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 series and David Pelham had not been expecting to produce the cover, but the designer he had commissioned to do it let him down at the last minute, and he found himself having to come up with a replacement design 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 image", as he called it, was still being used years later and was chosen in 2006 for the cover of 1001 Books You Must Read Before You Die.

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.