The actual leech is a worm from the annelid family which has suckers at both ends of its body. As such, this invertebrate attaches itself to the skin of vertebrates, sucking the immediate blood source that comes up in the process. Leeches produce a natural anticoagulant and blood thinner. This is the reason why leeches were the preferred method for "curing" people many centuries ago. However, leeches are making their way back into modern medicine.
Back to the story, in the time period where The Scarlet Letter is set (17th century) a physician such as Chillingworth (who pretended to be one) would have been referred to as a "leech" precisely because of the employment of the worms during treatments. However, this is also a figurative term that applies quite well to Chillngworth, who seems to be sucking away at the soul of Dimmesdale with his constant questioning and mentioning about what could be lurking within the soul of the priest. At first, the people saw Chillingworth as a blessing for their beloved and sickly Reverend Dimmesdale.
This learned stranger was exemplary, as regarded, at least, the outward forms of a religious life, and, early after his arrival, had chosen for his spiritual guide the Reverend Mr. Dimmsdale.
However, after a while, the true intentions of Chillingworth, his inner anger, and his hunger for revenge began to reflect in his face, making him seem evil and scary to all the villagers. We know as readers that Chillingworth, upon discovering the situation that Hester was under as a pariah of the village, was determined to bring out who it was that wronged him. Chillingworth is willing to do anything for Hester and her lover to come forward and tell the truth that it is Dimmesdale who fathered Pearl. Hence, to disguise himself as a "leech" and, literally, latch on to the body and soul of Dimmesdale would be the easiest way to make his plans work.
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