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Hollywood Reporter news items state that Twentieth-Century Fox bid for Henry Bellamann's best-selling novel as a vehicle for Henry Fonda. After Warner Bros. bought the rights for $35,000, David O. Selznick offered the studio $75,000 to sell them to him. News items in Hollywood Reporter and material included in The Warner Bros. collection at the USC Cinema-Television Library note that among the many actresses considered for the part of "Cassandra" were Katharine Hepburn, Adele Longmire, Marsha Hunt, Laraine Day, Susan Peters, Joan Leslie, Gene Tierney and Priscilla Lane. The studio wanted to cast Ida Lupino in the role, but she turned it down, as did Olivia de Havilland. Bette Davis wanted the part, but the studio was opposed and, according to modern sources, Davis later suggested Betty Field. In a memo included in the USC files, producer Hal Wallis requested that Ginger Rogers be sent a script, although the memo does not mention which part he thought she might play. At one point, Wallis wanted Donald Crisp for the part of "Dr. Tower." James Stephenson was originally cast as "Dr. Tower" but after his death, was replaced by Claude Rains. John Garfield was considered for the role of "Drake McHugh." Philip Reed, Rex Downing and Tyrone Power were all considered for the role of "Parris." According to modern sources, Wallis borrowed Robert Cummings from Universal after Twentieth-Century Fox refused to lend Power to Warner Bros. According to a still photo of the film, actress Faye Emerson was tested for a role. Hollywood Reporter news items note that some scenes were shot on location in Saugus, CA, and add that assistant director Sherry Shourds replaced Frank Heath after the latter was assigned to Captains of the Clouds. Douglas Wheatcroft, who was billed as Douglas Croft, made his film debut in Kings Row, as did Nancy Coleman.
Harry Bellamann's controversial novel, modeled on his home town of Fulton, MO, presented significant problems in regards to PCA censorship. According to information in the USC Cinema-Television Library, Wolfgang Reinhardt turned down an assignment to produce the film, stating in a memo to Hal Wallis, "As far as plot is concerned, the material in Kings Row is for the most part either censurable or too gruesome and depressing to be used. The hero finding out that his girl has been carrying on incestuous relations with her father...a host of moronic or otherwise mentally diseased characters...people dying from cancer, suicides-these are the principal elements of the story." Responding to an early draft of the screenplay in a letter dated April 22, 1941 included in the MPAA/PCA Collection in the AMPAS Library, Joseph I. Breen, director of the PCA, wrote Warner Bros.' studio head Jack L. Warner that the PCA objected to "illicit sexual relationships between Parris and Cassandra and Drake and Randy without sufficient compensating moral values; as well as the general suggestion of loose sex...which carries throughout the entire script....In addition, the suggestion, in the characterization of Cassandra, of gross sexual abnormality; the mercy killing of the grandmother by Parris; and the sadistic characterization of Dr. Gordon...." Ronald Reagan took the title of his autobiography Where's the Rest of Me? from a line he delivers in the scene in which he discovers that his legs have been amputated.
The film was nominated for an Academy Award for Best Picture, James Wong Howe was nominated for Best Cinematography, and Sam Wood was nominated for Best Directing. In 1955, Warner Bros. planned a remake with Montgomery Clift, Frank Sinatra, Eva Marie Saint and Ronald Reagan reprising his original role, but it was never made.