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The movie starts off with two shadowy figures struggling until one of them is stabbed to death while we hear a child's scream.
The film follows music teacher Marcus Daly (Hemmings) as he investigates the violent murder of psychic medium Helga Ulmann (Macha Meril), which he witnesses in an apartment building. Before the murder, Ulmann had a lecture in a theatre where she suddenly sensed that there was someone with a twisted and violent mind in the audience and she seems to know who it is but it was too late before she could tell anyone. Other major characters are introduced early, including Daly's friend Carlo (Gabriele Lavia), Carlo's mother Martha(Clara Calamai), Ulmann's associate Dr. Giordani (Glauco Mauri) and reporter Gianna Brezzi (Daria Nicolodi).
After his attempt to rescue the medium fails, Daly realizes he has seen a certain painting among a group of portraits on the wall of the victim's apartment, but it seems to have disappeared when the police arrive. The killing of Helga Ulmann is prefaced by a child's doggerel tune, the same music that accompanies the film's opening sequence. The music serves as the murderer's calling card. When Daly hears it in his own apartment soon after becoming involved in the case he is able to foil his attacker. Later, he plays the tune to Giordani, a psychiatrist, who theorizes that the music is important because it probably played an integral part in a traumatic event in the killer's past. He also tells him about a folktale involving a haunted house in which a singing child is heard, followed by the shrieking of someone being murdered.
In investigating the source of the music tune and the folktale, the search leads Marcus to a novel which was written by a writter Amanda Righetti (Giuliana Calandra), titled 'House of the Screaming Child' which describes a long-ago murder. In attempting to find Amanda Righetti to talk to her about her book, the unseen killer arrives at Righetti's villa first and murders her. The dying Righetti manages to write a message on the wall of the steam-filled bathroom before expiring. Marcus finds the body, but aware that the police will think he did it, and leaves the area without calling anyone. After some thorough investigation, Marcus locates the house where the folktale was involved with the picture of it and learns from the caretaker who claims that no one have lived in the house before 1963 when the previous owner was killed. Marcus looks around and discovers a children's drawing on a wall long plastered over of a little boy holding a bloody knife next to a murdered man.
Meanwhile, Giordani investigates the Righetti murder scene after the police collect the body and leave, and on a hunch, turns on the hot water in the bathroom and sees part of the message left on the wall by the murder victim. When Giordani returns to his office that night to investigate more, the unseen killer breaks in and kills him too. Marcus also discovers the clue that he overlooked in the photo of the deserted house: a window on one of the walls is missing. Marcus returns to the house after dark and after unsuccessfully trying to bash in the wall where the window was, which leads to him nearly falling off the scaffolding, he enters the house and using a pickaxe, bashes down an end-wall in a hallway and discovers the secret room with a rotting skeleton next to a Christmas tree. Daly's discovery of the corpse is one of the film's most dramatic moments. Then, the unseen killer arrives and knocks Marcus out. When he regains consciousness, he finds the house on fire, and Gianna by his side who arrived in the nick of time to pull him out of the house.
Marcus and Gianna go to the villa caretaker's house to call the police and fire department when Marcus discovers that the caretaker's young daughter, Olga, had drew an identical drawing of the little boy with a bloody knife standing next to a Christmas tree with the murder victim. Olga tells them that she found the drawing and copied it from old file archives at her junior high school. Marcus and Gianna break into the school to search the archives for the drawing, when Gianna is stabbed by the killer and Marcus finds the painting, with the name on it which is Carlo, who appears before Marcus holding a gun and threatening to kill him for getting too close. Just then, the police arrive and Carlo flees, but in a twist of fate, he gets sideswiped by a passing garbage truck which he gets hooked onto the fender and gets dragged down the street to his gruesome death.
With the case apparently wrapped up with Carlo being the killer, Marcus drops off the severely wounded Gianna at the hospital, but in going back to the scene of the crime, tries to remember what he thought he saw. Carlo could not have murdered Helga Ulmann because he was with Marcus on the street when they saw the killer killing Ulmann. Marcus enters the murder victim's apartment and, after looking around, finally remembers what he saw in a mirror reflection which he thought was a portrait that night: the face of the killer. When he turned back, the killer appears in front of him as the identity of the killer is finally revealed as Carlo's insane mother Martha. When Carlo was still a child, he watched as she stabbed her husband when he tried to have her committed to a psychiatric hospital and Carlo, traumatized, picks up the bloody knife. Then, they entomb his body in a room of their house.
In the climax, Martha confronts Marcus and tries to kill him. Wielding a butchering knife, Martha chases him around the complex and into a room with an elevator. Marcus is striked in the shoulder by the butcher knife, but kicks Martha toward the elevator shaft. A long necklace she wears around her neck catches in the bars of the shaft, and she is decapitated when Daly summons the lift. The film ends with Daly staring into the resultant pool of blood.