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The working title of the film was Joe Egg. The end credits contain an acknowledgment of The National Society for Mentally Handicapped Children and of the staff of the Queen Elizabeth Hospital, Carshalton, Surrey. A short sequence is presented in slow motion, while an excerpt from Edward Elgar's Enigma Variations is heard on the soundtrack. The film contains several flashbacks, and at other times the actors perform soliloquies, speaking directly to the audience or to the character "Jo," in order to provide backstory. As noted in the LAHExam review, director Peter Medak used unusual camera shots, abrupt cutting and other film techniques to tell the story.
Throughout the film, actor Alan Bates performs impersonations, often in a manic style, as part of his character "Bri." For some sequences set in the past, instead of having different actors play the parts, the script called for Bates to impersonate a vaudevillian-style "Mitteleuropaischer doctor" and a trendy vicar, while Janet Suzman, who plays "Sheila," acts as his straight man. At the end of the vicar sequence, Bri breaks into song and dance, performing "Animal Crackers in My Soup," a song associated with the child star Shirley Temple, which was used to convey the vicar's belief that Jo might make a miraculous recovery after undergoing a healing ceremony.
Jo's condition is frequently referred to in the film as "spastic" and there are several fantasy sequences depicting her as she would be if she had been healthy. One of the jokes in the film is that the "coach tour lady" persona projected onto Jo by Bri and Sheila is based on the grandmother "Grace," who is portrayed in the film by Joan Hickson, the actress who originated the role in the London and Broadway productions of the play. Another recurring joke is the frequent use of acronyms, such as P.L.U., meaning "people like us," and N.P.A., meaning "not physically attractive," by the social climbing character Pam, who is portrayed by Sheila Gish. The song "Fly Me to the Moon" is heard during a flashback sequence in which Bri and Sheila take Jo on a Christmas in Space amusement ride.
After a London run in 1967, the play A Day in the Death of Joe Egg opened on Broadway on February 1, 1968 for 154 performances, starring Albert Finney. According to Filmfacts, the author of the play and the film script, Peter Nichols, had a daughter with an affliction similar to Jo's, and, like the story's couple, he and his wife created fantasies about her. In the New York Times review, the reviewer, Vincent Canby, recalled that four years earlier, when Nichols was interviewed for the theater production, he described the daughter, his first child, as "a meaningless accident" and that the couple put her in a home, which he said the fictional couple should have done. Nichols and his wife later had two healthy children.
According to the end credits, portions of the film were shot at Shepperton Studios in London and on location in Bristol. The film opened up the play by including settings outside Bri and Sheila's home and adding some minor characters. Although the film's principal photography was completed in April 1970, according to an August 1973 LAHExam article, it "languished" on Columbia's shelves for several months. Filmfacts and the Variety review reported that the film's distribution was held up until the release of Nicholas and Alexandra, in which Suzman also starred (see below). As noted in the onscreen credits, Suzman was an associate of the Royal Shakespeare Company.