U.S. patent number 3,830,227 [Application Number 04/857,895] was granted by the patent office on 1974-08-20 for hand-held cardiac sound tone diagnostic device and method.
Invention is credited to Henry L. Green.
United States Patent |
3,830,227 |
Green |
August 20, 1974 |
HAND-HELD CARDIAC SOUND TONE DIAGNOSTIC DEVICE AND METHOD
Abstract
A compact self-contained and completely portable hand-held unit
employs electrical signals generated by the heart to produce
variations in a normally constant or even sound tone produced by
the unit. Every type of heart arrhythmia generates a characteristic
pitch variation or sound tone which can be readily recognized by
the physician for cardiac diagnosis. The unit embodies plural
spaced electrodes which are simply pressed against the patient's
chest without the necessity for any external electrical
connections.
Inventors: |
Green; Henry L. (Southfield,
MI) |
Family
ID: |
27069526 |
Appl.
No.: |
04/857,895 |
Filed: |
September 15, 1969 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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550666 |
May 17, 1966 |
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Current U.S.
Class: |
600/514 |
Current CPC
Class: |
A61B
5/332 (20210101); A61B 7/00 (20130101) |
Current International
Class: |
A61B
5/0404 (20060101); A61B 5/0402 (20060101); A61B
7/00 (20060101); A61b 005/04 () |
Field of
Search: |
;128/2.5P,2.5D,2.5S,2.5T,2.6A,2.6K,2.6E,2.6F,2.6R,2.1R |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
Smyth et al., "British Medical Journal" Oct. 25, 1958, pp.
1005-1009. .
Hagan et al., "American Journal of Medical Electronics" Apr.-June,
1963, pp. 147-151..
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Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Brady, O'Boyle & Gates
Parent Case Text
This application is a continuation-in-part of prior copending
application Ser. No. 550,666, filed May 17, 1966, for CARDIAC
MONITORING DEVICE, now abandoned.
Claims
I claim:
1. An on-the-spot method of diagnosing cardiac arrhythmias
comprising the steps of generating an audio frequency signal,
receiving electrical signals generated by the heart and amplifying
said signals, frequency modulating the generated audio frequency
signal with said amplified electrical signals, transducing the
frequency modulated signals to produce a variable frequency audible
tone whose frequency will vary automatically in response to changes
in the amplitude of the electrical signals generated by the heart,
and listening directly with the human ear to the variations in said
audible tone due to variations in frequency of the audible signal
to directly detect and analyze cardiac arrhythmias at the patient's
side from the variations in the audible tone.
2. An on-the-spot cardiac diagnostic method comprising the steps of
generating a normally even and unvarying sound tone, receiving and
amplifying electrical signals generated by the heart and allowing
variations in the heart generated signals to alter the frequency of
the sound tone at intervals responsive to the action of the heart,
and listening directly with the human ear to the changes in the
sound tones to effect the direct diagnosis of said cardiac
arrhythmias from the changes in the sound tones at the patient's
side.
3. A cardiac diagnostic apparatus comprising a completely
self-contained electrical battery-powered, portable, hand-held unit
including a housing, electrical means in said housing producing a
normally even and unvarying audible tone, said housing having a
generally flat bottom wall portion, three electrodes projecting
substantially equidistantly from said bottom wall portion and
arranged in triangular configuration thereon to thereby physically
stabilize said housing in free-standing relation while directly
engaging the chest of a patient to receive and conduct electrical
signals generated by the heart, amplifier means in said housing
connected to said three electrodes to receive and provide at an
output amplified electrical signals generated by the heart, said
output connected to said electrical means to produce variations in
said audible tone with said amplified electrical signals generated
by the heart, said housing having another wall portion with an
aperture therethrough, audio transducer means connected in said
housing to said electrical means to receive and transmit said
variations in said audible tone through the aperture in said
another wall portion, whereby said variations in said audible tone
are representative of cardiac arrhythmias thereby enabling a
physician hearing said audible tone variations to directly diagnose
said arrhythmias at the patient's side.
4. The structure of claim 3, and said electrodes being blunt, wide,
rigid pin elements and having wide skin contact faces to assure
firm and adequate electrical contact with the chest wall of the
patient.
5. The structure of claim 4, and said electrodes projecting
approximately three-quarters of an inch beyond said bottom wall
portion of said housing to enable all of the electrodes to firmly
engage the patient's chest irrespective of chest curvature and
flesh irregularities.
6. The structure of claim 3, and the intermediate electrode in the
triangular configuration being a grounding contact, and said other
two contacts spaced apart approximately 4 inches.
7. The structure of claim 6, and said wide skin contact faces of
the electrodes being roughened.
8. The structure of claim 3, and said transducer means being a
loudspeaker.
Description
This invention relates to a device and method for diagnosing heart
arrhythmias through variations in sound tones.
A variety of methods have beem employed for detecting and analyzing
heart rhythm. Actual heart sounds may be monitored by a stethoscope
or they may be amplified through various electronic means.
Electrical potentials generated by the action of the heart may be
monitored by electrocardiagraphic methods. In such a technique,
electrodes are fastened to the skin of the patient, and the
voltages generated by the action of the heart are recorded on a
continuous roll of graph paper by a galvanometer stylus which
deflects in proportion to the voltage signal. Alternatively, the
signal picked up by the electrodes can be fed into an oscilloscope
to provide a visual display of heart voltage.
Although the electrocardiograph provides the most complete
information, several disadvantages are inherent in its use. The
equipment is somewhat bulky, and is therefore difficult to
transport. It is impossible for a doctor to carry one in his bag
when he is out on calls or making hospital rounds. If a hospital
patient is not in a recovery or emergency room, there may be a
time-consuming delay before an electrocardiograph can be brought to
him. Furthermore, several minutes are generally required to connect
the machine to the patient and set it into operation. The delays
can be crucial in emergency situations.
To overcome these disadvantages of the electrocardiograph, various
portable devices have been developed. However, such devices do not
provide the qualitative information which is often essential, but
may simply produce a flashing light or an audible beep to represent
the heart beat rate.
Accordingly, it is an object of this invention to provide a
completely portable cardiac diagnostic device which produces
qualitative as well as quantitative information and which enables
the physician to distinguish among a variety of forms of heart
arrhythmias.
It is a further object of this invention to provide a cardiac
monitoring device which is capable of producing a signal without
need of the time-consuming connection of electrodes to the
patient's body.
It is another object of this invention to provide an improved means
for monitoring and analyzing heart rhythm which is inexpensive to
produce and simple and reliable in operation.
It is another object of this invention to provide a cardiac
monitoring device which is protected from strong currents used for
restoring normal heart rhythm.
Other objects, advantages and novel features of this invention will
become apparent from the following specification, when considered
in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF DRAWING FIGURES
FIG. 1 is an electrocardiogram fragment produced by a normal
heart.
FIG. 2 is a perspective view of the cardiac diagnostic device of
this invention, the device being inverted to reveal the
electrodes.
FIG. 3 is a perspective view showing the device in place on the
chest of a patient.
FIG. 4 is an enlarged vertical cross section through the
device.
FIG. 5 is a block diagram of the electrical system embodied in the
invention.
FIG. 6 is a circuit diagram of the device embodying this
invention.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENT
Briefly stated, the technique of cardiac diagnosis contemplated by
this invention comprises the production of a clearly audible signal
or tone which is frequency or pitch modulated in response to the
voltage generated by the heart. The device normally generates a
steady, plainly audible, sound tone of constant pitch. When the
heart signal is superimposed upon this steady pitch, the waves or
fluctuations which appear on the conventional electrocardiograph
will appear as variations in the frequency or pitch of the sound
tone produced by the device. Thus, the device produces a tone
pattern which can be audibly analyzed to identify and diagnose
various known types of heart arrhythmias.
FIG. 1 represents the electrocardiogram produced by a normal heart.
It comprises a series of peaks and valleys corresponding to the
voltage generated by the myocardium (heart muscle), each deflection
of the stylus of the electrocardiograph being proportional to the
amplitude of the corresponding voltage signal. The principal normal
waves of the characteristic electrocardiograph are generally
identified in the art by the letters P, Q, R, S and T as shown in
FIG. 1. The P wave represents the depolarization of the auricles.
The QRS complex represents the depolarization of the ventricles,
while the T wave represents the repolarization of the ventricles.
For diagnostic purposes a physician is concerned not only with the
pulse rate of the patient, but also with the individual rates of
auricular and ventricular contraction, the regularity and
relationship of these rates to one another, and the shapes of these
complexes.
Referring now to FIGS. 2 and 3 of the drawings, the cardiac
monitoring device 10, which I call an Electrocardiophone, generally
comprises a casing 12 to which are rigidly fixed electrodes 14, 16
and 18, in the form of blunt, rigid pin elements of considerable
width. Like the electrocardiograph, the Electrocardiophone is
sensitive to voltage changes at the body surface. The spacing
between the electrodes 14 and 16 has been selected as approximately
four inches, this being considered the minimum distance for easily
measuring the difference of potential between two points on the
surface of the skin. The length of the electrodes must be
sufficient, taking into consideration the curvature of the chest
surface, to prevent contact between casing 12 and the chest of the
patient. A length of approximately three-quarters of an inch is
considered adequate to assure firm contact.
The diameter of the electrodes is preferably a minimum of
five-eighths of an inch, so as to provide sufficient contact area
to prevent discomfort to the patient. For this purpose, the
electrodes may also be provided with hemispherical tips. The tips
of the electrodes are preferably knurled, so that if conductive
paste is used it may be applied directly to the electrodes and then
the electrodes rubbed against the skin to achieve the desired
abrading of the skin. This saves the separate step of roughening
the skin prior to application of the instrument, and permits the
use of non-abrasive pastes.
The third electrode 18 serves a dual purpose. It functions as a
ground to provide improved electrical stability and also as a third
supporting leg to permit the device to be self-supporting, or
physically stabilized on the patient's chest.
FIG. 5 is a block diagram of the electrical componnt stages of an
embodiment of the invention in which electrical voltages generated
by the heart are coupled to a limiter stage 22 via the electrodes
14, 16 and 18. The output of the limiter is presented to a
differential amplifier 24, a further stage of amplification 26, and
thereafter to a voltage sensitive oscillator circuit 28. The
oscillator output is suitably coupled to the speaker 20.
The limiter stage 22 serves to protect the Electrocardiophone if it
should be left on the chest during the application of a high
voltage shock for the restoration of normal heart rhythm.
Differential amplifier 24 is an amplifier which rejects voltage
signals occurring simultaneously between ground electrode 18 and
each of signal electrodes 14 and 16, while signals occurring out of
phase at both electrodes 14 and 16 will be amplified by the device.
The output of the differential amplifier 24 is typically of the
shape shown in FIG. 1. This cardiac signal is thereafter further
amplified in amplification stage 26.
The output of amplifier 26 is presented to the voltage variable
frequency oscillator 28. The oscillator, without an input signal
present, will generate a frequency well within the audible range,
for example 800 cycles per second. These signals are coupled to
speaker 20, which transduces the electrical energy to an audible
signal or sound tone of constant frequency or pitch. When input
signals are presented to the oscillator, the frequency of
oscillation will vary in direct proportion to the value of the
signal. Thus, an audible change in frequency will be evident to the
listener in the form of an audio representation of the voltage
generated by the heart.
Referring now to FIG. 6 for a detailed consideration of circuitry
employed in this embodiment, the electrical cardiac signals are
obtained directly from electrodes 14 and 16; electrode 18 providing
a ground or reference. These signals are fed from electrodes 14 and
16 to the differential amplifier inputs via coupling capacitors 30
and 32, respectively. The diodes 34, 36, 38 and 40, serve to limit
the signal to those less than a predetermined amplitude, to protect
the remaining circuitry in the device from strong currents which
might accidentally be applied to the input electrodes 14 or 16.
That is, the threshold value of the diodes is such that until they
are rendered conductive, all signals will pass through the coupling
circuit to the input terminals of differential amplifier 24. Once
the threshold value is exceeded, for example by signals of one volt
or more, and depending upon the polarity of the signal, one of
these diodes will appear as a short circuit and the signal will
pass between signal electrode 14 or 16 and ground electrode 18.
The differential amplifier 24 consists of a matched pair of
transistor amplifiers 42 and 44. The collector electrodes are
suitably biased from the B+ bus via dropping resistors. The base
electrodes are provided a biasing potential via fixed resistors 46,
48 and 50 and an adjustable resistor or potentiometer 52. The
emitter electrodes are tied together and connected to a further
transistor 54, as shown.
A differential amplifier is simply an amplifier which amplifies the
difference between input voltages and transmits such differences.
Thus, identical signals from electrodes 14 and 16 are not passed by
the amplifier and signals occurring out of phase are passed or
transmitted to the next circuit component.
The major limitation to the ultimate sensitivity of a direct
coupled amplifier is the drift caused by variation of transistor
bias as the temperature changes. The amplifier controls drift by
equal drift of both transistors thus extending the sensitivity of
the device by many orders or magnitude. Two matched transistors 42
and 44 are used to achieve equal thermal conditions.
To assure proper and identical biasing, the collector 42 may be
preset in transistor 41 via potentiometer 52 to equal the current
at the collector of transistor 44. Obviously, either or both
resistance components 46 and 52 could be made adjustable.
One of the more important features of a differential amplifier as
mentioned in conjunction with the description of the block diagram
is common-mode rejection. Theoretically if all conditions are
perfect, an equal or common mode voltage on both inputs would
produce no output signal. This may be closely approximated by
placing a constant current source between the junction of the
emitters and ground. Therefore, transistor 54, which behaves as a
constant current source, is placed in this position. The most
common source of noise, 60 cycle per second electrical power
signals, and other stray radiation which are inductively coupled to
the device, is thereby eliminated.
The output signal from the device is thereafter coupled to a
further stage of amplification 26 via a suitable coupling
capacitor. This stage of amplification consists of a conventional
transistor amplifier 56 having a feedback capacitor 58 between
collector and base.
The capacitor 58 functions as a negative feedback path at higher
frequencies to progressively attenuate such frequencies. This
serves to further eliminate noise signals and allows the lower
frequency heartbeat signal to pass therethrough.
The bias to the transistor 56 is provided via a potentiometer or
adjustable resistor 60, thereby allowing the transistor to be
properly biased.
The original heartbeat signal, as limited, filtered and amplified,
is applied to the voltage sensitive oscillator 28 via a coupling
capacitor. The oscillator 28 is a conventional capacitor
cross-coupled astable or free-running multivibrator consisting of
transistors 62 and 64, the base to collector junctions of which are
cross-coupled by capacitors 66 and 68, respectively.
When the multivibrator is operating, transistors 62 and 64 are
alternately conducting and non-conducting. The voltage at the base
of transistors 72 and 74 determines the collector current in each
of these transistors. If 62 is on and 64 is off the collector
current of 74 discharges capacitor 68 until the base of 64 becomes
forward biased relative to the emitter. At this time 64 switches
on, turning off transistor 62. The function of the collector
currents of 72 and 74 are then interchanged. The collector current
of 74 keeps transistor 64 on. The collector current of 72
discharges capacitor 66 until the base of 62 becomes forward biased
relative to the emitter. At this time 62 switches on, turning off
transistor 64. The cycle is repeated indefinitely. The time between
successive cycles is determined by the values of the coupling
capacitors 66 and 68, the resistors between the emitters of 72 and
74 and B+, and the instantaneous voltage at the base of 72 and 74.
With no current input from the amplifier stage 26, a constant audio
frequency output is generated over output lead 70. This frequency
is determined by the voltage on the bases of transistors 72 and 74
due to the setting of potentiometer 76. Voltage from amplifier
stage 26 adds to or subtracts from the voltage on the bases of the
transistors set by potentiometer 76. This addition or subtraction
modulates the output frequency.
The output signal over lead 70 is coupled to speaker 20 via output
transformer 78. The volume is made adjustable by potentiometer
80.
In my Electrocardiophone, the qualitative analysis of the voltage
signal generated by the heart is achieved not by visual inspection
of the deflection of an electrocardiograph stylus, but rather by
variations in the frequency or pitch of the audible tone produced.
That is, the steady tone normally produced by the device,
preferably about 800 cycles per second, is frequency modulated in
response to the superimposed voltage produced by the action of the
heart. A signal is thereby produced which could be described as a
melody. An increase in voltage produces a rise in pitch, while a
drop in voltage lowers the pitch. The Electrocardiophone is
calibrated to produce a signal or tone which varies approximately
two octaves in putch, or about one octave per millivolt of voltage
variation at the body surface. Normal heart rhythm and each of the
simple arrhythmias have their own characteristic melody or tone
when monitored by the Electrocardiophone. Because of the detection
ability and the memory potential of the human hearing system. the
very striking and vivid tone patterns produced through the
Electrocardiophone by these various heart rhythms may be readily
learned and identified by a physician.
When compared with the transient visual display produced by a
deflecting needle or a flashing light, the frequency modulated tone
is extremely effective in transmitting heart data. The human ear is
quite sensitive to pitch and rate variations in the range here
involved, while the eye is relatively unable to follow and
distinguish fluctuations in light intensity occurring at this
rate.
The P wave produces a very brief and relatively small upward
deflection or rise in pitch of the base tone. The QRS complex
produces a very distinctive chirp or squeak sound. The T wave
generates a sound which is readily distinguished by its relatively
long duration and greater frequency change than that of the P
wave.
A very simple use of the Electrocardiophone is in the
differentiation of ventricular fibrillation from asystole.
Ventricular fibrillation occurs when the normal rhythmical
contractions of the ventricles are replaced by rapid irregular
twitchings of the ventricular muscule wall, and presents an
electrocardiographic pattern of an undulating line rather than a
more conventional looking electrocardiogram. Asystole is cardiac
standstill or the absence of heart contractions, and presents an
electrocardiographic pattern of a straight line. The corresponding
Electrocardiophone responses are a warbling tone for ventricular
fibrillation and an unmodulated steady tone for cardiac standstill
(asystole). This differentiation is readily made by even fairly
unskilled personnel using the device of the invention. In
performing cardiac resuscitation, the Electrocardiophone permits
immediate diagnosis of the situation as cardiac arrest or
ventricular fibrillation. This differentiation is most urgently
needed un the situation of cardiac arrest, and the device of the
invention performs better in making this differentiation quickly
than any other existing instrument. Seconds count in such
circumstances. Application of the stethoscope or feeling the pulse
would reveal no cardiac activity whether this was due to
ventricular fibrillation or cardiac standstill, and no
differentiation could be made with these means.
If countershock (defibrillation) is applied without having an exact
diagnosis of the situation of the heart, and it turns out that the
heart is in asystole, this treatment cannot benefit the patient and
in the opinion of most people it would reduce the possibility of
survival of the patient. This exact diagnosis can be made with
application of an oscilloscope or electrocardiograph but this
wastes a good deal of vital time and such bulky and expensive
equipment is not always readily available. With the small portable
device of this invention the differentiation can be made in a few
seconds so that countershock can be effectively used or withheld,
thus preventing possible detrimental effects resulting from
application of unappropriate treatment when the exact condition of
the heart is not known, and enabling the vital seconds to be
effectively used for appropriate treatment.
Premature beats are easily identified as supraventricular or
ventricular in origin by the characteristic tone or pitch patterns.
That form of rapid heart beating known in the art as
supraventricular tachycardia produces a rapid, perfectly regular
tone pattern which is monotonously similar from cycle to cycle.
Ventricular tachycardia differs in that the cycle lengths generally
are lees uniform and the QRS and T signals are less uniform from
moment to moment. In some cases P signals can be recognized
sporadically between the ventricular signals.
Atrial flutter waves result in a tremolo quality of the base
requency produced by the Electrocardiophone. Atrial fibrillation
also induces a quivering quality, but it is less marked and more
variable from moment to moment.
In complete heart block the P signals can be heard and counted
independently of the QRS and T signals. If a Pacemaker is in use
its impulses are heard as clicks or squeaks. The relationship of
Pacemaker signals to ventricular activity and the condition of the
Pacemaker may be easily determined. Advanced first degree block and
second degree heart block have also been diagnosed with the
Electrocardiophone.
Artifacts or spurious signals are rarely a problem with the
Electrocardiophone. Somatic tremor is minimized by the precordial
application, but can occasionally be heard as a "hoarse" or impure
quality of the base frequency, quite different from any of the
patterns described above. Respiratory variation is slight unless a
positive pressure breathing device is being used. The effect is
merely that of transposing the tone patterns as the diaphragm
moves. Sixty cycle interference, recognizable as a "hoarse"
quality, can be minimized by good skin contact. Also poor skin
contact can produce an interrupted or irregular tone of reduced
amplitude. Although the device works best when a conductive paste
is applied to the skin, this is not essential.
The rigid electrodes permit rapid application of the instrument to
the patient. No straps need be connected, but rather the electrodes
are merely set firmly against the chest of the patient. These
electrodes are each provided with a transverse hole 82 near their
tips so that conventional limb electrodes can be easily connected
by means of banana plugs. The conventional electrode is so
connected when the chest of the patient is inaccessible due to
cardiac massage or covered with bandages which would prevent the
establishment of an adequate electrical contact. The conventional
electrodes also enable the device to be used to monitor cardiac
activity during surgery and during transportation of the patient
where the device itself might otherwise fall off the patient's
chest. These holes are also used for the connection of a
pre-amplifier when the device is used for monitoring brain signals.
As above described, the knurled roughened tips 84 of the electrodes
speed up and improve the establishment of proper electrical contact
with the skin, and eliminate the need for a grit-containing
paste.
As can be seen from FIG. 3 of the drawings, the size of the
Electrocardiophone (approximately 6 .times. 21/2 .times. 11/2
inches) permits it to be readily portable and held in one hand. It
may, therefore, be carried about by a physician in his medical bag
when he is on calls or making hospital rounds. The low cost of the
instrument makes it economically feasible for a hospital to have a
sufficient supply on hand so that no delay would be incurred in
bringing one to a patient in an emergency. The very compact and
lightweight nature of the device further permits it to be carried
with a patient while he is in transit, as between an ambulance and
the emergency room, or between surgery and a recovery room, so that
his heart action may be continuously audibly monitored, the sound
being loud enough so that it can be easily heard at a substantial
distance.
The production of a qualitative audible tone permits a patient's
heart action to be transmitted by telephone from the hospital to
the doctor's office or a central monitoring station, by merely
holding the telephone receiver adjacent the output loudspeaker 20
in housing 12 with the housing resting on the patient's chest.
A variety of additional features have been incorporated into the
basic Electrocardiophone as accessories. A "translator" comprising,
for example, a microphone and conversion unit is utilized to
convert the audible output of the Electrocardiophone into an input
for a conventional electrocardiograph to permit more thorough
analysis of complex heart signals. Alternatively, a jack 86 is
provided in the casing to permit direct pick-up of a signal
suitable for the input of the conversion unit. The same jack is
used for connecting a tape recorder to the Electrocardiophone to
permanently record the audible signals, and also as a connection
for stethophones.
Another accessory which may be employed is a counter for
continuously indicating the pulse rate. Since the P waves do not
always occur at the same rate as other constituent waves in certain
abnormal heart rhythms, the counter would be combined with a
selector switch and a frequency responsive filter network for
permitting the physician to have a rate readout of the various
constituent waves.
An important additional application of the device of this invention
as a means for producing audio-electroencephalograms. The same
basic unit could be employed with the addition of a further
amplification stage. Such a unit would be usable to provide a rapid
means for distinguishing between epileptic seizures and hysterical
or other types of fits. It could also be used to ascertain the
presence or absence of brain activity during cardiac arrest, so
that futile lengthly attempted resuscitation might be avoided.
Referring to FIG. 4, additional details of the apparatus unit 10
are shown. These details include a divider wall 88 within the
housing 12 forming an end compartment 90 for a suitable battery 92
secured by a removable cover section 94 held in place by a thumb
screw 96 which also engages the edge of main cover plate 98
carrying electrodes 14, 16 and 18, as shown. The main cover plate
98 is further secured by screws 100 which may engage within
conventional adjustable screw-threaded insulating spacers or
stand-offs 102 whose opposite ends are suitably anchored to the
casing or housing 12.
Within the main compartment of the housing separated from the
battery compartment 90 is a printed circuit board 104 supported by
the stand-offs 102 and having a printed circuit layer 106 on one
face thereof. The various electrical components detailed in FIG. 6
are disposed in the zone indicated by the phantom lines 108 at the
rear side of the printed circuit board. Other details of the unit
are conventional and unimportant to a full understanding of the
invention.
* * * * *