Page:CAB Accident Report, Pan American Flight 203.pdf/13

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Pan American's established procedure includes no specific directions as to throttle manipulation during landings of aircraft of this type. By long—established custom the manner in which captains handle throttle controls during landings is left to their own individual judgment. It is not believed that Captain Lorber's action in reducing the power to an idling condition at the time of contact can justifiably be criticized or that it contributed to the subsequent swerving of the aircraft.

However, it appears that Captain Lorber, through misjudgment, landed the airplane in an unduly nose-low attitude and while it was making some leeway. The surface of the water of San Juan Harbor was slightly disturbed in some areas and glassy in others. The existence of a glassy surface is frequently conducive to misjudgment of height above the water as well as, to a lesser extent, misjudgment regarding the altitude of the aircraft. Another factor tending to lessen depth perception was the presence of a bright moon nearly directly overhead. This had the effect of illuminating the smooth surface of the harbor with sufficient light to decrease the effectiveness of the aircraft's landing lights.

With such a surface condition, a small amount of side motion of the aircraft relative to the water would be difficult for the flight crew to observe. Although all known and reported winds ware light, they were nevertheless of such strength and so related to the direction in which the landing was being made as to have drifted the aircraft somewhat to the left.

The procedure which Captain Lorber followed when the swerve started, in first applying rudder in the opposite direction and then applying power on the inside of the turn, is in accord with the best technique.

Following the accident, the action of Captain Lorber, as well as that of other crew members, in assisting and directing rescue operations, was exemplary.


III

CONCLUSION

Findings

Upon all of the evidence available to the Board at this time, we find that the facts relating to the accident involving aircraft of United States registry NC 15376, which occurred at San Juan Harbor, Puerto Rico. on October 3, 1941, are as follows:

1. The accident, which occurred at approximately 5.48 p. m. (EST) on October 3, 1941, to Pan American's Trip 203 of that date, resulted in major damage to aircraft NC 15376, fatal injuries to two passengers, serious injuries to two members of the crew, and minor injuries to seven passengers and four members of the crew.

2. At the time of the accident Pan American Airways. Inc, held a currently effective certificate of convenience and necessity and an air carrier operating certificate for the route involved.

3. Captain Lorber and First Officer Breaux were physically qualified and held proper certificates of competency to operate as air carrier pilots over the route involved.

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