Items

Lynch Street Line Coin

Location: In the hand of the "mannequin" in the women's washroom B1, after getting the Pistol from Henry's apartment, Subway World.
Description: Train token for the subway's Lynch Street line. Can be used any number of times.
Purpose: Use to access the Lynch Street Line platform from the B1 turnstiles, Subway World (also 2nd time). Is rendered obsolete after taking Cynthia's Commuter Ticket in the Subway World 2nd time, but can still be used.

Temptation Placard

Location: On the door of the office within the King Street Line turnstiles on B1, Subway World.
Description: Placard from Subway World. It shows a woman and says, "Temptation."
Purpose: One of the four placards needed to insert into its respective depression in the laundry room of Henry's apartment to create a new portal, after using Succubus Talisman, following the Hospital World.

Chocolate Milk

Location: In the fridge of Henry's apartment at the beginning of the game.
Description: Chocolate-flavored milk. Very sweet. It was in the refrigerator at home.
Purpose: Give to Jasper at the steps of Wish House in the compound in return for the Blood-Inscribed Spade, Forest World.

Blood-Inscribed Spade

Location: Offered by Jasper after feeding him the Chocolate Milk by the Wish House front door in the compound, Forest World.
Description: Written in blood is: "Opposite where the lake and house meet, inside the hand holding onto the ground."
Purpose: Use to dig to find the Rusted Bloody Key by the hand-looking tree root in the 2nd last southeast pathway, Forest World.

Rusted Bloody Key

Location: In the earth by the hand-looking tree root in the second last path in the southeast pathway, Forest World (use the Blood-Inscribed Spade to dig up).
Description: Rusted and bloody key. Inscribed on it is: "The holder of this key will wander for eternity."
Purpose: Unlocks the front door to Wish House at the center of the Forest World.

Source Placard

Location: On the door at the left side inside Wish House, after Jasper goes through the door while you're reading the nearby memo, Forest World.
Description: Placard from Forest World. It shows a baby and says, "Source."
Purpose: One of the four placards needed to insert into its respective depression in the laundry room of Henry's apartment to create a new portal, after using Succubus Talisman, following the Hospital World.

Water Prison Exit Key

Location: On the ledge at the northwest of the waterwheel on B2, Water Prison World.
Description: Key found in the waterwheel room (2F basement). "Up" is carved into it.
Purpose: Unlocks the east door in the passage room at the south of 1F, Water Prison World.

Watchfulness Placard

Location: On the door at the west of the Kitchen B1, Water Prison World.
Description: Placard from Water Prison World. It shows an eye and says, "Watchfulness."
Purpose: One of the four placards needed to insert into its respective depression in the laundry room of Henry's apartment to create a new portal, after using Succubus Talisman, following the Hospital World.

Ghost's Key

Location: In the hands of the Ghost found pinned with a Sword of Obedience in the birthday room on B3, Building World.
Description: The key that the ghost was holding.
Purpose: Unlocks the east door in the same birthday room on B3, Building World.

Albert's Sports Key

Location: On the west shelf at the end of the middle isle by the cat food in the pet shop B7, Building World.
Description: Found in the pet shop. It has "Albert's Sports" written on it.
Purpose: Unlocks the west door in Albert's Sporting Goods B5, Building World.

Chaos Placard

Location: Hanging on the door marked "207" at the top of the large staircase on B10, accessed from Bar Southfield, Building World.
Description: Placard from Building World. It has an abstract picture and says, "Chaos."
Purpose: One of the four placards needed to insert into its respective depression in the laundry room of Henry's apartment to create a new portal, after using Succubus Talisman, following the Hospital World.

Locker Key #106

Location: Taped to the back of one of the orange-tinted photos on the wall in the open hallway room in Room 301 3F, Apartment World.
Description: It looks like a locker key. "106" is written on it.
Purpose: Unlocks locker number 106 in the lobby 1F, Apartment World.

Red Paper

Location: Two locations: on the table in the open room in Room 301 3F, and in the small box by the key rack in the living room of Room 105 1F. Both found in the Apartment World.
Description: Just red paper with nothing written on it... I'll stick it under Room 302's door.
Purpose: Slip under the front door of Room 302 3F from outside, and become readible from your apartment, Apartment World.

Superintendent's Key

Location: Taped to the back of one of the orange-tinted photos on the wall in the open room in Room 301 3F, Apartment World.
Description: South Ashfield Heights' superintendent's key. It says "105" on it.
Purpose: Unlocks Room 105 1F, Apartment World.

Shabby Doll

Location: Placed on the steps by the Man in the Coat in the stairwell 3F, Apartment World.
Purpose: Not a key item and does not need to be acquried. What it does is haunt your item chest if you leave it in there. It is recommended that you don't take the doll.

Torn Red Paper

Location: Three locations: in the box by the key rack in the living room of Room 105 1F, inside the fridge in the kitchen of Room 102 1F, and in the shirt on the bed frame in the northwest room of Room 203 2F. All locations in the Apartment World.
Description: Just torn red paper with nothing written on it... I'll stick it under Room 302's door.
Purpose: Slip under the front door of Room 302 3F from the Apartment World, to be able to read them from Henry's apartment (one specific piece must be read in order to continue on).

Apartment Keys

Location: On the key rack in the living room of Room 105 1F, Apartment World.
Description: Keys to each apartment in the building. Actually, it looks like #303 is missing.
Purpose: Unlocks every apartment room except for Rooms 302 and 303, Apartment World.

"Skinned Mike" Cassette

Location: On the living room table in Room 205 2F, Apartment World.
Description: Audiocassette with "Skinned Mike" on the label.
Purpose: Not a key item, but can be inserted into the radio on the shelf in Henry's apartment living room to hear its contents.

Doll Key

Location: By Henry's bed by the far wall in his apartment bedroom, after reading the Red Diary Scrap Cont. memo after slipping the specific Torn Red Paper under Room 302's door during the Apartment World.
Description: Key with a girl's doll keychain attached. "303" is engraved on it.
Purpose: Unlocks Room 303 3F, Apartment World.

Succubus Talisman

Location: Slipped under the front door of Henry's apartment after completing the Hospital World.
Description: Card with some kind of frightening demon on it.
Purpose: Use while facing the demon-looking face on the wall in the laundry room of Henry's apartment to create four rectangle depressions (for the four placards), after completing the Hospital World.

Hospital Room Key

Location: In the mouth of the snake in the snake statue room 2F, Hospital World.
Description: Key found in the hospital. It's probably the key to Eileen's hospital room.
Purpose: Unlocks the randomly only locked door, Eileen's room, in the 2F hallway of the Hospital World. Also unlocks the cage that comes down on Henry after picking the key up in the snake statue room in the same corridor.

Small Key

Location: On the ground by the front door in Henry's apartment after returning from the Hospital World, after finding Eileen.
Description: Small but ordinary key found in the red envelope.
Purpose: Unlocks the gate in the elevator shaft at the south of the Lobby 1F, Hospital World (must call the elevator on 2F beforehand to be able to enter the shaft).

Toy Key

Location: On the ground at the front door of Henry's apartment, with a memo, during the Subway World 2nd time.
Description: A key-shaped plastic kids' toy.
Purpose: Use to unlock the 1000$ toy box at the south of the northeast subway car of the Lynch Street Line platform on B3, Subway World 2nd time.

Filthy Coin

Location: Inside the toy box at the south of the northeast subway car at the Lynch Street Line platform, Subway World 2nd time (use Small Key to unlock box).
Description: Coin caked with dust and grime. I bet I could clean it in the kitchen sink in my room.
Purpose: Wash in the kitchen sink of Henry's apartment to get the 1$ Coin, during the Subway World 2nd time.

1$ Coin

Location: Derived from the Filthy Coin after washing in the kitchen sink in Henry's apartment, during the Subway World 2nd time.
Description: Toy coin with "1$" written on it. Maybe someone meant to write "1$"?
Purpose: Insert into the vending machine at the north of the east Lynch Street Line platform B3, Subway World 2nd time.

Murder Scene Key

Location: Falls out of the vending machine at the north of the east Lynch Street Line platform B3, after using the 1$ Coin, Subway World 2nd time.
Description: Key from the vending machine. The tag on it says, "Murder Scene."
Purpose: Unlocks the office within the King Stree Line turnstiles on B1, Subway World 2nd time.

Cynthia's Commuter Ticket

Location: On the ground among Cynthia's dropped items inside the King Street Line turnstiles by the office on B1, Subway World 2nd time.
Description: Commuter ticket for the subway's King Street and Lynch Street Lines. Can be used multiple times.
Purpose: Use to access both King and Lynch Street Line platforms from the B1 turnstiles, Subway World 2nd time. Renders the Lynch Street Line Coin obsolete.

Train Handle

Location: On the floor in the bloody office within the King Street Line turnstiles on B1, Subway World 2nd time.
Description: Handle from the King Street Line train. It's like a key needed to run the train.
Purpose: Insert into the control panel at the front of the subway train at the north of the King Street Line platform on B4, Subway World 2nd time.

Crested Medallion

Location: On the small statue on the Toluca Lake waterfront at the end of the northwest pathway, Forest World 2nd time.
Description: Medallion with a disturbing emblem carved into it. It's about 10 inches in diameter.
Purpose: Insert into the circle depression on the door under Wish House, through the hole after clearing the wheelchair doll, Forest World 2nd time.

Doll's Head

Location: In the well in the second southwest pathway, Forest World 2nd time (Torch must be equipped and lit to get).
Description: A wooden doll's head. It's charred and blackened.
Purpose: One of the five doll pieces needed to insert into the doll in the wheelchair among the Wish House remains, Forest World 2nd time.

Doll's Left Arm

Location: In the well in the second northeast pathway from the Wish House compound, Forest World 2nd time (Torch must be equipped and lit to get).
Description: Left arm from a wooden doll. It's charred and blackened.
Purpose: One of the five doll pieces needed to insert into the doll in the wheelchair among the Wish House remains, Forest World 2nd time.

Doll's Right Arm

Location: In the well in the northeast end pathway, Forest World 2nd time (Torch must be equipped and lit to get).
Description: Right arm from a wooden doll. It's charred and blackened.
Purpose: One of the five doll pieces needed to insert into the doll in the wheelchair among the Wish House remains, Forest World 2nd time.

Doll's Left Leg

Location: In the well in the southeast end pathway, Forest World 2nd time (Torch must be equipped and lit to get).
Description: Left leg from a wooden doll. It's charred and blackened.
Purpose: One of the five doll pieces needed to insert into the doll in the wheelchair among the Wish House remains, Forest World 2nd time.

Doll's Right Leg

Location: In the well in the first northwest pathway, Forest World 2nd time (Torch must be equipped and lit to get).
Description: Right leg from a wooden doll. It's charred and blackened.
Purpose: One of the five doll pieces needed to insert into the doll in the wheelchair among the Wish House remains, Forest World 2nd time.

Prisoner's Shirt

Location: On the ground of the circular platform in the northwest room of the inner core on B1, Water Prison World 2nd time.
Description: Something is written on it in wax. Maybe if you soak it in some kind of colored liquid...
Purpose: Soak in the blood in the bathtub in the washroom of Henry's apartment, to reveal a message (this must be done in order to continue on, although you do not get any items for it).

Water Prison Generator Room Key

Location: In the hand of Victim 18 (fat, shirtless Ghost) in the indoor stairs pathway on B1, up for grabs only after a Sword of Obedience has been stabbed into him, Water Prison World 2nd time.
Description: Key held by the ghost of Andrew. It opens the door on B2.
Purpose: Unlocks the northeast door in the B2 waterwheel room, which is the door of the generator room, Water Prison World 2nd time.

Cake Candles

Location: On the counter in Albert's Sporting Goods B5, Building World 2nd time.
Description: Colorful candles for putting on a birthday cake.
Purpose: One of the four reminiscent items required to unlock the Building World 2nd time clock door on B8. Place into the cake on the kitchen table in the birthday room on B3, Building World 2nd time.

Billiard Ball

Location: At the end of the hallway in the shower room under the elevators on B12, Building World 2nd time.
Description: It's white with no number on it. That means it's the cue ball.
Purpose: One of the four reminiscent items required to unlock the Building World 2nd time clock door on B8. Place on the billiard table in Bar Southfield B15, Building World 2nd time.

Stuffed Cat

Location: On the ground by the northeast door in the birthday party room on B3, Building World 2nd time.
Description: Stuffed cat with droopy ears.
Purpose: One of the four reminiscent items required to unlock the Building World 2nd time clock door on B8. Place in the open cage on the counter in the northwest of the pet shop B7, Building World 2nd time.

Volleyball

Location: On the ground by the boxes near the door at the south of the B12 pathway, Building World 2nd time.
Description: Looks like a plain volleyball.
Purpose: One of the four reminiscent items required to unlock the Building World 2nd time clock door on B8. Place in the volleyball basket in Albert's Sporting Goods B5, Building World 2nd time.

Pickaxe of Hope

Location: Stabbed into the wall at the end of the hallway of Room 302 of the Past, after the cutscene in the room, at the bottom of the spiral staircase beneath the Building World 2nd time.
Description: "Hope" is written on the handle. It doesn't look like I can use it as a weapon.
Purpose: Use to break a hole in the wall at the end of the hallway in Henry's actual apartment, after returning from Room 302 of the Past.

Keys of Liberation

Location: In the pocket of the coat on Walter's corpse in the hidden back room in Henry's apartment (through the Pickaxe of Hope hole), after returning to Henry's apartment from Room 302 of the Past.
Description: Extremely evil-looking keys held by the corpse of Walter.
Purpose: Unlock the chains on Henry's front door, allowing it to be opened, after returning to Henry's apartment from Room 302 of the Past.

Umbilical Cord

Location: On the shelf in the living room of Room 105 1F, Outside Room 302.
Description: Walter Sullivan's umbilical cord. The superintendent has kept it for years.
Purpose: Use while standing in front of the giant head creature during the Final Sacraments battle to release the eight spears around the room.

Spear of the Holy Mother

Location: Eight of them are found stuck in the stone statues during the Final Sacraments battle with Walter, after Outside Room 302 (they unlock after Henry uses the Umbilical Cord on the true Walter's body).
Description: Spear with "Holy Mother" carved into it. The "Crimson Tome" says that I have to stick eight of these spears into Walter's body.
Purpose: Stab all eight spears into the neck of the large head creature during the Final Sacraments battle, after using the Umbilical Cord. This causes Walter to become vulnerable to your attacks.

Nurse's Uniform

Location: On the cushion chair in the living room of Room 303 3F, Outside Room 302, only in A Brand-new Fear.
Description: Clothes found in Eileen's room.
Purpose: Unlocks Eileen's Nurse costume, after beating the game with an ending in which Eileen lives, with the item in your inventory.

   
Supplies

Nutrition Drink

Availability: Very Common (5/5)
Health Restored: 25%
Description: Heals your body with supplemental nutrition.
Notes: This small bottle is filled with some sort of red nutrition drink, and is the exact same thing as the Health Drink in the previous three games; only the name is different. Nutrition Drinks replenish a quarter of your health and are useful for quick use. In the first half of the game, your apartment regenerates your health, so Nutrition Drinks (and other medical items) aren't truly useful, nor widely available. However, instead of going back to your apartment, Nutrition Drinks are good for quick boosts in health when you find them in the different worlds on your journey. You'll only find a few Nutrition Drinks in the first half of the game because of their lack of necessity, but in the latter half of the game you'll find many of them.

Portable Medical Kit

Availability: Usual (3/5)
Health Restored: 50%
Description: Heals your body by repairing wounds.
Notes: A medical kit that offers a strong recovery of health, although not as abundant as Nutrition Drinks. Portable Medical Kits, although named different, are the same as First-Aid Kits from the earlier games and offer the same effects. You'll barely find any medical kits early in the game, but you'll start finding a decent amount of them once hauntings first start to appear in your apartment. Portable Medical Kits heal around half of your health status, so don't waste them on minor wounda. Leave that to Nutrition Drinks, and leave substantial wounds to Ampoules, if you have them.

Ampoule

Availability: Scarce (1/5)
Health Restored: 100%
Description: Restores a fairly large amount of health. Continues to restore health for a long time.
Notes: Ampoules are extremely rare health items that in return completely recover your health no matter what your health status is. Over time, Ampoules also slowly recover your health, and are very significant items. The drawback, though, is that there are only two Ampoule in the entire game. If you're goind to waste any supply, don't make it an Ampoule. Only use an Ampoule if your condition is critical and it is necessary.

Pistol Bullets

Availability: Often (4/5)
Power: Okay (3/5)
Description: Small-diameter bullets for use in the "Pistol." Not very powerful.
Notes: An ammo pack for the Pistol, with a varried amount of ammo based on your difficulty level. Each ammo box contains 12 bullets on Easy, 10 bullets on Normal, and 8 bullets on Hard. The availability of pistol ammo isn't nearly as much as previously in the series, although it is nowhere near scarce. Firearms don't play a large role in Silent Hill 4, so you shouldn't rely on them to save you. Each ammo box takes up a spot in your inventory, so this becomes quite a pain. If you seriously plan on using the Pistol, take around three boxes of ammo each time you leave your apartment.

Revolver Bullets

Availability: Rare (2/5)
Power: Great (5/5)
Description: Large-diameter bullets for use in 'Richard's Revolver.' Reasonably powerful.
Notes: Ammo for Richard's Revolver, which is obtained around halfway through the game. The Revolver is a very powerful weapon and so its bullets are quite useful when you're using it, but ammo boxes for the Revolver are quite rare and only hold six bullets each. It should only take one bullet to kill an enemy with the Revolver, provided that you are close enough to deliver a finishing kick on time. Don't waste Revolver ammo, but don't go relying on it either. Each pickup takes up a spot of your inventory, so firearms aren't very preferable to begin with.

Silver Bullets

Availability: Scarce (1/5)
Power: Great (5/5) (special)
Description: Special bullets effective against ghosts. Small diameter. Best used with 'Pistol.
Notes: Silver Bullets can only be used with the Pistol, and are extremely scarce items. Only two Silver Bullets are found in the game, and although named differently, only contain one bullet per pack. The effect of Silver Bullets is to temporarily kill Ghosts, most notably so you can stab a Sword of Obedience into them. Although it seems as if Ghosts are dead when shot with Silver Bullets, they're not. They'll get right back up in a moment, and you'll have completely wasted a Silver Bullet. Silver Bullets can be used on normal enemies, but it's truly a waste. One bullet will kill any regular enemy, but the Revolver already does that job (coupled with a finishing kick). Silver Bullets are best used against the two most annoying Ghosts. Recommended usage is for the Ghost of Andrew DeSalvo in the Water Prison World 2nd time, and either the Ghost of Cynthia in the Subway 2nd time or Richard in the Building 2nd time. Be sure to follow the Silver Bullet with a Sword of Obedience, or it will be useless. To load a Silver Bullet, press Square on the Silver Bullets icon in your inventory bar to load it into the Pistol, if it's in your inventory as well.

Saint Medallion

Availability: Usual (3/5)
Usage: Often (4/5)
Description: Can be equipped along with a weapon. Anti-spirit effects when held, but will eventually break.
Notes: This medallion repels the effect of a Ghost's presence when worn, and it is very effect to slip by Ghosts unharmed. Saint Medallions cause Ghosts to move a lot slower than normal and have difficulty injuring you because of this slowness, however, they still can hurt you. The catch with Saint Medallions, however, is that they will break once they've been used enough, and you can tell how much power they have by the faintness of them in your inventory. Saint Medallions also help rid of hauntings in your apartment, although they aren't as convenient as Holy Candles for that matter and are more valuable to waste. Saint Medallions aren't rare, but aren't abundant either, so be sure to make good use of them when you find them.

Holy Candle

Availability: Very Common (5/5)
Usage: Usual (3/5)
Description: Special candle with anti-spirit effects. Begins working shortly after being lit and placed down.
Notes: Holy Candles in the travelling worlds in the game aren't very useful, however, they are extremely handy in your apartment for taking care of hauntings. These large white candles share the same general effect as Saint Medallions, however, the are not portable (in the sense of being used while on the go). Holy Candles significanly slow down Ghosts nearby them and also repel their damaging effects from only their presence. However, the radius of these candles is quite small, so they're not very effect outside of your apartment. In your apartment, place a Holy Candle by a haunting, and if correctly placed, the haunting will diminish and shortly disappear. To place a Holy Candle, move up to where you want to plant it and use it from the inventory heads up display. Holy Candles are quite abundant in the latter half f the game, around when the hauntings start appearing, and should be used when necessary. Leave it to Saint Medallions for dealing with Ghosts in the severl different worlds.

Sword of Obedience

Availability: Rare (2/5)
Usage: Usual (3/5)
Description: Extremely rare sword. When used against downed ghosts, it stops them in place. When pulled out, the ghost is revived.
Notes: These swords are very useful for stopping annoying Ghosts from stalking you, although they are rare and work within a specific rule. This rule is that they can't be killed, per se, by the swords, but out of commision until the swords are removed. Swords of Obedience are used to pin down Ghosts to prevent them from moving anywhere else, and there's no way they can move until the sword is removed. The only condition in which you can use a Sword of Obedience is when a Ghost is on the ground, and you must act quick, becase Ghosts don't stay on the ground for long at all. Silver Bullets work like a dream to throw the Ghosts down, and for a while, actually, but they are rare. Just keeping shooting or smacking a Ghost until it falls and quicky use a Sword of Obedience from your heads up display when standing in front of the Ghost. If you wish to take the sword back, you can, but the Ghost will soon return to service. There are five Swords of Obedience in the game, so there's no reason not to use them. Just pick the Ghosts you find most annoying and pin them down to save you from future frustration.

   
by Conquerer (Silent Hill 4: The Room FAQ)