The scene cuts to Paris and the inner sanctum of Monseigneur, a powerful French lord. He drinks some hot chocolate with four richly dressed servants to help him. Monseigneur is surrounded by luxury, by state officials who know nothing of state business but everything about dressing well. Every aristocrat there seems disfigured by the "leprosy of unreality."
The hot chocolate exemplifies the nobility's self-indulgent and foolish focus on personal comforts. They are so out of touch with the hard realities of the common people in France that the narrator compares their disconnection to a disease.
One sinister lord with a pinched nose, the Marquis Evrémonde, leaves in a huff that the Monseigneur did not treat him a bit more warmly. He takes out his anger by having his carriage speed through the streets, scattering the commoners in the way.
The Marquis cares only about power. Feeling snubbed by the Monseigneur, he makes himself feel powerful again by taking it out on the commoners, whom he clearly cares nothing about.
The carriage runs over and kills a little boy. As a tall man wails over his dead son, the Marquis scolds the people for not taking care of their children and tosses the man a gold coin. As his carriage pulls away, the coin sails back in: Monsieur Defarge threw it back. Furious, the Marquis screams that he will "exterminate [the commoners] from the earth." He drives away while Madame Defarge looks on, knitting.
The boy's death is a metaphor for the brutality of tyranny. The man throwing the coin back shows how tyranny inspires revolution, creating a situation where both sides want to destroy the other. For his actions against the commoners, the Marquis gets his name knitted into Defarge's register of death.