epileptic, it will usually have no psychic sexual content, and it will certainly be liable to occur under all sorts of circumstances, when the patient is alone or in a miscellaneous concourse of people.  It will be on a level with the acts of the highly respectable young woman who, at the conclusion of an attack of petit mal, consisting chiefly of a sudden desire to pass urine, on one occasion lifted up her clothes and urinated at a public entertainment, so that it was with difficulty her friends prevented her from being handed over to the police.[63] Such an act is automatic, unconscious, and involuntary; the spectators are not even perceived; it cannot be an act of exhibitionism.  Whenever, on the other hand, the place and the time are evidently chosen deliberately,—­a quiet spot, the presence of only one or two young women or children,—­it is difficult to admit that we are in the presence of a fit of epileptic unconsciousness, even when the subject is known to be epileptic.

Even, however, when we exclude those epileptic pseudo-exhibitionists who, from the legal point of view, are clearly irresponsible, it must still be remembered that in every case of exhibitionism there is a high degree of either mental abnormality on a neuropathic basis, or else of actual disease.  This is true to a greater extent in exhibitionism than in almost any other form of sexual perversion.  No subject of exhibitionism should be sent to prison without expert medical examination.

FOOTNOTES: 

[54] Lasege first drew attention to this sexual perversion and gave it its generally accepted name, “Les Exhibitionistes,” L’Union Medicale, May, 1877.  Magnan, on various occasions (for example, “Les Exhibitionistes,” Archives de l’Anthropologie Criminelle, vol. v, 1890, p. 456), has given further development and precision to the clinical picture of the exhibitionist.

[55] B. Ball. La Folie Erotique, p. 86.

[56] Moll, Untersuchungen ueber die Libido Sexualis, bd. i, p. 661.

[57] “Exhibitionism in its most typical form is,” Garnier truly says, “a systematic act, manifesting itself as the strange equivalent of a sexual connection, or its substitution.”  The brief account of exhibitionism (pp. 433-437) in Garnier’s discussion of “Perversions Sexuelles” at the International Medical Congress at Paris in 1900 (Section de Psychiatrie:  Comptes-Rendus) is the most satisfactory statement of the psychological aspects of this perversion with which I am acquainted.  Garnier’s unrivalled clinical knowledge of these manifestations, due to his position during many years as physician at the Depot of the Prefecture of Police in Paris, adds great weight to his conclusions.

[58] The symbolism of coitus involved in flagellation has been touched on by Eulenburg (Sexuale Neuropathie, p. 121), and is more fully developed by Duehren (Geschlechtsleben in England, bd. ii, pp. 366, et seq.).