1928 is less clear to this reader, unless it is simply used as a century marker. The evolution of Egyptian medical discourse is plotted in relation to Egypt's growing domination by European powers economically and soon politically. The influence of Clot Bey is clearly presented, as is the creative adaptation of modern medical science by Egyptian doctors. However, Gadelrab does not shy away from the pernicious effects on “morality” that this encounter and engagement had. Put in other terms, modernity in a place like Egypt, subordinated to the West, entailed the transformation of a vibrant pre-modern fluidity of gendered and sexualized bodies into a more rigid regime focused on the reproduction of healthy, normal bodies for larger political and economic ends. The example that makes this point most vividly is that of female masturbation, which was prescribed by medieval Muslim physicians to calm women and was taken up by modern Western doctors as a treatment for hysteria (which led to the invention of the vibrator) but was rejected by Egyptian doctors in the late nineteenth century as culturally unsuitable.

In this chapter and those that follow it is the morality that emerges at the intersection of modern universalizing medical, legal and cultural discourses that concerns Gadelrab; because it is that morality and not some medieval one that continues to plague the present with its puritanical and purifying rhetoric of identity and difference. However, her careful attention to openings and possibilities helps her find kernels of that which was positive from the distant Islamic past even under the asymmetric conditions of colonial modernity that enabled the circulation of claims of incommensurability. The prime example of this was in chapter 4, on fatwas, wherein she draws out the conservativeness of Rashid Rida while simultaneously excavating his longing for an Islamic past in which sex was not categorically a problem, as Western thought had made it, but rather a God-given occasion for joy and pleasure.

The book as it is, bursting with ambition and tremendously wide in scope, has many weaknesses as such books often do, but the book that I have imagined Sherry Sayed Gadelrab to have completed – based on moments of exceptional clarity, nuance and insight that are indeed to be found in the text that exists – is a brilliant work that is a testament to a mind finely attuned to the ephemerality and vulnerability of biological life. It is also a work that displays the persistence and in some ways the historical immutability of formations of gender based on human assumptions or scientific truths about sexual differences – formations yet to be overcome.