Richie Goulding apparently works in bed because of back pains. In Proteus, Stephen imagines himself turning down Richie's offer of a hot breakfast, and Richie replying, "Sure? So much the better. We have nothing in the house but backache pills." Bloom thinks several times, compassionately, of Goulding's back problems, and, sardonically, of his patent medicine cure. He believes that Goulding's problems are a symptom of "Bright's" disease, a kidney ailment thought to have been caused by excessive alcohol consumption—a belief that coheres with Stephen's assumption that Richie would be calling for "Whusky!" in the morning hours.
Soon after the funeral carriage sets out in Hades, Bloom notices Stephen walking in Irishtown and points him out to Simon Dedalus, who infers that he has probably been visiting his Aunt Sara Goulding. Bloom's thoughts turn to Sara's husband: "His jokes are getting a bit damp. Great card he was. Waltzing in Stamer street with Ignatius Gallaher on a Sunday morning, the landlady's two hats pinned on his head. Out on the rampage all night. Beginning to tell on him now: that backache of his, I fear. Wife ironing his back. Thinks he'll cure it with pills. All breadcrumbs they are. About six hundred per cent profit."
In Sirens, as he is dining with Goulding at the Ormond Hotel, Bloom's compassionate eyes notice a wince of pain: "Tenderly Bloom over liverless bacon saw the tightened features strain. Backache he. Bright's bright eye. Next item on the programme. Paying the piper. Pills, pounded bread, worth a guinea a box. Stave it off awhile." Bright's disease was a 19th century name for certain kidney ailments that today are classed as acute or chronic nephritis. Back pain is one of the most common symptoms, but a "bright eye," Gifford observes, was also supposed to be a sign of the disease, and excessive alcohol consumption was regarded as one of its causes. Bloom's judgment that Goulding is "Paying the piper" for alcoholism coheres with what he has thought in Hades: Goulding used to be "Out on the rampage all night," and it is "beginning to tell on him now." Kidney disease is the "Next item on the programme" for this long-term alcoholic, and pills may "Stave it off awhile," but they won't cure Goulding's problem any more than having his wife iron his back will.