<alter> (Semitones)

<measure number="11"> <note> <pitch> <step>B</step> <alter>-2</alter> <octave>4</octave> </pitch> <duration>4</duration> <voice>1</voice> <type>eighth</type> <accidental>flat-flat</accidental> <stem default-y="-52">down</stem> <beam number="1">begin</beam> </note> <note> <pitch> <step>B</step> <alter>-1</alter> <octave>4</octave> </pitch> <duration>4</duration> <voice>1</voice> <type>eighth</type> <accidental>flat</accidental> <stem default-y="-52">down</stem> <beam number="1">continue</beam> </note> <note> <pitch> <step>B</step> <octave>4</octave> </pitch> <duration>4</duration> <voice>1</voice> <type>eighth</type> <accidental>natural</accidental> <stem default-y="-52">down</stem> <beam number="1">continue</beam> </note> <note> <pitch> <step>B</step> <alter>1</alter> <octave>4</octave> </pitch> <duration>4</duration> <voice>1</voice> <type>eighth</type> <accidental>sharp</accidental> <stem default-y="-52">down</stem> <beam number="1">end</beam> </note> <note> <pitch> <step>B</step> <alter>2</alter> <octave>4</octave> </pitch> <duration>8</duration> <voice>1</voice> <type>quarter</type> <accidental>double-sharp</accidental> <stem default-y="-55">down</stem> </note> </measure>