A Short History of Compression Stockings: From the Ebers Papyrus to the European Standard

Key references van den Bremer J, Moll FL. Ann Vasc Surg. 2010;24(3):426-432 (PMID: 20144527) · Asadi MH, Van Hee R, et al. Acta Chir Belg. 2023;123(6):589-600 (PMID: 37671628) · Rabe E, Partsch H, et al. Phlebology. 2018;33(3):163-184 (PMID: 28549402)

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Not a modern invention

A compression stocking feels like a product of twenty-first-century medicine. But the idea of wrapping the leg to help venous return is almost as old as civilisation. From Egyptian papyri, through Greek and Roman prescriptions and medieval Islamic medicine, to the textile innovations of industrial Europe, compression therapy has evolved gradually over thousands of years.

This article traces that history, with particular attention to the European developments that produced today's medical compression standard.

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1. The first record — the Ebers Papyrus, c. 1550 BC

The oldest description of what appears to be varicose veins is in the Egyptian Ebers Papyrus, dating to around 1550 BC. It describes tortuous, swollen vessels of the leg and refers to binding the leg with cloth. Asadi, Van Hee and colleagues, in their 2023 review in Acta Chirurgica Belgica, cite this papyrus as the earliest likely description of the condition, more than 3,500 years ago.

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2. Greece and Rome — Hippocrates and Galen

In the fifth century BC, Hippocrates advised bandaging the legs of patients with varicose veins, and the Hippocratic writings describe compressing the leg to treat venous ulcers. van den Bremer and Moll open their 2010 historical overview in Annals of Vascular Surgery with the line that varicose veins are as old as Hippocrates.

In the second century AD, Galen — physician to the gladiators of Pergamon before his career in Rome — is recorded as using compressive bandaging for leg wounds and vascular injuries. His medical system remained the dominant framework in Europe for some 1,300 years.

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3. Medieval Islamic medicine — al-Zahrawi and Ibn Sina

While medical learning stagnated in much of Europe, it was preserved and developed in the Islamic world. In the tenth century, al-Zahrawi (Albucasis) systematised the diagnosis and treatment of varicose veins and explicitly recommended firm bandaging of the leg before and after surgery. The review by Asadi and colleagues documents that scholars of this period used cleansing, phlebotomy, compression, leech therapy and surgery for varicose veins, and that some of them founded new treatments.

Ibn Sina (Avicenna), in the Canon of Medicine, also addressed compression in venous disease. This body of work re-entered Europe through Latin translation and helped lay the ground for Renaissance medicine.

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4. Sixteenth and seventeenth centuries — anatomy and the venous valve

The theoretical foundation for modern compression came from the anatomical revolution of the sixteenth century. Andreas Vesalius published his accurate anatomical atlas in 1543, fundamentally changing the understanding of vascular structure.

The Italian anatomist Hieronymus Fabricius formally described the venous valves in 1603. With the idea that blood could flow backwards when the valves failed, compression began to move from empirical practice toward a treatment with a rationale.

The decisive turn came in 1628, when William Harvey demonstrated the circulation of the blood. For the first time there was a physiological explanation for what had been known only from experience: that binding the leg improved its veins.

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5. Eighteenth and nineteenth centuries — industry and the elastic bandage

The industrial revolution had a paradoxical effect: as factory work kept people on their feet all day, varicose veins and venous ulcers became common occupational diseases of the working class. In response, elastic bandages and stockings of various designs were developed in Britain and France.

In the mid-nineteenth century, bandages incorporating natural rubber improved compressive effect considerably, and the principle of graduated compression — stronger at the ankle, weaker up the leg — began to be described systematically. This is the direct forerunner of today's graduated compression stocking.

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6. The twentieth century — synthetic elastic fibres and the modern stocking

The modern compression stocking depended on a material breakthrough. DuPont introduced nylon in the late 1930s and spandex (Lycra) in 1959. These synthetic elastic fibres were far more stable than natural rubber and allowed compression to be controlled with precision.

From the 1960s, Swiss and German manufacturers standardised precisely graduated stockings for medical use, and European makers came to lead the world market in medical compression.

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7. Standardisation — the RAL classes

As medical use expanded, so did the need to standardise compression strength. In Germany, the RAL-GZ 387 standard classified compression in mmHg at the ankle:

• Class I: 18–21 mmHg — mild varicose veins, prophylaxis
• Class II: 23–32 mmHg — moderate varicose veins, post-thrombotic syndrome
• Class III: 34–46 mmHg — severe venous insufficiency, lymphoedema
• Class IV: 49 mmHg and above — the most severe lymphoedema

The classification spread across Europe and remains the basic framework for prescribing. The 2018 international consensus statement by Rabe, Partsch and colleagues in Phlebology, issued under the International Compression Club, set out indications within this framework — reviewing 51 publications and issuing 25 recommendations.

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8. Late twentieth century onward — into evidence-based medicine

From the 1990s, randomised trials and meta-analyses brought compression therapy, long based on experience, inside the framework of evidence-based medicine.

One trial did more than any other to put compression stockings in the public eye. In 2001, Scurr and colleagues published in the Lancet a randomised trial of 231 passengers over 50 on flights of more than eight hours. Twelve of 116 passengers without stockings (10%) developed symptomless calf DVT on duplex ultrasound; none of the 115 wearing class-I below-knee stockings did. With the wave of public concern over "economy class syndrome," compression stockings became familiar to people who had never had a vein problem.

The 2018 consensus statement then consolidated decades of evidence, grading it — and, in the same document, stating plainly where evidence is still absent: no randomised trial shows that stockings slow the progression of chronic venous disease. We have written about that distinction separately in why compression stockings help, and where the evidence stops.

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In closing — 3,500 years, one principle

An Egyptian physician binding a patient's leg in linen and a modern doctor prescribing a class II stocking are doing, in essence, the same thing: physically supporting a dilated vein so that blood can return to the heart against gravity. Thirty-five centuries of continuous use is its own kind of evidence for how universal that principle is.

If you suspect varicose veins or chronic venous insufficiency, it is worth having them assessed with duplex ultrasound — and, where compression is indicated, being fitted for the right class rather than guessing.

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References

• van den Bremer J, Moll FL. Historical overview of varicose vein surgery. Ann Vasc Surg. 2010;24(3):426-32. (PMID: 20144527)
• Asadi MH, Van Hee R, Khosravi A, Shojaee R. The historical course of varicose vein surgery in the Persian medicine. Acta Chir Belg. 2023;123(6):589-600. (PMID: 37671628)
• Rabe E, Partsch H, Hafner J, et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology. 2018;33(3):163-184. (PMID: 28549402)
• Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet. 2001;357(9267):1485-9. (PMID: 11377600)