I want to talk today about a condition that we don't hear much of any longer, a painful malady that has largely been eliminated from our society. Just as the advent of a vaccine spirited away the looming fear of smallpox from an entire generation, making the virus seem little more than medical history, innovations in gaming have practically erased this threat from the social consciousness. But with the rise of interest towards retrogaming in popular culture, a new generation now stands at risk.

I'm speaking, of course, of "Gamer's Thumb." Players who use vintage controllers with directional pads will often develop this uncomfortable malady from holding down on a d-pad for hours at a time. The act can result in joint pain, numbness and (in extreme cases) blistering.

Few games encourage such behavior as much as Total Carnage on the SNES. While most games will wear you down on just one thumb, the control scheme in this arcade port can play murder on the thumbs of both hands.

Is it worth the risk? Read on.

In Total Carnage, one or two players are faced with the task of overthrowing a middle-eastern dictator who has taken news reporters hostage when it is discovered that he has been engaging in bio-weapons research. General Akhboob, leader of an unnamed nation, has been using his baby milk factory as a front for experiments in radioactivity and mutation and it's up to Captain Carnage and Major Mayhem to stop him by blowing up everything in their path.

Swarms of enemies will come at you from all sides, in increasingly overwhelming numbers. The variety is surprisingly good, with several different forms of mutated baddies out for your blood. And, as if they weren't enough, environmental threats plague the landscape, with landmines and barrels which explode in a spray of shrapnel if left undestroyed.

The most annoying and clever (from a design perspective) challenge comes from enemy bombs that drop into the playing field. After they've had a moment to sit there, they begin to shake, indicating that they are about to explode. Unless you manage to get to it and grab it before it does, you (and your co-op player) die in a gory pop.

Much like its predecessor, Smash T.V., the arcade version of this game was controlled with a dual joystick configuration. The left joystick moved your character while the right fired their weapon. It's an incredibly convenient system in the arcades but moving it to the home consoles, still reliant on directional pads and buttons, required the designers to treat the buttons as the right joystick.

What surprised me is how well this actually worked. In my memory of having played Total Carnage before, I always felt like the button configuration was inadequate. It isn't that it doesn't function well, merely that it hurts like hell to play for more than a level or two of it. 

In addition to your standard machine gun, power-ups with other weapons will crop up from time to time. Rocket launchers, flamethrowers and a little drone that circles you and fires in the same direction you do are all available. They have limited ammunition and never really last long enough, but it's great to just obliterate everything in your path for even a short while.

The last useful tools at your disposal are time bombs. They're exactly what they sound like: You drop one and, after a time, it detonates. The problem with them is that the timing is somewhat nebulous. It seems that the more active bombs there are on the playing field, the longer it takes for individual bombs to explode, which drastically reduces their helpfulness.

In between levels, you'll come face-to-face with General Akhboob on a communications monitor. He'll spout off in an incomprehenisble babble, not unlike the terrorist voices in Team America: World Police, and follows up with some soundbyte in English. It's one of those things that would probably be highly offensive to people with Liberal Arts degrees if it wasn't so goddamn funny.

And that's the reason to play Total Carnage. The absurdity level is off the charts and it's difficult to play without a smile on your face. I defy you to pick up a pair of sneakers (granting the ability to move more quickly), hear the Stooges-inspired "whoop-whoop-whup" sound effect associated with the item and not chuckle a little bit.

I also really like the replay value inherent in the game. The final boss has a special, highly challenging surprise in store for you when defeated which may have you starting the game over just to accomplish it. And, hidden throughout the levels are keys that you can collect. If you manage to have 120 of them by the end of the game, you enter a bonus level called the Pleasure Domes, filled with cash, prizes and Smash T.V.'s Mutoid Man.

It's a little disappointing that we don't see games like Total Carnage very often any longer. Sure, we still get our shoot-em-up fix from time to time on the download services. None of those games have the style, sense of humor or challenge of this one. 

Of course, they probably won't break your thumbs either.