E4M1: Hell Beneath is the first map of Thy Flesh Consumed in The Ultimate Doom. It was designed by American McGee and uses the music track "Sign of Evil." On Ultra-Violence, it is believed to be one of the hardest levels not only of the episode but also in the entire Doom series. On this difficulty, there are no medikits or stimpacks; any additional health is limited to nine health bonuses, and there is only one piece of green armor. To top it off, there are lots of enemies, including several Barons of Hell, and a limited amount of space. The easier difficulties have four medikits, two of which are available through a secret.