one of the really interesting things about DOS era games and even quite a while afterwards - particularly with PC games more than consoles - was the lack of too many real ‘rules’ with regards to game design, whether it be for ease of use for the player, or for some idea of maximizing profits and potential player base. you’d get an awful lot of designers who knew what they wanted to make in a game, but not necessarily an idea of how it’d work, no real ‘best practices’ guide, so people would just go in and invent all new shit, trying their best to find something that articulated their idea, mechanically or narratively. so you get a lot of experimental game mechanics and really out there kind of games in general, across bunches of genres.
one of the other things about this era too is that there’s a bunch of people trying to make games who aren’t game people, per se - they might be computer types to begin with, but they’re mostly coming in with expertise on something else. lots of military nerds, and subcategories of military nerds, covering every possible area of war and all having a different field of hyperspecific knowledge, and then trying to apply that knowledge into a game format, often while aiming for as a true to life experience as possible. submarine sims with dozens of buttons and possible commands are one of my favorite jokes in this area, but sims really could get wildly, overwhelmingly complex, with huge manuals. niche market kinda possibilities.
you’d get stuff like Cosmology Of Kyoto, which was like a mix of art via games, a game itself, and a history lesson on japan and the folklore thereof, teaching you about it while also putting you in the middle of it, and doing its best to balance all of these things at once. it was the only game roger ebert ever reviewed, and he loved it. there were all sorts of outside experts making games, or writers turned game designers, instead of writers starting in games, if you know what i mean. really wild and weird variety and no real bedrock of game design, and plus lower budgets, lower sales expectations…
anyway, this all leads back to that screenshot at the top, which is from a two game series of medical/surgery sims called Live & Death, which is designed by a real fucking doctor, and the sequel - which that screen cap is from - is about neurosurgery, and they’re dead serious about getting it accurate, so buckle the fuck up and start memorizing terms and procedures i guess