Tetanus is known to have afflicted mankind for several thousand years. Hippocrates described a case, and that eminent practitioner of ancient Rome, Areteus the Cappadocian, first used the word opisthotonus to describe the appearance of the patient. The World Health Organization lists the disease among the ten main causes of death in tropical countries, and in most developing countries it is a major cause of neonatal death. In Europe it kills more people each year than smallpox, rabies, malaria, and diphtheria (once the important infectious diseases of the area) combined.
In the United States there has been a steadily declining incidence of the disease over many decades. The northeastern part of the country has had the greatest decline, and tetanus antitoxin levels in the region have been shown to be higher than in other areas. This, together with the decline in number of people engaged in farming in these states,