Following the departure of Germano Facetti from Penguin in 1972, David Pelham's role as art director for fiction was expanded to overall art director. In the same year, Penguin published A Clockwork Orange to coincide with the release of Stanley Kubrick's film adaptation (which the novel's author Anthony Burgess later described as 'Clockwork Marmalade').

The novel was not part of a Penguin sf series and David Pelham had not been expecting to design the cover, but the designer he'd commissioned let him down at the eleventh hour and he found himself having to come up with a cover quite literally overnight. This he did, and to his surprise the cover went on to acquire iconic status. Pelham would eventually leave Penguin in 1979 but his cog-eyed droog was still being used years later.

The novel's title comes from an East London expression, he's as queer as a clockwork orange, meaning odd or peculiar although superficially normal. However, Burgess had also worked in Malaysia, where 'orang' means man, as in orang-utan or 'man of the forest' so A Clockwork Orange is also an allusion to the main character's loss of free will and reduction to a 'mechanical man' following a course of experimental treatment using the Ludovico conditioning technique, which causes him to suffer extreme nausea whenever he witnesses, or even contemplates, an act of violence.