On Symphonies of Sickness Carcass integrated a stronger Death metal influence into their music in regards to structure as the unorganized noise was given a clear vision and the short blasts of vitriol now communicate sickening short tales that have a greater sense of dynamism and progression. With these added tools, Carcass now had the ability to make the greatest gore related of all time. Though many band would use all the elements present here with varying levels of success as the style fell into the joke genres of Porno and Goregrind. Carcass remain the masters of this through meticulous arrangements as seen in one of the greatest introductions in metal.
A distant wind growing stronger can be heard before Ken Owens plays a short noisy fill that leads to the beginning of this song. A syncopated three note chromatic riff that briefly states the root note before embarking on three rapid descents that return to the root note at each time. Sounding like a barrage of noise, this is a piece of the puzzle that makes sense when used as the opening motif to the piece’s central melody.
The guitars stop as a synth melody consisting of a continuous stream of minor second chords that have shifted the song’s key down by a semitone. The shift is slight but noticeable enough to mark a disturbance in contrast to the previous section. This is very similar to the infamous shower scene from Psycho where a blast of dissonant chords were used to convey the victim’s fright as they are attacked an unknown assailant. This form the base on which a cheap mouth synth performs the song’s first instance of the harrowing main melody.
Returning to the initial root note but an octave higher the song’s main motif is carved out. The melody slowly ascends to a dissonant tritone before returning to the root note and then going to the intriguing and mysterious minor sixth that can lead the song in any possible direction but uses that suspense to drift towards a revolting minor second. A brief neutral stepping stone of a fourth that once again gives the possibility to return to safer territory but here it goes up a semitone towards what would normally be a happy major third but that has been perverted into a disgustingly mocking sustained ending.
As the synths end the guitar returns and utilizes the previous guitar riff to lead to a variation of the central motif played by the synth. The band now state their intentions as more steps are taken to reach the tritone. There is no attempt to build suspense as the band cycle through the natural minor scale to show that there is no ambiguity in the havoc that will be unleashed. The band then return to the root note through the minor scale which adds power and ferocity to the melody. The band once again jump to the minor sixth which in context of the minor scale has now become dark and haunting and the minor second fits and the melody ends on a transition from a major to minor third which is a tool often used to show desperation and a lurking evil in the background.
Just before the guitars reenter, Ken Owens lets out a pitch shifted laugh and despite the inherently ridiculous nature of pitchshifted vocals, it truly expresses the combination of medical horror and sadistic pleasure expressed on the album. Equally of note are Bill Steer’s lead guitar theatrics that consist of one note disfigured with creative vibrato and tremolo use and floats on top during the more dissonant intervals and pushes the song into even more sickening depths.