1127 centrations during the medication period increased satisfactorily. Detailed results will be published elsewhere. Meanwhile we would suggest that a dose of up to 75 mg a day is safe and particularly useful in moderate pre-eclampsia to tide the
and Chemical Pathology, Redhill General Hospital,
Redhill, Surrey
K. A. D. DRURY E. SPALDING D. DONALDSON
Poisons Unit, New Cross Hospital,
D. RUTHERFORD
MURDERING BEETHOVEN
SiR,—Iwas delighted to read Dr Agnew’s paper on Humanism in Medicine (Sept. 17, p. 596), but one of his examples seems to need correction. To get the attention of his class Agnew asks what students would advise when presented with the following family history. "The father has syphilis, the mother tuberculosis; they have already had four children-the first is blind, the second died, the third is deaf and dumb, and the fourth has tuberculosis. The mother is pregnant with her fifth child, and the parents are willing to have an abortion should you so decide." If there are not too many Catholics in the class, Agnew suggests that a majority usually favours abortion. "You congratulate the class on their decision to abortand then you tell them they have just murdered Beethoven." There is no hard evidence that Beethoven’s father had syphilis. His father and a grandmother were alcohol addicts. Ludwig (born 1770) was not the fifth but the second child of his parents. The first was Maria (born 1769) who died on the sixth day of life. Only two of the further five children attained adulthood (three died in infancy). Karl (1774) was not blind; he had a unilateral eye defect, probably due to some intrauterine damage. Johann (1776) was not too bright, but not deaf and dumb. It was the adult Ludwig van Beethoven who had a progressive deafness due to Paget’s disease or otosclerosis. In any case, most geneticists would not counsel abortion in this situation. The inheritance and mutagenic effect of parental alcoholism and tuberculosis (and even of an improbable syphilis) are negligible, and infant death (in the first child) was very common at that time. Thus I dare hope that the geneticists would not have "murdered" Beethoven. Laboratory of Human Genetics, National Institute of Hygiene, Budapest IX, Hungary
ANDREW CZEIZEL
SIR,-Dr Agnew’s anecdote caught the attention of the Milwaukee Journal, and sent me hurrying to literature on Beethoven. It did not ring true. Among other references I consulted Thayer’s Life of Beethoven (revised and edited by Elliot Forbes), Robert Haven Schauffler’s Beethoven: the Man Who Freed Music, and Paul Nettl’s Beethoven Handbook. All these sources agree that Ludwig was the second child; that the first died six days after birth, the third died at the age of two, two other younger brothers both lived to maturity although one died before and one after Beethoven, and there were two daughters, both younger than Beethoven who died in childhood ; and that none of the children was blind, none was deaf and dumb, and none is said to have had tuberculosis. While the father was a drunkard and "morally infirm", nowhere is he described as syphilitic. The mother did die of tuberculosis. If the point Dr Agnew was trying to make cannot be made truthfully perhaps it should not be made at all. 121 W. Thorne Street, Ripon, Wisconsin 54971, U.S.A.
different aspects of euthanasia and aborthe Belgian thalidomide case; and I was so taken with the teaching potential of the letters and accompanying editorials that I suggested that The Times reprint this material. This they did, in the form of a pamphlet The Acquittals at Liege. Even though the Beethoven anecdote did not seem to accord completely with the facts, I still found it useful in my teaching. When Associated Press took this anecdote out of context from my Lancet article I became embarrassed as the letters rolled in; but all I had said was that this anecdote was "one way of catching class attention". Had I known that the Associated Press would publicise this story I should have insisted that they also mention that the story was not mine and that it was not completely true anyway. I did not think all this was worth a footnote in my article (although I usually mention it in class)-but obviously it was. and several others
tion,
patient over to near maturity. Departments of Obstetrics, Pædiatrics,
SIR,-On Nov. 13, 1962, The Times published a letter from Bagnold, the novelist, in which she gave that Beethoven anecdote, attributed to Maurice Baring. Miss Bagnold’s letter, Enid
on
prompted by
Department of Anatomy, School of Medicine, Center for the Health Sciences, Los Angeles, California 90024,
U.S.A.
L. R. C. AGNEW
RAPID METHOD OF ASSAYING CREATINE KINASE MB
SIR,-The estimation of creatine kinase MB (MB-c.K.) in is the most accurate means of diagnosing acute myocardial infarction. Despite this, the test is routinely available in very few hospitals in Britain. This is because of technical difficulties in the assay methods. Dr Roberts and his colleagues (Aug. 13, p.319) describe a sensitive radioimmunoassay which, while being of considerable research interest, is very complex and time-consuming. Dr Grande and his colleagues (Oct. 8, p. 759) discuss their electrophoretic assay method which takes only a few hours. An even simpler assay has lately been described.l,2 It takes only 15 min and a commercial kit (Merck-1-Test CK MB) has been developed that any hospital laboratory could use. It is at least as sensitive as other methods. Measurement of MB-c.K. would be of particular clinical usefulness in patients with acute chest pain where the diagnosis is equivocal. We have prospectively studied 50 patients with acute chest pain, using the inhibition-antibody technique. 9 patients had some atypical features on the electrocardiograms and in routine enzyme measurements that could have confused the diagnosis. MB-c.K. seemed clearly to differentiate acute infarction from non-infarction in this group. In 1 case the clinical diagnosis was acute myocardial infarction, and a panel of cardiologists later concurred, by a majority, with this diagnosis. MB-c.K. undetectable, and the original clinical diagnosis serum
was
probably wrong.
Routine diagnostic methods may make too rigid a subdivision into myocardial infarction and non-infarction. In doubtful cases the patient is usually diagnosed and managed as having acute myocardial infarction. Enforced inactivity would be avoided in some of these patients were the diagnosis more certain. The inhibition-antibody test might improve diagnostic accuracy, and this test can be done in any district general hospital. Departments of Medical Cardiology and Biochemistry,
Royal Infirmary, Glasgow G4 *Present address: Division of Clinical G42 9TY.
D. I. MELVILLE* J. P. MCKENNA
J. KING Medicine, Victoria Infirmary, Glasgow
J. BARBARA SCOTT 1.
*t*To the many Beethoven experts whose wrath has fallen on his head
Dr Agnew replies as follows.-ED.L.
were
2.
Neumeier, D., Prellwitz, W., Wurzburg, U., Brundobler, M., Olbermann, M., Just, H., Knedel, M., Lang, H. Clin. chim. Acta, 1976, 73, 445. Ljungdahl, L., Hofvendahl, S., Gerhardt, W., Borjesson, J. ibid. 1977, 78, 43.
and Chemical Pathology, Redhill General Hospital,
Redhill, Surrey
K. A. D. DRURY E. SPALDING D. DONALDSON
Poisons Unit, New Cross Hospital,
D. RUTHERFORD
MURDERING BEETHOVEN
SiR,—Iwas delighted to read Dr Agnew’s paper on Humanism in Medicine (Sept. 17, p. 596), but one of his examples seems to need correction. To get the attention of his class Agnew asks what students would advise when presented with the following family history. "The father has syphilis, the mother tuberculosis; they have already had four children-the first is blind, the second died, the third is deaf and dumb, and the fourth has tuberculosis. The mother is pregnant with her fifth child, and the parents are willing to have an abortion should you so decide." If there are not too many Catholics in the class, Agnew suggests that a majority usually favours abortion. "You congratulate the class on their decision to abortand then you tell them they have just murdered Beethoven." There is no hard evidence that Beethoven’s father had syphilis. His father and a grandmother were alcohol addicts. Ludwig (born 1770) was not the fifth but the second child of his parents. The first was Maria (born 1769) who died on the sixth day of life. Only two of the further five children attained adulthood (three died in infancy). Karl (1774) was not blind; he had a unilateral eye defect, probably due to some intrauterine damage. Johann (1776) was not too bright, but not deaf and dumb. It was the adult Ludwig van Beethoven who had a progressive deafness due to Paget’s disease or otosclerosis. In any case, most geneticists would not counsel abortion in this situation. The inheritance and mutagenic effect of parental alcoholism and tuberculosis (and even of an improbable syphilis) are negligible, and infant death (in the first child) was very common at that time. Thus I dare hope that the geneticists would not have "murdered" Beethoven. Laboratory of Human Genetics, National Institute of Hygiene, Budapest IX, Hungary
ANDREW CZEIZEL
SIR,-Dr Agnew’s anecdote caught the attention of the Milwaukee Journal, and sent me hurrying to literature on Beethoven. It did not ring true. Among other references I consulted Thayer’s Life of Beethoven (revised and edited by Elliot Forbes), Robert Haven Schauffler’s Beethoven: the Man Who Freed Music, and Paul Nettl’s Beethoven Handbook. All these sources agree that Ludwig was the second child; that the first died six days after birth, the third died at the age of two, two other younger brothers both lived to maturity although one died before and one after Beethoven, and there were two daughters, both younger than Beethoven who died in childhood ; and that none of the children was blind, none was deaf and dumb, and none is said to have had tuberculosis. While the father was a drunkard and "morally infirm", nowhere is he described as syphilitic. The mother did die of tuberculosis. If the point Dr Agnew was trying to make cannot be made truthfully perhaps it should not be made at all. 121 W. Thorne Street, Ripon, Wisconsin 54971, U.S.A.
different aspects of euthanasia and aborthe Belgian thalidomide case; and I was so taken with the teaching potential of the letters and accompanying editorials that I suggested that The Times reprint this material. This they did, in the form of a pamphlet The Acquittals at Liege. Even though the Beethoven anecdote did not seem to accord completely with the facts, I still found it useful in my teaching. When Associated Press took this anecdote out of context from my Lancet article I became embarrassed as the letters rolled in; but all I had said was that this anecdote was "one way of catching class attention". Had I known that the Associated Press would publicise this story I should have insisted that they also mention that the story was not mine and that it was not completely true anyway. I did not think all this was worth a footnote in my article (although I usually mention it in class)-but obviously it was. and several others
tion,
patient over to near maturity. Departments of Obstetrics, Pædiatrics,
SIR,-On Nov. 13, 1962, The Times published a letter from Bagnold, the novelist, in which she gave that Beethoven anecdote, attributed to Maurice Baring. Miss Bagnold’s letter, Enid
on
prompted by
Department of Anatomy, School of Medicine, Center for the Health Sciences, Los Angeles, California 90024,
U.S.A.
L. R. C. AGNEW
RAPID METHOD OF ASSAYING CREATINE KINASE MB
SIR,-The estimation of creatine kinase MB (MB-c.K.) in is the most accurate means of diagnosing acute myocardial infarction. Despite this, the test is routinely available in very few hospitals in Britain. This is because of technical difficulties in the assay methods. Dr Roberts and his colleagues (Aug. 13, p.319) describe a sensitive radioimmunoassay which, while being of considerable research interest, is very complex and time-consuming. Dr Grande and his colleagues (Oct. 8, p. 759) discuss their electrophoretic assay method which takes only a few hours. An even simpler assay has lately been described.l,2 It takes only 15 min and a commercial kit (Merck-1-Test CK MB) has been developed that any hospital laboratory could use. It is at least as sensitive as other methods. Measurement of MB-c.K. would be of particular clinical usefulness in patients with acute chest pain where the diagnosis is equivocal. We have prospectively studied 50 patients with acute chest pain, using the inhibition-antibody technique. 9 patients had some atypical features on the electrocardiograms and in routine enzyme measurements that could have confused the diagnosis. MB-c.K. seemed clearly to differentiate acute infarction from non-infarction in this group. In 1 case the clinical diagnosis was acute myocardial infarction, and a panel of cardiologists later concurred, by a majority, with this diagnosis. MB-c.K. undetectable, and the original clinical diagnosis serum
was
probably wrong.
Routine diagnostic methods may make too rigid a subdivision into myocardial infarction and non-infarction. In doubtful cases the patient is usually diagnosed and managed as having acute myocardial infarction. Enforced inactivity would be avoided in some of these patients were the diagnosis more certain. The inhibition-antibody test might improve diagnostic accuracy, and this test can be done in any district general hospital. Departments of Medical Cardiology and Biochemistry,
Royal Infirmary, Glasgow G4 *Present address: Division of Clinical G42 9TY.
D. I. MELVILLE* J. P. MCKENNA
J. KING Medicine, Victoria Infirmary, Glasgow
J. BARBARA SCOTT 1.
*t*To the many Beethoven experts whose wrath has fallen on his head
Dr Agnew replies as follows.-ED.L.
were
2.
Neumeier, D., Prellwitz, W., Wurzburg, U., Brundobler, M., Olbermann, M., Just, H., Knedel, M., Lang, H. Clin. chim. Acta, 1976, 73, 445. Ljungdahl, L., Hofvendahl, S., Gerhardt, W., Borjesson, J. ibid. 1977, 78, 43.
