Olde-timey phrase, most commonly referring to the act of literally carrying someone perched uncomfortably on a rail to a point outside of the city limits. This was often a form of punishment for committing any act others thought was extremely bad. It is still sometimes used in the Southern states.
Doctor:What did she take?
Friend:These, Dexamil. Supposed to cure drinkin'
Doctor: Alan T. Whitman, M.D. That man ought to be run out of town on a rail.
by Shag Shag August 19, 2006
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