Cream attended the now-defunct Lachute Academy before becoming a student at McGill University in Montreal, graduating with an MDCM degree in 1876.

He received his post-graduate training at St Thomas's Hospital Medical School in London, and in 1878 obtained additional qualifications as a physician and surgeon in Edinburgh.

Cream then returned to North America seeking to practise in a community in need of physicians; after a brief experience in Des Moines, Iowa, he relocated to London, Ontario.

Cream claimed Gardner had threatened to poison herself when he had not agreed to perform the abortion, and that she had written him a letter in which she named the businessman as the father.

He was investigated in August 1880, after the death of Mary Anne Faulkner, a woman on whom he had allegedly operated; he escaped prosecution due to lack of evidence.

[2] In December 1880, another patient, Miss Stack, died after treatment by Cream, and he subsequently attempted to blackmail the pharmacist who had filled the prescription.

[3] In April 1881, a woman named Alice Montgomery died of strychnine poisoning following an abortion in a rooming house barely a block from Cream's office.

[4] On 14 July 1881, Daniel Stott died of strychnine poisoning at his home in Boone County, Illinois, after Cream supplied him with an alleged remedy for epilepsy.

Governor Joseph W. Fifer had commuted his sentence after Cream's brother pleaded for leniency and allegedly bribed the authorities.

[7] Using money inherited from his father, who had died in 1887, Cream sailed for England, arriving in Liverpool on 1 October 1891 (three years after the Jack the Ripper killings had been committed).

Cream, under the name M. Malone, wrote a letter to the prominent physician William Broadbent, claiming to have evidence of his involvement in Clover's death and demanding £25,000 for his silence.

[1][9] On 2 April 1892, after a vacation in Canada, Cream returned to London, where he met Louise Harvey (née Harris), a sex worker.

[10] On 11 April, Cream met two sex workers, Alice Marsh, 21, and Emma Shrivell, 18, and spent the night with them in their flat, then before leaving offered them three pills each and a can of tinned salmon.

The police quickly realised that the false accuser who had written the letter was the serial killer now referred to in the newspapers as the "Lambeth Poisoner".

[citation needed] The police at Scotland Yard put Cream under surveillance and soon discovered his habit of visiting sex workers.

They also conducted an investigation in the United States and Canada and learned about their suspect's history, including the conviction for a murder by poison in 1881.

After a deliberation lasting only 12 minutes, the jury found him guilty of all counts, and Justice Henry Hawkins sentenced him to death.

This will revoked a previous will he had made on 7 January 1892, naming Miss Laura Sabatini of Berkhamsted, who he had become engaged to marry on 23 December 1891, as his executor and heir.

It has generally been assumed that Cream was a sadist who enjoyed the thought of his victims' agonised deaths, and his control over them (even if he was not physically present to witness these).