A film adaptation of Bellamann's controversial novel, modeled on his home town of Fulton, Missouri, presented significant problems for movie industry censors, who sought to bring the film into conformity with the Hays Code. Screenwriter Casey Robinson believed the project was hopeless because of the Hays Code. Producer Hal B. Wallis said that Robinson felt "I was crazy to have bought so downbeat a property." Wallis urged him to reconsider, and it occurred to Robinson that he could turn this into the story of "an idealistic young doctor challenged by the realities of a cruel and horrifying world."