.jpg "Aviation Engine Test Systems (aets)")
On Sunday 10 March 1946 a Douglas DC-3 aircraft departed from Hobart, Tasmania for a flight to Melbourne. The aircraft crashed into the sea with both engines operating less than 2 minutes after takeoff. All twenty-five people on board the aircraft died. It was Australia's worst civil aviation accident.
An investigation panel was promptly established to investigate the accident. The panel was unable to conclusively establish the cause but it decided the most likely cause was that the automatic pilot was inadvertently engaged shortly after takeoff while the gyroscope was caged. The Department of Civil Aviation took action to ensure that operation of the automatic pilot on-off control on Douglas DC-3 aircraft was made distinctive from operation of any other control in the cockpit, and that instructions were issued impressing on pilots that gyroscopes should be un-caged prior to takeoff.
An inquiry chaired by a Supreme Court judge closely examined three different theories but found there was insufficient evidence to determine any one of them as the cause. This inquiry discovered that the captain of the aircraft was diabetic and had kept it secret from both his employer and the Department of Civil Aviation. The judge considered the captain's diabetes and self-administration of insulin probably contributed significantly to the accident but he stopped short of making this his official conclusion.