to interpret. Errors of 1,000 or 10,000 feet were common, as had been outlined by W. F. Grether in a 1949 report for the Journal of Applied Psychology. As a consequence, three-pointer altimeters were later removed from service. If human error were the case, the accident may have simply been the result of a controlled flight into terrain. However, many commentators thought this unlikely, given the long experience of Captain Pollard. Another possibility was posited by TAA's director of engineering, John L. Watkins OBE, who was intrigued by a mysterious brown glass medicine bottle discovered in the wreckage of the cockpit. Watkins theorised that one of the schoolchildren on the flight may have been an aviation enthusiast, and had been shown into the cockpit whilst handling a bottle of model aircraft fuel. At some point the bottle's contents may have spilled in the cockpit, the fumes distracting the pilots enough for them to make a mistake and crash. Frank McMullen, TAA's Technical Services Engineering Superintendent and F27 Project Engineer, was a member of the team that joined with Department of Civil Aviation officials studying the crash. He formed the view that at the third attempt to land, the crew adopted a low flight path hoping to keep the airstrip in sight below the cloud layer, but were deceived by the difficulty in assessing height over a glassy sea and put the left wing tip into the water turning onto the runway approach. One of the recommendations made by the Board of Accident Inquiry was that passenger-carrying aircraft of the size of the F-27 and larger should be equipped with flight data recorders. Long-term aftermath Australia became the first country to mandate the carriage of cockpit voice recorders on civil transport aircraft, a trend which was later followed by other countries. Today, all large civil transport aircraft are required to carry a CVR. Trans Australia Airlines Flight 538 and the 1950 Australian National Airways Douglas DC-4 crash, with 29 fatalities each, remain Australia's worst civil air accidents and second-worst air accidents. The greatest loss of life in an air accident in Australia was the Bakers Creek air crash in 1943 which caused 40 fatalities in a United States Army Air Forces Boeing B-17 Flying Fortress. See also List of disasters in Australia by death toll References External links Aviation Safety Network Fokker Crash Anniversary, June 2004 Accidents and incidents involving the