On November 12, 1872, Cream registered at McGill College in Montreal as a medical student. He would graduate with honors on March 31, 1876. Soon after, he travelled to the UK and was to meet a Flora Elizabeth Brooks, whose father own a prosperous hotel in Waterloo. She soon became the victim of an unwanted pregnancy, and Cream took it upon himself to perform his own abortion, nearly killing Brooks. Her father was understandably enraged, and insisted they marry, which Cream did on September 11, 1876. The next day he left for England, where he registered as a graduate student at St. Thomas's Hostpital in London. He also obtained a qualification from the Royal College of Physicians and Surgeons at Edinburgh. Flora died, apparently of consumption, in 1877, a death for which he would later be blamed.