‘How do you do?’

When did this die out as a greeting? 

When I met HMTQ at a Buck House garden party, neither of us said this upon greeting each other.

I merely nodded my head respectfully, and she asked if I was enjoying my tea.

it's one of those confusing English expressions that baffles people whose first language isn't English.

It has been replaced with "alright?" which Americans can't get to grips with.

 

I always use it.  It does cause a few looks of puzzlement as Dusty said.  I think it is seen as outdated or over formal nowadays.  "Dude" seems a bit informal for meeting certain individuals!

"How do you do" is something Professor Higgins would teach Eliza Doolittle, wot wot.

a simple "how are you" works, although the answer I give to this confuses non English speakers too when I say "Not too bad", which implies bad but not too bad.. 

I don't think I've ever said anything other than "how do you do?"

The only alternative I think I've ever heard is "pleased to meet you."

That's probably my lack of imagination though. 

I was told by my Mum that ‘Pleased to meet you ‘ was vulgar. 

There used to be a most amusing comedy quiz for Impressionists ( Yarwood, not Monet) called’Who Do You Do’. 

Happier times.