A useful article which is ruined by the poor quality of the photograph (Fig 1) in the printed edition of the BMJ. The caption says: "Subtle necrosis can also be seen in the thigh area." The paper on which the BMJ is printed is so cheap and nasty that I can barely recognise the scrotum. The same criticism now applies to most of the X-rays printed in the BMJ and many of the colour clinical photographs. the Endgames quiz would be much more interesting if the X-rays were visible. Please improve the quality of the paper, so that interesting clinical photographs are visible again.

Competing interests: None declared