10MALLORY WEISE TEARRunning head MALLORY WEISE .docx

10
MALLORY WEISE TEAR
Running head: MALLORY WEISE TEAR
1
Running head: MALLORY WEISE TEAR
Introduction
The following information will be an extensive in-depth review
of a patient with a condition known as a Mallory Weise Tear
(MWT). The paper will analyze peer-reviewed literature
surrounding this condition and the pathophysiology behind it.
There are complications that can arise with a diagnosis of an
MWT, so the paper will discuss how to recognize the warning
signs and how to manage patient care. The paper will also
cover the nursing process and treatments for a patient that
suffers from MWT. Last but not least, the paper will cover
suggested teachings that nurses can go over with their patient
and family on the how’s and why’s, along with signs and
symptoms of MWT and its complications.
Scenario
A 57-year-old male presents to the emergency department with
complaints of abdominal pain, dark black stools for the last four
days, and having coffee ground emesis with occasional red
streaks. He states a past medical history that includes mild

cirrhosis related to alcohol abuse, current smoker of one pack
per day, and chronic back pain from an MVA ten years ago that
he treats with Aleve and ibuprofen. He has been told that he
has hypertension but does not take any medication.
On examination, the vital signs are as follows: blood pressure
138/84, heart rate 105, tympanic temperature 98.9, respirations
19, O2 saturations 98% on room air. He complains of nausea
and is guarding his abdomen. There is no asities or obvious
jaundice noted. Upon auscultation the patient has normal heart
tones and clear breath sounds bilaterally. The doctor was at the
bedside and performed a digital rectal exam which reveals black
stool, occult blood positive. An 18g IV was stared in his right
antecubital vein and labs were sent. The labs showed the
following: WBC 11, HGB 8.4 g/DL, HCT 25 %, PLT 150 K/UL,
AST 78 U/L, ALT 54 U/L, Albumin 3.5 G/DL, Ammonia level
15 U/DL, Potassium 3.7 mEq/l, Sodium 135mEq/l, BUN 25
mg/dl, Creatinine 1.1 mg/dl, Glucose 96 mg/dl. The doctor
mentions that most of the labs are with in normal limits but
could be indicative of a hemorrhage.
Literature Review
E. Cherednikov, A.A. Kunun, E.E. Cherednikov, and N.S.
Moiseeva (2016), authors of “The Role of Etiopathogenetic
Aspects in Prediction and Prevention of Discontinuous-
Hemorrhagic (Mallory-Weiss) Syndrome,” provided numerous
etiological factors, and new insights into the pathogenesis of the
disease. S.S. Flanders (2018), author of “Effective Patient
Education: Evidence and Common Sense,” takes a close look at
patient education related to MWT, and what aspects are most
beneficial for knowledge retention. K. Hyun-Soo (2015), author
of “Endoscopic Management of Mallory-Weiss tearing,”
discusses surgical, nonsurgical options, and treatments
available. J. Jahraus (2018), author of “Medical Complications
of Eating Disorders,” discusses eating disorders that contribute
to MWT. Specifically, conditions discussed are those that
involve self-induced vomiting. D.T. Martin, and M.A.
Schreiber (2014), authors of “Modern Resuscitation of

Hemorrhagic Shock: What is on the horizon?”, this article
explored the pathophysiology, diagnosis, and treatment of
hemorrhagic shock, a subset of hypovolemic shock. B. Nojkov
and M.S. Cappell (2016), authors of “Distinctive Aspects of
Peptic Ulcer Disease, Dieulafoy's lesion, and Mallory-Weiss
Syndrome in Patients with Advanced Alcoholic Liver Disease or
Cirrhosis,” discusses distinctive aspects of advanced liver
disease and cirrhosis of the liver, as it relates to patients with
MWT. K. Rich (2018), author of “Overview of Mallory-Weiss
Syndrome,” discusses the medical diagnosis of MWT in general.
Pathophysiology
Mallory and Weiss presented the cause of upper gastrointestinal
bleeds not associated with peptic ulcers or non-variceal upper
gastrointestinal bleeds. The MWT represents a tear or
laceration in the mucosa lining in the stomach or
gastroesophageal junction. There are different severities when
talking about MWT meaning that some are far worse than
others. An MWT can result from actual physical trauma to the
area. Most often MWT is associated with alcohol induced
vomiting that causes an increase in intraesophageal pressure
caused by prolonged severe vomiting. Aside from alcohol,
development of an MWT can also be associated with eating
disorders, violent hiccups, hiatal hernia, gastritis, and the
overuse of non-steroidal anti-inflammatory drugs. Some of the
physical traumatic causes for an MWT can be linked to
transesophageal echocardiograms,
esophagogastroduodenoscopy, and blunt abdominal trauma. The
combination of a weakened mucosal lining and increased
esophageal pressure increased the chances of having an MWT
(Cherednikov, Kunun, Cherednikov, & Moiseeva, 2016).
Nursing Process
Nursing Actions
When the patient is presenting with gastrointestinal bleed there
are some common nursing actions that need to be done. The
nurse can anticipate starting one if not two large bore IV
catheters. This would be wise incase the patient does need

blood products. Blood must be administered by itself, therefor
necessitating the second line to run fluids. The nurse can
expect to give packed red blood cells (PRBC’s) and if there is a
coagulopathy problem, then other blood products such as fresh
frozen plasma (FFP), platelets, and possibly cryoprecipitate can
be used. Having a second site will also allow IV fluids, like
isotonic solutions to be given to replace fluid loss. The
registered nurse will need to get a complete set of vital signs,
complete a physical assessment, and a throughout health history
assessment to help determine the cause of the MWT. Labs will
be ordered so the nurse should be on the lookout for those
results and report any abnormalities to the doctor right away.
With any gastrointestinal bleed, the nurse needs to be vigilant
in assessing for increased bleeding such as vomiting bright red
blood, and the subtle signs of hemodynamic instability which
are increased heart rate and lower blood pressure. Medications
There is no specific medication that treats MWT, medications
are used to treat the common causes of MWT. A proton pump
inhibitor (PPI) can be prescribed to decrease the acidity of
gastric acid and reduce the erosions of the mucosal lining. The
registered nurse should be prepared to administer an antiemetic
medication to suppress and treat nausea and vomiting. Some of
the more common PPI’s you will see are Protonix and
Omeprazole. These medications decrease the amount of acid
your stomach makes. Zofran, Phenergan, and Compazine are
medications used to treat nausea and vomiting. If your patient
is on anticoagulation therapy for any reason, you could be
administering the reversal medication. Some examples of this
would be if your patient was on Coumadin then Vitamin K and
possibly fresh frozen plasma will be ordered to reverse the
medications effects. Some of the antiplatelet medications do
not have an antidote, so depending on the severity of the bleed,
a transfusion of platelets may be ordered (Davis Drug Guide,
2017).
Pertinent Specific Treatment
Most patients that suffer from an MWT do not need more than

close hemodynamic monitoring, fluid resuscitation, and rest
from the underlying cause to treat the condition. However, the
degrees of an MWT can vary greatly and a more complicated
bleed could occur that requires further invasive interventions.
When diagnosing MWT, an endoscopy is performed by the
doctor. If the bleed is severe, they have a few options for
treatment to choose from. They will localize the bleed and the
doctor will inject epinephrine around the site, this is the most
common drug treatment for local injections. If the injections do
not stop the bleeding, there are clips and bands that can be
deployed to stabilize the area. If hemostasis cannot be
achieved, then the patient will have to go for emergency surgery
to cauterize the vessel (Hyun-Soo, 2015).
Coagulation studies, hemogram, and electrolyte panel will be
performed for all patients suffering from an MWT.
Coagulopathies will be treated with either medication reversal
agents or blood products. Electrolyte and fluid replacement
may be needed due to prolonged vomiting and dehydration. If
hemoglobin is low and the patient is hemodynamically unstable,
a blood transfusion may be ordered (Nojkov & Cappell, 2016).
Comfort Measures
This can be a stressful time and diagnosis for patients and their
families. Some comfort measures that the nurse can facilitate
for the patient to help ease the anxiety include active listening
to the patient and family concerns. The nurse should
collaborate with chaplain services to help ease the anxiety of
the patient and family members. Also providing education and
utilizing the hospitals multidisciplinary team to help find
outside resources to help alleviate the stress or concerns the
patients or family have. Guided imagery can be used as an
alternative method for pain relief. Music therapy can be used to
distract the patient from pain. When the patient can eat again,
offering soft foods or cold liquids (patients’ preference) to help
alleviate his or her sore throat.
Safety Issues
The safety issues to be concerned with when you have a patient

with MWT, are based on the assessment and the treatments of
the patient. If the patient is hemodynamically unstable, the
patient is at risk for falls. Patients with MWT should be placed
on fall precautions and should be encouraged to call for
assistance if they need to get out of bed. Another major safety
issue the nurse should be aware of is possible ineffective airway
clearance. If the patient is vomiting, there is a great risk for
aspiration. Sedation medication used during endoscopy may
cause ineffective airway clearance and a throat numbing spray
used during the same procedure can increase the risk of
aspiration. The nurse will collaborate with speech therapy to
complete a swallow evaluation before allowing the patient to eat
and drink to avoid aspiration complications. The nurse will
ensure the patient passed the swallow evaluation and place the
patient on aspiration precautions. The nurse will make sure
there is a suction equipment in the patient’s room. The nurse
will put pads on bedrails to prevent bruising and monitor for
any bleeding.
Patient and Family Teaching
Readiness to Learn
It is important to assess the patient’s readiness to learn before
providing them with information. The nurse needs to evaluate
the patients emotional and physical state and decide when the
best time to begin teaching. The nurse should assess what
teaching style will be most beneficial to the patient. Many
factors need to be addressed and taken into consideration with
the assessment such as the patients pain level, education level,
primary language spoken, and what knowledge they have on the
subject already (Flanders, 2018). The nurse will also complete
a cultural assessment to gain an understanding of what the
illness means to the patient. The nurse should also assess
barriers to communication such as hearing and vision.
Teaching Strategies
Once the nurse has established the patient’s language of choice
and combination of learning styles, teaching strategies can be
selected that will be effective for the patient. Learning about

something new especially under a stressful situation takes time.
It is always good to try and involve the patient’s family with
teaching sessions. Patient teaching should be done in stages or
segments to enhance absorption of information. It is suggested
that the nurse should not introduce more than three topics at a
time. The patient in the hospital with MWT will be in the
hospital for a couple of days at minimum, affording the nurse
multiple teaching opportunities. The nurse should take notes on
the questions the patient has during teaching and find any
additional resources as needed. It is important to be attentive to
the patient, have uninterrupted time, maintain good eye contact,
and be at eye level with the patient. It is also very important to
acquire the appropriate teaching aids to maximize the education
experience. Example, if the patient does not read well, do not
load him or her up with papers and pamphlets, rather get
creative and utilize websites and videos. If written material is
used, go over it with the patient and them give them time to go
over it themselves. Give the patient a pen and paper and
encourage them to write down any question they may come up
with (Flanders, 2018). The learning environment should also be
free from distractions.
Content
Patient teaching will begin on admission. The patient will be
notified of all options available prior to any actions taking
place. The nurse will complete teaching with the patient and
family on the pertinent subjects specific to the patient’s needs.
For alcohol abuse the nurse will teach the patient about
different treatment options including, cutting back on alcohol
consumption and participation in alcoholics anonymous. The
nurse will teach the patient about smoking cessation and the
different options for quitting. For hypertension the nurse will
teach the patient the importance of taking prescribed medication
and checking blood pressure daily. The nurse will teach the
patient to take the medications even if feeling fine. In regard to
signs and symptoms, the nurse will educate the patient on what
to be aware of. The nurse will impress upon the patient to call

the doctor if they notice black, tarry stools, or coffee ground
emesis.
Realistic Complications
Complication 1
The most obvious severe complication associated with MWT
would be, hypovolemic shock related to hemorrhage. This is a
medical emergency where there could be a tear or laceration
large enough to cause a severe bleed. Hypovolemic shock
occurs when there is a significant loss of blood. The body
compensates at first by intense vasocontraction but is then
followed by vasodilation and cardiovascular failure. Noticeable
signs and symptoms of patient deterioration to hypovolemic
shock would be a decrease in blood pressure and an increase in
heart rate. The nurse will perform vitals every four hours as a
preventative measure for hypovolemic shock. The nurse can
anticipate rapid blood transfusions and fluid resuscitation. The
nurse can also anticipate having to administer a vasoactive drip
to maintain adequate perfusing blood pressure. Vasopressin and
Levophed are the two most common vasopressors used to assist
in blood pressure control while trouble shooting the underlying
cause and volume resuscitation (Martin & Schreiber, 2014).
Complication 2
The second complication of MWT is the chance of the patient
extending the bleed or re-bleeding after a treatment. The nurse
must be on high alert for the signs and symptoms of bleeding,
which are decreased blood pressure and increased heart rate.
For early detections of a re-bleed the nurse will do vitals every
four hours. If a re-bleed occurs the nurse will notify the doctor.
At this point the doctor may order an endoscopy or choose to
monitor the patient depending on the severity of the bleed. If
the bleed is extensive it may require a surgical procedure. The
patient may experience dark stools for the next few days
because of the old blood in the intestinal tract, but he or she
should report these finding along with any new bleeding or
bloody emesis immediately. Report the findings to the doctor
and an anticipate a series of hemoglobin and hematocrit

laboratory draws approximately every four to six hours.
Monitor the trend and make sure it is going in the right
direction (Rich, 2018).
Complication 3
Another complication that can be seen with a patient suffering
from MWT is dehydration and electrolyte imbalances related to
vomiting and being nothing by mouth (NPO). Frequent
vomiting can cause dehydration which can lead to a number of
electrolyte imbalances, mainly hypokalemia. Hypokalemia if
not treated can lead to a more serious complication like
arrhythmias. Sign and symptoms of hypokalemia are muscle
cramps, spasms, heart palpitations, and difficulty breathing.
Anticipate labs such as a basic metabolic panel will be along
with an electrolyte replacement protocol. Other electrolytes
than can be altered from being NPO are the magnesium and
phosphorus levels. These labs should also be monitored and
replaced per protocol as well. Dehydration can also contribute
to hypotension and symptomatic orthostatic hypotension. The
patient will more than likely be given a fluid bolus along with
maintenance intravenous fluids per the doctors’ orders (Jahraus,
2018). The nurse should anticipate placing the patient on a
heart monitor.
Conclusion
Although a Mallory Weise Tear can have very serious
complications, the majority of them heal on their own. This
ailment can be prevented and with good patient teaching,
hopefully the patient will not have a reoccurrence. The paper
discussed peer-reviewed literature surrounding MWT and the
pathophysiology. Next the paper provided complications that
can arise with a diagnosis of MWT, the warning signs and how
to manage patient care. The paper also covered the nursing
process and treatments for a patient that suffers from MWT.
The final paragraph of this paper covered teachings for the
patient and family on signs and symptoms of MWT and its
complications. While creating this paper this author learned
various techniques to research topics, and how to properly

format a paper. The experience afforded the author the
opportunity to practice skilled necessary to complete a
bachelor’s program in nursing.
Nursing Narrative
While performing my assessment on the patient I noticed bloody
sputum in his emesis basin. I asked the patient when this had
happened, he stated “I started coughing up some blood this
morning, it happened twice, it hasn’t happened again”. It is
now 1100, patient stated “it happened around 0730”. I elevated
the head of the bed to a minimum of 30 degrees and notified the
Dr. I have instructed the patient to notify the nurse right away if
it happens again. I also provided information on how to try not
to put any stress on his esophagus. If he needs to cough or
sneeze to try and do so into a pillow. Patient will remain on a
clear liquid diet. I will continue to monitor patient.
MALLORY WEISE TEAR 2
References
Cherednikov, E. F., Kunun, A. A., Cherednikov, E. E., &
Moiseeva, N. S. (2016). The role of etiopathogenetic aspects in
prediction and prevention of discontinuous-hemorrhagic
(Mallory-Weiss) syndrome. EPMA Journal, 7.
http://dx.doi.org/10.1186/s13167-016-0056-4
Flanders, S. A. (2018). Effective patient education: Evidence
and common sense. Medsurg Nursing, 27(1), 55-58. Retrieved
from
https://search.proquest.com/nahs/docview/2006753584/fulltext/
BE98929276D04CCEPQ/1?accountid=100141

Hyun-Soo, K. (2015, March ). Endoscopic management of
Mallory-Weiss tearing. Clinical Endoscopy, 48(2), 102-105.
http://dx.doi.org/10.5946/ce.2015.48.2.102
Jahraus, J. (2018). Medical complications of eating disorders.
Psychiatric Annals, 48(10), 463-467.
http://dx.doi.org/10.3928/00485713-20180912-04
Martin, D. T., & Schreiber, M. A. (2014, December ). Modern
resuscitation of hemorrhagic shock: What is on the horizon? .
European Journal of Trauma and Emergency Surgery, 40(6),
641-656. http://dx.doi.org/10.1007/s00068-014-0416-5
Nojkov, B., & Cappell, M. S. (2016, Jan 7). Distinctive aspects
of peptic ulcer disease, Dieulafoy's lesion, and Mallory-Weiss
syndrome in patients with advanced alcoholic liver disease or
cirrhosis. World Journal of Gastroenterolgy, 22(1), 446-466.
http://dx.doi.org/10.3748/2Fwjg.v22.i1.446
Rich, K. (2018, June). Overview of Mallory-Weiss syndrome.
Journal of Vascular Nursing, 36(2), 91-93.
http://dx.doi.org/10.1016/j.jvn.2018.04.001
a tumult ensued in the cemetery; too many had suddenly
stormed to his coffin, crying,
sobbing, screaming in a wild explosion of despair. It was
almost a riot, a fury. All
order was overturned through a sort of elemental ecstatic
mourning such as I have
never seen before or since at a funeral. And it was this
gigantic outpouring of grief
from the depths of millions of souls that caused me to
realize for the first time how

much passion and hope this lone and lonesome man had
borne into the world through
the power or a single idea.
1
So wrote an observer about the funeral of Theodor Herzl, the
founder of political
Zionism. Born in Budapest, Hungary, part of the Austro-
Hungarian Empire, Herzl had a
talent for writing and became the Paris correspondent for an
Austrian newspaper. Already
concerned about the rise of anti-Semitism in Austria, Herzl
reported on the Dreyfus
Affair, which began in 1894.
2
Captain Alfred Dreyfus was a Jewish officer in the French
army who was unjustly accused and convicted of giving military
secrets to Germany. The
verbal and physical assaults on Jews that occurred during the
affair intensified Herzl’s
search for a solution to the prejudice and persecution Jews
faced in Europe. Influenced by
the nationalism of the age. he proposed that Jews migrate to
establish their own state

outside of Europe in his 1896 The Jewish State. The state would
provide them with a safe
haven. Herzl envisaged the creation of a Society of Jews that
would raise funds and gain
the diplomatic support of the Great Powers for the creation of
the Jewish state. Herzl’s
ideas were greeted with skepticism in some quarters and with
opposition in others such as
among Jews who favored assimilation. On the other hand, other
groups such as the
Lovers of Zion in Russia and millenarian Christian evangelicals
supported political
Zionism. The latter offered hope to Russian Jews who endured
pogroms that destroyed
Jewish lives and property and who faced job and residential
discrimination.
Herzl helped to organize and presided over the First Zionist
Congress. It met in Basle,
Switzerland, in January 1897. The delegates endorsed the Basle
Program, which
contained Herzl’s ideas; and the congress established the
Zionist Organization. Herzl,
therefore, also played an important role in the organization of

the Zionist movement. He,
moreover, helped to establish contacts within the British
government that would
eventually lead to Britain’s formal support for a Jewish
homeland in Palestine after his
death. After the failure of his diplomatic overtures to the
Ottoman Empire, which ruled
Palestine, and to Germany, Herzl focused his efforts on Britain
in 1902-4. He was
somewhat flexible as to the location of a Jewish state, though he
preferred Palestine
because of its historical and religious significance to the Jewish
people. When, however,
Joseph Chamberlain suggested the possibility of Egypt as an
area for Jewish settlement,
Herzl smiled and replied: No, we will not go to Egypt. We have
been there.”
3
On the
other hand, the Zionist leader was willing to entertain the
possibility of British Kenya as
an area for Jewish colonization, but only as a stepping stone to
Palestine. The British
1

Howard M. Sachar, A History of Israel: From the Rise of
Zionism to Our Time (New York: Alfred A.
Knopf, 1976), pp. 63-64.
2
Jacques Kornberg points out that it was rising anti-Semitism in
Austria that first led Herzl to seek a
solution to the Jewish plight. See his Theodor Herzl: From
Assimilation to Zionism (Bloomington and
Indianapolis: Indiana University Press, 1993), p. 2.,
3
Sachar, A History of Israel, p. 54.
themselves grew cooler towards this idea. Russian Jews in
particular insisted that there
could be no Zionism without Zion and that Palestine should be
the Jewish homeland.
Herzl died from a heart attack in 1904, but the British gave
formal diplomatic support for
a Jewish homeland in Palestine through the Balfour Declaration
of November 1917.
Britain gained control over Palestine as a mandate under League
of Nations supervision
after WWI and so was able to give effect to its promise. The
following selection is taken
from Herzl’s The Jewish State.

4
.
1. Introduction
The Jewish Question still exists. It would be foolish to deny it.
It is a remnant of the
Middle Ages, which civilized nations do not even yet seem able
to shake off, try as they
will. They certainly showed a generous desire to do so when
they emancipated us. The
Jewish Question exists wherever Jews live in perceptible
numbers. Wherever it does not
exist, it is carried by Jews in the course of their migrations. We
naturally move to those
places where we are not persecuted, and there our presence
produces persecution. This is
the case in every country, and will remain so, even in those
highly civilized countries─
for instance, France─until the Jewish question finds a solution
on a political basis. The
unfortunate Jews are now carrying the seeds of Anti-Semitism
into England; they have
already introduced it into America.

We are a people─one people.
We have honestly endeavored everywhere to merge ourselves in
the social life of
surrounding and to preserve the faith of our fathers. We are not
permitted to do so. In
vain are we loyal patriots, our loyalty in some places running to
extremes; in vain do we
make the same sacrifices of life and property as our fellow-
citizens; in vain do we strive
to increase the fame of our native land in science and art, or her
wealth by trade and
commerce. In countries where we have lived for centuries we
are still cried down as
strangers, and often by those whose ancestors were not yet
domiciled in the land where
Jews had already had experience of suffering. The majority may
decide which are the
strangers; for this, as indeed every point which arises in the
relations between nations, is
a question of might. I do not here surrender any portion of our
prescriptive right, when I
make this statement merely in my own name as an individual. In
the world as it now is

and for an indefinite period wilt probably remain, might
precedes right. It is useless,
therefore, for us to be loyal patriots, as were the Huguenots,
who were forced to emigrate.
If we were left in peace. …
But I think we shall not be left in peace.
4
Theodor Herzl, The Jewish State (American Zionist Emergency
Council, 1946 ed.), translated from the
German by Sylvie D’Avigdor,
http://www.jewishvirtuallibrary.org/jsource/Zionism/herzl/2d.ht
ml
2. The Jewish Question
No one can deny the gravity of the situation of the Jews.
Wherever they live in
perceptible numbers, they are more or less persecuted. Their
equality before the law,

granted by statute, has become practically a dead letter. They
are debarred from filling
even moderately high positions, either in the army, or in any
public or private capacity.
And attempts are made to thrust them out of business also:
“Don’t buy from Jews!”
Attacks in Parliaments, in assemblies, in the press, in the pulpit,
in the street, on
journeys─for example, their exclusion from certain hotels─even
in places of recreation,
become daily more numerous. The forms of persecution varying
according to the
countries and social circles in which they occur. In Russia,
imposts are levied on Jewish
villages; in Rumania, a few persons are put to death; in
Germany, they get a good beating
occasionally; in Austria, Anti-Semites exercise terrorism over
all public life; in Algeria,
there are traveling agitators; in Paris, the Jews are shut out of
the so-called best social
circles and excluded from clubs. Shades of anti-Jewish feeling
are innumerable. But this
is not to be an attempt to make out a doleful category of Jewish
hardships.

I do not intend to arouse sympathetic emotions on our behalf.
That would be foolish,
futile, and undignified proceeding. I shall content myself with
putting the following
questions to the Jews: Is it not true that, in countries where we
live in perceptible
numbers, the position of Jewish lawyers, doctors, technicians,
teachers, and employees of
all descriptions becomes daily more intolerable? Is it not true,
that the Jewish middle
classes are seriously threatened? Is it not true, that our poor
endure greater sufferings than
any other proletariat? I think that this external pressure makes
itself felt everywhere. In
our economically upper classes it causes discomfort, in our
middle classes continual and
grave anxieties, in our lower classes absolute despair.
Everything tends, in fact, to one and the same conclusion, which
is clearly enunciated in
the classic Berlin phrase: “Juden Raus” (Out with the Jews!)
THE PLAN

The whole plan is in its essence perfectly simple, as it must
necessarily be if it is to come
within the comprehension of all.
Let the sovereignty be granted us over a portion of the globe
large enough to satisfy the
rightful requirements of a nation; the rest we shall manage for
ourselves.
The creation of a new State is neither ridiculous nor impossible.
We shall have in our day
witnessed the process in connection with nations which were
not largely members of the
middle class, but poorer, less educated, and consequently
weaker than ourselves. The
Governments of all countries scourged by Anti-Semitism will be
keenly interested in
assisting us to obtain the sovereignty we want.
The plan, simple in design, but complicated in execution, will
be carried out by two

agencies: The Society of Jews and the Jewish Company.
5
The Society of Jews will do the preparatory work in the domain
of science and politics,
which the Jewish Company will afterwards apply practically.
The Jewish Company will be the liquidating agent of the
business interests of departing
Jews, and will organize commerce and trade in the new country.
We must not imagine the departure of the Jews to be a sudden
one. It will be gradual,
continuous, and will cover many decades. The poorest will go
first to cultivate the soil. In
accordance with a preconceived plan, they will construct roads,
bridges, railways and
telegraph installations; regulate rivers; and build their own
dwellings; their labor will
create trade, trade will create markets and markets will attract
new settlers, for every man
will go voluntarily, at his own expense and his own risk. The
labor expended on the land
will enhance its value, and Jews will soon perceive that a new

and permanent sphere of
operation is opening here for that spirit of enterprise which has
heretofore met only with
hatred and obloquy.
PALESTINE OR ARGENTINE?
Shall we choose Palestine or Argentine? We shall take what is
given us, and what is
selected by Jewish public opinion. The Society will determine
both these points.
Argentine is one of the most fertile countries in the world,
extends over a vast area, has a
sparse population and a mild climate. The Argentine Republic
would derive considerable
profit from the cession of a portion of its territory to us. The
present infiltration of Jews
has certainly produced some discontent, and it would be
necessary to enlighten the
Republic on the intrinsic difference of our new movement.
Palestine is our ever-memorable historic home. The very name
of Palestine would attract

our people with a force of marvelous potency. If His Majesty
the Sultan were to give us
Palestine, we could in return undertake the whole finances of
Turkey. We should there
form a portion of a rampart of Europe against Asia, an outpost
of civilization as opposed
to barbarism. We should as a neutral State remain in contact
with Europe, which would
have to guarantee our existence. The sanctuaries of Christendom
would be safeguarded
by assigning to them an extra-territorial status such as is well-
known to the law of
nations. We should form a guard of honor about these
sanctuaries, answering for the
fulfillment of this duty with our existence. This guard of honor
would be the great symbol
of the solution of the Jewish question after eighteen centuries of
Jewish suffering.
3. The Jewish Company
OUTLINES
5
These became known as the Zionist Organization/Jewish

Agency and Jewish National Fund respectively.
The Jewish Company is partly modeled on the lines of a great
land-acquisition company.
It might be called a Jewish Chartered Company, though it
cannot exercise sovereign
power, and has other than purely colonial tasks.
The Jewish Company is an organization with a transitional
character. It is strictly a
business undertaking, and must be carefully distinguished from
the Society of Jews.
The Jewish Company will first of all convert into cash all
vested interests left by
departing Jews. The method adopted will prevent the
occurrences of crises, secure every
man’s property, and facilitate that inner migration of Christian
citizens which has already
been indicated.
PURCHASE OF LAND

The land which the Society of Jews will have secured by
international law must, of
course, be privately acquired. Provisions made by individuals
for their own settlement do
not come within the province of this general account. But the
Company will require large
areas for its own needs and ours, and these it must secure by
centralized purchase. It will
negotiate principally for the acquisition of fiscal domains, with
the great object of taking
possession of this land “over there” without paying a price too
high, in the same way as it
sells here without accepting one too low. A forcing of prices is
not to be considered,
because the value of the land will be created by the Company
through its organizing the
settlement in conjunction with the supervising Society of Jews.
The latter will see to it
that the enterprise does not become a Panama, but a Suez.
6
4. Local Groups
THE PHENOMENON OF MULTITUDES

I do not want to hurt anyone’s religious sensibility by words
which might be wrongly
interpreted.
I shall merely refer quite briefly to the Mohammedan
pilgrimages to Mecca, the Catholic
pilgrimages to Lourdes, and to many other spots whence men
return comforted by their
faith, and to the holy Hock at Trier. Thus we shall also create a
center for the deep
religious needs of our people. Our ministers will understand us
first, and will be with us
in this.
We shall let every man find salvation “over there” in his own
peculiar way. Above and
before all we shall make room for the immortal band of our
Freethinkers, who are
continually making new conquests for humanity.
6
The French entrepreneur Ferdinand de Lesseps had been
successful in building the Suez Canal, but failed

in the attempt to build a canal through Panama.
5. Society of Jews and the Jewish State
THE GESTOR OF THE JEWS
Externally, the Society will attempt, as I explained before in the
general part, to be
acknowledged as a State-forming power. The free assent of
many Jews will confer on it
the requisite authority in its relations with Governments.
Internally, that is to say, in its relations with the Jewish people,
the Society will create all
the first indispensable institutions; it will be the nucleus out of
which the public
institutions of the Jewish state will later be developed.
CONSTITUTION
Politics must take shape in the upper strata and work
downwards. But no member of the
Jewish State will be oppressed, every man will be able and will

wish to rise in it. Thus a
great upward tendency will pass through our people; every
individual by trying to raise
himself, raising also the whole body of citizens. The ascent will
take a normal form,
useful to the State and serviceable to the National idea.
Here I incline to an aristocratic republic. This would satisfy the
ambitious spirit of our
people, which has now degenerated into petty vanity. Many of
the institutions of Venice
pass through my mind; but all that which caused the ruin of
Venice must be carefully
avoided. We shall learn from the historic mistakes of others, in
the same way as we learn
from our own; for we are a modern nation, and wish to be the
most modern in the world.
Our people, who are receiving the new country from the
Society, will also accept the new
constitution it offers them. Should any opposition manifest
itself, the Society will
suppress it. The Society cannot permit the exercise of its
functions to be interpreted by
short-sighted or ill-disposed individuals.

LANGUAGE
It might be suggested that our want of a common language
would present difficulties. We
cannot converse with one another in Hebrew. Who amongst us
has sufficient
acquaintance with Hebrew to ask for a railway ticket in that
language! Such a thing
cannot be done. Yet the difficulty is very easily circumvented.
Every man can preserve
the language in which his thoughts are at home. Switzerland
affords a conclusive proof of
the possibility of a federation of tongues. We shall remain in
the new country what we
are here, and we shall never cease to cherish with sadness the
memory of the native land
out of which we have been driven.
We shall give up using those miserable stunted jargons, those
Ghetto languages which we
still employ, for these were the stealthy tongues of prisoners.
Our national teachers will
give due attention to this matter; and the language which proves

itself to be of greatest
utility for general intercourse will be adopted without
compulsion as our national tongue.
Our community of race is peculiar and unique, for we are bound
together only by the
faith of our fathers.
Questions
1. What was the situation of Jews in Europe as described by
Herzl?
2. What does Herzl advocate as the solution to the Jewish
predicament? What means
should be used to implement the solution?
3. What does Herzl view as the possible locations for a Jewish
state, and which does he
seem to prefer? Why? What does he think the Jewish state
should be like in terms of
government, language, and religion?

10MALLORY WEISE TEARRunning head MALLORY WEISE .docx

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