U.S. patent number 3,888,240 [Application Number 05/468,137] was granted by the patent office on 1975-06-10 for electrode assembly and methods of using the same in the respiratory and/or cardiac monitoring of an infant.
This patent grant is currently assigned to Survival Technology, Inc.. Invention is credited to Herbert E. Reinhold, Jr., Richard B. Toren.
United States Patent |
3,888,240 |
Reinhold, Jr. , et
al. |
June 10, 1975 |
Electrode assembly and methods of using the same in the respiratory
and/or cardiac monitoring of an infant
Abstract
A disposable electrode assembly and method of using the same in
the respiratory and/or cardiac monitoring of an infant comprising a
pad or very fine open pore polyurethane providing an infant back
receiving area of approximately 41/2 inches by 41/2 inches on which
a plurality of separate flexible carbon powder impregnated
polyvinyl chloride sheet electrodes are affixed in
surface-to-surface engagement so as to be intimately contacted by
the skin of an infant's back received on said back receiving pad
area. The pad has portions converging outwardly from opposite sides
of the back receiving area for extending generally beneath the
armpits and along the lower edge of the rib cage of an infant where
they are held to the sides of the infant's torso by integral pad
straps releasably adjustably secured together across the infant's
chest above the belly area by Velcro fastener elements. Snap
fastener terminal elements are provided for effecting a detachable
electrical connection with the leads of the monitoring
instrument.
Inventors: |
Reinhold, Jr.; Herbert E.
(Rockville, MD), Toren; Richard B. (Rockville, MD) |
Assignee: |
Survival Technology, Inc.
(Bethesda, MD)
|
Family
ID: |
27032538 |
Appl.
No.: |
05/468,137 |
Filed: |
May 8, 1974 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
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440750 |
Feb 8, 1974 |
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Current U.S.
Class: |
600/390; 600/536;
600/393; 600/508 |
Current CPC
Class: |
A61B
5/282 (20210101); A61B 5/6831 (20130101); A61B
5/113 (20130101) |
Current International
Class: |
A61B
5/0408 (20060101); A61B 5/11 (20060101); A61B
5/113 (20060101); A61b 005/04 () |
Field of
Search: |
;128/2.6E,2.6R,2.1E,379,404,416-418,DIG.4 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Cushman, Darby & Cushman
Parent Case Text
This application is a continuation-in-part of co-pending
application Ser. No. 440,750 which was filed Feb. 8, 1974 and now
abandoned.
Claims
What is claimed is
1. A disposable electrode assembly for use in respiratory and/or
cardiac monitoring of an infant comprising a sheet-like pad of soft
pliable non-conductive material having an infant back receiving
area of approximately 41/2 inches by 41/2 inches, a plurality of
separate flexible sheet form electrodes extending substantially
throughout the back receiving area of said pad so as to be
intimately contacted by the skin of an infant's back received on
said back receiving pad area, said pad having portions converging
outwardly from opposite sides of said back receiving area for
extending generally beneath the armpits and along the lower edge of
the rib cage of an infant when said converging side portions are
held to the sides of the infant's torso, strap means of soft
pliable material for extending across the chest cage of the infant
centrally between said converging side portions, means for
releasably adjustably securing said strap means in the aforesaid
extending relation to thereby hold said converging side portions
against the sides of the infant's torso so that said flexible
sheet-form electrodes are maintained in skin contact with the
infant's back without relative surface-to-surface movement
therebetween when the infant moves to either side from a normal
back supported position or is moved into a front supported
position, and terminal means for effecting a detachable electrical
connection of said electrodes with the leads of a monitoring
instrument.
2. A disposable electrode assembly as defined in claim 1 wherein
said electrodes are affixed in surface-to-surface engagement with
said pad and are formed of conductive particle impregnated plastic
material.
3. A disposable electrode assembly as defined in claim 2 wherein
said conductive particle impregnated plastic material comprises
carbon powder impregnated in polyvinyl chloride.
4. A disposable electrode assembly as defined in claim 3 wherein
said pad is formed of a sheet of very fine open pore foamed plastic
material.
5. A disposable electrode assembly as defined in claim 4 wherein
said foamed plastic material is polyurethane.
6. A disposable electrode assembly as defined in claim 4 wherein
said strap means includes an integral strap portion extending
centrally outwardly from each converging pad portion.
7. A disposable electrode assembly as defined in claim 6 wherein
said releasable adjustable strap securing means comprises
cooperating Velcro fastening strips on each strap portion.
8. A disposable electrode assembly as defined in claim 4 wherein
said terminal means includes an integral portion on each electrode
extending outwardly from said back receiving area in
surface-to-surface engagement with said pad and a male snap
fastener element of conductive material secured to each integral
electrode portion.
9. A disposable electrode assembly as defined in claim 4 wherein
said plurality of electrodes include four electrodes arranged in
quadrant fashion within said back receiving area.
10. A disposable electrode assembly as defined in claim 9 wherein
said pad includes an integral infant head and terminal carrying
portion extending from said back receiving area in a direction
toward and beyond the head of an infant whose back is received on
said back receiving portion, said terminal means including an
integral strip extending from the periphery of each electrode
through said pad and in surface-to-surface engagement with the
exterior surface thereof to a position adjacent the free end of
said integral infant head receiving and terminal carrying pad
portion and a male snap fastener element of conductive material
secured between the end of each integral electrode strip and the
associated pad free end portion.
11. A disposable electrode assembly as defined in claim 9 wherein
said terminal means includes an integral portion on each electrode
extending along the associated converging side portion of said pad
and a male snap fastener element of conductive material secured to
each integral electrode portion.
12. A method of monitoring the respiration and/or ECG of an infant
which comprises the steps of positioning the infant's back into
skin engagement with a plurality of generally coplanar flexible
sheet form electrodes substantially throughout the back area of the
infant while flexibly retaining the electrodes in a generally fixed
relation with respect to one another within said generally coplanar
relationship, applying a slight flexible retaining pressure along
the infant's sides generally between the lower edge portion of the
rib cage and the armpits and across the infant's chest above the
belly area to the aforesaid flexible retention of the electrodes to
maintain the aforesaid skin engagement between the infant's back
and the electrodes, and utilizing the skin engagement of the
electrodes with the infant's back to establish a circuit for the
change in resistance in the infant's thorax and/or the electrical
activity of the infant's heart to a monitoring device capable of
providing an indication of the infant's respiration and/or ECG
based upon the electrical signals conveyed thereto through the
established circuit.
13. A method as defined in claim 12 wherein a small quantity of
water is placed upon the skin engaging surface of the electrodes
before positioning the infant's back into skin engagement
therewith.
Description
This invention relates to infant or new born baby care and more
particularly to an improved electrode assembly and method of using
the same in the respiratory and/or cardiac monitoring of an
infant.
In the care of infants it is frequently necessary to continuously
monitor the respiratory and/or heart functions of the infant,
usually in conjunction with incubator treatments. The practice
heretofore has been to use separate adhesively applied electrodes
for purposes of respiratory and/or ECG monitoring. A typical
electrode of the type used in practice is disclosed in U.S. Pat.
No. 3,713,435. An electrode of this type embodies a central male
snap fastener assembly surrounded by a disk of flexible material.
The male element of the snap fastener assembly serves as a terminal
for connection with the lead of the monitoring equipment. The
opposite side of the male snap fastener assembly serves as a
receptacle for a conductive paste or electrolyte gel. The
corresponding face of the flexible disk is provided with a pressure
sensitive adhesive which serves to hold the electrolyte gel into
contact with the skin. In operation, usually three of these
electrodes are applied to the infant's chest area with the infant
being supported in the incubator on his or her back.
While the use of electrodes of this type produce reliable
monitoring, this reliability is obtained with the known
inconvenience and aggravation experienced by adults when being so
monitored. Thus, it is well known that conductive pastes or
electrolyte gels are a source of skin irritation and maceration.
Likewise, the area of the skin contacted by the pressure sensitive
adhesive frequently can become irritated and sore. While these
effects can be considered inconveniences and aggravations by adult
patients, they often become severe problems when applied to new
born babies or infants. The severity of the problem is magnified
and multiplied by the frequent attendant need to X-ray the infant's
chest undergoing treatment. Since the electrodes are adhered to the
infant's chest and contain metal, each one of the three must be
removed each time before the X ray is taken and then replaced after
the X ray has been completed. This removing and replacing procedure
further increases the chances of irritation to the infant's tender
skin. There exists a need for a reliable electrode system which
will eliminate the problems incident to direct skin contact of gels
and adhesives and is either easily and conveniently removable and
replaceable for X ray purposes or permit unobstructive X ray
picture taking while attached.
An object of the present invention is the provision of a reliable
electrode system and method of using the same in the respiratory
and/or cardiac monitoring of an infant which will fill the above
described need by eliminating the aforesaid disadvantages of
present practices. In accordance with the principles of the present
invention this objective is obtained by utilizing a plurality of
flexible sheet form electrodes, preferably formed of carbon powder
loaded polyvinyl chloride, sized and arranged so as to have a
maximum contact area with the infant's skin at a location
throughout the back area so that such contact can be maintained
primarily by the weight of the infant in his or her normally
supported position within the incubator. The utilization of
flexible sheet form electrodes enables a reliable electrical
connection to be effected without the use of conductive pastes or
electrolyte gels since electrical resistance to the connection can
be minimized by virtue of the greater area of contact of the
connection. Utilizing the infant's back as the area of contact also
secures many advantages. First, it utilizes a skin area which is
normally contacted anyway by virtue of the infant's normal position
in the incubator. Thus, skin areas which do not receive normal
intimate contact, such as the chest area, are allowed to remain
unencumbered. Second, the weight of the infant can be utilized to
facilitate a somewhat pressurized contact. Third, by utilizing
non-metallic electrodes which extend throughout the back area, the
metal leads of the ECG equipment can be peripherally attached to
the electrodes, thus making it possible to maintain the torso area
free of obstructing metal for X-ray purposes.
It is recognized that flexible sheet form electrodes which
eliminate the need for conductive paste or electrolyte gel have
long been proposed in the patented literature as, for example,
Ruben U.S. Pat. No. 1,973,911 dated Sept. 18, 1934. The single
electrode of the Ruben patent is provided with a mucilaginous
adhesive to effect securement to the skin, an arrangement which
would be unsuitable for infants and would not fill the need for an
electrode system which maintains reliable contact without the
possibility of skin irritation due to adhesive skin engagement. The
patented literature also contains other proposals for the use of
flexible sheet form electrodes where skin engagement is maintained
by adhesive eliminating means suitable for specific purposes other
than infant monitoring. For example, Browner U.S. Pat. No.
3,025,857 dated Mar. 20, 1962, discloses an electrotherapy device
in which a plurality of flexible sheet form electrodes are affixed
to a flexible wall of a treatment table with certain of the
electrodes being carried by straps affixed to the wall by means of
which the patient is both strapped to the treatment table and
contacted with the electrodes on exposed upwardly facing skin
areas. The Browner arrangement thus provides for the selective
contraction of the strapped patient's muscles by electrical
excitement through the various electrodes. Another specialized use
is disclosed in Roman U.S. Pat. No. 3,534,727 dated Oct. 20, 1970.
The purpose of the Roman arrangement is to enable monitoring to
take place while the patient is physically active. To this end, a
plurality of flexible sheet form electrodes are maintained in skin
contact by means of a tightly fitting elastic garment. Bolduc U.S.
Pat. No. 3,720,209 dated Nov. 25, 1970, discloses the use of a
plurality of flexible sheet form electrodes mounted on the upper
surface of a flat flexible plate-like base so that an ECG can be
taken with the patient simply lying on a treatment table with the
base mounted electrodes between the patient and the treatment
table.
In filling the aforementioned specific needs incident to infant
care, the present invention relies not only upon the use of a
plurality of flexible sheet form electrodes but also upon the
combination of such electrodes with an effective reliable
non-adhesive attaching structure which fulfills the needs specific
to infant care. The attaching structure of the present invention
and its mode of operation differs in principle from the attaching
structures of the prior art discussed above because it neither
utilizes a strapped to the table relationship, a tight fitting
elastic garment relationship nor a flat plate-like relationship.
While these latter relationships may be described or necessary for
the particular application to which they relate, they could not be
satisfactorily applied to infant care. Strapping the patient down
to the treatment table may be regarded as necessary while giving an
adult an electric muscle shock treatment but would not be desirable
for infants. Likewise, wearing an elastic garment may be required
dress for astronauts but is hardly suitable for infants. So also it
would be expected that an adult would lie still on a flat pad long
enough for an ECG reading, but such conduct cannot be expected in
the long term monitoring of an infant.
In accordance with the principles of the present invention, an
attaching structure is provided which will maintain a plurality of
flexible sheet form electrodes against the back of an infant in
such a way as to maintain reliable non-adhesive contact over an
extended period of time without strapping the infant to the
incubator, without requiring the infant to wear tight fitting
elastic garments or to be immobile. The attaching structure
embodying these principles includes a pad of soft pliable material,
preferably a very fine open pore foamed polyurethane sheet of
approximately one-fourth inch thickness, having a back engaging
area of approximately 41/2 inches by 41/2 inches to which the
plurality of flexible sheet from electrodes are attached
substantially throughout, the sides of the back engaging area
having portions which converge outwardly thereof so as to pass
under the infant's armpits and extend along the lower edge of the
infant's rib cage when held against the sides of the infant's
torso. Soft pliable quick connect and disconnect strap means,
preferably formed integrally of the pad material, is provided
between the converging portions to maintain the same against the
sides of the infant's torso which, in turn, maintains the electrode
carrying back engaging area against the infant's back. The soft
pliable strap means extends across the infant's chest above the
belly area so that attachment is effected by the application of a
soft pliable restraint which is completely unrestrictive to the
breathing movements which occur in the belly area of infants.
Another object of the present invention is the provision of a
reliable infant long term monitoring electrode assembly of the type
described which is sufficiently simple and economical in
construction as to be made sterile and disposable after one
use.
These and other objects of the present invention will become more
apparent during the course of the following detailed description
and appended claims.
The invention may best be understood with reference to the
accompanying drawings wherein illustrative embodiments are
shown.
In the drawings:
FIG. 1 is a perspective view illustrating the manner in which a
preferred electrode assembly embodying the principles of the
present invention is disposed in attached relation with an
infant;
FIG. 2 is a perspective view showing the electrode assembly in
attached relation with an infant;
FIG. 3 is a top plan view of the electrode assembly disposed in a
flat condition prior to attachment to the infant;
FIG. 4 is an enlarged, fragmentary sectional view taken along the
line 4--4 of FIG. 3 illustrating an electrode assembly of modified
form embodying the principles of the present invention;
FIG. 5 is a view similar to FIG. 3 illustrating an electrode
assembly of modified form embodying the principles of the present
invention; and
FIG. 6 is an enlarged fragmentary sectional view taken along the
line 6--6 of FIG. 5.
Referring now more particularly to the drawings, there is shown in
FIGS. 1-4 thereof a disposable electrode assembly, generally
indicated at 10, which, in accordance with the principles of the
present invention, is particularly suited for the respiratory
and/or cardiac monitoring of infants or new born babies. As best
shown in FIG. 3, the electrode assembly comprises a sheet-like pad
12 of soft pliable non-conductive material having an infant back
receiving area 14 of approximately 41/2 inches by 41/2 inches. A
plurality of separate flexible sheet form electrodes 16, 18, 20 and
22 of conductive particle impregnated plastic material are affixed
in surface-to-surface engagement with the pad 12 so as to extend
substantially throughout the back receiving area thereof.
The pad 12 also includes integral portions 24 which converge
outwardly from opposite sides of the back receiving area 14 thereof
for extending generally beneath the armpits and along the lower
edge of the rib cage of an infant when the converging side portions
are held to the sides of the infant's torso. The converging side
portions 24 are arranged to be held to the sides of the infant by
appropriate soft pliable strap means which in the preferred
embodiment are in the form of a pair of integral strap portions 26.
Mounted on the strap portions 26 are cooperating Velcro fastener
strips 28 and 30 which serve to releasably adjustably secure the
strap portions 26 in a position extending across the chest cage of
the infant.
In the embodiment shown in FIGS. 1-4, the pad 12 also includes an
infant head receiving and terminal carrying portion 32 extending
outwardly from the area 14 in the direction of and beyond an
infant's head whose back is received on the back receiving area 14.
The electrode assembly 10 also includes terminal means for
effecting a detachable electrical connection of each electrode 16,
18, 20 and 22 with a lead of a monitoring machine. In the
embodiment shown in FIGS. 1-4, the terminal means includes strips
34, 36, 38 and 40 which are integral with and extend from the
peripheries of the electrodes 16, 18, 20 and 22 respectively. The
strips extend through openings 42, 44, 46 and 48 respectively, in
the pad 12 and are affixed in surface-to-surface engagement with
the exterior of the pad in an outwardly extending parallel relation
in the direction of the portion 32. The terminal means also
includes male snap fastener elements 50, 52, 54, and 56 which are
fixedly secured to the free ends of the strips 34, 36, 38 and 40
respectively and the associated pad portion 32.
It will be understood that the pad 12 may be constructed of any
soft pliable non-conductive material or composite construction,
however, a preferred material is a very fine open pore polyurethane
of approximately one-fourth inch thickness. A pore size of 100 PPI
is preferred. As to the size of the back engaging area 14, it will
be understood that a measure of variation from the exact 41/2
.times. 41/2 dimension previously stated is clearly within the
purview of the present invention. Basically, it is desirable to
make the area be as large as possible to increase the electrical
contact area and hence minimize the resistance of the connector On
the other hand, it is desirable to make the area as small as
possible to accommodate the smallest size infant encountered.
Commensurate with this view, a 4 inch by 3 inch dimension of the
area is desirable and, of course, the term "approximately"
contemplates a slightly lower dimension as well as dimensions above
the exact 41/2 .times. 41/2 dimension specified. Moreover, it will
be appreciated that a variation in the dimension across the back is
more restricted than the dimension normal thereto in order to
achieve the proper functioning to the converging portions 24.
The electrodes can be of any desired electrically conductive
flexible material, the preferred material shown being carbon powder
impregnated polyvinyl chloride. While cooperating Velcro fastener
elements 28 and 30 are preferred, other fastening elements or
assemblies may be utilized. Likewise, while male snap fastener
elements made of metal are preferred as a terminal construction,
other types of terminals may be utilized, including simple
wires.
The electrodes are preferably relatively thin, the preferred
thickness shown being 0.030 inches. The shape of the electrodes and
the number of electrodes provided can be varied. It is preferred
that they be of generally equal size extending over as much of the
back receiving area 14 as possible but at least 50% of the area. In
the preferred embodiment shown, there are four electrodes of
generally equal square configuration (approximately 2 inches by
1-15/16 inches for the 41/2 inch .times. 41/2 inch size and 11/2
inches by 11/2 inches for the 4 inch .times. 31/2 inch size)
extending over approximately 80% of the back receiving area 14.
With the above in mind, it will be understood that the terms "pad
of soft pliable material" and "flexible sheet form electrodes" are
not limited to the preferred embodiments specifically described
above but comprehend other types of constructions. For example, the
pad and electrodes could be formed of woven or knitted material
with the electrodes being provided by electrically conductive yarns
(e.g., carbon powder loaded resin or metallic coated thread)
positioned in the fabric to engage the infant's back by the weaving
or knitting operation. Other arrangements will readily occur to
those skilled in the art.
In practicing the present method, the electrode assembly 10 is
first placed in a generally flat condition, as shown in FIG. 1, on
the upper surface of the incubator with the exterior surface of the
pad 12 engaging the upper surface of the incubator and the exposed
surfaces of the electrodes 16, 18, 20 and 22 facing upwardly. Next,
the leads of the monitoring instrument are detachably connected
with the snap fastener terminal elements 50, 52, 54 and 56. Next,
the infant is placed in the incubator in a position such that his
or her back rests upon the electrodes 16, 18, 20 and 22 and the
infant's head rests upon the pad portion 32, as is shown in FIG. 1.
Next, the strap portions 26 are brought up around the infant's
chest and the cooperating Velcro fastening elements 28 and 30 are
brought into engagement. FIG. 2 illustrates the operative position
of the assembly 10 when applied to the infant.
In summary, the method of the present invention involves the steps
of positioning the infant's back into skin engagement with a
plurality of generally coplanar flexible sheet form electrodes
substantially throughout the back area of the infant while flexibly
retaining the electrodes in a generally fixed relation with respect
to one another within said generally coplanar relationship,
applying a slight flexible retaining pressure along the infant's
sides generally between the lower edge portion of the rib cage and
the armpits and across the infant's chest above the belly area to
the aforesaid flexible retention of the electrodes to maintain the
aforesaid skin engagement between the infant's back and the
electrodes, and utilizing the skin engagement of the electrodes
with the infant's back to establish a circuit for the electrical
signals thus captured to a monitoring device. The monitoring device
may be of any well-known construction capable of providing an
indication of the infant's respiration and/or ECG based upon the
electrical signals conveyed thereto through the established
circuit.
Normally, the skin engagement is effected with the electrodes in a
dry condition, however, it is within the contemplation of the
present invention to place a small quantity of water (e.g., a drop
or a few drops) upon the skin engaging surface of the electrodes
before positioning the infant's back into skin engagement
therewith. The water is preferably sterilized water to eliminate
any possibility of irritation.
With the four electrode assembly shown, it will be understood that
one of the electrodes, such as the electrode 22, constitutes the
ground electrode. Normally, only two of the other three electrodes,
in addition to the ground electrode, would be operable at any one
time. The provision of the four electrodes enables the operator to
achieve a conventional Lead I reading, as by utilizing electrodes
16 and 18 along with the ground electrode 22; a conventional Lead
II reading, as by utilizing electrode 18 and electrode 20 along
with the ground electrode 22; or conventional Lead III reading, as
by utilizing electrodes 16 and 20 along with the ground 22.
It will be understood that the electrical signals which are thus
captured by the use of the present electrode assembly 10 are
suitable for either respiratory monitoring or cardiac monitoring or
both. In accordance with known practices, the signals captured
which are suitable for respiratory monitoring are the variations in
the electrical resistance of the infant's thorax due to breathing,
while the signals captured which are suitable for ECG monitoring
are the electrical signals which trigger the heart beat. Circuitry
suitable to provide appropriate output monitoring signals
corresponding to each type of captured signal is also
well-known.
The provision of the head receiving and terminal carrying pad
portion 32 is preferred since it serves to present the terminals
which are connected with the leads of the monitoring instrument in
the controlled manner which is spaced from the infant. With this
arrangement, X rays can be taken with the assembly 10 attached to
the infant since the electrical wires of the leads of the
instrument are maintained out of contact with the infant and there
are no metallic materials embodied in the assembly 10 which would
obstruct an X ray picture when taken with the device applied to the
infant.
It will be understood that while the provision of the pad portion
32 is preferred, it is within the contemplation of the present
invention to eliminate the portion 32 from the pad. A modification
of this type is illustrated in FIGS. 5 and 6. Since the embodiment
of FIGS. 5 and 6 varies from that of the preferred embodiment of
FIGS. 1-4 solely in the elimination of the pad portion 32 and the
specific configuration of the terminal means, corresponding
elements of the assembly illustrated in FIGS. 5 and 6 are
designated by corresponding prime numerals which do not require
further detailed description. Suffice it to say that the electrode
assembly 10' includes terminal means in which the electrodes 16',
18', 20' and 22' are provided with integral triangular portions or
strips 58, 60, 62 and 64 which extend in affixed surface-to-surface
engagement with the associated converging side pad portions 24.
These terminal electrode portions have small snap fastener elements
66, 68, 70 and 72 respectively fixed thereto. As best shown in FIG.
6, the pad adjacent each snap fastener element is preferably
apertured, as indicated at 74, to receive the lead connection
therein. In this embodiment the exterior surface portion of each
snap fastener element on the electrode side of the pad is provided
with electrical insulation in order to prevent metal-to-infant skin
contact. Such insulation can be provided in any suitable manner,
such as making the snap fastener portions of a non-metallic
material, by applying insulating tape thereto, or by plastic
coating the snap fastener portions, as indicated in FIG. 6.
It thus will be seen that the objects of this invention have been
fully and effectively accomplished. It will be realized, however,
that the foregoing preferred specific embodiments have been shown
and described for the purpose of illustrating the functional and
structural principles of this invention and are subject to change
without departure from such principles. Therefore, this invention
includes all modifications encompassed within the spirit and scope
of the following claims.
* * * * *